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Communication

Non-Lead Protective Aprons for the Protection of Interventional Radiology Physicians from Radiation Exposure in Clinical Settings: An Initial Study

by
Mamoru Kato
1,2,
Koichi Chida
1,3,*,
Masato Munehisa
2,4,
Tadaya Sato
2,5,
Yohei Inaba
1,3,
Masatoshi Suzuki
1,3 and
Masayuki Zuguchi
1
1
Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai 980-8575, Japan
2
Akita Cerebrospinal and Cardiovascular Center (Akita Medical Center), 6–10 Senshu-Kubota Machi, Akita 010-0874, Japan
3
Department of Radiation Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-0845, Japan
4
Department of Cardiovascular Medicine, Senseki Hospital, 53-7 Akai, Aza Dai, Higashi Matsushima 981-0501, Japan
5
Department of Cardiovascular Medicine, Saka General Hospital, 16-5 Nishiki-machi, Shiogama 985-8506, Japan
*
Author to whom correspondence should be addressed.
Diagnostics 2021, 11(9), 1613; https://doi.org/10.3390/diagnostics11091613
Submission received: 31 July 2021 / Revised: 29 August 2021 / Accepted: 30 August 2021 / Published: 3 September 2021
(This article belongs to the Section Medical Imaging and Theranostics)
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Versions Notes

Abstract

:
Radiation protection/evaluation during interventional radiology (IVR) poses a very important problem. Although IVR physicians should wear protective aprons, the IVR physician may not tolerate wearing one for long procedures because protective aprons are generally heavy. In fact, orthopedic problems are increasingly reported in IVR physicians due to the strain of wearing heavy protective aprons during IVR. In recent years, non-Pb protective aprons (lighter weight, composite materials) have been developed. Although non-Pb protective aprons are more expensive than Pb protective aprons, the former aprons weigh less. However, whether the protective performance of non-Pb aprons is sufficient in the IVR clinical setting is unclear. This study compared the ability of non-Pb and Pb protective aprons (0.25- and 0.35-mm Pb-equivalents) to protect physicians from scatter radiation in a clinical setting (IVR, cardiac catheterizations, including percutaneous coronary intervention) using an electric personal dosimeter (EPD). For radiation measurements, physicians wore EPDs: One inside a personal protective apron at the chest, and one outside a personal protective apron at the chest. Physician comfort levels in each apron during procedures were also evaluated. As a result, performance (both the shielding effect (98.5%) and comfort (good)) of the non-Pb 0.35-mm-Pb-equivalent protective apron was good in the clinical setting. The radiation-shielding effects of the non-Pb 0.35-mm and Pb 0.35-mm-Pb-equivalent protective aprons were very similar. Therefore, non-Pb 0.35-mm Pb-equivalent protective aprons may be more suitable for providing radiation protection for IVR physicians because the shielding effect and comfort are both good in the clinical IVR setting. As non-Pb protective aprons are nontoxic and weigh less than Pb protective aprons, non-Pb protective aprons will be the preferred type for radiation protection of IVR staff, especially physicians.

1. Introduction

The occupational exposure and patient radiation dose are important issues [1,2,3,4,5]. Especially, interventional radiology (IVR) procedures deliver high radiation doses to both the physician and patient [6,7,8,9,10,11,12,13,14]. Furthermore, IVR physicians are at high risk of radiation-induced injury [15,16,17,18,19,20]. Thus, radiation evaluation/protection is very important to the IVR physician [21,22,23,24,25].
Although physicians should wear protective aprons, the IVR physician may not tolerate wearing one for long procedures because protective aprons are generally heavy. In fact, orthopedic problems are increasingly reported in IVR physicians due to the strain of wearing heavy aprons during IVR [26,27,28].
Recently, non-lead (Pb) protective aprons (lighter weight, composite materials) have been developed [29,30]. Although non-Pb protective aprons are more expensive than Pb protective aprons, the former protective aprons weigh less. Furthermore, non-Pb protective aprons are environmentally friendly. Pb toxicity is obviously not in play. Thus, non-Pb protective aprons are optimal. However, whether the protective performance of non-Pb aprons is sufficient in the IVR clinical setting is unclear. Furthermore, the optimal Pb-equivalent of protective aprons, 0.25- and 0.35-mm Pb-equivalents, is unclear in the IVR clinical setting.
This study compared the ability of non-Pb and Pb protective aprons (0.25- and 0.35-mm Pb-equivalents) to protect physicians from scatter radiation in a clinical setting (cardiac catheterizations, including percutaneous coronary intervention, PCI) using an electric personal dosimeter (EPD). Physician comfort levels in each apron during procedures were also evaluated.
The purpose of this initial study was to demonstrate the effectiveness of non-lead protective aprons for the protection of IVR physicians from radiation exposure in clinical settings.

