Effectiveness of a Real-Time X-ray Dosimetry Monitor in Reducing Radiation Exposure in Coronary Procedures: The ESPRESSO-Raysafe Randomized Trial.

Maximilian Olschewski,Majid Ahoopai,Thomas Munzel,Recha Blessing,Aniela Petrescu,Moritz Brandt,Tommaso Gori,Helen Ullrich,Philip Wenzel,Sebastian Steven

doi:10.3390/jcm10225350

Abstract

Background—Several methods to reduce radiation exposure in the setting of coronary procedures are available on the market, and we previously showed that additional radiation shields reduce operator exposure during radial interventions. We set out to examine the efficacy of real-time personal dosimetry monitoring in a real-world setting of radial artery catheterization. Methods and Results—In an all-comer prospective, parallel study, consecutive coronary diagnostic and intervention procedures were performed with the use of standard radiation shield alone (control group) or with the addition of a real-time dosimetry monitoring system (Raysafe, Billdal, Sweden, monitoring group). The primary outcome was the difference in exposure of the primary operator among groups. Additional endpoints included patient, nurse, second operator exposure and fluoroscopy time. A total of 700 procedures were included in the analysis (n = 369 in the monitoring group). There were no differences among groups in patients’ body mass index (p = 0.232), type of procedure (intervention vs. diagnostic, p = 0.172), and patient sex (p = 0.784). Fluoroscopy time was shorter in the monitoring group (5.6 (5.1–6.2) min vs. 7.0 (6.1–7.7) min, p = 0.023). Radiation exposure was significantly lower in the monitoring group for the patient (135 (115–151) µSv vs. 208 (176–245) µSv, p < 0.0001) but not for the first operator (9 (7–11) µSv vs. 10 (8–11), p = 0.70) and the assistant (2 (1–2) µSv vs. 2 (1–2) µSv, p = 0.121). Conclusions—In clinical daily practice, the use of a real-time dosimetry monitoring device reduces patient radiation exposure and fluoroscopy time without an effect on operator radiation exposure.

Highlights

IntroductionRadiation exposure exposes patient and medical staff to dose-dependent damage (e.g., cataract for the operator and skin lesions for the patient), and it carries a stochastic risk for various severe diseases, including malignancies [1,2,3,4,5,6]
Radiation exposure exposes patient and medical staff to dose-dependent damage, and it carries a stochastic risk for various severe diseases, including malignancies [1,2,3,4,5,6]
In a large-scale, all-comer, controlled study we tested the effect of a radiation dosimetry monitor with real-time feedback against the current standard

Summary

Introduction

Radiation exposure exposes patient and medical staff to dose-dependent damage (e.g., cataract for the operator and skin lesions for the patient), and it carries a stochastic risk for various severe diseases, including malignancies [1,2,3,4,5,6]. The exposure to radiation for patients and operators is determined by the total dose emitted by the X-ray apparatus (modern ones being more dose-sparing), but it can be modulated by the operator’s experience, the type of procedure performed, patient characteristics, and the use of protection devices [11,12,13] Such devices are normally designed to reduce operator exposure and include, for instance, pads, screens, and aprons as well as robotic systems [14,15,16,17,18,19,20]. Real-time dosimetry monitors provide the operators with instantaneous feedback with respect to the level of exposure, triggering virtuous behavior (e.g., increasing the distance between operator and X-ray source, decreasing the intensity of radiation, shortening fluoroscopy time, and reducing the use of radiation-intensive projections) Such devices are on the market, evidence regarding their effectiveness in a real-life context remains limited. Conclusions—In clinical daily practice, the use of a real-time dosimetry monitoring device reduces patient radiation exposure and fluoroscopy time without an effect on operator radiation exposure

Methods

Results

Conclusion