Operator Radiation Exposure Research Articles

Measuring radiation exposure of operators engaged in the yttrium-90 microsphere radioembolization treatment of hepatocellular carcinoma patients

To validate the radiation safety norms for radiation operators, their exposure to radiation during the yttrium-90 radioembolization treatment of 20 hepatocellular carcinoma patients was measured and evaluated. The mean radioactivity of yttrium-90 used was 2.15 GBq, and the survey meter was placed between the radionuclide source and catheter at a distance of 50 cm. The radiation dose during fluoroscopy was measured for comparison. In addition, the total accumulated exposure to a radiation operator during a treatment was calculated. The results indicated that the mean radiation exposure during fluoroscopy was 459 μSv/h. The mean radiation exposures from the patient after the injection of yttrium-90 were 5.66 μSv/h at 1 min, 5.99 μSv/h at 3 min, 3.97 μSv/h at 5 min, 2.35 μSv/h at 10 min, and 1.98 μSv/h at 1 min. The total calculated accumulated radiation exposure to a operator during the treatment was 0.73 μSv. In conclusion, the radiation exposure to the administering operator was within the safe exposure range.

Results from areal-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings.

BackgroundThree-dimensional mapping systems and the use of ultra-low dose radiation protocols have supported minimization of radiation dose during left atrial ablation procedures. By using optimal shielding, scattered radiation reaching the operator can be further reduced. This prospective study was designed to determine the remaining operator radiation exposure during left atrial catheter ablations using real-time dosimetry.MethodsRadiation dose was recorded using real-time digital dosimetry badges outside the lead apron during 201 consecutive left atrial fibrillation ablation procedures. All procedures were performed using the same X‑ray system (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Germany) programmed with ultra-low dose radiation settings including a low frame rate (two frames per second), maximum copper filtration, and an optimized detector dose. To reduce scattered radiation to the operators, table-suspended lead curtains, ceiling-suspended leaded plastic shields, and radiation-absorbing shields on the patient were positioned in an overlapping configuration.ResultsThe 201 procedures included 139 (69%) pulmonary vein isolations (PVI) (20 cryoballoon ablations, 119 radiofrequency ablations, with 35 cases receiving additional ablation of the cavotricuspid isthmus) and 62 (31%) PVI plus further left atrial substrate ablation.Mean radiation dose measured as dose area product for all procedures was 128.09 ± 187.87 cGy ∙ cm2 with a mean fluoroscopy duration of 9.4 ± 8.7 min. Real-time dosimetry showed very low average operator doses of 0.52 ± 0.10 µSv. A subanalysis of 51 (25%) procedures showed that the radiation burden for the operator was highest during pulmonary vein angiography.ConclusionThe use of ultra-low dose radiation protocols in combination with optimized shielding results in extremely low scattered radiation reaching the operator.

The radioprotective effect of the cathpax air cabin during interventional cardiology procedures

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Puerta del Mar BACKGROUND The use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and the medical staff. Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has demonstrated to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real-world procedures. METHODS AND RESULTS In this non-randomized all-comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n = 59) and the non-RPC group (n = 60). No significant changes in patients and procedures characteristics, average contrast volume, air kerma (AK), dose area-product (PDA) and fluoroscopy time between both groups were apparent. In RPC group, the first operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures. CONCLUSIONS Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real-world setting. Table 3.Comparison of radiation exposureStructural (n = 12)Coronary (n = 107)pPrimary outcomesFirst operator relative exposure at chest*6.8 ± 33 ± 0.60.06First operator relative exposure at left wrist*19.3 ± 104 ± 1.50.01Secondary outcomesSecond operator relative exposure at chest*2.5 ± 1.21.2 ± 0.20.06First operator dose at chest (E in µSv)59.2 ± 4317.2 ± 50.08First operator dose at left wrist (E in µSv)134.1 ± 9623.4 ± 90.04Second operator dose at chest (E in µSv)19 ± 165.7 ± 20.1Patient exposure (DAP in mGy·cm2)62651 ± 2618059682 ± 142860.8Fluoroscopy time, min (±SD)24.2 ± 715.7 ± 40.2Abstract Figures 1 and 2

Evaluation of radiation exposure to operators of portable hand-held dental X-ray units.

