Interv Akut Kardiol. 2013;12(2):59-64

Increased radiation exposure in transradial approach. A real drawback or an obsolete problem?

Jan Škvařil¹, Pavel Sedloň¹, Miroslav Černohous¹, Patrik Jarkovský¹, Radka Kočková²

¹ Kardiologické oddělení ÚVN a VFN Praha

² Klinika kardiologie IKEM Praha

Objective: Beside many advantages of a transradial approach (TRA), the controversy concerning possibly increased radiation exposure

remains. The objective of the study was to compare left radial, right radial (TRA-R) and femoral (TFA) approaches concerning total time,

fluoroscopy time, radiation exposure of patients as well as of physicians.

Material and methods: 456 patients were prospectively randomized to TRA-L (154), TRA-R (159) or TFA (143). Procedural time, fluoroscopy

time, dose-area product (DAP) as patient´s exposure and physician´s equivalent dose, measured with personal electronic dosemeter,

were evaluated. Separately for diagnostic procedures and interventions.

Results: TRA-L and TFA diagnostic procedures were performed in the same fluoroscopy time (3.56 ± 2.6 min vs. 3.13 ± 2.56 min). The value

for TRA-R was longer (4.9 ± 6.53). There was no difference in PCI. Similarly, no differences between TFA, TRA-R and TRA-L were found in

patients´ exposure either in diagnostics (24.49 ± 25.4 Gy.cm2 vs. 27.46 ± 28.86 Gy.cm2 vs. 27.30 ± 19.59 Gy.cm2, p = 0.210), or PCIs (35.18

± 63.35 Gy.cm2 vs. 45.75 ± 70.11 Gy.cm2 vs. 47.05 ± 48.66 Gy.cm2, p = 0.990). The physician´s exposure was then the lowest in TRA-L both

in diagnostics (19.01 ± 23.85 μSv vs. 22.21 ± 29.84 μSv vs. 14.95 ± 17.01 μSv, p < 0.001) and in interventions (26.39 ± 59.25 μSv vs. 36.76

± 48.93 μSv vs. 15.30 ± 28.13 μSv, p = 0.004). Patient´s exposure was more dependent on pateint´s size (rs = 0.59) than the exposure of

physician (rs = 0.27). A good correlation between DAP and physician´s dose (rs = 0.64–0.85) was found.

Conclusion: Radial access performed routinely with sufficient learning curve and in view of radiation safety it is not associated with

increased radiation exposure either of patients or of performing physicians. Established TRA-L provides the optimal results.

Keywords: heart catheterisation, transradial approach, radiation exposure

Published: March 1, 2013  Show citation