Evaluation of patient-absorbed doses during coronary angiography and intervention by femoral and radial artery access

Abstract

The aim of this study was to compare the radiation dose to patients during coronary angiography (CA) and coronary intervention (percutaneous transluminal coronary angioplasty, PTCA) by the femoral or radial artery access routes. A plane-parallel ionisation chamber, mounted on an under-couch X-ray tube (Siemens Coroskop TOP with an optional dose reduction system), recorded the dose-area product (DAP) to the patient from 40 coronary angiographies and 42 coronary interventions by the femoral route. The corresponding numbers for radial access were 36 and 24, respectively. Using a human-shaped phantom, conversion factors between maximum entrance surface dose and DAP were derived for CA and CA plus PTCA, respectively. The dose to the staff was measured with TL dosimeters for 22 examinations. Fluoroscopy time and DAP were significantly (p=0.003) larger using the radial access route for coronary angiography (7.5 min, 51 Gy cm2) than the corresponding values obtained from femoral access route (4.6 min, 38 Gy cm2). For CA plus PTCA the fluoroscopy time and DAP were larger for radial access (18.4 min, 75 Gy cm2) than for femoral access (12.5 min, 47 Gy cm2; p=0.013). In our experience, radial access did significantly prolong the fluoroscopy time and increase the patient doses.

Radiation exposure and patient experience during percutaneous coronary intervention using radial and femoral artery access

“…Their values far exceed proposed reference levels and for several patients approach the DAP trigger level of 300 Gy cm 2 , which should alert the operator to possible skin injury [19]. Sandborg et al [6] also report higher median DAP values for combined procedures at 69 Gy cm 2 with radial access compared to 40 for femoral access, not randomised. These reports thus disagree with the results from our study.…”

“…Motivations for this have been that there are fewer complications and patients do not have to be immobilized as long as they do for femoral puncture [4,5]. However, there is concern that there might be a higher radiation exposure associated with radial puncture, due to both a more complicated handling of catheters leading to longer procedure times, and a more unfavourable position for the operator, closer to the irradiated part of the patient [5][6][7][8]. The radiation dose issue is very important since PCIs in general are procedures with a high radiation exposure both to the operator and the patient and a further increase would be most unwanted.…”

Radiation Exposure to Patients Undergoing Percutaneous Coronary Interventions

“…T F is widely considered to be a main criterion for the complexity of PCI and the operator's efforts to reduce patient DAP [2,6,9,11,14,21,39,41,43]. Mean values were reported in the range of 8.2-21 min for PCI [14,22,39,46], of 8.7-16 min for PCI plus stenting [9-11, 21, 22], and of 10.1-12.6 min for direct stenting [9][10][11]21].…”

“…Typical DAP (dose area kerma product) patient levels for percutaneous coronary interventions (PCI) are high and vary extensively in a range from 34 to 119 Gy · cm 2 for coronary intervention [6,14,17,18,22,39,46,49] and from 47 up to 191 Gy · cm 2 for combined interventions [7,34,43,49]. Upon application of accepted thoracic conversion factors [7,25,35], these findings correspond to equivalent effective doses (ED) in ranges from 7 to 24 and from 9 to 38 mSv.…”

Radiation Exposure During Percutaneous Coronary Interventions and Coronary Angiograms Performed by the Radial Compared With the Femoral Route

“…Over the years, contradictory results were reported on the radiation exposure of patients from procedures performed by the radial route (4)(5)(6)(7)(8). In the present study, we report radiation exposure data of a large, real-world patient population undergoing routine PCI or CAG.…”