2. Materials and Methods

2.1. Protective Apron and Radiation Measurement

In this study, physicians wore one of four types of protective apron at random: 0.25-mm Pb (QA 0.25, Kasei-optonics, Odawara, Japan), 0.35-mm Pb (QA 0.35, Kasei-optonics, Odawara, Japan), non-Pb, 0.25-mm Pb-equivalent (HGA 0.25, Kasei-optonics, Odawara, Japan), or non-Pb, 0.35-mm Pb-equivalent (HGA 0.35, Kasei-optonics, Odawara, Japan). Pb protective aprons consist of lead. Non-lead protective aprons consist of composite materials, mainly tungsten (W) and tin (Sn).
For radiation measurements, physicians wore two EPDs (PDM-117, Hitachi-Aloka, Taito-ku, Japan): One inside a personal protective apron at the chest, and one outside a personal protective apron at the chest. Figure 1 indicates the position of each EPD in the clinical setting (cardiac catheterizations, including PCI). We evaluated external (average dose of exterior EPDs at the chest) and internal doses (average dose of interior EPDs at the chest).
The radiation shielding effects (%) of the protective aprons were also determined as follows:
Radiation shielding effects (%) = (1 − inside dose/outside dose) × 100.

2.2. Cardiac Catheterization

Radiation exposure (external and internal radiation dose) for the two physicians during more than 50 cardiac catheterizations (including PCI) with the four types of protective apron were measured randomly at Akita Medical Center (Akita, Akita, Japan) (Table 1). We did not establish inclusion or exclusion criteria for this initial study. During each procedure, physicians were at liberty to choose any of the four types of protective apron.
In this study, an additional lead acrylic protection device was also used, if possible, during procedures (Figure 2).
Physician comfort levels in each protective apron during cardiac catheterizations procedures (including PCI) were also determined through interviews.
The procedures (cardiac catheterizations, including PCI) were performed using a digital cine X-ray single-plane system (Infinix Celeve-i, Toshiba, Ohtawara, Japan) with a 7-inch mode flat-panel detector, an acquisition (cine) rate of 15 frames/s, and pulsed fluoroscopy (15 pulses/s).
This study was approved by the Ethics Committee of Akita Cerebrospinal and Cardiovascular Center (Akita Medical Center). We also evaluated the radiation dose indicator (cumulative air karma [AK]) and fluoroscopy time undergoing cardiac catheterizations, including PCI.

3. Results

The X-ray procedure details used in cardiac catheterizations (including PCI) are shown in Table 1. Table 2 summarizes the findings of this clinical study. Although the radiation-shielding effect of the 0.35-mm Pb protective apron was the best (98.9%) among the four types, physician comfort was the worst (very poor) because this protective apron was the heaviest. Conversely, although physician comfort in the non-Pb 0.25-mm Pb-equivalent protective apron was highest (excellent) among the types because the protective apron was the lightest, the radiation shielding effect was the worst (96.1%).
The performance (both the shielding effect (98.5%) and comfort (good)) of the non-Pb 0.35-mm-Pb-equivalent protective apron was good in the clinical setting. The radiation-shielding effects of the 0.35-mm Pb and non-Pb 0.35-mm-Pb-equivalent protective aprons were very similar. The extent of physician comfort when wearing the non-Pb 0.35-mm-Pb-equivalent protective apron was similar to that when wearing the non-Pb 0.25-mm-Pb-equivalent protective apron. Thus, non-Pb 0.35-mm Pb-equivalent protective aprons may be more suitable in providing radiation protection for IVR physicians. Thus, we recommend that IVR physicians should wear the non-Pb 0.35-mm-Pb-equivalent protective apron.

