Japanese Journal of Radiology

, Volume 37, Issue 1, pp 95–101 | Cite as

The effectiveness of additional lead-shielding drape and low pulse rate fluoroscopy in protecting staff from scatter radiation during cardiac resynchronization therapy (CRT)

  • Yoshiaki MorishimaEmail author
  • Koichi Chida
  • Yoshiaki Katahira
Original Article



Cardiac resynchronization therapy (CRT) often requires a long fluoroscopic time and protection from scatter radiation. This study reports on scatter radiation levels during CRT, with and without additional shielding, and using standard or low pulse rate fluoroscopy.

Materials and methods

Additional lead-shielding drape (0.35-mm lead equivalent) was used on the left side of the table and pulsed fluoroscopy was performed at rates of 10 pulses/s (usual rate) and 7.5 pulses/s (low pulse rate). Fluoroscopy scatter radiation was measured for both pulse rates using an acrylic phantom with a radiation survey meter, both with and without the additional lead-shielding drape.


With the additional lead-shielding drape, the fluoroscopy scatter radiation was reduced by 74.3% at 10 pulses/s and 78.6% at 7.5 pulses/s. If the fluoroscopy was changed from 10 pulses/s to 7.5 pulses/s, the scattered radiation at the primary physician’s position was reduced by 24.0%. The combined use of additional shielding drape and low pulse rate fluoroscopy reduced scatter radiation by over 80%.


Additional lead-shielding drape and low pulse rate fluoroscopy are effective in reducing the scattered radiation dose to physicians and nurses during CRT.


CRT procedure Additional lead-shielding drape Low pulse rate fluoroscopy Radiation protection Scatter radiation 



We would like to acknowledge Koichi Tabayashi, MD, PhD Department of Cardiovascular Center, Tohoku Medical and Pharmaceutical University Hospital. We also thank Hiroo Chiba RT, Department of Radiology, Tohoku Medical and Pharmaceutical University Hospital, for technical assistance in this study. We thank Karl Embleton, PhD, from Edanz Group ( for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical statement

Not applicable.


