RAdiation Dose Attenuation using Radpad in CATH lab in primary and secondary operator- RADAR-CATH STUDY

Background Radiation injury is an important concern for interventional cardiologists and needs to be addressed. RADPAD is a sterile, disposable lead-free surgical drape, radiation protection drape that has been shown to reduce radiation exposure to the primary operator (PO). While Indian data on radiation exposure in the cath lab are scarce, the exposure to secondary operator (SO) is even less well studied. Purpose The aim of this study was to evaluate the efficacy of RADPAD drapes in reducing radiation dose in the cath lab for the primary as well as secondary operator. Methods and results One hundred and sixty patients (40 patients each of single vessel, double vessel and triple vessel disease undergoing coronary angioplasty: SVD, DVD, TVD and 40 patients undergoing balloon mitral valvotomy: BMV), were randomized in 1:1 pattern to "with RADPAD" or "without RADPAD" use. The mean age was 51.45 ± 15.18 years (range, 27-75 years). For patients with single vessel disease (SVD), despite similar fluoroscopic screening times and total radiation dose received, the operator received dose (mrem) for PO was much higher for SO. Use of RADPAD significantly reduced the operator received dose both for PO (2.66 ± 1.29 vs 7.92 ± 2.87, p .001) as well as for the SO (1.08 ± 0.63 vs 5.52 ± 1.47, p .001). The relative operator exposure (expressed as mrem/Gy) was similarly reduced with use of RADPAD (PO: 1.99 ± 1.7 vs 4.49 ± 2.88, p .001) and SO: 0.85 ± 0.72 vs 3.28 ± 2.16, p .001). For patients with DVD, operator received dose both for PO (4.98 ± 1.22 vs 11 ± 1.99, p <.001) as well as for SO (2.36 ± 0.73 vs 6.47 ± 1.38, p <.001). The relative operator exposure was also significantly reduced with RADPAD (PO: 2.31 ± 1.73 vs 3.54 ± 1.72, p .001) and SO: 1.07 ± 0.85 vs 2.01 ± 0.69, p <.001). For patients with TVD, operator received dose both for PO (9.12 ± 1.34 vs 12.84 ± 1.69, p < 0.001) as well as for SO (5.76 ± 1.31 vs 8.66 ± 0.87, p < 0.001). The relative operator exposure was also significantly reduced with RADPAD (PO: 2 ± 1.27 vs 2.45 ± 0.8, p 0.01) and SO: 1.25 ± 0.74 vs 1.64 ± 0.51, p 0.07). For patients undergoing BMV, operator received dose both for PO (1.59 ± 0.44 vs 4.91 ± 1.42, p < 0.001) as well as for SO (0.69 ± 0.22 vs 2.26 ± 0.8, p < 0.001). The relative operator exposure was also significantly reduced with RADPAD (PO: 1.23 ± 0.40 vs 5.06 ± 1.89, p 0.02) and SO: 1.16 ± 0.29 vs 4.98 ± 1.06, p 0.03). The analysis of radiation emitted per second (mGy) for LAO and non-LAO oriented views demonstrated significantly higher radiation levels in the LAO caudal group (7.18 ± 2.48 in cranial view and 11.67 ± 2.68 in caudal view) compared to the non-LAO group (4.83 ± 0.87 in cranial view and 4.33 ± 1.12 in caudal view) (p < 0.001). Conclusion RADPAD significantly reduces radiation exposure to the primary and secondary operator during prolonged complex PCI and BMV proceduresRADPAD position. Relative operator exposure