Personal Radiation Monitor Registers ‘Real Time’ Operator Exposure in Cath Lab

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Using a personal radiation monitor decreases operator exposure in the cath lab by approximately one-third, according to data presented May 29, 2014, at the Society for Cardiovascular Angiography and Interventions (SCAI) Scientific Sessions in Las Vegas. The study also showed a trend toward decreasing patient radiation exposure but was not powered to detect such a difference.

Methods

For the RadiCure study, investigators led by Georgios Christopoulos, MD, of the University of Texas Southwestern Medical Center (Dallas, TX), randomized 505 left cardiac catheterization procedures between January 2012 and May 2014 to be performed with radiation monitoring (n = 253) or no monitoring (n = 252) using the Bleeper Sv (Vertec Scientific Ltd, Berkshire, UK). The device sounds approximately every 15 minutes in response to normal background radiation, increasing its beeping rate as exposure increases. The operator wears the device inside a leg pocket of his or her scrubs and can reset it for each procedure.


Procedural characteristics were similar between groups, including use of radial access (P = .549) and procedure times (P = .267).

Operator Exposure Lessened

Overall, there was a 36% reduction in radiation exposure for the first operator, who was wearing the device, and a 29% reduction for the second operator during both angiography and PCI procedures (table 1).

Table 1. Operator Radiation Exposure

 

Radiation Monitor
(n = 253)

No Monitor
(n = 252)

P Value

First Operator, mrem

0.9

1.4

< .001

Second Operator, mrem

0.6

0.8

< .001


Additionally, the radiation monitor group had lower dose area product compared with the non-monitored group (86.42 vs 75.40 Gy cm2; P = .043) with a trend for lower patient air kerma (1.049 vs 0.843 Gy; P = .09) and shorter fluoroscopy time (6.6 vs 5.4 min; P =.13). However, the study was powered for operator exposure only.

On multivariate analysis, the findings were consistent across multiple subgroups including those with and without chronic total occlusions, prior CABG, and radial procedures.

When Monitor Beeps, Operators Can Take Precautions

In a press briefing prior to his presentation, Dr. Christopoulos said that while there was no mandated protocol for what operators should do when they heard the monitor, the recommendations for behavior modification were to adjust the position of the shield, decrease flouroscopy dose, step away from the radiation source, or use radiation-absorbant drapes.

“The idea of this device is that it can sensitize the operator to the fact that he’s being exposed at a particular point in time during the procedure and this can make him aware [and] ready him to make some adjustments to reduce his radiation exposure,” he said.

The device serves a dual purpose, Dr. Christopoulos added, since in addition to making the operator aware of exposure, it also records the dose so it can be reported at the end of each case. Furthermore, there was no learning curve for using the device, he reported.

A Tool for Cancer Prevention?

“The device allows for immediate reaction that can limit exposure, unlike current monitoring that physicians undergo months after exposure,” Emmanouil Brilakis, MD, PhD, also of the University of Texas Southwestern Medical Center and the study’s principal investigator, said in a press release.

At the press briefing, Dr. Brilakis said although it would take many years to know if wearing the device prevents operators from developing radiation-induced disease, “what we can say is that reducing the dose that the [operator] gets by inference most likely is going to reduce his chance or her chance of getting cancer.”


Source:
Christopoulos G. Effect of a real time radiation monitoring device on radiation exposure during cardiac catheterization: the RAdiation reDuctIon during Cardiac Catheterization Using Real timE monitoring (RadiCure). Presented at: SCAI Scientific Sessions; May 29, 2014; Las Vegas, NV.

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Disclosures
  • Drs. Christopoulos and Brilakis report no relevant conflicts of interest.

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