26 Apr Use of Disposable Radiation-absorbing Surgical Drapes Results in Significant Dose Reduction During EVAR Procedures
RADPAD Radiation Protection shields have been tested in many clinical studies to prove their efficacy in reducing radiation exposure, including the study below.
Throughout 36 endovascular aneurysm repair (EVAR) procedures, dose measurements were taken to evaluate the reduction RADPAD shielding provided. Results showed that scatter radiation was significantly lower at the interventionalists hands and chest as well as the theatre nurse’s chest.
RADPAD shielding will protect you and your team from up to 95% of scatter radiation presented in your OR. Protect yourself and your team.
Editor’s Choice – Use of Disposable Radiation-absorbing Surgical Drapes Results in Significant Dose Reduction During EVAR Procedures
In the last two decades endovascular aortic repair (EVAR) has become the preferred treatment of abdominal aortic aneurysm in patients suitable for EVAR.
Despite precautions like a lead apron and thyroid shield, this increasing use of EVAR and other endovascular interventions results in considerable fluoroscopic exposure of the intervening physician.
Low-energy scattered radiation scatters in all directions from the patient during fluoroscopy. This scatter radiation is the main source of exposure for medical staff during fluoroscopic procedures. Chronic exposure to low-dose radiation confers a small risk of stochastic effects, including malignant disease, skin damage, or eye problems.Recently the International Commission on Radiological Protection (ICRP) reported that the equivalent dose limit for the lens of the eye should be reduced from 150 to 20 mSv per year, averaged over a 5-year period, with no year’s dose exceeding 50 mSv.
This reduction in eye dose limit and the applicable ALARA (as low as reasonably achievable) principle demands additional dose-protecting measures for operating staff performing EVAR procedures, especially in a non-dedicated endosuite, where no additional dose-protecting measures, like lead flaps or shields, are available.
In cardiac interventions, it is shown that the use of sterile disposable radiation-absorbing surgical drapes reduces the radiation exposure of the medical staff, from 23% to 80%.
The aim of this study is to evaluate the effect of these drapes in reducing scatter radiation exposure for endovascular surgeons and supporting medical staff during EVAR procedures.
Materials and Methods
Positioning of the interventionalist and theatre nurse during the EVAR procedures was standardized: the primary operator (interventionalist) stood on the right side of the patient near the pelvis, and the secondary operator stood on the opposite side of the operating table. The theatre nurse stood beside the secondary operator (Fig. 1). Both the interventionalist and the theatre nurse wore dosimeters for dosimetric measurements.
The drapes are the only commercially available, sterile, disposable, lead-free surgical drapes. They have a uniform thickness of a few millimeters and contain bismuth and barium. The dose-reducing function is comparable to 0.4–0.8 mm lead (Pb) depending on the kilovoltage used to make the image (90–60 kV). In the “drape” group two drapes were used. These sterile drapes were interposed between the patient and interventionalist, outside the radiation field, and positioned above the normal sterile surgical drape after the femoral operative site had been prepared. Positioning of the drapes is shown in Figs. 1 and 2.
Data are presented as mean (range), mean ± SD, and percentages. A skewness test was performed to investigate whether data were normally distributed. A Student t-test was performed to determine whether dosimetric measurements with the use of the drapes were significantly different from those without the drapes. A value of p ≤.05 was considered statistically significant. The analyses were performed using SPSS (Version 15.0, IBW Company, Chicago, IL, USA). The annual doses for both the interventionalist and the theatre nurse were calculated by multiplying the mean dose per procedure by the number of procedures performed annually per surgeon. It was assumed that each interventionalist and supporting staff members were present during 80 EVAR procedures annually. Since all medical staff wear a lead apron and thyroid shield during the procedure, the measured dose on the chest can be reduced fivefold to obtain the actual dose received.
|Number of procedures
|Fluoroscopy time (s)
|Dose per procedure in front of apron chest operator (μSv)
|167.7 ± 134.1
|73.0 ± 50.9
|Dose/DAP per procedure chest operator (mSv/Gycm2)
|Dose per procedure on hand operator (μSv)
|470.3 ± 222.4
|236.8 ± 193.1
|Dose/DAP per procedure hand operator (mSv/Gycm2)
|Dose per procedure in front of apron chest theatre nurse (μSv)
|41.9 ± 74.8
|21.4 ± 33.3
|Dose/DAP per procedure chest theatre nurse (mSv/Gycm2)
This randomized trial in humans shows that the use of a sterile lead-free disposable drape is feasible during EVAR procedures and significantly reduces the radiation exposure of the intervening endovascular surgeons. The Radpad drape is simple to position and does not interfere with the EVAR procedure. There were no safety issues, prolonged fluoroscopy times or complications associated with the use of the drape. The protective lead-free drape we used in the study has been tested before in phantoms showing a radiation exposure reduction varying from 14% up to 94%, depending on the amount of radiation-absorbing material used in the drape, distance, and position of the measurements and additional protection measures.
In humans the drape has been tested during percutaneous coronary angiography, complex coronary interventions, pectoral device implantation, electrophysiology procedures, and cardiac resynchronization therapy all showing a significant reduction in radiation exposure. The drape had not previously been tested during abdominal procedures like EVAR.