4. Discussion

In X-ray examination, radiation protection/evaluation of physicians and patients is significant. Although the wide acceptance of IVR procedures, such as PCI, has led to increasing numbers of interventions being performed, radiation exposures from IVR are conclusively higher, exposing both the IVR staff and the patient to high radiation doses. [31,32,33,34,35,36,37,38,39].
Many radiation-related injuries caused by excessive radiation exposure during cardiac intervention IVR procedures have been reported [40,41,42,43]. Therefore, radiation monitoring for physicians is essential in reducing the radiation injury risk during IVR. Furthermore, most IVR physicians stand close to the patient where the scattered radiation and consequently the physicians’ exposure is higher. Therefore, radiation protection/measurement for the physician during IVR poses a very important problem [44,45,46,47,48,49,50,51,52,53,54].
A protective apron is inevitably heavy but should be worn by all staff working in catheterization suites. The protective aprons increase the risk of musculoskeletal disorders. Careful selection of a personal protective apron is thus important [55,56].
As non-lead aprons consist of composite materials, mainly W and Sn, they are approximately 20% lighter than lead aprons [29,30]. In the phantom study, the performance of these non-Pb and Pb protective aprons was similar for scattered X-rays [30]. However, whether the performance (both shielding effect and comfort) of non-Pb aprons is sufficient in the clinical setting (cardiac catheterizations including PCI) is unclear. In this study, the radiation protection provided by non-Pb and Pb protective aprons in clinical IVR settings are compared. As a result, we demonstrated the effectiveness of non-Pb protective aprons for the protection of IVR physicians from radiation exposure in clinical IVR settings.
Namely, our results showed that the performance (both shielding effect and comfort) of the non-Pb 0.35-mm Pb-equivalent protective apron was good in the clinical setting (cardiac catheterizations including PCI). Thus, non-Pb 0.35-mm Pb-equivalent protective aprons may be more suitable in providing radiation protection for IVR physicians.
For procedures during which non-lead protective aprons were worn, the mean external dose tended to be lower than that when lead protective aprons were worn (non-lead protective aprons 142.6 or 123.9 μSv; lead protective aprons 166.4 or 209.2 μSv, Table 2). Moreover, the cumulative AK was higher (non-lead protective aprons 1345.7 or 1345.3 mGy, lead protective aprons 1037.2 or 812.3 mGy, Table 1) and the fluoroscopy time longer (non-lead protective aprons 34.5 or 31.7 min, lead aprons 30.4 or 21.2 min, Table 1). The probable explanation is that an additional, lead-containing, acrylic protection device was employed during many procedures featuring non-lead protective aprons. Thus, if the cumulative AK was higher, the external dose was lower because the non-apron device shielded staff from scattered radiation. We did not evaluate the effect of the non-apron device because the shielding effect (%) is relative.
Possible ergonomic improvements include the use of a two-part protective apron (that separately protects the chest and waist). This would distribute the protective apron weight more equally across the shoulders and waist, possibly reducing the risk of musculoskeletal pain [56].

Limitation

This was an initial study of non-Pb protective apron use in clinical settings. A controlled comparison of four groups (wearing non-Pb and Pb protective aprons; 0.25- and 0.35-mm-Pb-equivalents), with statistical evaluation, is necessary.

5. Conclusions

This study compared the protective performance of Pb and non-Pb aprons of 0.25-mm and 0.35-mm Pb-equivalents in the clinical setting (cardiac catheterizations including PCI). Non-Pb 0.35-mm Pb-equivalent protective aprons may be more suitable for providing radiation protection for IVR physicians because the shielding effect and comfort are both good in the clinical setting.
As non-Pb protective aprons are nontoxic and weigh less than Pb protective aprons, and IVR staff mainly receive doses from scattered X-rays, non-Pb protective aprons will be the preferred type for radiation protection of IVR staff, especially physicians.

