At 95 medical centers, radiation readings from 1,222 endovascular procedures were often too low for the operators’ dosimeters to detect. The results, reported in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI) and presented at TCT 2026, offer an early look at a ceiling-mounted, lead-free shielding system called Rampart Guardian.
Doctors who guide instruments through blood vessels often use fluoroscopy, a type of continuous X-ray imaging. The X-rays can expose physicians and other staff to radiation over time. Traditional lead aprons help block that exposure, but their weight can strain the body. Shielding systems are designed to protect staff without requiring them to wear those heavy aprons.
The observational study examined procedures at U.S. and international institutions after the Rampart Guardian system was installed. From September 2025 through June 2026, 416 operators took part in 1,222 procedures. The system was used in 1,208 cases, or 98.9%. Most procedures also used shielding beneath the operating table and a flexible radiation-protection drape placed on the patient.
Researchers measured exposure with dosimeters worn on the primary operator’s left shoulder. Across all procedures, 29.6% recorded exposure below the device’s detection threshold. That does not mean there was no radiation; it means the amount was too low for the dosimeter to register. For coronary procedures, the median exposure was 1 microsievert, a unit used to measure radiation dose. Electrophysiology procedures had the largest share of readings below detection, at 66.3%. Aortic procedures had a higher median reading, at 10 microsieverts.
Corresponding author Eric A. Secemsky, M.D., M.Sc., FSCAI, said physician protection should not come at the cost of musculoskeletal health. The findings are encouraging because they cover many procedures and centers, but they do not establish that the system is better than lead aprons: the study did not directly compare the two approaches.
There are other limits to keep in mind. Manufacturer representatives were present during every case to help optimize the system’s setup, and operators could see radiation readings in real time. Both factors may have affected how procedures were carried out. Since measurements were taken only at the left shoulder, they do not describe exposure at every part of the body.
The results suggest that a lead-free setup can be associated with low measured operator exposure across a wide range of endovascular procedures. The next step is to test how it works in routine practice without manufacturer-supervised setup or live radiation feedback. That research could help hospitals understand how reliably the approach protects staff while reducing the physical burden of lead aprons.