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A randomized controlled trial to assess operator radiation exposure from cardiac catheterization procedures using RAD
Ramya Suryadevara1, Eddie D Brown2, Sandy M Green3
1Department of Cardiology, Harton Regional Medical Center, Tullahoma, Tennessee.
Insights
The RAD BOARD® radial access arm board did not reduce, but actually increased, operator radiation exposure during cardiac catheterizations. This was likely because it prevented the use of standard radiation shielding.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Physics
Background:
- Radial access for cardiac catheterization is increasingly common.
- Operator radiation exposure with radial access can be similar to or higher than femoral access.
- The RAD BOARD® aims to reduce operator radiation exposure but its efficacy is debated.
Purpose of the Study:
- To evaluate the effectiveness of the RAD BOARD® in reducing operator radiation exposure during diagnostic cardiac catheterizations.
- To compare radiation doses between standard shielding and the RAD BOARD® plus standard shielding.
Main Methods:
- A randomized trial involving 265 patients undergoing right radial access cardiac catheterization.
- Patients were assigned to either standard pelvic lead drape shielding or the RAD BOARD® plus pelvic drape.
- Operator radiation exposure was measured using nanoDot™ badges.
Main Results:
- The RAD BOARD® group had significantly higher mean operator radiation doses (.65 mSv) compared to the nonboard group (.56 mSv).
- Higher radiation doses in the RAD BOARD® group were observed across all body mass index subgroups.
- Multivariate analysis identified the RAD BOARD® as a significant predictor of increased operator dose.
Conclusions:
- The RAD BOARD®, when used with a pelvic shield, was associated with increased operator radiation exposure.
- This increase is likely due to the inability to properly position standard radiation shielding when using the RAD BOARD®.
Objective:
To study radiation exposure to the primary operator during diagnostic cardiac catheterizations using a radio-dense RAD BOARD® radial access arm board.
Background:
The use of radial access for catheterization in the United States has increased from 1% in 2007 to 41% in 2018. Compared to femoral access, operator radiation exposure from radial access is similar or higher. The RAD BOARD radio-dense radial access arm board has been marketed as reducing radiation to operators by 44%.
Materials And Methods:
We randomized 265 patients undergoing catheterization via right radial access to standard pelvic lead drape shielding (nonboard group) versus RAD BOARD in addition to pelvic drape (board group). Operator radiation exposure was measured using Landauer Microstar nanoDot™ badges worn by the operator.
Results:
Board and nonboard groups were similar with respect to demographic and procedural variables. Mean operator dose per case was higher in the board group (.65mSieverts) than in the nonboard group (.56mSieverts, P < 0.0001). In sub-group analyses, radiation doses were higher in the board group compared to the nonboard group in patients across all body mass index groups (P < 0.03). In multivariate analysis, operator dose correlated with use of the RAD BOARD more closely than any other variable (P < 0.001). Post hoc analysis of the table setup with RAD BOARD revealed that use of RAD BOARD prevented placement of a shield normally inserted into the top of the standard below-table shield.
Conclusion:
RAD BOARD with the pelvic shield was associated with higher radiation exposure to the operator compared with pelvic shield alone, likely due to inability to use standard radiation shielding along with the RAD BOARD.
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