Reduction of Operator Radiation Dose by a Pelvic Lead Shield During Cardiac Catheterization by Radial Access

Lange, Hans; Boetticher, Heiner von

doi:10.1016/j.jcin.2011.12.013

Cited by 57 publications

(27 citation statements)

References 14 publications

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“…To this end, a number of studies have attempted to quantify the differences in radiation exposure between access sites with increasing TR experience, with conflicting results . Given this, we performed a patient‐level, multi‐center, international, collaborative analysis to determine differences in patient radiation exposure in the context of TR access.…”

Section: Introductionmentioning

confidence: 99%

Impact of Center Experience on Patient Radiation Exposure During Transradial Coronary Angiography and Percutaneous Intervention: A Patient‐Level, International, Collaborative, Multi‐Center Analysis

Simard

Hibbert

Natarajan

et al. 2016

JAHA

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BackgroundThe adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient‐level, multi‐center analysis to definitively address the impact of TR access on radiation exposure.Methods and ResultsOverall, 10 centers were included from 6 countries—Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose‐area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted‐average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=−0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=−0.8; P=0.006). Ultimately, when a center's balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent.ConclusionsThe TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency—a guiding principle for centers adopting the TR approach.

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Section: Introductionmentioning

confidence: 99%

Impact of Center Experience on Patient Radiation Exposure During Transradial Coronary Angiography and Percutaneous Intervention: A Patient‐Level, International, Collaborative, Multi‐Center Analysis

Simard

Hibbert

Natarajan

et al. 2016

JAHA

Self Cite

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“…Previous randomised prospective studies19 25 that have compared the radial and femoral techniques have shown an average increase in radiation received by the operator of 61.3% in PCI when using the transradial approach. Another study_ENREF_1818 evaluating chest radiation between radial and femoral approaches showed an average operator absorption of 20.9±13.8 mSv in the radial procedure and 15.3±10.4 mSv in the femoral procedure (p<0.001). To analyse a hostile scenario with a SD of 13.8 and 6.45 mSv difference, we calculated a 72 dosimeter sample (24 patients per group) for 80% power and 96 dosimeters per group for a 90% power with an α error of 0.05.…”

Section: Discussionmentioning

confidence: 99%

“…On average, a coronary angiography and angioplasty correspond to patient radiation exposure levels of 300 and 1000 radiographs, respectively 16. Several randomised studies have examined differences between radial and femoral techniques related to this topic; most of their data infer higher fluoroscopy time, but without significance when compared to radiation dose absorbed by the patient derived from the access route 17 18. The literature is relatively scarce when focusing on operator exposure.…”

Section: Introductionmentioning

confidence: 99%

Comparative test of radiological exposure between femoral and radial techniques, development of a protective device and clinical trial design

et al. 2015

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BackgroundInterventional procedures via radial technique have progressively increased due to improved patient comfort, lower complication rates and reduced mortality in some scenarios. One area of interest is radiation exposure and ways of minimising it. Most studies focus on patient radiation risk with conflicting results, but there is reasonable consensus for increased operator exposure from the radial technique. The aim of this study was to evaluate radiological exposure under controlled radial and femoral access simulation tests, mapping radiation paths and developing a radiological protection device for the transradial technique.Methods and resultsRadiation exposure was simulated under controlled conditions for femoral and radial techniques using a pressurised ionisation chamber and water phantom. Different measurement points were defined according to standard positions to simulate radiation received by the operator in the gonads, thyroid and eyes at different angles during real procedures. The radial technique increased total exposure by 33% over the femoral technique. A protective device was developed and tested after radiation mapping. The protective device reduced cumulative radiation by 52% against the radial and 36% against the femoral technique.ConclusionsIn our study, operator exposure to cumulative ionising radiation was higher from the radial technique and the protective device reduced radiation exposure levels in the radial and femoral techniques. These results provided the basis for a clinical trial design to better define the impact of the protection device and radiation exposure during real world practice using different interventional techniques.Trial registration numberhttp://www.clinicaltrials.gov. Unique identifier: NCT02200783.

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“…Another challenge with transradial coronary procedures is that they are associated with longer fluoroscopy time [45,46]. There have been two randomized controlled trials that have shown increased operator radiation dose with radial compared with femoral access [47,48]. However, these were both single-center studies with a single operator.…”

Section: Zhou Et Al (2007) Unfractionated Heparin 7215mentioning

confidence: 99%

Comparing radial and femoral access for coronary angiography and interventions

Hsieh

Jolly

2013

J. Compar. Effect. Res.

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Cardiac catheterization and coronary intervention via the radial approach is increasingly adopted as the preferred vascular access to avoid transfemoral vascular complications. Recent clinical trials have confirmed that radial access reduces vascular complications and local bleeding with similar procedural efficacy. Transradial access has inherent technical challenges, including smaller vessel size of the radial artery, arterial spasm and tortuosity involving the radial and subclavian arteries, which may undermine the procedural success of this approach. A number of strategies have been reported to minimize complications of radial access, including the use of hydrophilic introducer sheaths and smaller sheath sizes, administration of nitroglycerin and unfractionated heparin during the procedure, patent hemostasis of the radial artery and careful patient selection. Operators experienced in transradial percutaneous coronary intervention can achieve comparable clinical outcomes to the transfemoral approach and minimize vascular complications. Radial artery access is likely to become widely accepted as the preferred percutaneous coronary intervention approach.

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Reduction of Operator Radiation Dose by a Pelvic Lead Shield During Cardiac Catheterization by Radial Access

Abstract: Pelvic lead shielding is highly effective in reducing operator radiation exposure for radial as well as femoral procedures. However, despite its use, radial access remains associated with a higher operator radiation dose.

Cited by 57 publications

References 14 publications

Impact of Center Experience on Patient Radiation Exposure During Transradial Coronary Angiography and Percutaneous Intervention: A Patient‐Level, International, Collaborative, Multi‐Center Analysis

Impact of Center Experience on Patient Radiation Exposure During Transradial Coronary Angiography and Percutaneous Intervention: A Patient‐Level, International, Collaborative, Multi‐Center Analysis

Comparative test of radiological exposure between femoral and radial techniques, development of a protective device and clinical trial design

Comparing radial and femoral access for coronary angiography and interventions

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