The use of hand-held dental X-ray units is increasing within Australia since their portability is advantageous in applications such as aged care. However, proximity of the operator to the X-ray unit raises radiation safety concerns. The aim of this study was to evaluate operator radiation exposure and methods of dose reduction for the Rextar X camera-style hand-held dental X-ray unit. Leakage and scattered radiation were measured using a solid state detector. Scatter was generated using a Perspex head phantom. Measurements of scattered radiation dose as a function of distance were made with and without a lead acrylic scatter shield (0.6mmPb equivalence at 100kVp) attached to the X-ray unit. Without the scatter shield, doses to the operator from a single adult maxillary molar X-ray exposure were 0.69, 0.78 and 0.47µGy at the left hand, right hand and eyes respectively. With the scatter shield attached, doses were reduced to 0.25, 0.12 and 0.15µGy respectively, corresponding to a dose reduction of 64, 85 and 68%. The contribution from leakage radiation was insignificant in comparison. It is highly unlikely that an operator would reach occupational dose limits when using the Rextar X hand-held dental X-ray unit, even without the scatter shield in place. Nevertheless, it is strongly recommended that the scatter shield is attached to keep operator doses as low as reasonably achievable. Use of the scatter shield additionally ensures compliance with the Australian legislative requirement for a protective barrier and is considered a preferable alternative to X-ray protective clothing.

Pulmonary Artery Intervention for Submassive Pulmonary Embolism From an Arm Superficial Venous Access.

Pulmonary embolism (PE) endovascular interventions are often approached from an internal jugular or femoral venous access. There are multiple advantages of right basilic vein (RBV) access for both patient and operator, especially in the setting of morbid obesity. We hereby describe the case of a 48-year-old, morbidly obese man who presented with acute respiratory insufficiency and was found to have bilateral submassive subocclusive PE, worse on the right. The right ventricular to left ventricular ratio was 2.1 and troponin was elevated. A 7 Fr sheath was placed in the RBV under ultrasound guidance. Selective bilateral pulmonary arteriography was then performed. A 106 x 12 cm EKOS catheter was placed in the segment of highest thrombotic burden for a 6-hour protocol of catheter-directed ultrasound-facilitated thrombolytic therapy. The patient recovered well on a direct oral anticoagulant and his acute symptoms resolved. Treating massive/submassive PE from a RBV access offers the convenience and safety of superficial venous access (for patient and operator), better patient comfort, less venous stasis during therapy with ability to ambulate, less potential for bleeding and vascular complications, less potential for operator radiation exposure when compared with the jugular approach, and better operator ergonomics.

Robotic Peripheral Vascular Intervention With Drug-Coated Balloons Is Feasible and Reduces Operator Radiation Exposure: Results of the Robotic-Assisted Peripheral Intervention for Peripheral Artery Disease (RAPID) Study II

Robotic Peripheral Vascular Intervention With Drug-Coated Balloons Is Feasible and Reduces Operator Radiation Exposure: Results of the Robotic-Assisted Peripheral Intervention for Peripheral Artery Disease (RAPID) Study II

Influence of the transient conditions on release of corrosion products and oxidation of alloy 690 tubes during pressurized water reactor restart after steam generators replacement

The radioactivity of the Reactor Coolant System (RCS) of Pressurized Water Reactors (PWRs) mainly comes from the release of corrosion products of Steam Generator (SG) tubes made of Ni-base alloys. In order to reduce this activity and thus the radiation exposure of PWR operators during maintenance operations, it is necessary to minimize the release. That requires prior understanding of the various mechanisms involved. EDF R&D constructed a loop, BOREAL, to specifically measure rates of release of SG tubes in various conditions of primary environment. Tubes were usually tested at high temperature, under constant conditions of primary chemistry. So, it is necessary to carefully investigate the impact of transient conditions during a PWR restart after SG replacement. Tests were performed on the industrial material with curvature, roughness, defects and heterogeneities, regularly observed on this type of component. Characterisations of the inner surface were done on as-received and corroded specimens of SG tubes and were correlated with the obtained release kinetics.The native oxide layer is formed of a very thin layer (1-2 nm) of oxidised matrix, without specific enrichment. During the restart, the most critical step for the release phenomenon is revealed from 170°C to 297°C. The majority of the metal is indeed released into the fluid during this step. The characterisations after release tests have made it possible to propose oxidation and release mechanism during a PWR restart after SG replacement. Up to 170°C, a thin layer of amorphous chromium oxide is formed by selective dissolution of iron and nickel. When the temperature rises, this chromium oxide layer is not stable enough to be protective and the diffusion phenomena are activated. At 325°C, the oxide does not exhibit any particular enrichment and corresponds to an oxidised metal layer; an equilibrium is established and the rate of release reaches a pseudo-stationary regime.

