RS25 - 0.35-mm Lead-Equivalent Aprons Provide Similar Radiation Protection to Interventionalists Compared to 0.5-mm Lead-Equivalent Aprons During Fluoroscopically Guided Interventions

Saturday, June 22, 2024

11:35 AM – 11:42 AM CT

Location: West Building, Level 3, Skyline Ballroom W375ab

Submitting & Presenting Author(s)

Antonio Solano, MD (he/him/his)

Research Fellow
University of Texas Southwestern Medical Center
Dallas, Texas

Co-Author(s)

Bala Ramanan, MBBS, MS

Assistant Professor
UT Southwestern
Dallas, Texas
MS

Michael C. Siah, MD

Assistant Professor, Vascular and Endovascular Surgery Division
University of Texas Southwestern Medical Center
Dallas, Texas
KC

Khalil Chamseddin

Assistant Professor, Vascular and Endovascular Surgery Division
University of Texas Southwestern Medical Center
Dallas, Texas
GG

Gerardo Gonzalez-Guardiola

Assistant Professor, Vascular and Endovascular Surgery Division
University of Texas Southwestern Medical Center
Dallas, Texas
VP

Vivek Prakash

Assistant Professor
University of Texas Southwestern Medical Center
MS

Michael Shih

Assistant Professor, Vascular and Endovascular Surgery Division
University of Texas Southwestern Medical Center
Dallas, Texas
MB

Mirza S. Baig

Associate Professor
Department of Vascular Surgery UT Southwestern Medical Center
Dallas, Texas
Carlos H. Timaran, MD, MS

Associate Professor
Department of Vascular Surgery UT Southwestern Medical Cente
Dallas, Texas
JG

Jeffrey Guild

Associate Professor, Division of Medical Physics, Department of Radiology
University of Texas Southwestern Medical Center
Dallas, Texas

Senior Author(s)

Melissa L. Kirkwood, MD

Professor and Chief, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas

Objectives: 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.

Methods: 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, were evaluated in clinical and simulated settings. In the clinical setting, optically stimulated luminescence nanoDotTM detectors were placed at the upper outer quadrant (UOQ) chest wall (CW) position, both over and under the apron vests on two vascular surgeons performing FGIs. All interventions were performed in hybrid rooms with Allura Clarity 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 12-inch-thick acrylic scatter phantom at 68, 80, 100 and 120 kvP. Experiments were performed on the 0.35 mm and 0.5 mm lead-equivalent aprons. Paired Wilcoxon and chi square 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 (99-437) when 0.5 mm apron vest was worn versus 250 mGy (144-410) with the 0.35 mm apron. There was no significant difference in UOQ CW radiation dose between the two lead equivalencies: thick 89 % vs thin 86%, p=0.2. In the simulated scenario, radiation dose attenuation was similar for both aprons for all measured kVp (95% thick vs 94% thin).

Conclusions: Heavier leaded aprons do not offer significant increased protection over thinner lead. Due to the long-term musculoskeletal strain on interventionalists it is safe to consider light weight lead protection.