Radiation protection for the interventional cardiologist: Practical approach and innovations

Table 1 Qualities of protective measures

Protective measures	Evidence1	Reduction	Operator protection	Patient protection
Technical issues	A[2,3,13,14]	60%	Yes	Yes
Traditional LPPE	B[5-9,51]	35-95%	Yes	No
Surgical caps	D[44]	3.3%	Yes	No
Gloves	D[9]	20-50%	Yes	No
Radiation-blocking cream	D[46]	85%	Yes	No
Shield, curtain and TRPB	B[9,10-12]	30-70%	Yes	No
CathPax®	C[16,20-22]	70- 80%	Yes	No
Zero gravity®	C[19]	78-93%	Yes	No
RadPad®	A[26,29,30]	30-35%	Yes	No
Robotic systems	B[32,34,35,42]	96%	Yes	No

¹Clinical evidence: A ≥ 1 randomized clinical trial; B ≥ 4 conclusive non-randomized clinical studies or safety/feasibility randomized trial; C < 4 conclusive non-randomized clinical studies or safety/feasibility randomized trial; D inconclusive clinical studies.

LPPE: Lead personal protective equipment; TRPB: Transradial radiation protection board.

Table 2 Regulatory limit on occupational radiation exposure and the current status with respect to the limit

Type of dose limit	Limit on dose from occupational exposure1
Effective dose	20 mSv/yr averaged over 5 consecutive years and 50 mSv in a single year
Effective dose on pregnancy	The dose to embryo/fetus should not exceed 1mV during remainder of pregnancy
Equivalent dose: Lens of the eye	20 mSv/yr averaged over 5 consecutive years and 50 mSv in a single year
Equivalent dose: Skin	500 mSv/yr
Equivalent dose: Extremities (hands and feet)	500 mSv/yr

¹Occupational Exposure: Planned exposure situations where radiological protection can be planned in advance, and exposures can be reasonably predicted.

Dose limits recommended by international commission on radiological protection (ICRP)[52].