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Shielding SPECIAL

Special Shielding Could Fix Cath Lab Staff’s Radiation and Orthopedic Issues

PARIS — An operator shielding system offered body protection rivaling that of standard lead gowns in the catheterization lab, providing a glimpse at a potential tantalizing future where interventional cardiologists can ditch their heavy gear without sacrificing radiation protection.

At a center in Australia, an experiment showed that the Rampart shielding system — an adjustable stand made of lead equivalent acrylic shielding — blocked 96% to 98% of radiation scattered to the operator’s head, torso, and waist during an average week of cardiac angiography, according to medical radiation specialist Glenn Ison, Dip Med Rad, of St. George Hospital in Sydney.

This was equivalent or better than shielding provided by lead gowns and a ceiling-mounted lead shield, Ison said in a presentation at the EuroPCR meeting.

“We found it’s like walking on the moon, doing cases without a lead gown. It’s quite strange,” he stated.

Notably, protection to the head and face was substantially better with the Rampart shield (radiation exposure -96% vs -70% with standard practice), Ison emphasized.

Indeed, the cumbersome lead gowns of standard practice — weighing up to 30 lbs each — only protect major areas of the torso and waist. The addition of protective glasses and shin guards only mean more weight borne by the operator.

Ison cited a survey showing that half of interventional cardiologists reported neck or back pain during their careers.

“The ability to maintain protection from scatter radiation whilst lowering or even removing the weight of current lead gowns is a game changer for operators with current back or neck troubles and a way to prevent such problems in the future,” he said. “The longer you’ve been in the game, the more this appeals.”

He added that anaesthetic and nursing staff also had a new highly shielded area to stand in, thanks to the new system.

EuroPCR session panelist and interventional cardiologist Giampiero Vizzari, MD, PhD, of G. Martino University Hospital in Messina, Italy, questioned whether the Rampart would restrict the operator’s arm movements and work as a barrier to timely emergency CPR.

Ison suggested that other companies are coming out with their own versions of lead-equivalent shielding, perhaps some with ceiling-mounted designs that make it easier for operators to move around.

“Any benefit to reduce radiation exposure to the operators and staff is an important step forward. The occupational hazards for interventional cardiology are not small, and we need to focus on ways to improve this in the future. To me this is a good step forward,” commented Roxana Mehran, MD, interventional cardiologist at Mount Sinai Health System in New York City.

For the present study, Ison’s group had operators wear radiation monitors to measure operator scatter dose to the head, torso, and waist (both under and over their lead gowns) with and without the Rampart.

Ison cautioned that the effectiveness of the shield relies on correct positioning. “You must make sure it’s locked in correctly” and test it according to table size and shape, he said. “Use of real-time audible alarm radiation monitors would be advised.”

Since the study coincided with the first COVID-19 outbreak in Sydney, the investigators are also testing whether draping patients and the Rampart together in a cocoon of clear plastic would help reduce the transmission of SARS-CoV-2 in the cath lab.

Disclosures

Ison disclosed research support from Wilhelm Integrated Solutions.

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