0.35-mm lead-equivalent aprons provide similar protection to interventionalists compared to 0.5-mm lead-equivalent aprons during fluoroscopically guided interventions

Abstract

Objective

Protective garments are part of the routine radiation safety equipment used during fluoroscopically guided interventions (FGIs). New elements and lead equivalences have been introduced by manufacturers, which may influence protection for interventionalists from ionizing radiation. We sought to determine the performance of different lead-equivalent apron vests during FGIs in clinical and simulated scenarios.

Methods

Our primary endpoint was to evaluate the effectiveness of radiation dose attenuation of two different protective leaded apron vests, one with nominal 0.5-mm lead equivalence and a second with 0.35-mm lead equivalence, which were evaluated in clinical and simulated settings. In the clinical setting, optically stimulated luminescence nanoDot™ detectors were placed at the upper outer quadrant (UOQ) chest wall (CW) position, both over and under the apron vests on one vascular surgeon performing FGIs over a 21-month period. All interventions were performed in hybrid rooms with Allura Clarity (Phillips Healthcare) C-arms with state of-the-art software for vessel navigation, digital subtraction angiography, digital magnification, and collimation. Dosimeters were placed on either side of the primary operator’s body, located on the side closest to the X-ray source. In the simulation, fluorography was performed on a 30-inch-thick acrylic scatter phantom at 68, 80, 100, and 120 kVp for an exposure of 2000 mGy reference air kerma. Experiments were performed on the 0.35-mm and 0.5-mm lead-equivalent aprons. Paired Wilcoxon, χ², and analysis of variance tests were performed to identify statistical significance of radiation attenuation dose rates.

Results

Operator UOQ CW radiation dose was measured during 32 FGIs: 16 were performed with the 0.5-mm lead-equivalent apron and 16 with the 0.35-mm lead-equivalent apron. Median procedure reference air kerma was 167 mGy (interquartile range, 99-437 mGy) when the 0.5-mm apron vest was worn vs 250 mGy (interquartile range, 144-410 mGy) with the 0.35-mm vest. There was no significant difference in UOQ CW radiation dose attenuation between the two lead equivalencies: thick 89% vs thin 86%; P = .2. In the simulated scenario, radiation dose attenuation was similar for all measured kVp, with no significant differences for both apron vests (94% thick vs 95% thin; P = .49).

Conclusions

Heavier leaded aprons do not offer clinically significant increased protection over thinner lead. Due to the long-term musculoskeletal strain on interventionalists, it is safe to consider lightweight lead protection.