Investigation of scatter radiation intensities in the cardiac catheter laboratory: novel versus traditional shielding solutions.

A manufacturer has released a novel shielding solution (NSS): Rampart M1128 and claimed that the personal protective equipment (PPE) can be removed. This study investigates the scatter intensities with the NSS or the traditional shielding solutions (TSS) including the ceiling-suspended screen and the tableside lead drape. Isodose maps were generated by two series of measurements with an anthropomorphic phantom using NSS and TSS. Three survey meters were positioned at different heights to measure the scatter intensities at the eye, chest, and pelvic levels. Additional measurements were made at the primary and secondary operators? locations to evaluate the scatter intensities with different clinical projections. For the main operator positions, the isodose maps showed that NSS could result in a scatter dose that reduced by 80% to 95% compared to the same positions with TSS at the eye and chest levels. The corresponding result at the pelvic level was a reduction of 50%. These reductions should be compared to the additional protection by PPE: up to 80% reduction from lead eyeglasses and up to 95% from protective garments. Considering both operators at clinically relevant LAO projections, NSS resulted in scatter dose that was 80% to 96%, 76% to 96% and 25% to 60% lower than those of the TSS at eye, chest and pelvis levels. The protection of NSS is comparable with that of TSS alongside PPE at the eye but not at the chest and the pelvic levels under the setup of coronary angiography.

Trial of a Novel Radiation Shielding Device to Protect Staff in the Cardiac Catheter Laboratory.

Continuous exposure to low-level scattered radiation to staff performing cardiac angiography and intervention is of concern. A novel shielding solution (NSS) (Rampart IC M1128) has the potential to provide greater shielding for staff present at the table-side. This study aimed to investigate the effectiveness of the NSS compared with a traditional shielding solution (TSS) in a randomized controlled trial that enrolled 100 patients who underwent cardiac angiography and/or intervention which were randomized to the NSS or TSS. Baseline patient characteristics and radiation dose data were collected. Staff who were scrubbed at the table-side wore 5 real-time dosimeters on the head, collar, waist, ankle, and under the apron. The median primary operator radiation dose was significantly lower (p <0.001) for all dosimeter locations with the NSS when compared with the TSS, being reduced by 86%, 80.0%, 100%, and 50.0% for the head, collar, waist, and leg respectively. Median under-apron dose was 0.0 µSv for both NSS and TSS. Median second operator dose was reduced by 100%, 100%, and 100% for the head, collar, and waist respectively (p <0.001). Median NSS and TSS dose at the ankle and under apron was 0.0 µSv. Median scrub nurse dose was reduced by 50% and 100% for the head and collar respectively (p <0.001). Median NSS and TSS dose at the waist, ankle, and under apron was 0.0 µSv. In conclusion, the NSS tested in this study demonstrates a significant decrease in radiation dose to operators and scrub nurses when compared with traditional radiation protection measures.

Is Digital Tomosynthesis on Par With Computed Tomography for the Detection and Measurement of Pulmonary Nodules?

Chest digital tomosynthesis (DT) has potential advantages compared to computed tomography (CT) such as radiation dose reduction. However, the role of DT in pulmonary nodule management remains investigative. We compared DT against CT for pulmonary nodule detection and size measurement. A clinical population comprising 54 nodules from 30 patients and a screening population comprising 42 nodules from 52 patients were included. Scans were independently read by two radiologists. Agreement in nodule measurements between readers and between modalities was assessed by Bland-Altman analysis using a 95% level of significance. The DT true positive fraction for the two readers was 0.44 and 0.39 in the clinical population, and 0.10 and 0.05 in the screening population. No significant inter-modality bias was observed between DT and CT measurements of nodule size, but the range of variation between modalities was approximately 30%. Inter-reader DT measurements also showed no significant bias, with a range of variation of approximately 15%. We conclude that DT has poor nodule detection sensitivity compared to CT. However, DT showed good measurement reproducibility and may be useful for monitoring growth of existing pulmonary nodules.