Real-World Reductions in Lead-Free Radiation Exposure with the Rampart System during Endovascular Procedures

Endovascular operators experience elevated rates of occupational orthopedic injuries and persistent radiation exposure with current lead shielding. Novel shielding systems eliminate the need to wear lead aprons while also mitigating occupational radiation exposure, but real-world evidence of their efficacy remains needed. This study evaluated consecutive endovascular procedures requiring fluoroscopy at U.S. and international institutions following installation of a commercially available portable shielding system consisting of interlocking radiation-attenuating acrylic and soft shielding components. Live dosimeters were placed at the left shoulder of the main and assistant operators for quantification of radiation exposure. In total, 1,712 endovascular procedures performed by 671 operators at 153 sites (19% non-U.S.). In 1,712 (99.4%), radiation exposure was recorded. A majority of procedures (83.6%) were coronary interventions including diagnostic angiography (43.8%), nonchronic total occlusion PCI (27.6%), and chronic total occlusion PCI (6.7%). Median fluoroscopy time was 7.7 mins (IQR 3.9 to 15.3 min), and median radiation exposure to the main operator and first assistant was 2 μSv and 1 μSv. This was comparable to historical measurements of under-lead radiation exposure. In conclusion, the Rampart system effectively reduced radiation exposure in real-world practice, enabling a safe lead-free procedure lab.