Radiation Exposure During Transcatheter Aortic Valve Replacement: Impact of Arterial Approach and Prosthesis Type

The impact of novel alternative access and valve type on radiation exposure during transcatheter aortic valve replacement (TAVR) has not yet been evaluated. This study sought to determine the impact of a transarterial approach and prosthesis type on physician and patient exposure to radiation during TAVR. This was a prospective study including 140 consecutive patients undergoing TAVR by transfemoral (n= 102) or transcarotid (TC) (n= 38) access at 2 centers. Implanted valves were the self-expanding Evolut R/PRO system (Medtronic, Minneapolis, MN; n= 38) and the balloon-expandable SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA; n= 102). The primary endpoint was first operator radiation exposure. The secondary endpoint was patient radiation exposure. First operator radiation exposure was 4-fold greater during TC TAVR (P < .001). The use of a self-expanding valve was associated with a longer x-ray time (P= .015) and a 2-fold greater first operator radiation dose (P= .018). Patient radiation dose was not significantly affected by arterial approach (P= .055) or valve type (P= .095). After adjustment for potential confounders, the TC approach remained associated with a 174.8% (95% confidence interval, 80.6-318.3, P < .001) increase in first operator radiation dose, whereas the use of a self-expanding valve no longer influenced the first operator dose (P= .630). TC access and the use of a self-expanding valve were associated with a 4- and 2-fold greater first operator radiation exposure during TAVR procedures, respectively. Unlike the arterial approach, the effect of bioprosthesis type on radiation exposure was mainly related to x-ray time and was no longer significant after adjustment.

Dose-reducing fluoroscopic system decreases patient but not occupational radiation exposure in chronic total occlusion intervention.

Several novel low-dose fluoroscopic systems (LDS) developed recently, but real practice information of the net benefit for the patient and professionals is scarce. We evaluated separately patient and operator radiation exposure during percutaneous interventions of chronic total occlusions (CTO). A total of 116 consecutive CTOs were analyzed (60 in LDS and 56 in standard-dose fluoroscopic system [SDS]). Digital dosimetry of patient and occupational (operator and scatter dose) exposure was prospectively recorded. Biometrics, demographics, CTO variables, and operators were distributed evenly. Patient radiation exposure was effectively decreased in LDS (dose area product [DAP] by 36%, Air Kerma [AK] by 47%). However, occupational data showed no statistical differences between LDS and SDS. The LDS uses less radiation amount but with higher energy (due to additional filtration) compared to SDS, therefore increasing the scatter dose. When comparing the C-arm scatter dose to the DAP we found higher scatter dose with the LDS (0.0139 mSv/gray (Gy)*cm2 vs. 0.0082 mSv/Gy*cm2, p < .001). This was confirmed in a larger dataset comprising 5,221 coronary procedures. LDS was safer for patients reducing DAP and AK compared to SDS. However, occupational doses were not lower and scatter dose higher. Radiological protection measures must be kept maximized even in LDS.

Effectiveness of a radiation protective device for anesthesiologists and transesophageal echocardiography operators in structural heart disease interventions.

In structural heart disease (SHD) interventions, the exposure of staff other than the first operator such as anesthesiologists and transesophageal echocardiography (TEE) operators to the radiation can also pose the risks of cancer and cataracts in the long term. This study was conducted to test our new radiation protective device (RPD) for anesthesiologists and TEE operators in SHD interventions. The RPD, which consists of a head side shield and a cradle shield, was mounted on a 0.25 mm Pb-equivalent unleaded radiation protection sheet on a self-made J-shaped acrylic table, and it was placed on the head side and cradle on the operating table. A CT human body phantom was placed on the operating table, and the C-arm was set in five directions: posteroanterior, right anterior oblique 30°, left anterior oblique 30°, caudal 30°, and cranial 30°. The ambient dose equivalent rate at the usual positions of the anesthesiologist and TEE operator were measured under a fluoroscopic sequence with and without the RPD, and the dose reduction rate was obtained. The height of each measurement point was set to 100, 130 or 160cm. The reduction rates at the positions of the anesthesiologist and the TEE operator were 82.6-86.4% and 77.9-89.5% at the height of 100cm, 48.5-68.4% and 83.3-91.0% at 130cm, and 23.6-62.9% and 72.9-86.1% at 160cm, respectively. The newly developed RPD can thus effectively reduce the radiation exposure of anesthesiologists and TEE operators during SHD interventions.

