Evaluation of a Suspended Personal Radiation Protection System vs. Conventional Apron and Shields in Clinical Interventional Procedures


Purpose: This clinical study compares conventional lead aprons and ancillary shields to a functionally weightless personal overhead-supported system with expanded coverage. Materials and Methods: Primary operators performed procedures (N = 126, fluoroscopy minutes = 1209) using one of 2 methods of radiation protection and wearing dosimeters on multiple body locations. Method LAS (Lead-Apron+Shields): lead skirt, vest, thyroid shield, with 100% use of under-table shield, side shield, and mobile suspended lead-acrylic shield. Method Zgrav: ZeroGravity system (CFI Medical Solutions) with variable use of shielding. The studied early model moving with the operator had a curved lead-acrylic head shield (0.5 mm Pb) and expansive lead apron (0.5 - 1.0 mm Pb) that covered leg to distal calf and proximal arm to elbow, and a drape that permitted sterile entry and exit. Study was institutional review board approved and HIPPA-compliant. Results: Measured with a sensitive electronic dosimeter, eye exposures were 99% (P < 0.001) reduced for Zgrav with upgraded face shield vs. LAS, regardless of use or non-use of suspended shield with Zgrav. With optically stimulated luminescence (OSL) dosimeters, operator exposures, standardized to minutes of fluoroscopy and Fluoroscopic Patient Dose Area Product, were reduced by 87% - 100% for eye & head, neck, humerus, and tibia (Zgrav vs. LAS). Overall eye & head exposure reduction for entire study was 94%. Non-equivalence of torso exposures was not demonstrated. A brief user survey showed ergonomic advantages of Zgrav. Conclusion: Compared to conventional lead aprons with shields, the suspended system provided superior operator protection during interventional fluoroscopy, allowing operators to perform procedures without potentially obstructive shields.

Share and Cite:

