Suspended lead suits were associated with lower occupational radiation exposure among interventional echocardiographers during left atrial appendage occlusion procedures in a single-center cross-sectional study with historical controls published in JAMA Network Open.
Researchers evaluated 125 patients who underwent left atrial appendage occlusion procedures at a quaternary care center and compared head-level radiation exposure in clinicians using suspended lead suits with exposure recorded during earlier procedures in which traditional lead aprons were used. The suspended lead suit group included 95 procedures performed in 2023, and the traditional lead apron group included 30 procedures performed from 2016 to 2018.
Among procedures in which suspended lead suits were used, the median head-level radiation dose was 0 μSv vs 11 μSv with traditional lead aprons. Radiation exposure was undetectable in 60% of procedures with suspended lead suits and in none of the procedures with traditional lead aprons. Exposure of at least 20 μSv occurred in 30% of procedures with traditional lead aprons and in none of the procedures with suspended lead suits.
Researchers also normalized physician exposure to dose area product to account for differences in procedural radiation use between groups. Even after that adjustment, radiation exposure remained lower with suspended lead suits, at 0.0 μSv/Gy × cm² vs 0.6 μSv/Gy × cm² with traditional lead aprons.
The study focused on left atrial appendage occlusion because the procedure can require steep fluoroscopic angles and continuous transesophageal echocardiography probe manipulation, which may place interventional echocardiographers close to the main source of scatter radiation. The researchers said that long-term occupational radiation exposure in catheterization laboratory staff has been associated with cataracts, carotid atherosclerosis, and possibly left-sided brain malignant lesions.
Still, the findings should be interpreted cautiously. The study was conducted at a single institution and focused only on left atrial appendage occlusion procedures, so the results may not generalize to other structural heart interventions. The researchers also noted that additional multicenter studies are needed to assess variation across sites and to better understand implementation and cost-effectiveness.
Disclosures: One researcher reported grant funding during the conduct of the study, and another reported grants and personal fees from multiple companies outside the submitted work. No other disclosures were reported.
Source: JAMA Network Open
