Introduction: Transesophageal echocardiography (TEE) provides intraprocedural guidance for cardiac structural interventions. There is a paucity of data regarding ionizing radiation exposure for TEE operators during these procedures. Furthermore, conventional lead shields are not designed to simultaneously provide adequate radiation protection and optimal TEE maneuverability. We investigated the feasibility of a radiation protection cabin (RPC), designed for proceduralists, and its impact on radiation exposure to the echocardiographer.
Hypothesis: A RPC is a practical option for lead shielding that results in a significant reduction in radiation exposure to TEE operators during structural interventions.
Methods: Radiation exposure to TEE operators using a RPC (Lemer Pax; Carquefou, France) was measured for ten TEE-dependent structural cases. Placement of the RPC was amenable for continuous TEE (Figure). Radiation exposure was measured using real time radiation detection meters placed within (experimental arm) and outside (control arm) the RPC. Fluoroscopy time (FT), dose area product (DAP), and detector proximity were assessed. The primary endpoint was radiation exposure.
Results: Higher FT, cine imaging, DAP (Gy·cm2), and detector proximity to the radiation source correlated with higher radiation exposure (in Roentgen). The average fluoroscopy time was 37.3 ± 5.5 minutes and DAP was 60.9 ± 37.1 Gy·cm2. Use of a RPC resulted in a 98.6 ± 14.9 -fold reduction in radiation exposure (95% CI: 64.8-132.3; p<0.05) with an average radiation exposure of 21,606 ± 6028.2 μR (CI: 7,969.3-35,242.7) outside the cabin and 231.6 ± 69.2 μR (CI: 75.2-388) within the cabin.
Conclusions: For physicians performing intraprocedural TEE, use of a RPC is a feasible strategy resulting in an average 99-fold reduction in overall radiation exposure. As structural technologies develop, strategies to minimize radiation exposure to echocardiographers are of utmost importance.