Treffer: Efficacy of an X-Ray Protective Drape in Reducing Operator Radiation Dose in Transfemoral Arterial Liver Interventions: a Randomized-Controlled Trial.
Title:
Efficacy of an X-Ray Protective Drape in Reducing Operator Radiation Dose in Transfemoral Arterial Liver Interventions: a Randomized-Controlled Trial.
Authors:
Bonne L; Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. lawrence.bonne@uzleuven.be., Bergans N; Department of Oncology, University Hospitals Leuven, Louvain, Belgium.; Radiation Protection and Dosimetry Service of the Department of Health, Safety and Environment, University Hospitals Leuven, Louvain, Belgium., McCutcheon K; Department of Cardiovascular Medicine, University Hospitals Leuven, Louvain, Belgium., Laenen A; Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Louvain, Belgium., Bogaerts R; Radiation Protection and Dosimetry Service of the Department of Health, Safety and Environment, University Hospitals Leuven, Louvain, Belgium., Vanheule J; Radiation Protection and Dosimetry Service of the Department of Health, Safety and Environment, University Hospitals Leuven, Louvain, Belgium., Bennett J; Department of Cardiovascular Medicine, University Hospitals Leuven, Louvain, Belgium., Cockmartin L; Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium., Bosmans H; Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.; Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Louvain, Belgium., Desmet W; Department of Cardiovascular Medicine, University Hospitals Leuven, Louvain, Belgium., Maleux G; Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
Source:
Cardiovascular and interventional radiology [Cardiovasc Intervent Radiol] 2025 Nov; Vol. 48 (11), pp. 1625-1631. Date of Electronic Publication: 2025 Oct 06.
Publication Type:
Journal Article; Randomized Controlled Trial
Language:
English
Journal Info:
Publisher: Springer Verlag Country of Publication: United States NLM ID: 8003538 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-086X (Electronic) Linking ISSN: 01741551 NLM ISO Abbreviation: Cardiovasc Intervent Radiol Subsets: MEDLINE
Imprint Name(s):
Publication: New York Ny : Springer Verlag
Original Publication: [Berlin, New York] Springer International.
Original Publication: [Berlin, New York] Springer International.
MeSH Terms:
Occupational Exposure*/prevention & control , Radiation Protection*/instrumentation , Radiation Protection*/methods , Radiation Dosage* , Radiography, Interventional*/methods , Radiation Exposure*/prevention & control , Liver*/diagnostic imaging, Humans ; Male ; Female ; Femoral Artery ; Middle Aged ; Aged
References:
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Chida K, Kaga Y, Haga Y, et al. Occupational dose in interventional radiology procedures. Am J Roentgenol. 2013;200(1):138–41. https://doi.org/10.2214/AJR.11.8455 . (PMID: 10.2214/AJR.11.8455)
Degiorgio S, Gerasia R, Liotta F, et al. Radiation doses to operators in hepatobiliary interventional procedures. Cardiovasc Intervent Radiol. 2018;41(5):772–80. https://doi.org/10.1007/s00270-017-1870-3 . (PMID: 10.1007/s00270-017-1870-329344710)
Reeves RR, Ang L, Bahadorani J, et al. Invasive cardiologists are exposed to greater left sided cranial radiation: the BRAIN study (brain radiation exposure and attenuation during invasive cardiology procedures). JACC Cardiovasc Interv. 2015;8(9):1197–206. https://doi.org/10.1016/j.jcin.2015.03.027 . (PMID: 10.1016/j.jcin.2015.03.02726292583)
Chida K. What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel? Radiol Phys Technol. 2022;15(2):101–15. https://doi.org/10.1007/s12194-022-00660-8 . (PMID: 10.1007/s12194-022-00660-835608759)
Budošová D, Horváthová M, Bárdyová Z, Balázs T. Current trends of radiation protection equipment in interventional radiology. Radiat Prot Dosimetry. 2022;198(9–11):554–9. https://doi.org/10.1093/rpd/ncac098 . (PMID: 10.1093/rpd/ncac09836005965)
Gonzales JP, Moran C, Silberzweig JE. Reduction of operator radiation dose by an extended lower body shield. J Vasc Interv Radiol. 2014;25(3):462-468.e1. https://doi.org/10.1016/j.jvir.2013.11.006 . (PMID: 10.1016/j.jvir.2013.11.00624332242)
