title: Efficacy of RADPAD® protection drape in reducing radiation exposure to the primary operator during Transcatheter Aortic Valve Implantation (TAVI).
abstract: BACKGROUND
  The efficacy of RADPAD® (a sterile, lead-free drape) has been demonstrated to reduce the scatter radiation to the primary operator during fluoroscopic procedures. However, the use of the RADPAD® during TAVI procedures has not been studied. Transcatheter aortic valve implantation (TAVI) is now an established treatment for patients with symptomatic severe aortic stenosis who are deemed inoperable or at high risk for conventional surgical aortic valve replacement (AVR). Consequently the radiation exposure to the patient and the interventional team from this procedure has become a matter of interest and importance. Methods to reduce radiation exposure to the interventional team during this procedure should be actively investigated. In this single center prospective study, we determined the radiation dose during this procedure and the efficacy of RADPAD® in reducing the radiation dose to the primary operator.
  
  
  METHODS
  Fifty consecutive patients due to undergo elective TAVI procedures were identified. Patients were randomly assigned to undergo the procedure with or without the use of a RADPAD® drape. There were 25 patients in each group and dosimetry was performed at the left eye level of the primary operator. The dosimeter was commenced at the start of the procedure, and the dose was recorded immediately after the end of the procedure. Fluoroscopy times and DAP were also recorded prospectively.
  
  
  RESULTS
  Twenty-five patients underwent transfemoral TAVI using a RADPAD® and 25 with no-RADPAD®. The mean primary operator radiation dose was significantly lower in the RADPAD group at 14.8 mSv vs. 24.3 mSv in the no-RADPAD group (P=0.008). There was no significant difference in fluoroscopy times or dose-area products between the two patient groups. The dose to the primary operator relative to fluoroscopy time (RADPAD: slope=0.325; no RADPAD: slope=1.148; analysis of covariance F=7.47, P=0.009) and dose area product (RADPAD: slope=0.0007; no RADPAD: slope=0.002; analysis of covariance F=7.38; P=0.009) was smaller in the RADPAD group compared to no-RADPAD group.
  
  
  CONCLUSIONS
  Use of a RADPAD® significantly reduces radiation exposure to the primary operator during TAVI procedures.
authors.affiliation: Royal Victoria Hospital, Belfast, Northern Ireland, UK - marks.spence@belfasttrust.hscni.net.
authors.forename: Divyesh
authors.initials: D
authors.lastname: Sharma
authors.forename: Adesh
authors.initials: A
authors.lastname: Ramsewak
authors.forename: Ganesh
authors.initials: G
authors.lastname: Manoharan
authors.forename: Mark S
authors.initials: MS
authors.lastname: Spence
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control*; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control*; D011832:Radiation Injuries / Q000517:prevention & control; D011835:Radiation Protection / Q000295:instrumentation*; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation / Q000379:methods*