The benefits of using a bismuth-containing, radiation-absorbing drape in cardiac resynchronization implant procedures.
BACKGROUND
Radiation exposure is a major concern in cardiac device implantation, especially cardiac resynchronization therapy (CRT) procedures. The RadPad™ (Worldwide Innovations & Technologies, Inc., Kansas City, MO, USA), a radiation-attenuating adhesive drape, has been shown to be beneficial in several clinical settings involving fluoroscopy, but less is known about the actual benefits in CRT procedures.


METHODS
Consecutive CRT implants performed with and without a RadPad™ drape over a 10-month period were analyzed. Two thermoluminescent dosimeters (TLDs) were attached to each implanting physician at several locations (adjacent to eyes, center abdomen [outside lead apron], left and right index fingers, and dorsum of the right foot). Results were corrected for background using control TLDs, and normalized to dose-area product (DAP).


RESULTS
Thirty-six patients (31 male), 16 with and 20 without the RadPad™, were included in the study. No technical problems were caused by the presence of the radiation-absorbing drape. Time required to position the drape never exceeded 30 seconds, no acute skin reactions were noted, and no radiation-absorbing drape became displaced. Despite a trend toward longer fluoroscopy times and higher DAPs in the radiation-absorbing drape group, radiation exposure was significantly reduced: 65% in the case of the hands and body (P < 0.001), and 40% the eyes (P < 0.01).


CONCLUSIONS
The use of a radiation-absorbing drape results in a significant reduction in radiation dose to the implanting physician during CRT procedures. Not only is the dose to the hands reduced, but also the eye and body doses are significantly reduced. The routine use of radiation-absorbing drapes should be considered for all CRT implant procedures in the light of these findings.
Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS trust, Oxford, UK.
Michael A
MA
Jones
Mary
M
Cocker
Raj
R
Khiani
Paul
P
Foley
Norman
N
Qureshi
Kelvin C K
KC
Wong
Kim
K
Rajappan
Timothy R
TR
Betts
D000368:Aged; D001729:Bismuth / Q000627:therapeutic use*; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation*
D001729:Bismuth
CRT; cardiac pacemaker; defibrillator; exposure; radiation; radiation-absorbing drape