Marcusohn E, Postnikov M, Musallam A, et al. Usefulness of pelvic radiation protection shields during transfemoral procedures—operator and patient considerations. Am J Cardiol. 2018;122(6):1098–103. https://doi.org/10.1016/j.amjcard.2018.06.003 . (PMID: 10.1016/j.amjcard.2018.06.00330057233)
Koenig AM, Maas J, Viniol S, et al. Scatter radiation reduction with a radiation-absorbing pad in interventional radiology examinations. Eur J Radiol. 2020;132:109245. https://doi.org/10.1016/j.ejrad.2020.109245 . (PMID: 10.1016/j.ejrad.2020.10924533011604)
Eder H, Seidenbusch MC, Treitl M, Gilligan P. A new design of a lead-acrylic shield for staff dose reduction in radial and femoral access coronary catheterization. RoFo Fortschr Geb Rontgenstr Bildgeb Verfahr. 2015;187(10):915–23. https://doi.org/10.1055/s-0034-1399688 . (PMID: 10.1055/s-0034-1399688)
Vlastra W, Delewi R, Sjauw KD, et al. Efficacy of the RADPAD protection drape in reducing operators’ radiation exposure in the catheterization laboratory: a sham-controlled randomized trial. Circ Cardiovasc Interv. 2017. https://doi.org/10.1161/CIRCINTERVENTIONS.117.006058 . (PMID: 10.1161/CIRCINTERVENTIONS.117.00605829089313)
McCutcheon K, Vanhaverbeke M, Pauwels R, et al. Efficacy of MAVIG X-Ray protective drapes in reducing operator radiation dose in the cardiac catheterization laboratory: a randomized controlled trial. Circ Cardiovasc Interv. 2020. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009627 . (PMID: 10.1161/CIRCINTERVENTIONS.120.00962733092401)
McCutcheon K, Vanhaverbeke M, Dabin J, et al. Efficacy of MAVIG X-ray protective drapes in reducing CTO operator radiation. J Interv Cardiol. 2021. https://doi.org/10.1155/2021/3146104 . (PMID: 10.1155/2021/3146104349873148692020)
Kloeze C, Klompenhouwer EG, Brands PJM, Van Sambeek MRHM, Cuypers PWM, Teijink JAW. Editor’s choice - Use of disposable radiation-absorbing surgical drapes results in significant dose reduction during EVAR procedures. Eur J Vasc Endovasc Surg. 2014;47(3):268–72. https://doi.org/10.1016/j.ejvs.2013.12.008 . (PMID: 10.1016/j.ejvs.2013.12.00824445087)
Kohlbrenner R, Lehrman ED, Taylor AG, et al. Operator dose reduction during transjugular liver biopsy using a radiation-attenuating drape: a prospective, randomized study. J Vasc Interv Radiol. 2018;29(9):1248–53. https://doi.org/10.1016/j.jvir.2018.05.006 . (PMID: 10.1016/j.jvir.2018.05.00630061059)
Bacchim Neto FA, Alves AFF, Mascarenhas YM, Nicolucci P, de Pina DR. Occupational radiation exposure in vascular interventional radiology: a complete evaluation of different body regions. Phys Med. 2016;32(8):1019–24. https://doi.org/10.1016/j.ejmp.2016.06.014 . (PMID: 10.1016/j.ejmp.2016.06.01427453204)
Moriarty HK, Clements W, Phan T, Wang S, Goh GS. Occupational radiation exposure to the lens of the eye in interventional radiology. J Med Imaging Radiat Oncol. 2022;66(1):34–40. https://doi.org/10.1111/1754-9485.13307 . (PMID: 10.1111/1754-9485.1330734342393)
Venneri L, Rossi F, Botto N, et al. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council’s biological effects of ionizing radiation VII report. Am Heart J. 2009;157(1):118–24. https://doi.org/10.1016/j.ahj.2008.08.009 . (PMID: 10.1016/j.ahj.2008.08.00919081407)
Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol. 2013;111(9):1368–72. https://doi.org/10.1016/j.amjcard.2012.12.060 . (PMID: 10.1016/j.amjcard.2012.12.06023419190)
Picano E, Vano E, Domenici L, Bottai M, Thierry-Chef I. Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer. 2012. https://doi.org/10.1186/1471-2407-12-157 . (PMID: 10.1186/1471-2407-12-157225404093495891)
Honorio da Silva E, Vanhavere F, Struelens L, Covens P, Buls N. Effect of protective devices on the radiation dose received by the brains of interventional cardiologists. EuroIntervention. 2018;13(15):1778–84. (PMID: 10.4244/EIJ-D-17-00759)
Ohno S, Shindo R, Konta S, Yamamoto K, Inaba Y. Radiation exposure to the brains of interventional radiology staff: a phantom study. Bioengineering. 2024. https://doi.org/10.3390/bioengineering11111083 . (PMID: 10.3390/bioengineering111110833959374311591093)
