Decreasing operators’ radiation exposure during coronary procedures: The Transradial Radiation Protection Board.

Miles Behan, Peter Haworth, Paul Colley, Michael Brittain, Andrew Hince, Michael Clarke, Azad Ghuran, Mrinal Saha, David Hildick-Smith, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.

AIM: Transradial coronary procedures are associated with decreased vascular access site complications and other benefits compared to the femoral approach. There is some concern however about high-recorded radiation doses for interventional cardiologists using the transradial route. We therefore designed and investigated the effect of a transradial radiation protection board (TRPB) on operator radiation exposure during coronary procedures.

METHODS AND RESULTS: One hundred and six patients were randomly assigned by time period to undergo radial coronary procedures either with or without a TRPB. This is a grooved arm board with a detachable 0.5-mm lead equivalent shield designed to rest between the patient’s arm and side. Individual case-specific radiation exposures were measured using electronic personal dosimeter worn on the left outer pocket of the lead apron at chest level. The TRPB was used in addition to standard lead apron and thyroid shielding, below-table leaded flaps, and leaded glass. Operator radiation exposure was significantly decreased in the TRPB group overall: 28 [18-65] SV versus 19.5 [10.5-35] SV, P = 0.003. There were no significant differences in procedure duration, total fluoroscopy dose, or contrast load between the two groups.

CONCLUSION: Identification of methods to reduce operator radiation dose is important. The use of the TRPB can significantly reduce radiation exposure to radial operators.

Editorial Comment:

Old is the new New.

Stephen Balter, Departments of Radiology and Medicine Columbia University Medical Center New York.

The article by Behan Decreasing operators’ radiation exposure during coronary procedures: The transradial radiation protection board in this issue of CCI [[1]] is reminiscent of a comparable discussion regarding the brachial approach in the early history of coronary angiography [[2]]. Both articles describe the use of a similar radiation shield placed between the patient’s arm and torso. Not surprisingly, the substantial clinically measured protective value of such a shield was similar in both situations.

Radiation protection devices are often perceived to be a procedural impediment. They are often removed or parked until the next cohort of interventional cardiologists rediscovers that they actually work. Maeder provided a recent example [[3]].

All of the relevant literature relies on personnel dose measurements to document the radiation protective value of a device. Operators who decline to use their dosimeters loose the feedback provided by their readings. Without feedback, the protection devices are often seen as valueless impediments, hence their removal.

There is the ethical need to balance patient and staff safety. Patient safety is often only inferred by subjective evaluation of procedural ease. Behan et al. are to be commended for tracking procedural time and patient dose as part of their study.

This study has practical value to you the operator: The appropriate use of protective devices, such as the transradial protection board will reduce your radiation exposure. How much can only be determined by using your badges all the time. What you don’t know can hurt you!

1. Behan M, Haworth P, Colley P, Brittain M, Hince A, et al. Decreasing Operato Radiation Exposure During Coronary     Procedures: The Transradial Radiation Protection Board. Catheter Cardiovasc Interv 2010. DOI 10.1002/ccd.22466.     Links

2. Balter S,Sones FM Jr,Brancato R. Radiation exposure to the operator performing cardiac angiography with U-arm     systems. Circulation 1978; 58: 925-932. Links

3. Maeder M,Brunner-La Rocca HP,Wolber T,Ammann P,Roelli H,Rohner F,Rickli H. Impact of a lead glass screen on     scatter radiation to eyes and hands in interventional cardiologists. Catheter Cardiovasc Interv 2006; 67: 18-23. Links

Catheterization and Cardiovascular Interventions, Volume 76, Issue 1.