Lead shields protect nurses, technologists from radiation in the cath lab

Physicians aren’t the only ones who might benefit from using lead shields to guard against radiation exposure during cardiac catheterization, a new study suggests.

“The relatively simple approach of using accessory lead shields to protect staff members during cardiac catheterization was associated with a nearly two-thirds reduction in radiation exposure among nurses and technologists,” reported Ryan D. Madder, MD, with Spectrum Health in Grand Rapids, Michigan, and colleagues in JACC: Cardiovascular Interventions.

Even though it is common for cath labs to have lead shields between patients and physicians for protection from radiation exposure, it is not the case for other staff members, Madder et al. wrote.

The researchers collected real-time radiation exposure data from nurses and technologists during 764 consecutive catheterizations. Technologists had more than double the radiation exposure than nurses when standard radiation protection measures were followed, including the use of lead clothing by all staff members.

When those measures were coupled with accessory shields in areas where the staff members typically stood or worked, both groups experienced similar reductions of radiation exposure—62.5 percent for technologists and 63.6 percent for nurses.

“Whereas use of accessory shields has previously been shown to effectively attenuate physician radiation exposure, the present study is the first, to our knowledge, to observe a similar benefit among nonphysician staff members, an observation that may have important implications for occupational safety in the cardiac catheterization laboratory,” Madder and colleagues wrote.

The authors noted differences in radiation exposure were not significant between procedures for technologists, but nurses were exposed to more than four times the radiation during PCI than other cases. They speculated this is because technologists perform coronary injections and are usually at a fixed distance from the patient, whereas only some procedures (like PCI) require nurses to be in closer proximity to the patient during catheterization.

“These PCI-related duties may include approaching the patient while fluoroscopy is in use to administer oral antiplatelet therapy, provide supplemental oxygen, or administer intravenous medications,” Madder et al. wrote. “Similar duties, such as administering intravenous heparin or adenosine, are performed during FFR (fractional flow reserve) and may account for the observed 171% increase in E_DAP (radiation exposure) among nurses in cases in which FFR was performed. The observations in the present study indicate that PCI and FFR may represent targets through which future efforts could be made to improve occupational radiation exposure among nurses."

The study was conducted at a single center with accessory lead shields used during the second half of the trial. The authors pointed out this could have led to nurses and technologists having an increasing awareness of radiation protection, therefore biasing the results toward lower radiation exposure in phase II.