Bahar AR, Khanal R, Hamza M, et al. Assessing the efficacy of RADPAD protection drape in reducing radiation exposure to operators in the cardiac catheterization laboratory: a systematic review and meta-analysis. Cureus. 2024. https://doi.org/10.7759/cureus.59215 . (PMID: 10.7759/cureus.592153975963811700026)
Jansen MM, Koster A, van Herwaarden JA, Hazenberg CEVB. Reduction of occupational radiation exposure during endovascular treatment of peripheral artery disease using radiation absorbing drapes. Ann Vasc Surg. 2022;84:336–43. https://doi.org/10.1016/j.avsg.2022.01.030 . (PMID: 10.1016/j.avsg.2022.01.03035257909)
Murphy JC, Darragh K, Walsh SJ, Hanratty CG. Efficacy of the RADPAD protective drape during real world complex percutaneous coronary intervention procedures. Am J Cardiol. 2011;108(10):1408–10. https://doi.org/10.1016/j.amjcard.2011.06.061 . (PMID: 10.1016/j.amjcard.2011.06.06121861961)
Politi L, Biondi-Zoccai G, Nocetti L, et al. Reduction of scatter radiation during transradial percutaneous coronary angiography: a randomized trial using a lead-free radiation shield. Catheter Cardiovasc Interv. 2012;79(1):97–102. https://doi.org/10.1002/ccd.22947 . (PMID: 10.1002/ccd.2294721520391)
Kijima K, Krisanachinda A, Tamura M, Monzen H, Nishimura Y. Reduction of occupational exposure using a novel tungsten-containing rubber shield in interventional radiology. Health Phys. 2020;118(6):609–14. https://doi.org/10.1097/HP.0000000000001177 . (PMID: 10.1097/HP.000000000000117731855596)
Monzen H, Tamura M, Shimomura K, et al. A novel radiation protection device based on tungsten functional paper for application in interventional radiology. J Appl Clin Med Phys. 2017;18(3):215–20. https://doi.org/10.1002/acm2.12083 . (PMID: 10.1002/acm2.12083284223975689848)
Yamada R, Bracewell S, Bassaco B, et al. Transradial versus transfemoral arterial access in liver cancer embolization: randomized trial to assess patient satisfaction. J Vasc Interv Radiol. 2018;29(1):38–43. https://doi.org/10.1016/j.jvir.2017.08.024 . (PMID: 10.1016/j.jvir.2017.08.02429150395)
Chida K, Kaga Y, Haga Y, et al. Occupational dose in interventional radiology procedures. Am J Roentgenol. 2013;200(1):138–41. https://doi.org/10.2214/AJR.11.8455 . (PMID: 10.2214/AJR.11.8455)
Degiorgio S, Gerasia R, Liotta F, et al. Radiation doses to operators in hepatobiliary interventional procedures. Cardiovasc Intervent Radiol. 2018;41(5):772–80. https://doi.org/10.1007/s00270-017-1870-3 . (PMID: 10.1007/s00270-017-1870-329344710)
Reeves RR, Ang L, Bahadorani J, et al. Invasive cardiologists are exposed to greater left sided cranial radiation: the BRAIN study (brain radiation exposure and attenuation during invasive cardiology procedures). JACC Cardiovasc Interv. 2015;8(9):1197–206. https://doi.org/10.1016/j.jcin.2015.03.027 . (PMID: 10.1016/j.jcin.2015.03.02726292583)
Chida K. What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel? Radiol Phys Technol. 2022;15(2):101–15. https://doi.org/10.1007/s12194-022-00660-8 . (PMID: 10.1007/s12194-022-00660-835608759)
Budošová D, Horváthová M, Bárdyová Z, Balázs T. Current trends of radiation protection equipment in interventional radiology. Radiat Prot Dosimetry. 2022;198(9–11):554–9. https://doi.org/10.1093/rpd/ncac098 . (PMID: 10.1093/rpd/ncac09836005965)
Gonzales JP, Moran C, Silberzweig JE. Reduction of operator radiation dose by an extended lower body shield. J Vasc Interv Radiol. 2014;25(3):462-468.e1. https://doi.org/10.1016/j.jvir.2013.11.006 . (PMID: 10.1016/j.jvir.2013.11.00624332242)
Marcusohn E, Postnikov M, Musallam A, et al. Usefulness of pelvic radiation protection shields during transfemoral procedures—operator and patient considerations. Am J Cardiol. 2018;122(6):1098–103. https://doi.org/10.1016/j.amjcard.2018.06.003 . (PMID: 10.1016/j.amjcard.2018.06.00330057233)
