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Operator Radiation Exposure Comparing the Left Radial Artery Approach and a Uniform Hyper-Adducted Right Radial
Richard Casazza1, Bilal Malik1, Arsalan Hashmi1
1Department of Cardiology, Maimonides Medical Center, Brooklyn, NY (R.C., B.M., A.H., E.M., R.F., E.B., S.A., M.F., N.M., S.V., J.M., N.C., Y.H., C.R., H.H.C., S.R., S.C., D.G., A.P., C.A., M.V.N., J.S.).
Background:
Radiation exposure is one of the most adverse occupational hazards faced by interventional cardiologists. Various arterial access sites have shown to yield different operator radiation exposure during diagnostic cardiac catheterization.
Methods:
This single-center randomized controlled trial assessed the cumulative radiation exposure and normalized radiation exposure at 4 different anatomic locations (thorax, abdomen, left eye, and right eye) of the primary operator when using the left radial artery (LRA) approach compared with a uniform hyper-adducted right radial artery (HARRA) approach. Patients (n=534) were randomized to LRA (n=269) or HARRA (n=265). During diagnostic catheterization, real-time radiation dosimeters were placed on the thorax, abdomen, left eye, and right eye of each operator.
Results:
Cumulative radiation measurements were as follows: thorax (LRA, 9.66±8.57 microsieverts [μSv] versus HARRA, 12.27±7.09 μSv; P<0.001); abdomen (LRA, 27.46±21.20 μSv versus HARRA, 36.56±23.72 μSv; P<0.001); left eye (LRA, 2.65±2.59 μSv versus HARRA, 3.77±2.67 μSv; P<0.001); and right eye (LRA, 1.13±1.69 μSv versus HARRA, 1.44±1.62 μSv; P=0.01). Normalized radiation measurements were: thorax (LRA, 0.38±0.35 versus HARRA, 0.49±0.24; P<0.001); abdomen (LRA, 1.06±0.72 versus HARRA, 1.38±0.69; P<0.001); left eye (LRA, 0.10±0.09 versus HARRA, 0.15±0.10; P<0.001); and right eye: (LRA, 0.04±0.06 versus HARRA, 0.05±0.06; P=0.02). LRA had lower subclavian tortuosity than HARRA (15.6% versus 32.5%, P<0.001).
Conclusions:
The LRA was associated with significantly less cumulative and normalized radiation exposure to the thorax, abdomen, left eye, and right eye of the primary operator compared with HARRA during diagnostic cardiac catheterization. Operators should consider using LRA more frequently than HARRA for diagnostic cardiac catheterization as this approach can reduce occupational radiation exposure.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT05833516.
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