Redundant Protective Barriers: Minimizing Operator Occupational Risk

Background: The ubiquitous use of less invasive therapeutic angiographic procedures has created the milieu for long-term occupational risk of cancer and genetic defects. This study set out to determine the relative effectiveness of redundant radiation protective barriers and their impact on operator total-body-ionizing radiation exposure in the catheterization suite. Methods: Thermolucent dosimeter x-irradiation was measured inside and outside personal and movable protective barriers used concurrently during 50 consecutive procedures by a single operator. Additionally, the entrance/exit doses were recorded on the back and chest for all patients to provide insight into radiation scatter patterns. Results: The x-ray beam had an average 90.8% decrement in energy traversing the patient's chest when entrance and exit doses were compared, suggesting a 3.3-fold greater operator scatter radiation exposure below the table compared with that above the table. All 0.5-mm lead equivalent personal barriers reduced operator exposure by 72-95%, whereas the 1.0-mm leaded personal barrier (overlapping gown) reduced exposure by 96%. The 0.75-mm leaded glasses reduced exposure to the left eye by 67%. A leaded left-hand glove reduced exposure by only 20%. The effective calculated operator radiation exposure risk reduction provided by the use of personal and movable barriers reduced the theoretical risk of fatal or nonfatal cancer by 22-fold while decreasing potential severe genetic effect by 25-fold in comparison to movable barriers alone. Conclusions: The optimal use of combined personal and movable (redundant) lead barriers results in a significant reduction in total-body operator radiation exposure in the catheterization laboratory. The use of redundant barriers in the catheterization suite is associated with a dramatic theoretical long-term occupational risk reduction and should be encouraged. (J Interven Cardiol 2009;22:299-307).