Author Contributions

Conceptualization, M.K. and K.C.; methodology, M.K. and K.C.; software, M.K. and Y.I.; validation, K.C., M.S., and M.Z.; formal analysis, M.K., M.M., and T.S.; investigation, M.K., M.M., and T.S.; resources, K.C.; data curation, M.K., Y.I., and M.S.; writing—original draft preparation, M.K.; writing—review and editing, M.K. and K.C.; visualization, M.K. and Y.I.; supervision, K.C. and M.Z.; project administration, K.C. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported in part by the Industrial Disease Clinical Research Grants (200701-1), Japan.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Akita Cerebrospinal and Cardiovascular Center (Akita Medical Center), (IRB approval number: 21-11).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Acknowledgments

We thank Hiroki Ishii, Tohoku university hospital, Japan, and Yoshihiro Haga of the Sendai Kousei Hospital, Japan for their invaluable assistance.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

References

  1. Nemoto, M.; Chida, K. Reducing the breast cancer risk and radiation dose of radiography for scoliosis in children: A phantom study. Diagnostics 2020, 10, 753. [Google Scholar] [CrossRef] [PubMed]
  2. International Commission on Radiological Protection (ICRP). Radiological Protection and Safety in Medicine; ICRP Publication 73; Pergamon: Oxford, UK, 1996; Volume 26, Available online: https://journals.sagepub.com/doi/pdf/10.1177/ANIB_26_2 (accessed on 28 August 2021).
  3. Vano, E. Challenges for managing the cumulative effective dose for patients. Br. J. Radiol. 2020, 93, 20200814. [Google Scholar] [CrossRef]
  4. International Commission on Radiological Protection (ICRP). Diagnostic Reference Levels in Medical Imaging; ICRP Publication 135; Sage: Thousand Oaks, CA, USA, 2017; Volume 46, Available online: https://journals.sagepub.com/doi/pdf/10.1177/ANIB_46_1 (accessed on 28 August 2021).
  5. Morishima, Y.; Chida, K.; Watanabe, H. Estimation of the dose of radiation received by patient and physician during a videofluoroscopic swallowing study. Dysphagia 2016, 31, 574–578. [Google Scholar] [CrossRef] [PubMed]
  6. Haga, Y.; Chida, K.; Sota, M.; Kaga, Y.; Abe, M.; Inaba, Y.; Suzuki, M.; Meguro, T.; Zuguchi, M. Hybrid operating room system for the treatment of thoracic and abdominal aortic aneurysms: Evaluation of the radiation dose received by patients. Diagnostics 2020, 10, 846. [Google Scholar] [CrossRef] [PubMed]
  7. Chida, K.; Kato, M.; Kagaya, Y.; Zuguchi, M.; Saito, H.; Ishibashi, T.; Takahashi, S.; Yamada, S.; Takai, Y. Radiation dose and radiation protection for patients and physicians during interventional procedure. J. Radiat. Res. 2010, 51, 97–105. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  8. Chida, K.; Inaba, Y.; Masuyama, H.; Yanagawa, I.; Mori, I.; Saito, H.; Maruoka, S.; Zuguchi, M. Evaluating the performance of a MOSFET dosimeter at diagnostic X-ray energies for interventional radiology. Radiol. Phys. Technol. 2009, 2, 58–61. [Google Scholar] [CrossRef]
  9. Inaba, Y.; Chida, K.; Murabayashi, Y.; Endo, M.; Otomo, K.; Zuguchi, M. An initial investigation of a wireless patient radiation dosimeter for use in interventional radiology. Radiol. Phys. Technol. 2020, 13, 1–6. [Google Scholar] [CrossRef] [PubMed]
  10. Chida, K.; Kato, M.; Inaba, Y.; Kobayashi, R.; Nakamura, M.; Abe, Y.; Zuguchi, M. Real-time patient radiation dosimeter for use in interventional radiology. Phys. Medica 2016, 32, 1475–1478. [Google Scholar] [CrossRef]
  11. Chida, K.; Saito, H.; Zuguchi, M.; Shirotori, K.; Kumagai, S.; Nakayama, H.; Matsubara, K.; Kohzuki, M. Does digital acquisition reduce patients’ skin dose in cardiac interventional procedures? An experimental study. Am. J. Roentgenol. 2004, 183, 1111–1114. [Google Scholar] [CrossRef]