  1. 1.
    Wells G, Parkash R, Healey JS, Talajic M, Arnold JM, Sullivan S, et al. Cardiac resynchronization therapy: a meta-analysis of randomized controlled trials. CMAJ. 2011;183:421–9.CrossRefGoogle Scholar
  2. 2.
    Haga Y, Chida K, Kaga Y, Sota M, Meguro T, Zuguchi M. Occupational eye dose in interventional cardiology procedures. Sci Rep. 2017;7:569.CrossRefGoogle Scholar
  3. 3.
    Brambilla M, Occhetta E, Ronconi M, Plebani L, Carriero A, Marino P. Reducing operator radiation exposure during cardiac resynchronization therapy. Europace. 2010;12:1769–73.CrossRefGoogle Scholar
  4. 4.
    Butter C, Schau T, Meyhoefer J, Neumann K, Minden HH, Engelhardt J. Radiation exposure of patient and physician during implantation and upgrade of cardiac resynchronization devices. Pacing Clin Electrophysiol. 2010;33:1003–12.Google Scholar
  5. 5.
    Vano E, Rosenstein M, Liniecki J, Rehani MM, Martin CJ, Vetter RJ, ICRP Publication 113. Education and training in radiological protection for diagnostic and interventional procedures. Ann ICRP. 2009;39:7–68.CrossRefGoogle Scholar
  6. 6.
    Efstathopoulos EP, Pantos I, Andreou M, Gkatzis A, Carinou E, Koukorava C, et al. Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures. Br J Radiol. 2011;84:70–7.CrossRefGoogle Scholar
  7. 7.
    Thibault B, Andrade JG, Dubuc M, Talajic M, Guerra PG, Dyrda K, et al. Reducing radiation exposure during CRT implant procedures: early experience with a sensor-based navigation system. Pacing Clin Electrophysiol. 2015;38:63–70.CrossRefGoogle Scholar
  8. 8.
    Chida K, Inaba Y, Saito H, Ishibashi T, Takahashi S, Kohzuki M, et al. Radiation dose of interventional radiology system using a flat-panel detector. AJR Am J Roentgenol. 2009;193:1680–5.CrossRefGoogle Scholar
  9. 9.
    Chida K, Kaga Y, Haga Y, Kataoka N, Kumasaka E, Meguro T, et al. Occupational dose in interventional radiology procedures. AJR A J of Roentgenol. 2013;200:138–41.CrossRefGoogle Scholar
  10. 10.
    Chida K, Kato M, Kagaya Y, Zuguchi M, Saito H, Ishibashi T, et al. Radiation dose and radiation protection for patients and physicians during interventional procedure. J Radiat Res. 2010;51:97–105.CrossRefGoogle Scholar
  11. 11.
    Funama Y, Nagasue N, Awai K, Sakamoto I, Kakei K, Shimamura M, et al. Radiation exposure of operator performing interventional procedures using a flat panel angiography system: evaluation with photoluminescence glass dosimeters. Jpn J Radiol. 2010;28:423–9.CrossRefGoogle Scholar
  12. 12.
    Heidbuchel H, Wittkampf FH, Vano E, Ernst S, Schilling R, Picano E, et al. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace. 2014;16:946–64.CrossRefGoogle Scholar
  13. 13.
    Valentin J. Avoidance of radiation injuries from medical interventional procedures. Ann ICRP. 2000;30:7–67.Google Scholar
  14. 14.
    Ertel A, Nadelson J, Shroff AR, Sweis R, Ferrera D, Vidovich MI. Radiation dose reduction during radial cardiac catheterization: evaluation of a dedicated radial angiography absorption shielding drape. ISRN Cardiol. 2012;2012:769167.CrossRefGoogle Scholar
  15. 15.
    Abdelaal E, Plourde G, MacHaalany J, Arsenault J, Rimac G, Dery JP, et al. Effectiveness of low rate fluoroscopy at reducing operator and patient radiation dose during transradial coronary angiography and interventions. JACC Cardiovasc Interv. 2014;7:567–74.CrossRefGoogle Scholar
  16. 16.
    Brambilla M, Cerini P, Lizio D, Vigna L, Carriero A, Fossaceca R. Cumulative radiation dose and radiation risk from medical imaging in patients subjected to endovascular aortic aneurysm repair. Radiol Med. 2015;120:563–70.CrossRefGoogle Scholar
  17. 17.
    Malliet N, Andrade JG, Khairy P, Nguyen Thanh HK, Venier S, Dubuc M, et al. Impact of a Novel Catheter Tracking System on Radiation Exposure During the Procedural Phases of Atrial Fibrillation and Flutter Ablation. Pacing Clin Electrophysiol. 2015;38:784–90.CrossRefGoogle Scholar
  18. 18.
    Chida K, Takahashi T, Ito D, Shimura H, Takeda K, Zuguchi M. Clarifying and visualizing sources of staff-received scattered radiation in interventional procedures. AJR Am J Roentgenol. 2011;197:W900–W903.CrossRefGoogle Scholar
  19. 19.
    Sciahbasi A, Rigattieri S, Sarandrea A, Cera M, Di Russo C, Fedele S, et al. Determinants of operator radiation exposure during percutaneous coronary procedures. Am Heart J. 2017;187:10–8.CrossRefGoogle Scholar
  20. 20.
    Chida K, Morishima Y, Katahira Y, Chiba H, Zuguchi M. Evaluation of additional lead shielding in protecting the physician from radiation during cardiac interventional procedures. Nihon Hoshasen Gijutsu Gakkai zasshi. 2005;61:1632–7.CrossRefGoogle Scholar
  21. 21.
    van Dijk JD, Ottervanger JP, Delnoy PP, Lagerweij MC, Knollema S, Slump CH, et al. Impact of new X-ray technology on patient dose in pacemaker and implantable cardioverter defibrillator (ICD) implantations. J Interv Card Electrophysiol. 2017;48:105–10.CrossRefGoogle Scholar
  22. 22.
    ICRP publication 103. The 2007 recommendations of the International Commission on Radiological Protection. Ann ICRP. 2007;37:1–332.Google Scholar
  23. 23.
    Morishima Y, Chida K, Katahira Y, Seto H, Chiba H, Tabayashi K. Need for radiation safety education for interventional cardiology staff, especially nurses. Acta Cardiol. 2016;71:151–5.CrossRefGoogle Scholar
  24. 24.
    Inaba Y, Chida K, Kobayashi R, Kaga Y, Zuguchi M. Fundamental study of a real-time occupational dosimetry system for interventional radiology staff. J Radiol Prot. 2014;34:N65–N7.CrossRefGoogle Scholar
  25. 25.
    Chida K, Morishima Y, Inaba Y, Taura M, Ebata A, Takeda K, et al. Physician-received scatter radiation with angiography systems used for interventional radiology: comparison among many X-ray systems. Radiat Prot Dosimetry. 2012;149:410–6.CrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2018

Authors and Affiliations

  • Yoshiaki Morishima
    • 1
    • 2
    Email author
  • Koichi Chida
    • 2
  • Yoshiaki Katahira
    • 3
  1. 1.Department of RadiologyTohoku Medical and Pharmaceutical University HospitalSendaiJapan
  2. 2.Department of Radiological TechnologyTohoku University School of Health SciencesSendaiJapan
  3. 3.Department of Cardiovascular CenterTohoku Medical and Pharmaceutical University HospitalSendaiJapan

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