Association between distance from the radiation source and radiation exposure: A phantom‐based study

The study evaluated the association between distance from radiation source and radiation exposure. Radiation exposure during medical procedures is associated with increased risk of cancer and other adverse effects. An American National Standards Institute phantom was used to study the relationship between measured entrance surface exposure (MESE) and distance from the X-ray source in postero-anterior, left anterior oblique, and right anterior oblique projections. Three distance settings for table height were evaluated with "low" defined as 52 cm, "mid" 66 cm, and "high" 80 cm from the focal point of the X-ray source. Air-kerma and dose-area product measurements were recorded. Operator exposure with each of these conditions was measured, in a short operator (150 cm) as well as in a tall operator (190 cm). Aggregate results for the three projections were as follows. MESE (μGy/frame) significantly decreased as table-height increases (median, interquartile range, p-value) (low table-height 192.5 [122.4-201.2], mid table-height 105.8 [82.7-115.8], and high table-height 71.7 [58.4-75], p < .0005). The operator exposure (μGy/frame), significantly increased as the table-height increased (low table-height 0.0943 [0.0598-0.1157], medium table-height 0.1128 [0.0919-0.1397], and high table-height 0.158 [0.1339-0.2165], p < .0005). A shorter operator received higher radiation exposure compared to a taller operator (short operator 0.1405 [0.1155-0.1758] and tall operator 0.0995 [0.0798-0.1212], p < .0005). Increasing table-height is associated with a significant decrease in MESE. Operator radiation exposure increases with increasing table-height and shorter operators receive greater radiation exposure compared to taller operators.

Retrospective analysis of pedicle screw accuracy for patients undergoing spinal surgery assisted by intraoperative computed tomography (CT) scanner AIRO® and BrainLab© navigation

Minimally invasive spine surgery techniques for pedicle screw instrumentation are being more frequently used. They offer shorter operative times, shorter hospital stays for patients, faster recovery, less blood loss, and less damage to surrounding tissues. However, they may rely heavily on fluoroscopic imaging, and confer radiation exposure to the surgeon and team members. Use of the AIRO Mobile Intraoperative CT by Brainlab during surgery is a way to eliminate radiation exposure to staff and may improve accuracy rates for pedicle screw instrumentation. We designed a retrospective analysis of our first 12 patients who had a total of 59 pedicle screws inserted when we began to incorporate the AIRO iCT scanner to our surgical workflow. During pedicle screw insertion, projection images were saved, and compared to CT scans gone at the end of the case. We measured the distances between the projected and postprocedural screw locations, at both the screw tips and tulip heads. We observed a mean of 2.8 mm difference between the projection and postprocedural images. None of the screws inserted had any clinically significant complications, and no patient required revision surgery. Overall, iCT guided navigation with the AIRO system is a safe adjunct to spinal surgery. It decreased operator and staff radiation exposure, and helped facilitate successful MIS surgery without fluoroscopic imaging. Additional studies and research can be done to further improve accuracy and reliability.

Comparative Study in Different Filters for Efficient Sterile Filtration

Simple membrane filtration is suitable as a terminal sterilization method for radiopharmaceuticals due to their short half‐life and radiation exposure of process operator. However, it often adheres to the filter membrane and causes a considerable loss of radioactivity. We herein describe the investigation of sterile filtration performance varying individual sterile filters in order to identify the optimal sterile filter on demand for lipophilic radiopharmaceuticals.

Optimization of the radiosynthesis of [68Ga]Ga-PSMA-11 using a Trasis MiniAiO synthesizer: do we need to heat and purify?

The radiosynthesis of [Ga]Ga PSMA-11 was performed using a Trasis MiniAio synthesizer and a Ge/Ga GalliaPharm generator supplied by Eckert & Ziegler, Berlin, Germany. Optimized labeling parameters were evaluated by variation of sodium acetate concentrations and temperature of radiolabeling as well as the purification process. For each condition tested, radiochemical purity was higher than 99% in the final vial without batch failure, indicating a robust and fast radiosynthesis process. Radiosynthesis without the solid phase extraction purification process at room temperature in less than 5 min resulted in a radiolabeling efficiency of over 99% and remained stable at least 4 h without manual processing to limit operator radiation exposure. The procedure was completely automated and provided a high radiochemical yield. It can be performed several times a day, facilitating the clinical demand of this radiopharmaceutical.