  12. International Commission on Radiological Protection (ICRP). Radiological Protection in Medicine; ICRP Publication 105; Elsevier: Amsterdam, The Netherlands, 2007; Volume 37, Available online: https://journals.sagepub.com/doi/pdf/10.1177/ANIB_37_6 (accessed on 28 August 2021).
  13. Chida, K.; Saito, H.; Otani, H.; Kohzuki, M.; Takahashi, S.; Yamada, S.; Shirato, K.; Zuguchi, M. Relationship between fluoroscopic time, dose—Area product, body weight, and maximum radiation skin dose in cardiac interventional procedures. Am. J. Roentgenol. 2006, 186, 774–778. [Google Scholar] [CrossRef]
  14. Chida, K.; Kagaya, Y.; Saito, H.; Takai, Y.; Takahashi, S.; Yamada, S.; Kohzuki, M.; Zuguchi, M. Total entrance skin dose: An effective indicator of maximum radiation dose to the skin during percutaneous coronary intervention. Am. J. Roentgenol. 2007, 189, W224–W227. [Google Scholar] [CrossRef]
  15. International Commission on Radiological Protection (ICRP). ICRP Statement on Tissue Reactions / Early and Late Effects of Radiation in Normal Tissues and Organs—Threshold Doses for Tissue Reactions in a Radiation Protection Context; ICRP Publication 118; Elsevier: Amsterdam, The Netherlands, 2012; Volume 41, Available online: https://journals.sagepub.com/doi/pdf/10.1177/ANIB_41_1-2 (accessed on 28 August 2021).
  16. Chida, K.; Kaga, Y.; Haga, Y.; Kataoka, N.; Kumasaka, E.; Meguro, T.; Zuguchi, M. Occupational dose in interventional radiology procedures. Am. J. Roentgenol. 2013, 200, 138–141. [Google Scholar] [CrossRef]
  17. Attigah, N.; Oikonomou, K.; Hinz, U.; Knoch, T.; Demirel, S.; Verhoeven, E.; Böckler, D. Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms. J. Vasc. Surg. 2016, 63, 198–203. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  18. Haga, Y.; Chida, K.; Kaga, Y.; Sota, M.; Meguro, T.; Zuguchi, M. Occupational eye dose in interventional cardiology procedures. Sci. Rep. 2017, 7, 1–7. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  19. Presidência da República. Casa Civil. Subchefia para Assuntos Jurídicos. Decreto—Lei nº 227, De 28 de Fevereiro de 1967. Dá Nova Redação ao Decreto-lei nº 1.985, de 29 de Janeiro de 1940 (Código de Minas). 1967. Available online: http://www.planalto.gov.br/ccivil_03/Decreto-Lei/Del0227.htm (accessed on 19 October 2020).
  20. Ishii, H.; Chida, K.; Satsurai, K.; Haga, Y.; Kaga, Y.; Abe, M.; Inaba, Y.; Zuguchi, M. A phantom study to determine the optimal placement of eye dosemeters on interventional cardiology staff. Radiat. Prot. Dosim. 2019, 185, 409–413. [Google Scholar] [CrossRef] [PubMed]
  21. Martin, C.J.; Magee, J.S. Assessment of eye and body dose for interventional radiologists, cardiologists, and other interventional staff. J. Radiol. Prot. 2013, 33, 445–460. [Google Scholar] [CrossRef]
  22. Chida, K.; Morishima, Y.; Masuyama, H.; Chiba, H.; Katahira, Y.; Inaba, Y.; Mori, I.; Maruoka, S.; Takahashi, S.; Kohzuki, M.; et al. Effect of radiation monitoring method and formula differences on estimated physician dose during percutaneous coronary intervention. Acta Radiol. 2009, 50, 170–173. [Google Scholar] [CrossRef]
  23. Vano, E.; Sanchez, R.M.; Fernández, J.M. Strategies to optimise occupational radiation protection in interventional cardiology using simultaneous registration of patient and staff doses. J. Radiol. Prot. 2018, 38, 1077–1088. [Google Scholar] [CrossRef] [PubMed]
  24. Kato, M.; Chida, K.; Ishida, T.; Toyoshima, H.; Yoshida, Y.; Yoshioka, S.; Moroi, J.; Kinoshita, T. Occupational radiation ex-posure of the eye in neurovascular interventional physician. Radiat. Prot. Dosim. 2019, 185, 151–156. [Google Scholar] [CrossRef]
