Randomized comparison of operator radiation exposure during coronary angiography and intervention by radial or femoral approach

Abstract

Controversial data have been published on the amount of radiation exposure during radial coronary procedures. We hypothesized that in the current era, high-volume operators with optimal technique would not be exposed to higher radiation doses during radial procedures. A total of 297 patients undergoing cardiac catheterization (195 elective diagnostic coronary angiograms and 102 elective coronary interventions) were prospectively assigned in a random fashion to the radial access (RA) or femoral access (FA). All procedures were performed by the same operator with vast experience in radial procedures and standard measures for radiation protection were used. Operator radiation exposure was measured with an electronic radiation dosimeter attached to the breast pocket of the operator on the outside of the lead apron and estimates of the ambient dose equivalent were derived. For coronary angiograms, fluoroscopy time (2.8 +/- 2.1 vs. 1.7 +/- 1.4 min; P < 0.001) and dose-area product (15.1 +/- 8.4 vs. 13.1 +/- 8.5 Gy x cm(2); P < 0.05) were increased by 18% and 15%, respectively, for RA vs. FA. Operator radiation exposure was 100% higher for the RA compared to the FA (64 +/- 55 vs. 32 +/- 39 microSv; P < 0.001). For coronary interventions, fluoroscopy time (11.4 +/- 8.4 vs. 10.4 +/- 6.8 min; P = NS) and dose-area product (46.3 +/- 28.7 vs. 51.0 +/- 29.4 Gy x cm(2); P = NS) for RA and FA were not statistically different. However, operator radiation exposure was increased by 51% for the RA compared to the FA (166 +/- 188 vs. 110 +/- 115 microSv; P < 0.05). This study demonstrates that the radial approach is burdened with a 100% increase in operator radiation exposure during diagnostic coronary catheterization procedures and a 50% increase during coronary interventions, provided that no special devices for radiation protection are used. Measurements of radiation dose, such as fluoroscopy time and dose-area product, substantially underestimate the disproportionate rise in radiation exposure. Special precautions are warranted to improve radiation protection during invasive coronary procedures via the radial approach.

Comparison of fluoroscopy time during coronary angiography and interventions by radial and femoral routes- can we decrease the fluoroscopy time with increased experience? An observational study

“…In our study, significantly high fluoroscopy time of r-CA and r-PCI groups is consistent with previous studies (9,21,22). It may be argued that mean fluoroscopy time of f-CA as well as r-CA is relatively high.…”

“…But, Rao et al (27) (from the National Cardiovascular Data Registry) also reported higher fluoroscopy time in r-PCI group as compared to f-PCI group (13.5 vs 11.3 min; p<0.01). Moreover, Lange et al (9) demonstrated 50 % increase in radiation exposure with radial approach despite the non-significant difference in fluoroscopy time among r-PCI and f-PCI groups. This shows the diversity in available data and demands further randomized, blinded studies in larger cohorts.…”

“…Although, some studies have shown that with increasing operator experience radiation exposure can be minimized with transradial approach (TRA) and hence majority of radial operators assume that special radiation exposure precautions are unnecessary (7,8). On the contrary, few other studies demonstrated increased fluoroscopy time and radiation exposure with radial access and advocated special radiation protection methods to reduce operator radiation exposure (9,10). While this controversy continues, very few studies have compared the operator radiation exposure with radial versus femoral approach particularly in our part of the world.…”

Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico

“…Adicionalmente, a análise de uma escala subjetiva do grau de dificuldade nos leva na mesma direção. Isso se explica por ser esse um estudo de curva de aprendizagem, ou seja, a falta de experiência do operador no acesso transradial tem papel maior na extensão do procedimento e no tempo de exposição aos raios X 22 . Preocupações quanto ao aumento da exposição à radiação nos operadores primários podem ser diminuídas pelo posicionamento do braço junto do paciente e pelo uso de campos de proteção de chumbo com movimentação livre e suporte superior.…”

Transradial approach: Do we have gain without excessive pain?

“…It also saves the time of busy catheterization laboratories by reducing occupancy and hence increases the number of procedures. It also helps reducing the radiation exposure that often considered trivial but in fact a worrisome problem (14,15).Nature believes in diversity and hence in this way it maintains the beauty and continuity in life. Variety is a blessing and it often gives us a way out from a trapped situation.…”