Effectiveness of a radiation protective device of interventional echocardiographers during structural heart disease interventions

Abstract

Interventional echocardiographers (IE) have a crucial role in growing structural heart interventional procedures. Previous studies showed a 5 times higher exposure of IE than that of the invasive cardiologist. No dedicated and adapted radiation protection device currently exists for IE. It is from this observation that the interventional cardiology team of the Nantes University Hospital, together with the company “LemerPax”, have designed a radiation protection cabin (EchoSafe) dedicated to the protection of the IE in the operative room. The objective of this study is to evaluate the radioprotective performances of this cabin in real life. We included during 6 months all procedures that required transesophageal echocardiography. These procedures were divided into two groups (the first on which the usual protection device were used, i.e. a leaded glass door – the second on which the “Echosafe” device was used). We matched the procedures to obtain a total amount of irradiation estimated by the DAP (dose area product) close between the two groups. Irradiation measurements of the IE were performed with 10 TLD (thermoluminescent detectors) distributed over the whole body. We included a total of 64 procedures: 24 procedures in the control group, and 40 in the “echosafe” group. The cumulative DAP for each group was 75,206.9 Cgy/cm2 in the control group, and 70,042 mGy.cm2 in the echosafe group. Patient characteristics were identical between the two groups. The results show that in the “echosafe” group, irradiation was below the dose limit for the left lens, shoulders, thorax, and neck, a 49% reduction in irradiation of the right lens, 76% of the right wrist, 12% of the left wrist, 49% of the pubis, and 36% of the right ankle. The “echosafe” device offers a clear reduction in the irradiation of the IE during structural heart intervention. Irradiation measurment of the sonographer (Fig. 1).