Single-Center, Open-Label, Randomized Controlled Trial on the Reduction of Scattered Radiation Exposure to the Primary Operator in Radial, Femoral, and Pectoral Cath Lab Procedures Using a Radiation Protection Drape

Radiation exposure in the catheterization laboratory poses a significant occupational hazard for primary operators. This single-center, open-label, randomized controlled trial conducted at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, evaluated scattered radiation exposure to the primary operator during procedures via radial, femoral, and pectoral vascular access sites and the effectiveness of radiation protection drapes in reducing this exposure. A total of 216 patients (72 in each vascular access group) were randomized using coin flipping to receive either standard radiation protection or additional shielding with a radiation protection drape. The primary operator's scattered radiation dose was assessed in comparison to the radiation emitted during the procedure, with normalization to procedural radiation parameters including air kerma (AK), dose area product (DAP), and cine-adjusted screen time (CAST). Pectoral access was associated with the highest operator exposure (96.75 µSv) compared to femoral (45.72 µSv) and radial (49.06 µSv) access, despite lower AK values. Radiation protection drapes significantly reduced operator exposure across all access sites, with radial access showing reductions of 51% (DAP), 48% (AK), and 53% (CAST); femoral access showing reductions of 82% (DAP), 74% (AK), and 63% (CAST); and pectoral access showing reductions of 62% (DAP), 49% (AK), and 52% (CAST), all statistically significant (P < 0.05). No adverse events were reported. The findings provide strong support for the routine use of radiation protection drapes to minimize primary operator radiation exposure during catheterization procedures, especially when using the pectoral access site.