Effective use of radiation shields to minimize operator dose during invasive cardiology procedures

Objectives: This study sought to measure the protection from scatter radiation offered to the primary physician by a variety of available shields and to provide best practice guidelines for shield use during invasive cardiology procedures. Background: It is accepted that exposure to radiation includes a predicted increase in cancer risk. In the cardiac interventional laboratories, radiation shields are widely available; however, proper use of the shields to optimize protection during cardiac interventional procedures is not well understood. Methods: The protection from scatter radiation offered by a variety of shields used alone and in combination was measured. Protection was assessed from air-kerma measurements of scatter radiation from a phantom performed without and with the shields. Protection was assessed for 3 patient- access locations (right jugular vein, right femoral artery, and left anterior chest) and for elevations ranging from 25 to 175 cm from the floor. The influence of precise placement of the ceiling-mounted upper body shield was specifically assessed. Results: The utility and protection of shielding varied for the 3 access points and with elevation. For femoral artery access locations, the shields can provide at least 80% protection from scatter at all elevations; however, protection depends substantially on upper body shield position. A disposable radiation-absorbing pad can provide 35% to 70% upper body protection for procedures during which the upper body shield cannot be used effectively. Conclusions: Radiation shields can provide substantial protection from radiation during cardiac interventional procedures. Shields must be thoughtfully and actively managed to provide optimum protection. Best practice guidelines for shield use are provided.