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Your Position Matters: Simple ways to reduce radiation exposure during PCI

Posted by Corindus Staff
November 13, 2015
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Radiation safety in the cath lab is an ongoing topic of discussion in interventional cardiology. Recently, Cath Lab Digest editor Dr. Morton Kern published an article examining gaps in current radiation safety practices and initiatives that some of country’s leading hospitals have undertaken to improve radiation safety protocols for the entire cath lab team.  Although there are common themes that span all cath labs including use of personal protective equipment such as lead aprons and regular monitoring of dosimeters, practices vary widely and not everyone receives the same radiation safety training across the board.

 

An alarming finding in the 2014 SCAI survey on occupational hazards in interventional cardiology revealed that nearly 30% of respondents don’t wear dosimeters routinely1, and almost 20% indicate that they don’t use dosimeters for every procedure.1 Unfortunately, just because this radiation exposure does not show up on the report does not mean it is not impacting your health. Occupational radiation exposure can potentially lead to serious risks for cancer, cataracts, and other radiation illnesses.

 

With the advent of robotic-assisted PCI, physicians now have a tool to reduce their radiation exposure significantly2 while simultaneously eliminating the need to wear heavy lead aprons when seated behind the interventional cockpit. The benefits of robotic-assisted PCI also have the potential to extend to the staff that remains scrubbed in for the procedure. We’ll show you how:

 

In this example, we see a typical manual PCI procedure. The physician is occupying position 1, nearest the patient and the X-ray source. Next to the physician in position 2 is the scrubbed staff member.

 

manual pci position

 

Separately, a study was done by BÖtticher et al to measure the mean radiation dose (per procedure) by position, using a phantom rather than a human patient and without shielding or a person standing at the other postions at the patient table.  You can can see in the chart, that there is a significant difference in radiation exposure based on where you are positioned at the table

 

Mean Radiation Dose (per procedure) By Position (μSV)3

radiation exposure graph - manual

You can see the scrubbed staff member is receiving less than half of the exposure of the physician simply by being positioned a few feet farther away from the radiation source.

 

With robotic-assisted PCI the physician is now seated behind the lead-lined interventional cockpit, robotically manipulating his wires and devices during his interventions. During a robotic procedure, the bedside unit fixates devices in place, enabling precise robotic control from the physician console. When fluoroscopy is on, the cath lab staff can step away from the x-ray source.  Additionally, staff can independently position shielding to reduce scatter. With a few measures, the scrubbed staff member is now able to move even farther down the table to position 3, which can reduce their exposure by over 14 times!

robotic pci position

 

Mean Radiation Dose (per procedure) By Position (μSV)3

radiation exposure graph - robotics

Ultimately, radiation safety takes a partnership between the entire cath lab team to encourage best practices at all times. Robotics is a tool that has the potential to improve the overall safety profile of PCI procedures for physicians and staff working in cath labs and just a few small measures can go a long way in reducing radiation exposure significantly.

 

Want more information on current data on the occupational risks of interventional cardiology and potential solutions? Download our free issue brief on operator safety in complex PCI.

 

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1 Klein LW, Tra Y, Garratt KN, Powell W, et al. Occupational health hazards of interventional cardiologists in the current decade: Results of the 2014 SCAI membership survey. Catheter Cardiovasc Interv. 2015.

2 Weisz, G. et al. Safety and Feasibility of Robotic Percutaneous Coronary Intervention: PRECISE Study. J Am Coll Cardiol. 2013;61(15):1596-1600.

3 BÖtticher H, Meenen C, Lachmund J, Hoffmann W, Engel HJ Strahlenexposition des Personals im Herzkatheterlabor. Z Med Phys 2003; 13: 251–256. Radiation measured using a phantom and without a shield.

  
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