Snuff Box Access makes left radial approach more comfortable for both patient and cardiologist. JIC June, 2018
Cardio-TRAP® Left Radial Base supports this procedure.
SHIELD Study in the May 2018 Cath Lab Digest: Bottom line: "Use Lead Shields!"
From the SHIELD study: "Based on the observation from the SHIELD study that use of an accessory lead shield was associated with a nearly two-thirds reduction in radiation doses received by staff members, the RSC set out to increase the availability of accessory lead shields in our laboratory and to encourage their consistent use in all cases. Two barriers had to be overcome for this initiative to be successful. First, our laboratory did not have enough accessory shields for simultaneous use in each of our catheterization laboratory rooms. The RSC overcame this barrier by using the results of the SHIELD study to convince the hospital administration to purchase a dedicated mobile accessory lead shield for each of our rooms. Second, we found that some nurses were initially reluctant to use the shields, as they felt it was difficult to reach the medication pump on the IV pole while standing behind the shield. To address this barrier, one of the RSC members designed a mount on the lead shield that was capable of housing the medication pump (Figure 2). This simple alteration of the lead shields has led to their more consistent and widespread use by our nurses." (emphasis ours).
The Rad-Guard does exactly that!
BRAIN AND NECK TUMORS AMONG PHYSICIANS PERFORMING INTERVENTIONAL PROCEDURES. A. ROGUIN, ET AL, AMERICAN JOURNAL OF CARDIOLOGY 9: 1368-72 (MAY 2013):
More left-sided brain tumors among interventionists, who are exposed to scatter radiation mostly from the left. Therefore, head exposure leads to increased incidence of brain tumors. Reducing exposure from all directions, including to the front of the head, should be a high priority for hospital safety administrators, cath lab directors, physicians, and staff. The Cardio-TRAP has been shown to reduce exposure to the operator's head up to 64%.
OCCUPATIONAL RISKS OF CHRONIC LOW DOSE RADIATION EXPOSURE IN CARDIAC CATHETERISATION LABORATORY: THE ITALIAN HEALTHY CATH LAB STUDY. Eugenio Picano, et.al. EMJ Int Cardiol. 2013:1,50-58:
"Contemporary interventional cardiologists have an exposure per person, per year, two to ten times higher than that of diagnostic radiologists. Cumulative doses after 30 years of working life are in the range of 50 to 200 mSv, with a projected professional lifetime attributable excess cancer risk in the order of magnitude of 1 in 100. Of special concern, the left side of the operator is more exposed (30% to 100%) than the right side, and less protected parts of the body (e.g. head and hands) can receive equivalent doses between 5 and 50 mSv per year."
The Cardio-TRAP not only reduces head exposure up to 64%, but also the hands and arms (chest level) by 72%.
Interventional Cardiologists have the greatest exposure to radiation of any medical profession.
MINIMIZING RADIATION EXPOSURE TO THE VASCULAR SURGEON. Haquanni, et al: J Vasc Surg; Mar, 2012; 55(3):799-805). Radiation measurements using standard fluoroscopy and a fresh cadaver, taken 5 feet above floor without shielding, demonstrated that table height above 105 cm increases radiation exposure to the operator by 0.12 mSv/hr/cm. The Cardio-TRAP Right Radial Base is 5.7 cm above table top, allowing a 5.7 cm lower table height,
resulting in additional operator exposure reduction.
Beware of "Lead Equivalency"!
J Vasc Interv Radiol. 2017 Jan;28(1):148-155. doi: 10.1016/j.jvir.2016.08.006. Epub 2016 Oct 24.
Clinical Evaluation of Protective Garments with Respect to Garment Characteristics and
Manufacturer Label Information.
Lichliter A1, Weir V2, Heithaus RE3, Gipson S3, Syed A3, West J3, Rees C3.
To test operator exposures inside radiation protection garments in a simulated clinical setup, examining trends related to multiple characteristics.
MATERIALS AND METHODS:
Sixteen garment models containing lead or nonlead materials and a suspended device (Zero-Gravity) were tested for operator exposure from X rays scattered from an acrylic patient phantom. Weight and surface area were determined. The operator phantom was a wooden frame containing a dosimeter in its cavity. Garments were draped over the frame, and the setup was placed in a typical working position.