Koenig AM, Maas J, Viniol S, et al. Scatter radiation reduction with a radiation-absorbing pad in interventional radiology examinations. Eur J Radiol. 2020;132:109245. https://doi.org/10.1016/j.ejrad.2020.109245 . (PMID: 10.1016/j.ejrad.2020.10924533011604)
Eder H, Seidenbusch MC, Treitl M, Gilligan P. A new design of a lead-acrylic shield for staff dose reduction in radial and femoral access coronary catheterization. RoFo Fortschr Geb Rontgenstr Bildgeb Verfahr. 2015;187(10):915–23. https://doi.org/10.1055/s-0034-1399688 . (PMID: 10.1055/s-0034-1399688)
Vlastra W, Delewi R, Sjauw KD, et al. Efficacy of the RADPAD protection drape in reducing operators’ radiation exposure in the catheterization laboratory: a sham-controlled randomized trial. Circ Cardiovasc Interv. 2017. https://doi.org/10.1161/CIRCINTERVENTIONS.117.006058 . (PMID: 10.1161/CIRCINTERVENTIONS.117.00605829089313)
McCutcheon K, Vanhaverbeke M, Pauwels R, et al. Efficacy of MAVIG X-Ray protective drapes in reducing operator radiation dose in the cardiac catheterization laboratory: a randomized controlled trial. Circ Cardiovasc Interv. 2020. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009627 . (PMID: 10.1161/CIRCINTERVENTIONS.120.00962733092401)
McCutcheon K, Vanhaverbeke M, Dabin J, et al. Efficacy of MAVIG X-ray protective drapes in reducing CTO operator radiation. J Interv Cardiol. 2021. https://doi.org/10.1155/2021/3146104 . (PMID: 10.1155/2021/3146104349873148692020)
Kloeze C, Klompenhouwer EG, Brands PJM, Van Sambeek MRHM, Cuypers PWM, Teijink JAW. Editor’s choice - Use of disposable radiation-absorbing surgical drapes results in significant dose reduction during EVAR procedures. Eur J Vasc Endovasc Surg. 2014;47(3):268–72. https://doi.org/10.1016/j.ejvs.2013.12.008 . (PMID: 10.1016/j.ejvs.2013.12.00824445087)
Kohlbrenner R, Lehrman ED, Taylor AG, et al. Operator dose reduction during transjugular liver biopsy using a radiation-attenuating drape: a prospective, randomized study. J Vasc Interv Radiol. 2018;29(9):1248–53. https://doi.org/10.1016/j.jvir.2018.05.006 . (PMID: 10.1016/j.jvir.2018.05.00630061059)
Bacchim Neto FA, Alves AFF, Mascarenhas YM, Nicolucci P, de Pina DR. Occupational radiation exposure in vascular interventional radiology: a complete evaluation of different body regions. Phys Med. 2016;32(8):1019–24. https://doi.org/10.1016/j.ejmp.2016.06.014 . (PMID: 10.1016/j.ejmp.2016.06.01427453204)
Moriarty HK, Clements W, Phan T, Wang S, Goh GS. Occupational radiation exposure to the lens of the eye in interventional radiology. J Med Imaging Radiat Oncol. 2022;66(1):34–40. https://doi.org/10.1111/1754-9485.13307 . (PMID: 10.1111/1754-9485.1330734342393)
Venneri L, Rossi F, Botto N, et al. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council’s biological effects of ionizing radiation VII report. Am Heart J. 2009;157(1):118–24. https://doi.org/10.1016/j.ahj.2008.08.009 . (PMID: 10.1016/j.ahj.2008.08.00919081407)
Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol. 2013;111(9):1368–72. https://doi.org/10.1016/j.amjcard.2012.12.060 . (PMID: 10.1016/j.amjcard.2012.12.06023419190)
Picano E, Vano E, Domenici L, Bottai M, Thierry-Chef I. Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer. 2012. https://doi.org/10.1186/1471-2407-12-157 . (PMID: 10.1186/1471-2407-12-157225404093495891)
Honorio da Silva E, Vanhavere F, Struelens L, Covens P, Buls N. Effect of protective devices on the radiation dose received by the brains of interventional cardiologists. EuroIntervention. 2018;13(15):1778–84. (PMID: 10.4244/EIJ-D-17-00759)
Ohno S, Shindo R, Konta S, Yamamoto K, Inaba Y. Radiation exposure to the brains of interventional radiology staff: a phantom study. Bioengineering. 2024. https://doi.org/10.3390/bioengineering11111083 . (PMID: 10.3390/bioengineering111110833959374311591093)
Bahar AR, Khanal R, Hamza M, et al. Assessing the efficacy of RADPAD protection drape in reducing radiation exposure to operators in the cardiac catheterization laboratory: a systematic review and meta-analysis. Cureus. 2024. https://doi.org/10.7759/cureus.59215 . (PMID: 10.7759/cureus.592153975963811700026)
