Reducing Radiation Exposure in the EP Lab: Interview with Dr. Roderick Tung

   In this interview we speak with Dr.Tung, who describes his use of Anthem Medical’s CATHPAX radiation protection cabin at UCLA. The CATHPAX is a new application that allows for lead-free, radiation-free procedures in the electrophysiology lab.

How long have you been using the CATHPAX cabin in your EP lab? How many of the electrophysiologists at UCLA use the CATHPAX?

   We received the CATHPAX in June 2009, so it’s been in use for almost a year now. All six of our electrophysiologists now use the CATHPAX.

Why was it purchased?

   Our program is geared toward complex catheter ablation, and inherent to complex ablations are the long proce- dure times, especially for ablation of atrial fibrillation or ventricular tachycardia. So in order to try and minimize some of the operator’s radiation exposure, we chose to get the CATHPAX.

What methods were used previously for radiation protection in your lab?

   We practice the ALARA principles to keep radiation as low as achievable, including keeping the IIs down on the patient, wearing lead, and sometimes placing lead over the patient’s legs to try and decrease scatter. For patient safety, we try and change the fluoroscopic angulation during long procedures.

Had you or any of your staff experienced back or health problems because of heavy lead apron use?

   No, but the temporary aching back after a long procedure is common!

How did the CATHPAX compare with your previous methods for reducing radiation exposure in the lab?

   Although we’re always very conscious about the radiation dosage to the patient, the CATHPAX has been great in the sense that in difficult cases that require complex mapping and ablation, it lets the operator feel more comfortable about being committed to the case and staying longer if the case lasts longer than anticipated. Cumulatively, I believe that the CATHPAX offers reassurance, because as a young EP, I’m devoting my career to complex ablations and I know that my dosing is going to be drastically diminished.

Was there a learning curve in using this technology?

   The technology is fairly self-explanatory; the hardest part is making sure you know how to apply the sterile drape on the booth. In terms of ergonomics, we also had to find the right way to bring the CATHPAX into each room, since we circulate it between 2-3 labs. However, our lab tech is now trained on how to best bring the CATHPAX in, including which door to use, and how to place the sterile drape. For the operator, who stands behind the CATHPAX and puts their hands through, there is a slight learning curve in terms of being able to know where to put it on the table and where to put your foot pedals in relation to the booth.

Are visibility and accessibility affected during cases?

   One thing that can be a bit challenging is when you need to work closer to the patient, for example, during epicardial ventricular tachycardia ablation. However, the way that this has been ameliorated is by using a longer sheath into the epicardium, which allows the operator to stand further away from the patient.

How is the CATHPAX beneficial to EPs?

   It is not necessary to wear lead aprons behind the booth, and there have been studies demonstrating this based on radiation badge readings. We have done our own real-time dosimetry readings during a case and found the exposure immediately behind the lead cabin to be negligible compared to background radiation in the control room. I still wear the thinnest lead as the protection does not appear to be as effective for an operator standing to the right of the booth, and we often switch places and positions during a procedure.

How has the CATHPAX changed the way you do procedures?

   I don’t think it has changed the procedural approach, it has just enabled all of us to feel more comfortable knowing that every day we are minimizing the occupational hazard inherent to our field.

Have you felt a greater sense of safety when using the CATHPAX?

    Absolutely. It is not just safer for the operators, but for the operator assistant who stands behind the operator as well as some of the nursing staff who also stand behind it. Therefore, it provides an extra level of protection for everyone in that area.

Are lead aprons still used in other cases in your lab, or will their use become obsolete?

   Currently we’re using the CATHPAX only for the really long cases, so we’ll still be in lead aprons for the device cases.We plan on doing real-time dosimetry, which we have the technology to do, in order to see what we’re being exposed to in real time rather than waiting for a badge recording. Once we do some of those real time measurements, I think we’re going to have more confidence not to use lead behind the CATHPAX.

Is there anything else you’d like to add?

   On a personal level, I’m extremely passionate about the field of electrophysiology,and I couldn’t be more excited to be a part of the field at this really unique point in time where ablation technology and approaches are emerging as we tackle more complex arrhythmias. It has always been a concern of mine that this chosen career may be detrimental to my own health. However, being able to have additional radiation protection where I feel like this risk is mitigated, gives me much more confidence on a daily basis in my choice to go into EP.