  25. Kato, M.; Chida, K.; Ishida, T.; Sasaki, F.; Toyoshima, H.; Oosaka, H.; Terata, K.; Abe, Y.; Kinoshita, T. Occupational radiation exposure dose of the eye in department of cardiac arrhythmia physician. Radiat. Prot. Dosim. 2019, 187, 361–368. [Google Scholar] [CrossRef]
  26. Ross, A.M.; Segal, J.; Borenstein, D.; Jenkins, E.; Cho, S. Prevalence of spinal disc disease among interventional cardiologists. Am. J. Cardiol. 1997, 79, 68–70. [Google Scholar] [CrossRef]
  27. Goldstein, J.A.; Balter, S.; Cowley, M.; Hodgson, J.; Klein, L.W. Interventional committee of the society of cardiovascular interventions occupational hazards of interventional cardiologists: Prevalence of orthopedic health problems in contemporary practice. Catheter. Cardiovasc. Interv. 2004, 63, 407–411. [Google Scholar] [CrossRef]
  28. Pleis, J.R.; Ward, B.W.; Lucas, J.W. Summary health statistics for US adults: National Health Interview Survey, 2009. Vital Health Stat. 2010, 249, 1–207. [Google Scholar]
  29. Yaffe, M.J.; Mawdsley, G.E.; Lilley, M.; Servant, R.; Reh, G. Composite materials for X-ray protection. Health Phys. 1991, 60, 661–664. [Google Scholar] [CrossRef]
  30. Zuguchi, M.; Chida, K.; Taura, M.; Inaba, Y.; Ebata, A.; Yamada, S. Usefulness of non-lead aprons in radiation protection for physicians performing interventional procedures. Radiat. Prot. Dosim. 2008, 131, 531–534. [Google Scholar] [CrossRef]
  31. Chida, K.; Inaba, Y.; Saito, H.; Ishibashi, T.; Takahashi, S.; Kohzuki, M.; Zuguchi, M. Radiation dose of interventional radiology system using a flat-panel detector. Am. J. Roentgenol. 2009, 193, 1680–1685. [Google Scholar] [CrossRef]
  32. Chida, K.; Ohno, T.; Kakizaki, S.; Takegawa, M.; Yuuki, H.; Nakada, M.; Takahashi, S.; Zuguchi, M. Radiation dose to the pediatric cardiac catheterization and intervention patient. Am. J. Roentgenol. 2010, 195, 1175–1179. [Google Scholar] [CrossRef]
  33. Chida, K.; Inaba, Y.; Morishima, Y.; Taura, M.; Ebata, A.; Yanagawa, I.; Takeda, K.; Zuguchi, M. Comparison of dose at an interventional reference point between the displayed estimated value and measured value. Radiol. Phys. Technol. 2011, 4, 189–193. [Google Scholar] [CrossRef] [PubMed]
  34. Inaba, Y.; Nakamura, M.; Chida, K.; Zuguchi, M. Effectiveness of a novel real-time dosimeter in interventional radiology: A comparison of new and old radiation sensors. Radiol. Phys. Technol. 2018, 11, 445–450. [Google Scholar] [CrossRef] [PubMed]
  35. International Commission on Radiological Protection (ICRP). Radiological Protection in Cardiology; ICRP Publication 120; Elsevier: Amsterdam, The Netherlands, 2013; Volume 42, Available online: https://journals.sagepub.com/doi/pdf/10.1177/ANIB_42_1 (accessed on 28 August 2021).
  36. Inaba, Y.; Nakamura, M.; Zuguchi, M.; Chida, K. Development of novel real-time radiation systems using 4-channel sensors. Sensors 2020, 20, 2741. [Google Scholar] [CrossRef] [PubMed]
  37. Kato, M.; Chida, K.; Nakamura, M.; Toyoshima, H.; Terata, K.; Abe, Y. New real-time patient radiation dosimeter for use in radiofrequency catheter ablation. J. Radiat. Res. 2019, 60, 215–220. [Google Scholar] [CrossRef] [Green Version]
  38. Inaba, Y.; Chida, K.; Kobayashi, R.; Zuguchi, M. A cross-sectional study of the radiation dose and image quality of X-ray equipment used in IVR. J. Appl. Clin. Med. Phys. 2016, 17, 391–401. [Google Scholar] [CrossRef] [PubMed]
  39. Chida, K.; Kato, M.; Saito, H.; Ishibashi, T.; Takahashi, S.; Kohzuki, M.; Zuguchi, M. Optimizing patient radiation dose in intervention procedures. Acta Radiol. 2010, 51, 33–39. [Google Scholar] [CrossRef]
