Reduction of operator radiation dose by a pelvic lead shield during cardiac catheterization by radial access: comparison with femoral access.

OBJECTIVES This study sought to determine the efficacy of patient pelvic lead shielding for the reduction of operator radiation exposure during cardiac catheterization via the radial access in comparison with the femoral access. BACKGROUND Cardiac catheterization via the radial access is associated with significantly increased radiation dose to the patient and the operator. Improvements in radiation protection are needed to minimize this drawback. Pelvic lead shielding has the potential to reduce operator radiation dose. METHODS We randomly assigned 210 patients undergoing elective coronary angiography by the same operator to a radial and femoral access with and without pelvic lead shielding of the patient. Operator radiation dose was measured by a radiation dosimeter attached to the outside breast pocket of the lead apron. RESULTS For radial access, operator dose decreased from 20.9 ± 13.8 μSv to 9.0 ± 5.4 μSv, p < 0.0001 with pelvic lead shielding. For femoral access, it decreased from 15.3 ± 10.4 μSv to 2.9 ± 2.7 μSv, p < 0.0001. Pelvic lead shielding significantly decreased the dose-area product-normalized operator dose (operator dose divided by the dose-area product) by the same amount for radial and femoral access (0.94 ± 0.28 to 0.39 ± 0.19 μSv × Gy(-1) × cm(-2) and 0.70 ± 0.26 to 0.16 ± 0.13 μSv × Gy(-1) × cm(-2), respectively). CONCLUSIONS Pelvic lead shielding is highly effective in reducing operator radiation exposure for radial as well as femoral procedures. However, despite its use, radial access remains associated with a higher operator radiation dose.