Use of Disposable Radiation-Absorbing Surgical Drapes Results in Significant Dose Reduction During EVAR Procedures

Abstract

The effect of carotid artery stenting (CAS) and carotid endarterectomy (CEA) on cognitive function is unclear. Both cognitive improvement and decline have been reported after CAS and CEA. We aimed to compare the changes in postprocedural cognitive function after CAS versus CEA. A systematic qualitative review of the literature was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement for studies evaluating the changes in cognitive function after CAS compared with CEA. Thirteen studies (403 CEAs; 368 CAS procedures) comparing the changes in cognitive function after CEA versus CAS were identified. Most studies did not show significant differences in overall cognitive function or only showed a difference in a single cognitive test between the two procedures. A definitive conclusion regarding the effect of CAS versus CEA on cognitive function was not possible owing to heterogeneity in definition, method, timing of assessment, and type of cognitive tests. For the same reasons, performing a meta-analysis was not feasible. The lack of standardization of specific cognitive tests and timing of assessment of cognitive function after CAS and CEA do not allow for definite conclusions to be drawn. Larger, adequately-powered and appropriately designed studies are required to accurately evaluate the effect of CAS versus CEA on postprocedural cognitive function. Objectives: Because of the increasing number of interventional endovascular procedures with fluoroscopy and the corresponding high annual dose for interventionalists, additional dose-protecting measures are desirable. The purpose of this study was to evaluate the effect of disposable radiation-absorbing surgical drapes in reducing scatter radiation exposure for interventionalists and supporting staff during an endovascular aneurysm repair (EVAR) procedure.Materials: This was a randomized control trial in which 36 EVAR procedures were randomized between execution with and without disposable radiation-absorbing surgical drapes (Radpad: Worldwide Innovations & Technologies, Inc., Kansas City, US, type 5511A). Dosimetric measurements were performed on the interventionalist (hand and chest) and theatre nurse (chest) with and without the use of the drapes to obtain the dose reduction and effect on the annual dose caused by the drapes.Results: Use of disposable radiation-absorbing surgical drapes resulted in dose reductions of 49%, 55%, and 48%, respectively, measured on the hand and chest of the interventionalist and the chest of the theatre nurse.Conclusions: The use of disposable radiation-absorbing surgical drapes significantly reduces scatter radiation exposure for both the interventionalist and the supporting staff during EVAR procedures. , and the evidence base to answer those questions was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines.Results: Most of the previous definitions were kept untouched, or were slightly modified. Four new defin...

Occupational Radiation Exposure During Endovascular Aortic Repair

“…It therefore resulted in an overestimation of their real personal dose. Kloeze et al reported a significant reduction in operator doses during EVAR using disposable radiationabsorbing drapes (Radpad, Worldwide Innovations and Technologies Inc., Kansas City, Missouri) in a non-dedicated angiosuite [12]. Their FO doses obtained in group with shielding drapes are comparable to the EVAR FO doses from our study on a dedicated fluoroscopy system without additional shielding.…”

“…Recently, work has been published on radiation exposure during endovascular aortic repair procedures [11][12][13]. Besides differences in fluoroscopy units and acquisition parameters, some general comments can be made.…”

Significant Radiation Dose Reduction in the Hybrid Operating Room Using a Novel X-ray Imaging Technology

“…Recently, a randomized study by Kloeze et al involving the use of radiation absorbing surgical drapes resulted in a 55% reduction in radiation dose for the interventionalist. 23 However, these methods do not reduce the dose of radiation to the patient, are often made disposable by design, and need to be reinstalled before every procedure. Therefore, lowering the patient entry dose seems more appropriate to reduce radiation exposure to all persons involved.…”

Does the type of surgical drape (disposable versus non-disposable) affect the risk of subsequent surgical site infection?

“…46 While radiation reducing surgical drapes are now routinely available and have been shown to successfully reduce the radiation exposure of staff, these have been primarily used by radiologists and not adopted by orthopaedic or spinal surgeons. 48 , 49 With the current economic climate stretching resources globally, it is also worth considering the cost of equipment, including drapes. Disposable surgical drapes cost relatively more than reusable drapes and, as our review has not clearly shown benefit over reusable drapes, there remains economic debate over the use of disposable drapes.…”