Jansen MM, Koster A, van Herwaarden JA, Hazenberg CEVB. Reduction of occupational radiation exposure during endovascular treatment of peripheral artery disease using radiation absorbing drapes. Ann Vasc Surg. 2022;84:336–43. https://doi.org/10.1016/j.avsg.2022.01.030 . (PMID: 10.1016/j.avsg.2022.01.03035257909)
Murphy JC, Darragh K, Walsh SJ, Hanratty CG. Efficacy of the RADPAD protective drape during real world complex percutaneous coronary intervention procedures. Am J Cardiol. 2011;108(10):1408–10. https://doi.org/10.1016/j.amjcard.2011.06.061 . (PMID: 10.1016/j.amjcard.2011.06.06121861961)
Politi L, Biondi-Zoccai G, Nocetti L, et al. Reduction of scatter radiation during transradial percutaneous coronary angiography: a randomized trial using a lead-free radiation shield. Catheter Cardiovasc Interv. 2012;79(1):97–102. https://doi.org/10.1002/ccd.22947 . (PMID: 10.1002/ccd.2294721520391)
Kijima K, Krisanachinda A, Tamura M, Monzen H, Nishimura Y. Reduction of occupational exposure using a novel tungsten-containing rubber shield in interventional radiology. Health Phys. 2020;118(6):609–14. https://doi.org/10.1097/HP.0000000000001177 . (PMID: 10.1097/HP.000000000000117731855596)
Monzen H, Tamura M, Shimomura K, et al. A novel radiation protection device based on tungsten functional paper for application in interventional radiology. J Appl Clin Med Phys. 2017;18(3):215–20. https://doi.org/10.1002/acm2.12083 . (PMID: 10.1002/acm2.12083284223975689848)
Yamada R, Bracewell S, Bassaco B, et al. Transradial versus transfemoral arterial access in liver cancer embolization: randomized trial to assess patient satisfaction. J Vasc Interv Radiol. 2018;29(1):38–43. https://doi.org/10.1016/j.jvir.2017.08.024 . (PMID: 10.1016/j.jvir.2017.08.02429150395)
Contributed Indexing:
Keywords: Pelvic drapes; Radiation protection; Transarterial liver interventions
Entry Date(s):
Date Created: 20251005 Date Completed: 20251030 Latest Revision: 20251208
Update Code:
20251208
DOI:
10.1007/s00270-025-04223-3
PMID:
41047378
Database:
MEDLINE
Weitere Informationen
Purpose: Interventional radiologists are among the healthcare professionals most exposed to ionizing scatter radiation. A 0.5 mm lead equivalent X-ray protective drape (MXPD, Mavig, Germany) was introduced to reduce operator radiation dose and has demonstrated efficacy during cardiac interventions. This study evaluates the efficacy of the MXPD during transfemoral liver interventions.
Materials & Methods: A single-center randomized controlled study was conducted to compare operator radiation exposure during transfemoral liver interventions (n = 100) with and without the MXPD. Primary outcome was the ratio of the combined operator radiation dose values-measured at the chest, eyes and both hands and normalized to the respective dose area products - between MXPD and control groups. Secondary outcomes included the ratios in operator radiation doses measured for the individual dosimeter locations.
Results: The MXPD group showed a significantly lower normalized radiation dose per DAP (mean reduction 0.31 µSv; 95% CI 0.083-0.536, p = 0.009), representing a 43% reduction. The effect of the drape was the highest for the whole-body dose measured above the lead apron (55% reduction, p = 0.10), the left hand finger dose (43%, p = 0.20) and the eye lens dose estimated at the left temple (63%, p = 0.10) and in between the eyes (47%, p = 0.10).
Conclusion: The MXPD can effectively reduce operator radiation dose during transfemoral arterial liver interventions, offering a practical adjunct to standard protective measures.
Level of Evidence: Level 1b, Randomized Controlled Trial.
(© 2025. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)
Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical Approval: This study was approved by the institutional Ethics Committee (s65831). Consent to Participate: Consent for publication was obtained for every individual person’s data included in the study. Human Participants or Animals: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all individual participants included in the study.