cath lab

Ways To Reduce The Adverse Impact Of Cath Lab Radiation

October 2, 2021

Exposure to ionizing radiation is a matter of prime concern for interventional cardiologists and other cath lab staff. Such radiation increases the risk of cancer and cataract amongst them. Apart from radiation, there is an orthopedic injury-related risk too. The radiation protection apron worn by the medical personnel is heavy enough to affect the spine or lead to chronic back problems. For this reason, the new generation of interventional cardiologists is actively looking for cath lab software that eliminates the risk of radiation exposure and promotes overall cath lab management. Apart from digital solutions, there are some minor but essential measures that can reduce the impact to half. Let’s study this.

Ways to reduce the adverse impact of cath lab radiation

  • The staff who are supposed to work in the cath lab should be properly trained regarding radiation dose and protection. They should be made aware of all the radiation protection measures in the interventional cardiology or specialized electrophysiology device training programs.
  • The cath lab staff and cardiologists should observe a distance of two steps from the table at the time of imaging. This will minimize the exposure to half of what it would be otherwise.
  • Place the X-ray generator as far as possible from the patient, whereas the detector should be placed as close as possible. The resultant effect of this step will be minimization in the scatter radiation with optimum image quality.
  • Minimize the frame rate. Try to maintain the level at 10 FPS or 7.5 FPS, if possible.
  • Avoid the use of fluoro. Instead, use ultrasound, intravascular ultrasound IVUS, optical coherence tomography OCT or transesophageal echo (TEE).
  • Make use of the ‘fluoro save’ feature, which allows the cath lab operators to save the last taken image, and eliminate the need for additional X-ray imaging.
  • If possible, make use of the vessel road-mapping technology, to reduce the additional fluoro requirement.
  • Make use of lead drapes under the patient table. Careful placement of these drapes helps to overcome any obstruction in the way of C-arm travel.
  • The X-ray source should be under the patient’s table. This will reduce the scatter radiation, because it needs to be passed through the table and patient, before reaching the staff.
  • Make use of tubing extensions, as it allows the operators to maintain a distance of several feet from the table during imaging.
  • The cath lab management should ensure that a minimum amount of time is spent by the staff in the radiation area. The duration of radiation exposure depends on diagnostic coronary angiogram, interventional procedure, the fluoroscopic and cine screening times.
  • The use of cine should be as less as possible because, during cine, the radiation is five times higher than compared to that during fluoroscopy.

Technology to reduce the adverse impact of cath lab radiation

In this section, we will read about the technological advancements which are of immense help in minimizing exposure to cath lab radiation.

  1. RadPads has several products like table skirts, drapes, and other wearable protection pads that minimize exposure to scatter radiation.
  2. Zero-Gravity drape wrap from the list of TIDI products is a secure, lightweight, and comfortable radiation protection system to be used in cath labs. Its lead-acrylic head shield safeguards the staff working with fluoroscopy. It is also beneficial from an orthopedic point of view, as it reduces the risk of injury to the back, shoulder, neck, knees, hips, and ankles. The drape also reduces any risk of contamination.
  3. The Corindus Corpath robotic system is another technological tool that safeguards the operators against direct radiation. The cardiologists are seated at a distant place and remotely control the entire operation.
  4. The EggNest cath lab table reduces the cath lab radiation by approximately 91%. It has built-in radiation shielding. Its radiation protection strategy protects the entire cath lab. This means it is of immense help in complete cath lab management.
  5. New Angiography technologies help lower the dose needed for high-quality images. This dose reduction feature requires well-optimized machinery to give the desired results. For this, the FPS and other filters of the machine need to be set. The staff should be well trained and accustomed to the feature.
  6. The use of supplemental imaging reduces the reliance on X-ray imaging in a cath lab. Ultrasound, IVUS, and TEE play a significant role in reducing the use of angiographic imaging. One needs to have a well-trained staff for the use of these technologies, too.

Conclusion

Ionizing radiation is a cath lab hazard that might not be visible but has a long-term adverse impact on staff and patients. The radiation risks can be deterministic or stochastic. Therefore, every initiative is taken to reduce the amount and impact of scattered radiation. Proper education and training of the cath lab staff, monitoring of the radiation dose, use of personal protection equipment, use of shields, and other procedural techniques like the one mentioned above, should be adhered to. Special care should be given to pregnant women working in cath labs.

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