Scatter Radiation in the Cath-Lab

September 23, 2021

During a procedure in the cath lab, radiation is deflected from the patient's body and spreads to all parts of the room. Not only is this scattered radiation associated with skin damage and eye injury, but low-dose radiation has also been shown to increase the number of circulating lymphocytes and chromosomal abnormalities, increasing the risk of developing cancer.

The increased risk has led to the application of radiation-protective clothing, techniques and equipment in hospitals. Although cath lab personnel routinely wear X-ray protective clothing, the incidence of radiation-related illness is statistically higher in cath lab personnel versus non-cath cab personnel (1). By placing radiation-protective disposable drapes over the patient, the amount of scatter radiation reaching the healthcare professional can be drastically reduced.

The intensity of scatter radiation
The occupational radiation exposures in cardiovascular fluoroscopic procedures are the highest recorded doses among medical personnel using X-rays. Interventional cardiologists and electrophysiologists have a two to three times higher annual exposure than that of radiologists. This is because they are closer to the radiological source and patient (scatter radiation). (1,2)

Despite the use of radiation protection, the treating cardiologist and support staff working close to the patient have been shown to be exposed to radiation equivalent to more than 2,500 – 10,000 chest X-rays over a 30-year working career (1).
Other research shows that cardiologists' neck and head receive radiation doses of 20 to 30 mSv per year. Due to the preferred position, the left side of the head receives more radiation than the right side, which is also reflected in an increased number of malignancies on that side of the head (3).

Health risks
Compared to healthcare professionals who were not exposed to radiation, cathlab employees (including doctors, nurses and technicians) who had been exposed to radiation for an average of 10 years had:

-          2.8 times higher risk of skin injury
-          7.1 times higher chance of orthopedic (back/neck/knee) problems
-          6.3 times greater risk of cataracts

In addition, professionals with more than 16 years of experience in a cath lab are about 10 times more likely to develop cataracts and more than eight times more likely to develop cancer after adjusting for other factors such as age and smoking status. In addition, the prevalence of hypertension and hypercholesterolemia is significantly higher. (1)

Finally, a new finding was made in the study by Andreassi et al. Anxiety and depression occurred in 12% of exposed subjects, compared to 2% of controls. The authors suggest that this may be a radiation effect of radiation on the practitioner's unprotected head. Chronic low doses of ionizing radiation may adversely affect hippocampal neurogenesis and neuronal plasticity. (1)

Conventional protective measures
Standard methods of protecting cath lab personnel from radiation exposure include radiation-protective clothing and techniques such as lead or composite shields, in some cases supplemented by moveable radiation shields.

Scatter Armor Radiation Protection
Scatter radiation occurs when the direct beam hits objects, such as the patient's body, and reflects harmful secondary radiation in all directions. One method of reducing the exposure of medical personnel to this hazardous scatter radiation is to implement Scatter Armor Shields. These drapes are placed on the patient's body and positioned to counteract scatter radiation in all cath lab procedures. There are different shields that suit different procedures. Lead-free, sterile and disposable.

Lead free? Yes! Although lead has been the standard for many years, the weight and environmental properties of lead-based shielding are undesirable and other alternatives have been explored. The KIARMOR double layer offers the perfect solution. KIARMOR is made of the elements bismuth and antimony, which are combined into one compressed double layer. This innovative technology not only offers a lighter and more environmentally friendly alternative, but is also more effective against scatter radiation than the same lead-based protection.

Our KIARMOR Scatter shield from Infab is lead-free and its shielding properties are such that it meets the requirements of the three international standards (ASTM F2547-18, IEC 61331-1:2014 and DIN 68571-1) related to radiation protection. In addition, each Scatter Shield has KIARMOR at its core, making these shields the most effective option for reducing the amount of scatter radiation exposure in the cath lab.

Want to know more? Check out our Scatter Armor Shield guide or ask our staff for more information!

References.
1. Andreassi MG, et al., Occupational health risks in cardiac catheterization laboratory workers. Circ Cardiovascular Interv. 2016 Apr;9(4).
2. Picano E., et al., The Radiation Issue in Cardiology: the time for action is now. Cardiovasc Ultrasound 2011 Nov 21, 9:35.
3. Roguin A, e

• Scatter Armor Shield guide