1. Radiation Protection Systems to Mitigate Occupational Health Risks
James A. Goldstein M.D.
Director of Research and Education
Department of Cardiology
William Beaumont Hospital

2. Owner of equity in ECLS, Inc, developing Radiation Protection System
I, James A Goldstein M.D., have a relevant conflict of interest to disclose:
Owner of equity in ECLS, Inc, developing Radiation Protection System

3. Occupational Health Hazards in the Interventional Laboratory
Time for a Safer Environment
Klein et al: On behalf of the Multi-Specialty Occupational Health Group
Cath and CV Intervent 2009; 73:432/J Vasc Intervent Radiol 2009; 20:147
“Interventional physicians and their professional societies should strive toward the ultimate zero radiation exposure work environment, that would eliminate the need for personal protective apparel and prevent its orthopedic and ergonomic consequences“

4. Evolution of Cardiac Catheterization Laboratory
1970
Interventional Era

5. Causes of Occupational Injuries
X-Ray Imaging
Radiation
Exposure
Radiation Injury
Orthopedic Injury
Radiation Protection

6. Risk for Radiation-Induced Cataract for Staff in
Interventional Cardiology: Is There Reason for Concern?
Ciraj-Bjelac, et al. Cath Cardiovasc Intv 2010;76:826-34
Table III. Number of Interentional Cardiologists with Posterior Lens Changes Graded by Severity of Lens Changes with Associated Cumulative Doses to the Lens of the Eye
Dose (Gy)
Score
No. %
Mean
Median
Min
Max
0 in both eyes
0.5 in one eye
0.5 in both eyes
>1 in one eye
(0.5 or more in the
other eye) 27 8 18 3 48 14 32 5
1.6
2.4
7.4
3.0
0.94
1.8
1.3
2.8
0.02
0.04
0.24
8.4
43.0
4.5
Lens changes found in either or both eyes in 34/67 (51%)

7. Occupational Radiation Exposure:
Brain Tumors  
12%
16%
Left side of Brain 85%
Mean latency period=23.5 years
17%
55%
Roguin A. AJC 2013;111:

8. Work-Related Musculoskeletal Pain by Job
Back Pain>50%
Survey: N=1,543
N=1,042 Exposed vs
501 Unexposed
Age Related
Not just MD’s
Nurses and Techs Suffer too!
Yrs Working
Age>50,
Working>15 yrs
= >50% Sx!
Orme N, et al. JACC 2015;65:820-6

9. Rate Of Health Problems By Years Of Work
Survey: N=466 Exposed vs 280 Unexposed
Ortho Illness
Skin Lesions
Cataracts
Rate of health problems by years of occupational work.
Andreassi et al. Circ Cardiovasc Interv. 2016;9:

10. Cath Lab Orthopedic Epidemic
ACC Survey
Nagelhout CardioSurve 2016;40
Ortho Issues in 48%
Caused/Worsened by Work in 70%
Retire or cut Back in 50%

11. We are Like Football Players
with Leather Helmets and No Face Masks

12. Reducing Radiation Exposure
Conventional
(No impact on ortho injury)
Novel
(↓ ortho injury)
 Training & awareness
Remove operator (Robotic)
Operator Issues
Distance from source
↓ “Time-on”
↓ Oblique, angulated views
Keep hands out of field!
Unique radiation shielding
ZeroGravity Radiation Apparel
Trinity Shielding System
Shielding or coverage
Head cover
Rad-pad (30-70% reduction)
↓ Frame rate

13. We Need a Paradigm Shift in Cath Lab Occupational Health
Zero Radiation Exposure
Eliminate Cancer/Cataract Risk
No Lead Aprons
Eliminate Orthopedic Burdens

14. RADPAD Reduced exposure 30-70%, depends on site measured
Still need to wear leaded aprons, doesn’t protect brain

15. Radiation Shielding Systems
Novel Systems for Improved Occupational Health in the Catheterization Laboratory
Robotic Systems
Getting the Operator Out of Harms Way
Radiation Shielding Systems
Getting the Lead off Our Backs

16. Trinity Radiation Protection SystemTM
Ceiling Mounted Shield
Vascular Access Aperture
Radiation Patient Drape
Opened December 2013
Another example of ways we have benefited from generous donations
Allows Beaumont to have the state of the art equipment
Complete Radiation Shielding
Eliminates Orthopedic Burden of Lead

17. Trinity Radiation Protection System
Single Ceiling Element
Ceiling-suspended
upper lead barrier w
Drop Down lower Shield
Tandem Motion with Table
Vertical, longitudinal,
lateral movement w x-ray table movement
Vascular Access Aperture
Radial and Femoral Access
Radiation Patient Drape
Interlocks with
Upper Shield Aperture

18. Elimination of Radiation Exposure to Operators
Fattal et al: Cath and Cardiovasc Intervent 2013

19. State of Michigan: Lead Not Needed
The State of Michigan Radiation Safety Section Bureau of Health Systems reviewed these testing results and provided a certification letter stating:
“The Trinity Radiation Protection Shield meets the intent of rule 348(1) which requires lead aprons equivalent to 0.5 mm lead as long as the physician or other personnel remain in the area protected by the device”

20. Trinity Evolution Next Version: “Apple-Like”
Lower Footprint
Lighter
More Facile

21. Physicians Deserve & Should Demand a Safe Work Environment!
Institutions Should Embrace the Need for Operator/Health Care Team Protection
OSHA May Eventually Mandate it