Radiation Exposure of the Operator During Coronary Interventions (from the RADIO Study)

Abstract

We sought to compare operator radiation exposure during procedures using right femoral access (RFA), right radial access (RRA), and left radial access (LRA) during coronary angiography (CA) and percutaneous coronary intervention (PCI). Because of an increased incidence of long-term malignancy in interventional cardiologists, operator radiation exposure is of rising concern. This prospective study included all consecutive patients who underwent elective or emergency CA -PCI from September 2014 to March 2015. The primary end point was operator radiation exposure, quantified as the ratio of operator cumulative dose (CD) and patient radiation reported as dose-area product ( The LRA showed lower CD compared with RRA (p <0.001). There were no significant differences in DAP among the 3 access sites. FT was similar for the 3 groups (RFA 7 -7, RRA 5 -5, LRA 6 -5 minutes, RFA vs RRA: p [ 1, RFA vs LRA: p [ 0.16, RRA vs LRA: p [ 0.52). In conclusion, the use of RFA during CA -PCI is associated with significantly lower operator radiation exposure compared with RRA. LRA is associated with significantly lower operator radiation exposure compared with RRA.Because of a presumably increased stochastic risk of cancer induction among interventional cardiologists, especially neoplasms of the unprotected brain, nasopharyngeal tract, and upper extremities, operator radiation exposure during coronary angiography (CA) and/or percutaneous coronary intervention (PCI) is of rising concern. 1,2 Therefore, we undertook a comparison of operator radiation exposure during right femoral access (RFA), left radial access (LRA), and right radial access (RRA) during CA and CA followed by ad hoc PCI in a real-world population. MethodsFrom September 2014 to March 2015 at the University and Hospital Fribourg, all consecutive procedures of elective or emergency CA and CA followed by ad hoc PCI were prospectively considered for operator radiation exposure measurements. Procedures were performed by 5 senior interventional cardiologists with significant experience (>3,000 PCI each) in both femoral and radial access routes. Selection of the percutaneous access site was left to the discretion of the operator. Crossover access site procedures were excluded. This study was part of the Catheterization Registry Fribourg (CardioFR), which was approved by the Ethics Committee of Canton Vaud (protocol no: 339/14).The primary end point of the study was operator radiation exposure, expressed as the cumulative equivalent dose (in mSv) over the lead apron at chest level, normalized for the patient radiation exposure (dose-area product [DAP] in Gycm 2 ). Secondary end points included cumulative dose (CD), DAP, and fluoroscopy time (FT).Procedures were performed on a digital single-plane cineangiography unit (Allura FD10; Philips Medical Systems, Hamburg, Germany) with an undertable x-ray tube MRC20025 with a magnification factor leading to a field of view of 21 cm and an acquisition frequency of 15 frames/s. All procedures were performed with respect to current guidel...

In patients undergoing percutaneous coronary intervention with rotational atherectomy radial access is safer and as efficient as femoral access

“…Additionally, the use of TRA for RA did not increase the radiation exposure and fluoroscopy time. This is in line with two aforementioned studies concerning this issue, however in contrary to general population undergoing PCI, where an increase in radiation exposure with TRA has been demonstrated . And finally, a hospital stay after RA via TRA was significantly shorter than via TFA, similar to Kassimis et al, that matters also in terms of lowering health care costs.…”

Experience with the novel unifemoral parallel sheath technique in percutaneous intervention of chronic total coronary occlusions

“…Since the right femoral access site was shown to bring about the lowest radiation exposure, one might speculate that the novel technique is likely to be advantageous in this regard as well [18,19].…”

Efficacy of the SEPARPROCATH® radiation drape to reduce radiation exposure during cardiac catheterization: A pilot comparative study

“…The development of cardiac catheterization procedures has been associated with increasing numbers of radiation‐induced diseases in the medical staff, ranging from “benign” subcapsular cataracts to a presumed higher risk of malignancies . Interventional cardiologists and room staff are exposed to two main sources of radiation: X‐ray tube leakage and scatter radiation from the patient .…”

“…The development of cardiac catheterization procedures has been associated with increasing numbers of radiation-induced diseases in the medical staff, ranging from "benign" subcapsular cataracts to a presumed higher risk of malignancies. 1,2 Interventional cardiologists and room staff are exposed to two main sources of radiation: X-ray tube leakage and scatter radiation from the patient. 3,4 Other than procedural characteristics such as frame rate reduction or minimizing cineangiography, various protective tools have been developed (lead apron, leaded glass mobile panel, RADPAD ® drapes) with proven radiation protection.…”