Savage, C. , Seale IV, T. , Shaw, C. , Angela, B. , Marichal, D. and Rees, C. (2013) Evaluation of a Suspended Personal Radiation Protection System vs. Conventional Apron and Shields in Clinical Interventional Procedures. Open Journal of Radiology, 3, 143-151. doi: 10.4236/ojrad.2013.33024.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] L. W. Klein, D. L. Miller, S. Balter, et al., “Occupational Health Hazards in the Interventional Laboratory: Time for a Safer Environment,” Journal of Vascular and Interventional Radiology, Vol. 20, No. 2, 2009, pp. 147153. doi:10.1016/j.jvir.2008.10.015
[2] N. Hidajet, P. Wüst, M. Kreuschner, et al., “Radiation Risks for the Radiologist Performing Transjugular Intrahepatic Portosystemic Shunt (TIPS),” British Journal of Radiology, Vol. 79, No. 942, 2006, pp. 483486. doi:10.1259/bjr/67632946
[3] Z. J. Haskal, “Interventional Radiology Carries Occupational Risks for Cataracts,” RSNA News, Vol. 14, 2004, pp. 56.
[4] A. M. Ross, J. Segal, D. Borenstein, et al., “Prevalence of Spinal Disc Disease among Interventional Cardiologists,” American Journal of Cardiology, Vol. 79, No. 1, 1997, pp. 6870.
[5] B. A. Schueler, “Operator Shielding: How and Why,” Techniques in Vascular and Interventional Radiology, Vol. 13, No. 3, 2010, pp. 167171. doi:10.1053/j.tvir.2010.03.005
[6] D. L. Miller, E. Vano, G. Bartal, et al., “Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology,” Journal of Vascular and Interventional Radiology, Vol. 21, No. 5, 2010, pp. 607615. doi:10.1016/j.jvir.2010.01.007
[7] B. V. Worgul, Y. I. Kundiyev, N. M. Sergiyenko, et al., “Cataracts among Chernobyl CleanUp Workers; Implications Regarding Permissible Eye Exposures,” Vol. 167, No. 2, 2007, pp. 233243.
[8] E. Nakashima, K. Neriishi and A. Minamoto, “A Re analysis of AtomicBomb Cataract Data, 20002002: A Threshold Analysis,” Health Physics, Vol. 90, 2006, pp. 154160.
[9] K. Neriishi, E. Nakashima, A. Minamoto, et al., “Postoperative Cataract Cases among Atomic Bomb Survivors: Radiation Dose Response and Threshold,” Radiation Research, Vol. 168, No. 4, 2007, pp. 404408. doi:10.1667/RR0928.1
[10] National Council on Radiation Protection and Measure ments, “Radiation Dose Management for Fluoroscopi callyGuided Interventional Medical Procedures,” Report No. 168, 21 July 2010, p. 26.
[11] M. M. Finkelstein, “Is Brain Cancer an Occupational Disease in Cardiologists?” Canadian Journal of Cardiol ogy, Vol. 14, 1998, pp. 13851388.
[12] D. B. Wilson, R. A. Becker, R. G. Molnar, et al., “The Cranial Radiation Exposure of Vascular Interventionalists,” Journal of Vascular Surgery, Vol. 51, No. 6, 2010, pp. 67S68S.
[13] A. J. Cousin, R. B. Lawdahl, D. P. Chakraborty, et al., “The Case for Radioprotective Eyewear/Facewear. Practical Implications and Suggestions,” Investigative Radiology, Vol. 22, 1987, pp. 688692.
[14] W. Moore, G. Ferguson and C. Rohrmann, “Physical Fac tors Determining the Utility of Radiation Safety Glasses,” Medical Physics, Vol. 7, No. 1, 1980, pp. 812. doi:10.1118/1.594661
[15] D. L. Preston, E. Ron, S. Yonehara, et al., “Tumors of the Nervous System and Pituitary Gland Associated with Atomic Bomb Radiation Exposure,” Journal of the Na tional Cancer Institute, Vol. 94, No. 20, 2002, pp. 1555 1563. doi:10.1093/jnci/94.20.1555
[16] L. Hardell, K. Hansson Mild, A. Pahlson, et al., “Ionizing Radiation, Cellular Telephones and the Risk for Brain Tumours,” European Journal of Cancer Prevention, Vol. 10, No. 6, 2001, pp. 523529. doi:10.1097/0000846920011200000007
[17] S. Yonehara, A. V. Brenner, M. Kishikawa, et al., “Cli nical and Epidemiologic Characteristics of First Primary Tumors of the Central Nervous System and Related Or gans among Atomic Bomb Survivors in Hiroshima and Nagasaki, 19581995,” Cancer, Vol. 101, No. 7, 2004, pp. 16441654.
[18] V. Tsapaki, S. Kottou, E. Vano, et al., “Correlation of Patient and Staff Doses in Interventional Cardiology,” Radiation Protection Dosimetry, Vol. 117, No. 13, 2005, pp. 2629.
[19] E. Vano, L. Gonzalez, F. Beneytez, et al., “Lens Injuries Induced by Occupational Exposure in NonOptimized Interventional Radiology Laboratories,” British Journal of Radiology, Vol. 71, 1998, pp. 728733.
[20] C. Koukorava, E. Carinou and G. Simantirakis, “Doses to Operators during Interventional Radiology Procedures: Focus on Eye Lens and Extremity Dosimetry,” Radiation Protection Dosimetry, Vol. 10, 2010, pp. 10931097.
[21] R. H. Thornton, L. T. Dauer, J. P. Altamirano, et al., “Comparing Strategies for Operator Eye Protection in the Interventional Radiology Suite,” Journal of Vascular and Interventional Radiology, Vol. 21, No. 11, 2010, pp. 17031707. doi:10.1016/j.jvir.2010.07.019
[22] E. Kuon, M. Günther, O. Gefeller, et al., “Standardization of Occupational Dose to Patient DAP Enables Reliable Assessment of RadiationProtection Devices in Invasive Cardiology,” Fortschr Rontgenstr, Vol. 175, No. 11, 2003, pp. 15451550. doi:10.1055/s200343412
[23] M. Maeder, H. P. BrunnerLa Rocca, T. Wolbwer, et al., “Impact of a Lead Glass Screen on Scatter Radiation to Eyes and Hands in Interventional Cardiologists,” Catheterization and Cardiovascular Interventions, Vol. 67, No. 1, 2006, pp. 1823. doi:10.1002/ccd.20457
[24] O. Dragusin, R. Weerasooriya, P. Jais, et al., “Evaluation of a Radiation Protection Cabin for Invasive Electrophysiological Procedures,” European Heart Journal, Vol. 28, No. 2, 2007, pp. 183189.
[25] D. M. Pelz, “Low Back Pain, Lead Aprons, and the Angiographer,” American Journal of Neuroradiology, Vol. 21, No. 7, 2000, pp. 1364.
[26] B. A. Schueler, T. J. Vrieze, H. Bjarnason, et al., “An Investigation of Operator Exposure in Interventional Radiology,” Radiographics, Vol. 26, 2006, pp. 15331541. doi:10.1148/rg.265055127
[27] T. A. Pratt and A. J. Shaw, “Factors Affecting the Radiation Dose to the Lens of the Eye During Cardiac Catheterization Procedures,” British Journal of Radiology, Vol. 66, No. 784, 1993, pp. 346350. doi:10.1259/0007128566784346
[28] M. Zorzetto, G. Bernardi, G. Morocutti, et al., “Radiation Exposure to Patients and Operators during Diagnostic Catheterization and Coronary Angioplasty,” Catheterization and Cardiovascular Diagnosis, Vol. 40, No. 4, 1997, pp. 348351.
[29] J. R. Williams, “The Interdependence of Staff and Patient Doses in Interventional Radiology,” British Journal of Radiology, Vol. 70, 1997, pp. 498503.
[30] D. A. Marichal, T. Anwar, D. Kirsch, et al., “Comparison of a Suspended Radiation Protection System versus Standard Lead Apron for Radiation Exposure of a Simulated Interventionalist,” Journal of Vascular and Interventional Radiology, Vol. 22, No. 4, 2011, pp. 437442.
[31] E. Vano, L. Gonzales, J. M. Fernández, et al., “Eye Lens Exposures to Radiation in Interventional Suites: Caution Is Warranted,” Radiology, Vol. 248, 2008, pp. 945953.
[32] A. Servomaa and J. Karppinen, “The DoseArea Product and Assessment of the Occupational Dose in Interventional Radiology,” Radiation Protection Dosimetry, Vol. 96, No.13, 2001, pp. 235236.
[33] N. W. Marshall and K. Faulkner, “The Dependence of the Scattered Radiation Dose to Personnel on Technique Factors in Diagnostic Radiology,” British Journal of Radiology, Vol. 23, 1996, pp. 12711276.
[34] M. V. Marx, L. Niklason and E. Mauger, “Occupational Radiation Exposure to Interventional Radiologists: A Prospective Study,” Journal of Vascular and Interventional Radiology, Vol. 3, No. 4, 1992, pp. 597606. doi:10.1016/S10510443(92)729030

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.