Abstract
BACKGROUND: During structural heart disease procedures, interventional echocardiographers are exposed to high doses of radiation, particularly in their right waist and lower body regions. Currently, no radiation shields that are practical for use during transesophageal echocardiography are available. OBJECTIVES: The authors aimed to develop a novel radiation shield that enables interventional echocardiographers to perform transesophageal echocardiography with minimal radiation exposure during structural heart disease procedures. METHODS: A shape prototype model, including a freestanding radioprotective board with lateral windows, was used to assess clinical usability and Monte Carlo simulations were employed. Real-life radiation exposures, both with and without completed shields, were measured during 193 consecutive structural heart disease procedures (114 transcatheter edge-to-edge repairs of the mitral valve and 79 transcatheter aortic valve replacements). RESULTS: The shape prototype experiment determined the optimal window size to be 300 mm wide and 200 mm high. The actual use of the shield was trouble-free in all procedures. Real-life exposure measurements showed a significant reduction in both types of procedures when the shield was used, especially around the waist (median: 0-8.0 μSv; P < 0.001 for transcatheter edge-to-edge repair and median: 0-14.0 μSv; P < 0.001 for transcatheter aortic valve replacement). CONCLUSIONS: Through assessment of clinical usability using a shape prototype model and Monte Carlo simulations, a novel radiation shield with practical use was developed for interventional echocardiographers. Clinical studies and simulations demonstrated that this shield is practical for transesophageal echocardiography monitoring and guidance while providing sufficient radiation protection during structural heart disease procedures. (Japanese Development of radiation protection plates for catheter surgery for structural heart disease [echocardiologist and anesthesiologist]; UMIN000046478).