Comparison of a stationary X-ray protection system with current practice protection in routine clinical use for coronary angiography and interventions

Felix Johannes Hofmann (Bad Segeberg)1, M. C. Köstering (Gießen)2, O. Dörr (Gießen)2, S. Keranov (Gießen)2, K. D. Piayda (Gießen)2, M. Arsalan (Gießen)2, J. Lorenz (Gießen)2, L. Rust (Gießen)2, S. Fichtlscherer (Bad Segeberg)1, A. Elsässer (Oldenburg)3, C. W. Hamm (Gießen)2, S. T. Sossalla (Gießen)2, H. Nef (Bad Segeberg)1

1Segeberger Kliniken GmbH Herz- und Gefäßzentrum Bad Segeberg, Deutschland; 2Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland; 3Klinikum Oldenburg AöR Klinik für Kardiologie Oldenburg, Deutschland



The current practice of percutaneous coronary intervention (PCI) still poses numerous potential hazards for surgeons and cardiac catheterization laboratory assistants. These are primarily radiation exposure and orthopedic damage due to hours of standing work wearing a lead apron. In recent years, further developments have reduced the risks associated with radiation (e.g. through newer X-ray systems) and improved X-ray protection. Regardless, certain unprotected parts of the body (e.g. hands, eyes, head, legs) remain exposed to ionizing X-rays. 



The aim of this investigation was to evaluate the net benefit of a new-generation, stationary X-ray protection device in real, everyday routine for the catheter laboratory staff.



All consecutive patients who underwent left heart catheterization with a minimum of one coronary angiogram were included in this analysis. STEMI, ECLS, and cases with resuscitation <12 h were excluded. In the first period of the trial (03/2023 - 06/2023), the X-ray protection device was used, while in the second period (06/2023 - 10/2023), there was no device. Throughout clinical routine, specially trained staff used an online dosimeter to measure the radiation dose at 3 different anatomical landmarks for the operator as well as for the catheter laboratory staff (left hand, left temple, and left chest). The data were compared for each point of measurement separately.



We consecutively assigned 339 cases from the clinical routine (nprotect = 156 and nw/o = 183) to our trial. The cohorts were well balanced except for family history of coronary artery disease (Protect: 83.1% vs. W/O: 72.2%, p=0.015) and preprocedural need for dialysis (Protect: 1.3% vs. W/O: 5.5%, p = 0.036). Regarding the primary endpoint, the radiation exposure was equal between the groups for the operators’ head as well as chest (p = n.s.). A reduction in the operators’ exposure was seen for the hands (Protected: 13.53 µGy vs. W/O: 19.22 µGy, p = 0.028). For the laboratory staff, there was a significant reduction of approx. 50% to 70% for all measurement points (p = <0.001).



Here we report preliminary data comparing radiation protection using current and new-generation protection devices. Interestingly, the reduction for the operator was not as clear as expected; nevertheless, there was a tendency for a reduction of radiation exposure. This was significant for all measurements conducted for the staff. Although the groups were well balanced, there were slight differences in clinical characteristics. To account for these issues, a propensity matching will be performed in future studies. Taken together, our data show promising evidence for strengthening radiation protection to protect the examiners. In the future, radiation protection that goes beyond the use of heavy aprons should be mandatory to reduce health hazards.

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