There was substantial variability in exposures for all garments, ranging from 0.52 to 13.8 µSv/h (mean, 5.39 µSv/h ± 3.82), with a 12-fold difference for garments labeled 0.5 mm Pb equivalent. Most of the especially poor protectors were nonlead, even when not lightweight. Nonlead models were not more protective per weight overall. For closed-back garments labeled 0.5 mm Pb equivalent, mean exposures were lower for lead than for nonlead materials (mean, 1.48 µSv/h ± 0.434 vs 6.26 µSv/h ± 5.13, respectively). Density per exposure-1 was lower for lead than nonlead materials in the 0.5-mm Pb equivalent group, counter to advertised claims. Open-back configurations were lighter than closed (3.3 kg vs 6.0 kg, respectively), with similar mean exposures (5.30 µSv/h vs 5.39 µSv/h, respectively). The lowest exposure was 0.52 µSv/h (9.8% of the mean of all garments) for the suspended device.
Operator exposure in a realistic interventional setup is highly variable for similarly labeled protective garments, highlighting the necessity of internal validation when considering nonlead and lightweight models.
November, 2017 study confirms limited shielding value of lead-free pads
Efficacy of the RADPAD Protection Drape in Reducing Operators’ Radiation Exposure in the Catheterization Laboratory...A Sham-Controlled Randomized Trial. Wieneke Vlastra, MD, et.al.
In the current, double-blind, sham-controlled, all-comer trial, patients undergoing diagnostic catheterization or percutaneous coronary interventions were randomized in a 1:1:1 ratio to a radiation absorbing shield (RADPAD), standard treatment (NOPAD), or a sham shield (SHAMPAD). The sham shield allowed testing for shield-induced radiation behavior. The primary outcome was the difference in relative exposure of the primary operator between the RADPAD and NOPAD arms and was defined as the ratio between operator’s exposure (E in μSv) and patient exposure (dose area product in mGy·cm2), measured per procedure. A total of 766 consecutive coronary procedures were randomized to the use of RADPAD (N=255), NOPAD (N=255), or SHAMPAD (N=256). The use of RADPAD was associated with a 20% reduction in relative operator exposure compared with that of NOPAD (P=0.01) and a 44% relative exposure reduction compared with the use of a SHAMPAD (P<0.001). Use of the SHAMPAD was associated with a 43%
higher relative radiation exposure than procedures with NOPAD (P=0.009).
February, 2018 study shows operator pelvic exposure exceeds thoracic. (Cardio-TRAP Full Shield helps close that "Pelvic Gap".)
J Invasive Cardiol. 2018 Feb;30(2):71-74. Epub 2017 Dec 15.
Operator Pelvic Radiation Exposure During Percutaneous Coronary Procedures.
Sciahbasi A1, Piccaluga E, Sarandrea A, Nucci G, Caretto N, Rigattieri S, Fedele S, Romano S, Penco M.
To evaluate operator pelvic radiation exposure during percutaneous coronary procedures.
During percutaneous coronary procedures, the operator's pelvic region is close to the x-ray source and is probably exposed to more radiation than the operator's thorax. However, no data are available on the pelvic radiation exposure of interventional cardiologists.
The RADIANT study (NCT01974453) is a prospective, single-center, observational study evaluating operator radiation exposure during percutaneous coronary procedures using electronic dosimeters placed at thorax level. In the last period of the study enrollment, a single operator was also equipped with an adjunctive electronic dedicated dosimeter to evaluate pelvic radiation exposure.
From a total of 2028 procedures included in the RADIANT study, operator pelvic doses were available for 138 procedures (68 right radial, 55 left radial, and 15 transfemoral). Median fluoroscopy time was 226 sec (interquartile range [IQR], 117-407 sec) and the dose-area product (DAP) was 15.3 Gy•cm² (IQR, 9.3-27.8 Gy•cm²). Radiation dose at pelvic region was significantly higher (40.1 μSv; IQR, 22.7-76.3 μSv) compared to thorax dose (5.6 μSv; IQR, 1.5-12 μSv; P<.001) even after normalization by DAP (2.98 μSv/Gy•cm² [IQR, 1.6-4.6 μSv/Gy•cm²] at pelvic vs 0.33 μSv/Gy•cm² [IQR, 0.11-0.81 μSv/Gy•cm²] at thorax level; P<.001). No significant differences were observed comparing pelvic dose in right radial (42 μSv), left radial (39 μSv), or femoral access (40 μSv; P=.43).
Operator radiation exposure to the pelvic region during percutaneous coronary procedures is significantly higher compared to thorax radiation dose independently of the vascular access site employed.
Our First Radiation Reduction Survey