Reduction of Occupational Exposure Using a Novel Tungsten-Containing Rubber Shield in Interventional Radiology.

This study investigates whether a novel tungsten-containing rubber shield could be used as substitute shielding material in interventional radiology to reduce the occupational exposure of operators to scattered radiation from a patient. The tungsten-containing rubber is a lead-free radiation-shielding material that contains as much as 90% tungsten powder by weight. Air kerma rates of scattered radiation from solid-plate phantoms, simulating a patient, were measured with a semiconductor dosimeter at the height of the operator's eye (1,600 mm from the floor), chest (1,300 mm), waist (1,000 mm), and knee (600 mm) with and without tungsten-containing rubber shielding (1-5 mm thickness). The tungsten-containing rubber and a commercial shielding material (RADPAD) were affixed onto the phantom on the operator's side, and reductions in air kerma rates were compared. Reduction rates for tungsten-containing rubber shielding with thicknesses of 1, 2, 3, 4, and 5 mm at each height level were as follows: 70.37 ± 0.40%, 72.17 ± 0.29%, 72.95 ± 0.31%, 72.58 ± 0.35%, and 73.63 ± 0.63% at eye level; 76.36 ± 0.19%, 77.13 ± 0.10%, 77.36 ± 0.14%, 77.62 ± 0.25%, and 77.66 ± 0.14% at chest level; 67.78 ± 0.31%, 68.12 ± 0.19%, 68.88 ± 0.28%, 68.97 ± 0.14%, and 68.85 ± 0.45% at waist level; and 0.14 ± 0.94%, 0.72 ± 0.56%, 1.08 ± 0.74%, 1.77 ± 0.80%, and 1.79 ± 1.82% at knee level, respectively. Reduction rates with RADPAD were 61.80 ± 0.67%, 60.33 ± 0.61%, 64.70 ± 0.25%, and 0.14 ± 0.66% at eye, chest, waist, and knee levels, respectively. The shielding ability of the 1 mm tungsten-containing rubber was superior to that of RADPAD. The tungsten-containing rubber could be employed to minimize an operator's radiation exposure instead of the commercial shielding material in interventional radiology.

Occupational radiation exposure in femoral artery approach is higher than radial artery approach during coronary angiography or percutaneous coronary intervention

Medical radiation exposure is a significant concern for interventional cardiologists (IC). This study was aimed at estimating the radiation exposure of IC operators and assistants in real clinical practice. The radiation exposure of the operator and assistant was evaluated by conducting two types of procedures via coronary angiography (CAG) and percutaneous coronary intervention (PCI) on 1090 patients in 11-cardiovascular centers in Korea. Radiation exposure was measured using an electronic personal dosimeter (EPD). EPD were attached at 3 points on each participant: on the apron on the left anterior chest (A1), under the apron on the sternum (A2), and on the thyroid shield (T). Average radiation exposure (ARE) of operators at A1, A2, and T was 19.219 uSv, 4.398 uSv, and 16.949 uSv during CAG and 68.618 uSv, 15.213 uSv, and 51.197 uSv during PCI, respectively. ARE of assistants at A1, A2, and T was 4.941 uSv, 0.860 uSv, and 5.232 uSv during CAG and 20.517 uSv, 4.455 uSv, and 16.109 uSv during PCI, respectively. AED of operator was 3.4 times greater during PCI than during CAG.

Vascular access and radiation exposure during percutaneous coronary procedures.

In the cardiology community, the use of transradial access for percutaneous coronary procedures is progressively increasing all around the world overtaking the use of transfemoral access. The advantages of the transradial access are based on a significant reduction in bleeding and vascular events compared to the femoral access and on a reduction in mortality in the setting of acute coronary syndromes. However, in recent years a slight but significant increase in radiation exposure for patients and operators associated with the radial approach has been detected, increasing concerns about possible long term increased stochastic risk. In particular interventional cardiologists are among physicians performing interventional procedures using X-rays, those exposed to the highest radiation dose during their activity and this exposure is not without possible long-term clinical consequences in term of deterministic and stochastic effects. All the operators should be aware of these risks and manage to reduce their radiation exposure. In this review we analysed the differences in term of radiation exposure comparing the radial and the femoral access for percutaneous coronary procedures. Then, we discussed the possible clinical consequences of these differences and finally we showed the available tools aimed to reduce the operator radiation exposure. In particular the use of adjunctive protective drapes placed on the patient might reduce operator radiation exposure in up to 81% of the dose.

