Occupational dose attenuation and dosimetric performance of autonomous radiation protection systems in fluoroscopy: a scoping review with implications for the role of conventional lead aprons

Abstract Background: Interventional cardiology procedures chronically expose healthcare personnel to ionizing radiation, raising concerns about long-term health effects such as cataracts and cancer. Consequently, growing attention has been directed toward advanced shielding technologies capable of substantially reducing occupational dose while improving ergonomic conditions." Objective: To synthesize the available evidence on the technical performance and radiation attenuation capabilities of Autonomous Radiation Protection Systems (Protego™, Rampart™, and EggNest XR™), used in interventional cardiology settings. Methods: A scoping review was conducted following the PRISMA-ScR framework. Relevant studies were identified through a systematic search of PubMed, EBSCO, Scopus, WOS and Cochrane. Eligible studies included clinical and phantom-based assessments reporting quantitative dosimetric outcomes. Results: Fourteen studies met the inclusion criteria. Protego™ was associated with consistently high reported attenuation, typically ≥95% in studies providing quantifiable measurements; in several investigations, post-shielding doses fell below the detection limits of standard personal dosimeters, whereas Rampart™ demonstrated wider reported attenuation ranges (approximately 16.7-100%) across heterogeneous study designs and measurement protocols and EggNest XR™ exhibited attenuation values ranging from 91.5% to 99.0% in a single phantom-based study. Device performance varied by anatomical site and professional role, with higher attenuation typically observed among primary operators (often exceeding 95% at head and torso levels) compared with more variable reductions in peripheral personnel such as nurses and anesthesiologists, where attenuation occasionally decreased to the 80-90% range depending on positioning and projection. Conclusion: The attenuation results for autonomous shielding systems are promising, particularly for fixed systems, which demonstrate consistently high performance. Given their potential for ergonomic improvement and radiation reduction, Autonomous Radiation Protection Systems (ARPS) are emerging as valuable tools. However, given the limited clinical validation and the heterogeneity of existing study, the implementation of these systems should be supported by site-specific validation and standardized dosimetry protocols." .