  40. International Commission on Radiological Protection (ICRP). Avoidance of Radiation Injuries from Medical Interventional Procedures; ICRP Publication 85; Pergamon: Oxford, UK, 2000; Volume 30, Available online: https://journals.sagepub.com/doi/pdf/10.1177/ANIB_30_2 (accessed on 28 August 2021).
  41. Vañó, E.; González, L.; Beneytez, F.; Moreno, F. Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories. Br. J. Radiol. 1998, 71, 728–733. [Google Scholar] [CrossRef]
  42. Kato, M.; Chida, K.; Sato, T.; Oosaka, H.; Tosa, T.; Munehisa, M.; Kadowaki, K. The necessity of follow-up for radiation skin injuries in patients after percutaneous coronary interventions: Radiation skin injuries will often be overlooked clinically. Acta Radiol. 2012, 53, 1040–1044. [Google Scholar] [CrossRef] [PubMed]
  43. Koenig, A.; Maas, J.; Viniol, S.; Etzel, R.; Fiebich, M.; Thomas, R.; Mahnken, A. Scatter radiation reduction with a radiation-absorbing pad in interventional radiology examinations. Eur. J. Radiol. 2020, 132, 109245. [Google Scholar] [CrossRef]
  44. Chida, K.; Takahashi, T.; Ito, D.; Shimura, H.; Takeda, K.; Zuguchi, M. Clarifying and visualizing sources of staff-received scattered radiation in interventional procedures. Am. J. Roentgenol. 2011, 197, W900–W903. [Google Scholar] [CrossRef]
  45. Chida, K.; Morishima, Y.; Inaba, Y.; Taura, M.; Ebata, A.; Takeda, K.; Shimura, H.; Zuguchi, M. Physician-received scatter radiation with angiography systems used for interventional radiology: Comparison among many X-ray systems. Radiat. Prot. Dosim. 2011, 149, 410–416. [Google Scholar] [CrossRef] [PubMed]
  46. Inaba, Y.; Chida, K.; Kobayashi, R.; Kaga, Y.; Zuguchi, M. Fundamental study of a real-time occupational dosimetry system for interventional radiology staff. J. Radiol. Prot. 2014, 34, N65–N71. [Google Scholar] [CrossRef]
  47. Kuon, E.; Schmitt, M.; Dahm, J.B. Significant reduction of radiation exposure to operator and staff during cardiac interventions by analysis of radiation leakage and improved lead shielding. Am. J. Cardiol. 2002, 89, 44–49. [Google Scholar] [CrossRef]
  48. Haga, Y.; Chida, K.; Kimura, Y.; Yamanda, S.; Sota, M.; Abe, M.; Kaga, Y.; Meguro, T.; Zuguchi, M. Radiation eye dose to medical staff during respiratory endoscopy under X-ray fluoroscopy. J. Radiat. Res. 2020, 61, 691–696. [Google Scholar] [CrossRef]
  49. Endo, M.; Haga, Y.; Sota, M.; Tanaka, A.; Otomo, K.; Murabayashi, Y.; Abe, M.; Kaga, Y.; Inaba, Y.; Suzuki, M.; et al. Evaluation of novel X-ray protective eyewear in reducing the eye dose to interventional radiology physicians. J. Radiat. Res. 2021, 62, 414–419. [Google Scholar] [CrossRef]
  50. Inaba, Y.; Hitachi, S.; Watanuki, M.; Chida, K. Occupational radiation dose to eye lenses in CT-guided interventions using MDCT-fluoroscopy. Diagnostics 2021, 11, 646. [Google Scholar] [CrossRef] [PubMed]
  51. Morishima, Y.; Chida, K.; Muroya, Y.; Utsumi, Y. Effectiveness of a New lead-shielding device and additional filter for reducing staff and patient radiation exposure during videofluoroscopic swallowing study using a human phantom. Dysphagia 2018, 33, 109–114. [Google Scholar] [CrossRef] [PubMed]
  52. Morishima, Y.; Chida, K.; Meguro, T. Effectiveness of additional lead shielding to protect staff from scattering radiation during endoscopic retrograde cholangiopancreatography procedures. J. Radiat. Res. 2018, 59, 225–232. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  53. Ishii, H.; Haga, Y.; Sota, M.; Inaba, Y.; Chida, K. Performance of the DOSIRIS™ eye lens dosimeter. J. Radiol. Prot. 2019, 39, N19–N26. [Google Scholar] [CrossRef]
