Efficacy of novel radiation protective systems during cardiac interventions: a systematic review and meta-analysis of randomized controlled trials.

Abstract

The cumulative exposure to X-ray radiation during cardiac intervention can indeed pose various health risks. The present meta-analysis aims to compare novel radiation protective systems (drapes and X-ray shields) versus conventional safety measures on the operator's procedural radiation exposure during cardiac interventions. A systematic review and meta-analysis were performed including randomized controlled trials from PubMed, Embase, Cochrane, Scopus, and WOS until February 2024. The random-effects model was used to report continuous outcomes using mean difference (MD) with a 95% confidence interval (CI). Sixteen Trials with 3,370 patients were included. Novel radiation protective systems were significantly associated with low total operator radiation dose (MD: -7.3, 95%CI [-11.9, -2.7], p < 0.01) with no significant difference between both arms regarding chest radiation dose (MD: -20.7, 95%CI [-48.9, 7.6], p = 0.15) and thyroid radiation dose (MD: -15.4, 95%CI [-32.4, 1.7], p = 0.08). Also, the novel systems were significantly associated with low air kerma (MD: -46.4, 95%CI [-87.3, 5.5], p = 0.03) and low fluoroscopy duration (MD: -0.3, 95%CI [-0.6, -0.04], p = 0.02). However, there was no difference between both arms regarding the total procedure time (MD: -0.7, 95%CI [-3.1, 1.6], p = 0.54), contrast volume (MD: -3.2, 95%CI [-10.2, 3.7], p = 0.36), and dose area product (MD: 628.4, 95% CI [-3,466.9, 4,723.8], p = 0.76). Also, no differences were found between the drape and shields subgroups in most outcomes. The present literature review showed a low to very low certainty level that novel radiation protective systems significantly reduced the total radiation dose exposure of operators and air kerma. They were also associated with lower fluoroscopy duration, insignificantly lower procedure time, and contrast volume. Given the limited available data it is concluded that novel radiation protective systems are promising, but further large-scale, multicenter, placebo-controlled randomized trials are needed to confirm the efficacy of the newly developed RPSs in lowering radiation exposure of staff in the medical setting.