Radiation Dose Reduction Using a Novel Fluoroscopy System in Patients Undergoing Diagnostic Invasive Coronary Angiography.

Invasive coronary angiography (ICA) still causes a significant amount of radiation exposure for patients and operators. In February 2017, the Azurion system was introduced, a new-generation fluoroscopy image acquisition and processing system. Radiation exposure in patients undergoing ICA was assessed comparing the novel Azurion 7 F12 angiography system to its predecessor Allura Xper in a randomized manner. Radiation exposure was prospectively analyzed in 238 patients undergoing diagnostic ICA. Patients were randomly assigned to the novel Azurion system (119 patients) or its predecessor Allura Xper system (119 patients). In each patient, 8 predefined standard projections (5 left coronary artery, 3 right coronary artery) were performed. Image quality was quantified by grading of the images on the basis of a 5-point grading system. Radiation dose area product was significantly lower in the Azurion group 109 (interquartile range [IQR 75-176] cGy cm) compared with the Allura Xper group 208 [IQR 134-301] cGy cm (P<0.001). Body mass index (26.6 [IQR 23.9-29.7] kg/m vs. 26.2 [IQR 24.2-29.4] kg/m; P=0.607), body surface area (1.96 [IQR 1.81-2.11] m vs. 1.90 [IQR 1.77-20.4] m; P=0.092), and procedure duration (1.5 [IQR 1.2-2.3] min vs. 1.6 [IQR 1.2-2.5] min; P=0.419) were similar in both groups. Images from the Azurion system were at least of equal quality compared with Allura Xper (image quality grade 4.82±0.45 vs. 4.75±0.52, P=0.43). Use of the novel Azurion 7 F12 angiography system resulted in a significant reduction of dose area product in patients undergoing diagnostic ICA by 56%.

Reduced radiation exposure in the cardiac catheterization laboratory with a novel vertical radiation shield.

ObjectivesInvestigation of novel vertical radiation shield (VRS) in reducing operator radiation exposure.BackgroundRadiation exposure to the operator remains an occupational health hazard in the cardiac catheterization laboratory (CCL).MethodsA mannequin simulating an operator was placed near a computational phantom, simulating a patient. Measurement of dose equivalent and Air Kerma located the angle with the highest radiation, followed by a common magnification (8 in.) and comparison of horizontal radiation absorbing pads (HRAP) with or without VRS with two different: CCL, phantoms, and dosimeters. Physician exposure was subsequently measured prospectively with or without VRS during clinical procedures.ResultsDose equivalent and Air Kerma to the mannequin was highest at left anterior oblique (LAO)‐caudal angle (p < .005). Eight‐inch magnification increased mGray by 86.5% and μSv/min by 12.2% compared to 10‐in. (p < .005). Moving 40 cm from the access site lowered μSv/min by 30% (p < .005). With LAO‐caudal angle and 8‐in. magnification, VRS reduced μSv/min by 59%, (p < .005) in one CCL and μSv by 100% (p = .016) in second CCL in addition to HRAP. Prospective study of 177 procedures with HRAP, found VRS lowered μSv by 41.9% (μSv: 15.2 ± 13.4 vs. 26.2 ± 31.4, p = .001) with no difference in mGray. The difference was significant after multivariate adjustment for specified variables (p < .001).ConclusionsOperator radiation exposure is significantly reduced utilizing a novel VRS, HRAP, and distance from the X‐ray tube, and consideration of lower magnification and avoiding LAO‐caudal angles to lower radiation for both operator and patient.

TCT-200 Reduced Radiation Exposure in the Cardiac Catheterization Laboratory Using Combination of both Horizontal and a Novel Vertical Radiation Shield

Radiation exposure in the cardiac catheterization laboratory (CCL) is a safety risk. In this study, we investigated the impact of a novel sterile Vertical Radiation Shield (VRS) on operator radiation exposure. Prior to a coronary procedure, a dosimeter measured radiation exposure on a mannequin