Use of a dose-dependent follow-up protocol and mechanisms to reduce patients and staff radiation exposure in congenital and structural interventions.

BACKGROUND: Increasingly complex structural/congenital cardiac interventions require efforts at reducing patient/staff radiation exposure. Standard follow-up protocols are often inadequate in detecting all patients that may have sustained radiation burns. METHODS: Single-center retrospective chart review divided into four intervals. Phase 1 (07/07-06/08, 413 procedures (proc)): follow-up based on fluoroscopy time only; frame rate for digital acquisition (DA) 30 fps, and fluoroscopy (FL) 30 fps. Dose-based follow-up was used for phase 2-4. Phase 2 (07/08-08/09, 458 proc): DA: 30 fps, FL: 15 fps. Phase 3 (09/09-06/10, 350 proc): DA: 15-30 fps, FL: 15 fps, use of added radiation protection drape. Phase 4 (07/10-10/10, 89 proc): DA: 15-30 fps, FL: 15 fps, superior noise reduction filter (SNRF) with high-quality fluoro-record capabilities. RESULTS: There was a significant reduction in the median cumulative air kerma between the four study periods (710 mGy vs. 566 mGy vs. 498 mGy vs. 241 mGy, P < 0.001), even though the overall fluoroscopy times remained very similar (25 min vs. 26 min vs. 26 min vs. 23 min, P = 0.957). There was a trend towards lower physician radiation exposure over the four study periods (137 mrem vs. 126 mrem vs. 108 mrem vs. 59 mrem, P = 0.15). Fifteen patients with radiation burns were identified during the study period. When changing to a dose-based follow-up protocol (phase 1 vs. phase 2), there was a significant increase in the incidence of detected radiation burns (0.5% vs. 2%, P = 0.04). CONCLUSIONS: Dose-based follow-up protocols are superior in detecting radiation burns when compared to fluoroscopy time-based protocols. Frame rate reduction of fluoroscopy and cine acquisition and use of modified imaging equipment can achieve a significant reduction to patient/staff exposure.

Radiation protection during hybrid procedures: innovation creates new challenges.

BACKGROUND: The cooperation between interventional cardiologists and cardiothoracic surgeons has expanded the spectrum of treatment modalities for patients with congenital heart disease. These hybrid techniques have created new challenges, one of which being the provision of adequate but practical radiation protection. This study evaluates the use of a lightweight radiation protection drape (RADPAD) that may be suitable for shielding during hybrid procedures. METHODS: To simulate a pediatric patient, an 8.7 liter water-filled tub was placed on an X-ray table and exposed to 10-second cine acquisition runs. Radiation exposure was measured at twelve specified locations around the table using a model with three different levels of radiation protection: no shielding, shielding using a traditional 0.35 mm lead-equivalent apron, and shielding using the 0.25 mm lead-equivalent RADPAD. RESULTS: The traditional lead apron and the RADPAD significantly reduced the amount of radiation dose when compared with no shielding. The standard lead apron provided slightly greater radiation protection than the RADPAD (0.000064 radiation absorbed dose [rad] vs. 0.000091 rad; p = 0.012). The measured rad was significantly higher on the right side of the table, and the measured radiation dose decreased significantly with increasing distance from the table. CONCLUSIONS: The RADPAD has been shown to function as an efficient shielding device, even though it does not quite match the protection that can be expected from a standard lead apron. It complies with regulatory radiation protection requirements and its lightweight and sterile use make it particularly useful during hybrid procedures in the operating room.