Novel modification to leaded eyewear results in significant operator eye radiation dose reduction

Objective: Ocular radiation exposure from fluoroscopically guided interventions (FGIs) can cause cataracts. Standard lead eyewear may not significantly reduce eye radiation dose as the majority of scattered radiation penetrates the operator's eye obliquely. Our aim was to evaluate the efficacy of standard leaded eyewear and a customized eyewear design in lowering eye radiation dose to vascular surgeons. Methods: The attenuating efficacy of three forms of leaded eyewear (standard eyewear, eyewear with built-in leaded side shields, and our modified eyewear) was tested in both a simulated setting and clinical practice. The modified design consisted of safety eyewear with 0.75 mm of added lead shielding attached to the lateral and inferior borders of the eyewear frame to attenuate oblique radiation. We performed simulated experiments using an anthropomorphic head phantom (ATOM model 701; CIRS, Norfolk, Va) positioned to represent a primary operator performing right femoral access. Optically stimulated, luminescent nanoDot detectors (Landauer, Glenwood, Ill) were placed inside the phantom's ocular spaces and at the surface of the left eye within and outside the leaded glasses to measure the eye radiation dose reduction provided by each eyewear type. All three eyewear types were also tested during clinical FGIs by placing nanoDots below the operator's left eye, inside and outside of the eyewear coverage. Means and standard errors were calculated using a pooled linear mixed model with repeated measurements. Results: This prospective, single-center study included 60 FGIs, 30 with traditional eyewear and 30 with our modified design. There was no significant eye radiation dose reduction (P > .05) with the standard eyewear or leaded side shield eyewear in both the simulated and clinical settings. In the simulated environment, our modified design resulted in an 86% radiation dose reduction to the surface of the left eye and an 80% reduction in left lens radiation dose (P < .0001). In the clinical FGIs, the modified eyewear led to a 62% left ocular radiation dose reduction (P < .0001). Conclusions: Standard lead-equivalent glasses are ineffective at reducing ocular radiation dose during FGIs. Eyewear modification with lateral and inferior lead shielding molded to the operator's face significantly decreases radiation exposure to the eye closest to the X-ray source.