The RADIATION (Radiation dose in percutaneous coronary procedures through transradial approach using dedicated radiation shields) study, published in EuroIntervention, indicates that using a lower body X-ray curtain as a radiation protection pelvic drape significantly reduces radiation exposure to the operator compared with a specifically-made arm drape. The study also found that left radial access is associated with lower radiation exposure than is right radial access.
Authors Alessandro Sciahbasi (Interventional Cardiology and Emergency Department, Sandro Pertini Hospital, Rome, Italy) and others report that the transradial approach—increasingly becoming the preferred approach—“seems to be associated with an increased radiation exposure compared with to transfemoral approach” and add that “dedicated adjunctive radiation shields might be necessary to reduce the operators’ radiation exposure during transradial procedures”.
Sciahbasi et al comment that previous studies have showed that adjunctive radiation protection drapes are associated with a reduction in radiation exposure to the operator, but note “in these studies, different kinds and positioning of the drapes were used without direct comparisons”. Therefore, in the RADIATION study, they compared a radiation protection drape over the arm with a drape over the pelvic region. Sciahbasi et al write that they used a bismuth barium drape (RADPAD, Worldwide innovations) for the arm drape, positioned along the patient’s right side to cover their right arm, but “differently, the pelvic lead shield used was a homemade lead drape obtained a lower body X-ray curtain, 0.5mm lead equivalent (Kenex)”.
Overall, 340 patients undergoing coronary interventions were randomised into one of four groups: no adjunctive drape (group one; 114 procedures), adjunctive radiation protection drape placed on the patient’s arm (group two; 117), adjunctive drape placed on the patient’s pelvic region (group three; 111); and combined use of adjunctive arm drape and adjunctive pelvic drape (group four; 110). The primary endpoint was the operator radiation dose at the thorax.
Radiation exposure to the operator was significantly reduced in groups three and four compared with group one (no radiation drape used); radiation exposure was also reduced in group two compared with group one but, according to the authors, “did not reach the prespecified criteria for significance”. Sciahbasi et al report: “Moreover in three groups with adjunctive drapes, the use of the pelvic drape was associated with a significantly lower radiation dose compared with the arm drape and the combined use of the pelvic and arm drapes was not associated with a significant advantage over the pelvic drape alone (=0.302).”
The authors comment that as well as its apparent advantages of reducing radiation exposure to the operator, the pelvic drape has benefits “also in economic terms as it is associated with no adjunctive procedural costs”. “Actually, according to our results, the use of the adjunctive pelvic drape has become the standard of care for most of our transradial procedures,” they add.
Furthermore, in a pre-specified analysis, left radial access was associated with a significant reduction in radiation exposure compared with right radial access. Sciahbasi et al note: “Our study is reassuring for operators that prefer the use of left radial access. Indeed, we observed that, compared with right radial access, the left radial access is associated with a significantly lower dose for the operator at left wrist, head and thorax even with the use of adjunctive radiation protection drapes”. They add that the pelvic drape was associated with a reduction in radiation exposure in both access groups whereas the arm drape only reduced radiation exposure in the right radial access group.
Sciahbasi et al conclude: “In our study, the use of adjunctive radiation protection drapes during transradial percutaneous coronary procedures is associated with a significantly lower radiation dose to operators. However, the use of a pelvic drape is more effective and less expensive than the use of a single arm drape.”
Sciahbasi told Cardiovascular News: “We recommend the use only of the pelvic drape because it is easier to place on the patient, it consents to perform an arm angiography in case of radial tortuosity (impossible or very difficult using the arm drape) and its efficacy in term of radiation protection is superior compared to the arm drape.”