Suspended Lead Suits and Radiation Exposure in Interventional Echocardiographers

Percutaneous left atrial appendage occlusion (LAAO) is frequently performed with an interventional echocardiographer (IE) in close proximity to the patient and radiation source, increasing the risk for occupational radiation exposure. Yet optimal radiation shielding methods for IEs remain unknown.

To assess whether using a suspended lead suit reduces IE radiation dose compared with traditional lead apron shielding during LAAO procedures.

In this blinded cross-sectional study, IE radiation exposure data were prospectively collected during all LAAO procedures conducted for adults at a single quaternary care center from February 21 to August 22, 2023. Head-level dosimeters were worn by IEs who were using suspended lead suits during sequential LAAO procedures conducted at the center.

Use of a suspended lead suit or traditional lead apron radiation protection device.

The primary outcome was measured personal dose equivalents at head level to IEs per case using real-time radiation dosimeters. Dosimeter-derived physician radiation doses and procedural radiation (dose area product) were compared with a control group of 30 sequential historical LAAO cases performed with IEs wearing traditional lead aprons from July 1, 2016, to January 31, 2018.

Overall, 125 patients (mean [SD] age, 78 [8] years; 77 [61.6%] male) were included. Among 95 cases in which IEs used suspended lead suits, the median (IQR) radiation dose was 0.0 (0.0-0.3) μSv, which was significantly lower than 30 cases in which IEs wore traditional lead aprons (median [IQR], 10.6 [5.8-24.1] μSv; P < .001). Radiation doses were undetectable in 60% of IEs (57of 95) using suspended lead suits compared with 0% of IEs (0 of 30) using traditional lead aprons (P < .001). Radiation doses of at least 20 μSv were observed in 0 of 95 cases (0%) with suspended lead suits vs 9 of 30 cases (30%) with traditional lead aprons (P < .001). Similar associations were noted in exploratory analyses adjusting IE radiation doses for procedural dose area product (mean [IQR], 0.0 [0.0-0.0] μSv/Gy × cm2) for suspended lead suits vs traditional lead aprons (mean [IQR], 0.6 [0.3-1.0] μSv/Gy × cm2; P < .001).

In this cross-sectional study, the use of suspended lead suits was associated with large reductions in head-level radiation doses to IEs compared with the use of traditional lead aprons during LAAO cases. These findings have important ramifications for the risk of occupational radiation exposure to IEs and potential shielding mechanisms during structural heart interventions.