  54. Morishima, Y.; Chida, K.; Katahira, Y. The effectiveness of additional lead-shielding drape and low pulse rate fluoroscopy in protecting staff from scatter radiation during cardiac resynchronization therapy (CRT). Jpn. J. Radiol. 2019, 37, 95–101. [Google Scholar] [CrossRef] [Green Version]
  55. Dixon, R.G.; Khiatani, V.; Statler, J.D.; Walser, E.M.; Midia, M.; Miller, D.L.; Bartal, G.; Collins, J.D.; Gross, K.A.; Stecker, M.S.; et al. Society of interventional radiology: Occupational back and neck pain and the interventional radiologist. J. Vasc. Interv. Radiol. 2017, 28, 195–199. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  56. Cornelis, F.H.; Razakamanantsoa, L.; Ammar, M.B.; Lehrer, R.; Haffaf, I.; El-Mouhadi, S.; Gardavaud, F.; Najdawi, M.; Barral, M. Ergonomics in interventional radiology: Awareness is mandatory. Medicina 2021, 57, 500. [Google Scholar] [CrossRef]
Diagnostics 11 01613 g001 550
Figure 1. The position of the two electric personal dosimeters (EPDs) worn on the physician’s protective apron in a clinical setting.
Figure 1. The position of the two electric personal dosimeters (EPDs) worn on the physician’s protective apron in a clinical setting.
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Figure 2. Photograph during the cardiac catheterization procedure.
Figure 2. Photograph during the cardiac catheterization procedure.
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Table
Table 1. A summary of our study.
Table 1. A summary of our study.
Protective ApronNumber of ProceduresCumulative AKFluoroscopy Time
Pb-Equivalent [mm]TotalCAGPCI[Mean ± SD, mGy][Mean ± SD, min]
Non-lead7832461345.7 ± 1378.934.5 ± 27.7
0.25
Non-lead5119271345.3 ± 1637.331.7 ± 27.1
0.35
Lead5023271037.2 ± 824.730.4 ± 21.7
0.25
Lead502624812.3 ± 704.921.2 ± 15.5
0.35
AK: Air karma, CAG: Coronary angiography, PCI: Percutaneous coronary intervention.
Table
Table 2. Summary of our study on the performance of protective aprons in the clinical setting. Each was used for more than 50 catheterizations, including PCI.
Table 2. Summary of our study on the performance of protective aprons in the clinical setting. Each was used for more than 50 catheterizations, including PCI.
Protective ApronApron WeightOutside (External) DoseInside (Internal) DoseShielding EffectsComfortably
Pb-Equivalent [mm][kg][Mean ± SD, μSv][Mean ± SD, μSv][%]
Non-lead1.8142.6 ± 199.35.5 ± 7.196.1Excellent
0.25
Non-lead2.9123.9 ± 99.31.8 ± 1.598.5Good
0.35
Lead3.0166.4 ± 153.64.6 ± 4.797.3Somewhat poor
0.25
Lead3.8209.2 ± 163.12.2 ± 1.998.9Very poor
0.35
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MDPI and ACS Style

Kato, M.; Chida, K.; Munehisa, M.; Sato, T.; Inaba, Y.; Suzuki, M.; Zuguchi, M. Non-Lead Protective Aprons for the Protection of Interventional Radiology Physicians from Radiation Exposure in Clinical Settings: An Initial Study. Diagnostics 2021, 11, 1613. https://doi.org/10.3390/diagnostics11091613

AMA Style

Kato M, Chida K, Munehisa M, Sato T, Inaba Y, Suzuki M, Zuguchi M. Non-Lead Protective Aprons for the Protection of Interventional Radiology Physicians from Radiation Exposure in Clinical Settings: An Initial Study. Diagnostics. 2021; 11(9):1613. https://doi.org/10.3390/diagnostics11091613

Chicago/Turabian Style

Kato, Mamoru, Koichi Chida, Masato Munehisa, Tadaya Sato, Yohei Inaba, Masatoshi Suzuki, and Masayuki Zuguchi. 2021. "Non-Lead Protective Aprons for the Protection of Interventional Radiology Physicians from Radiation Exposure in Clinical Settings: An Initial Study" Diagnostics 11, no. 9: 1613. https://doi.org/10.3390/diagnostics11091613

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