Does a Novel Lead-Free Radiation Shield Improve Surgeon Protection Compared with Lead Apron Alone?

Introduction: The RADPAD is a novel lead-free shield that can be positioned directly in the surgical field to block scatter radiation. The primary objective of this study was to assess the effectiveness and added protection of the RADPAD compared with conventional lead during simulated percutaneous nephrolithotomy (PCNL). Methods: To simulate a PCNL, a radiographical phantom patient and a mannequin surgeon were utilized. Using a real-time dosimeter, radiation doses were measured in µSv at seven surgeon locations: head, neck, chest, abdomen, pelvis, forearm, and leg. Two shielding strategies were evaluated: conventional lead apron and thyroid shield (LATS) and triple-thickness RADPAD. The effectiveness of combining LATS with RADPAD was compared with baseline (no lead). Five trials of 5 seconds of fluoroscopy were conducted for each location and shielding combination. The Mann-Whitney U test was used to compare exposures with p < 0.05 considered significant. Results: LATS alone significantly reduced radiation exposure at all locations compared with baseline (>95%; p < 0.05) except the surgeon head, forearm, and leg. RADPAD alone significantly reduced radiation at all tested locations (p < 0.05), except the legs. Compared with LATS alone, RADPAD significantly reduced radiation exposure to the head (as much as 48%) and forearm (as much as 84%; p < 0.05). LATS with RADPAD yielded the greatest radiation reduction, performing significantly better than LATS alone at the head, pelvis, and forearm (p < 0.05). No device or combination significantly reduced radiation exposure to the leg. Conclusions: The LATS alone reduced radiation >95% at shielded sites, but provided no protection to the head, forearm, and leg. Addition of the RADPAD to conventional LATS functions as an effective and novel strategy that reduces radiation exposure at all measured sites except the legs and provides important protection to the head and arms of the surgeon without increasing the weight burden.