The use of a radiation shield system—Protego (Image Diagnostics)—could markedly cut the exposure of cath lab staff to radiation during coronary and structural heart procedures, new research suggests.
David Rizik (HonorHealth Research Institute, Scottsdale, USA) presented at the 2024 Cardiovascular Research Technologies (CRT) meeting (9–12 March, Washington, DC, USA) the findings of a three-year study investigating the use of the Protego system in 300 cases.
Use of the shield system was compared to 150 cases performed using standard protection, which includes the use of a personal lead apron by operators, as well as a thyroid collar and leaded glasses together with a drop-down shield.
The Protego system consists of a combination of rigid shields above and below the cath lab table, integrated with inter-connecting flexible radiation resistant drapes designed to provide a comprehensive radiation barrier that minimises radiation exposure from the X-ray source, as well as patient scatter. Radiation exposure was measured using real-time dosimetry, which analysed total body exposure at waist and thyroid levels.
Rizik reported that the use of the Protego system reduced operator radiation exposure by >99% compared to standard protection. The median exposure at the waist with Protego was 0.0 (0.0, 0.0) vs 10.0 (5.0, 16.6) mSv, with Standard Protection (p < 0.001). The median “head level” radiation exposure measured at the thyroid with Protego was 0.0 (0.0, 0.0) vs 10.0 (5.0, 16.6) mSv with Standard Protection (p<0.001). This level of operator radiation exposure with the Protego system is lower than levels ever reported previously with any radiation protection strategy, Rizik noted.
Rizik also reported that coronary and structural procedural success was 100% with the Protego system; there were no cases in which the advanced shielding system limited C-arm angulations, impaired procedural performance, limited catheter manipulation or limited communication with the patient.
‘Zero’ exposure—whereby no detectable radiation exposure was picked up at both heights—was recorded in 64% (n=32) of transcatheter aortic valve implantation (TAVI) cases and 73.2% (n=183) of coronary cases undertaken using the shield system, whereas no cases using standard protection were able to achieve this level. The significantly lower operator exposure in the Protego arm of the study was achieved despite higher fluoroscopy times.
“We’ve known about this for decades and yet we have not done anything to improve workplace safety in the cardiac catheterisation laboratory,” Rizik was quoted as saying of the results in a press release issued by his institution following the presentation at CRT 2024. “It’s time for us to get with it, and hospitals aren’t doing it.”
In his concluding remarks, Rizik said that the Protego shield provides “exceptional” total body radiation exposure protection for operators performing both coronary and structural heart procedures, and would allow procedural performance without the need for personal lead aprons, meaning that it has the further potential to reduce occupational health hazards such as orthopaedic problems associated with catheterisation procedures.
