ATTENUATE: Protective Drape Cuts Operator Radiation Dose Across Interventions

WASHINGTON, DC—An inexpensive and widely available scatter-radiation absorbing drape helps reduce the amount of radiation that operators are exposed to across a range of diagnostic, coronary, and structural interventions in the cath lab, according to data from the ATTENUATE study.

Compared with procedures when it wasn’t used, there was a 50.7% relative reduction in the dose-area product-normalized operator dose with use of the RADPAD protection drape, Giorgio A. Medranda, MD (NYU Langone Hospital-Long Island, Glen Cove), reported in a session here at CRT 2025.

The 1,000-patient series included structural interventions like TAVI and mitral transcatheter edge-to-edge repair (TEER), as well as miscellaneous procedures like Impella (Abiomed) placement and cardiac biopsies. Prior studies with the drape not only were far smaller, but also involved predominately coronary procedures.

“This was an opportunity to get a big mix of cases in there and figure out if the radiation protection holds up,” Medranda told TCTMD. “There was a variation, which you would expect, but it was nice to see that no matter what I'm doing in the lab, putting this down on the patient has its benefits.”

For the investigator-initiated ATTENUATE trial, researchers used the 11 x 34” RADPAD Orange, which Medranda calls a “workhorse” that provides middle-of-the-road level radiation protection. It was chosen because of its wide availability and low price, which is around $50 per pad.

“In my opinion, it's [quite] inexpensive,” he added. “For all the waste that goes on in the cath lab and in medicine as a whole, this is such a small cost with a lot of upside.”

Medranda noted that in a recent Society for Cardiovascular Angiography and Interventions radiation survey, only about 45% of cases performed by operators used the protective drape, a figure he said he hopes to see increase.

“There are elaborate systems for the cath lab to reduce radiation down to zero. I think we have a ways to go with that, both in terms of lowering the cost and reproducibility,” he said. “But in the interim, something as easy and simple as one of these scatter reduction shields seems like a no-brainer.”

Fellows, techs, and nurses in the trial had no issues with putting the drape on the patient or feeling that it impeded workflow. “I think a lot of this is just about starting the conversation at your institution and getting people on board with using it,” Medranda added.

For all the waste that goes on in the cath lab and in medicine as a whole, this is such a small cost with a lot of upside. Giorgio A. Medranda

Following the presentation, panelist Sukhdeep S. Bhogal, MD (Sovah Health, Roanoke, VA), noted that while the study captured radiation exposures through a dosimeter at the level of the most proximal operators’ chests, future work might consider placing it lower to gain additional information about how much of a difference a RADPAD can make in radiation scatter coming from below the waist.

Fluoroscopy Time Differences Seen

For the single-center all-comers ATTENUATE study, Medranda and colleagues randomized 500 patients undergoing a procedure to use of the RADPAD and 500 patients to standard radiation protections alone. Procedure types included coronary diagnostic (n = 516), structural (n = 208), coronary intervention (n = 138), and miscellaneous (n = 138).

The primary endpoint of dose-area product-normalized operator dose was 3.119 uSv/Gy·cm² with the RADPAD versus 6.324 uSv/Gy·cm² without (P < 0.0001). Likewise, a secondary endpoint of operator exposure was 9 uSv with the RADPAD versus 14 uSv without it. Fluoroscopy time was slightly higher in the group that didn’t use the RADPAD, at 5.6 minutes versus 4.4 minutes (P < 0.0001).

Medranda said the fluoroscopy result may have been related to operators seeing the RADPAD and “letting up on the fluoro a little sooner than when they didn't see it there.”

In subgroup analyses by case type, use of the RADPAD led to a 30% reduction in dose-area product-normalized operator dose when used in radial coronary cases, a 39.6% reduction in femoral coronary cases, a 17.7% reduction in femoral structural cases, and a 62.2% reduction in non-radial/femoral cases.

Medranda said further analyses are planned to examine radiation exposure by patient body mass index and by dose per case. Noting the predominantly male operator cohort, several panelists also suggested that since there may be differences by operator gender, future analyses would benefit from the inclusion of more women operators.

Medranda agreed, adding that the onus is on operators to protect themselves, their fellows, and their cath lab teams.

 ”This is something with clear data, and my trial is not the only trial out there, and it's relatively inexpensive, practical, and easy to use,” he said. “I just don't see a reason not to be using this.”