Randomized Controlled Trial of Patient Positioning and Operator Radiation Exposure During Lower Extremity Catheter...

Area of Science:

• Interventional Radiology
• Vascular Imaging
• Radiation Safety

Background:

• Digital subtraction angiography (DSA) is key for chronic limb-threatening ischemia (CLTI).
• Left transradial access (TRA) is preferred for CLTI evaluations due to lower complications and better patient comfort.
• Operator radiation exposure during lower extremity catheter angiography (CA) is a concern, with patient positioning's impact understudied.

Purpose of the Study:

• To evaluate the effect of patient positioning (head-first vs. feet-first) on operator radiation exposure during lower extremity CA via left TRA.
• To assess if patient orientation influences scatter radiation levels for interventional radiologists.

Main Methods:

• A single-center randomized controlled trial involving 24 patients with CLTI.
• Patients were randomized to either head-first (HF) or feet-first (FF) supine positions.
• Operator radiation exposure was measured using thermoluminescent dosimeters (TLDs) at the eye, chest, and left ring finger, with background radiation subtracted.

Main Results:

• No statistically significant differences in operator radiation exposure (eye, chest, finger) were observed between HF and FF groups.
• Patient BMI and procedural parameters (fluoroscopy time, DAP, contrast) were comparable between groups.
• A trend towards higher finger radiation exposure in the FF group was noted, suggesting a need for enhanced hand protection.

Conclusions:

• Patient positioning (head-first vs. feet-first) does not significantly impact operator radiation exposure during lower extremity CA from left TRA.
• Flexible patient positioning is feasible without compromising operator safety.
• Adherence to ALARA (As Low As Reasonably Achievable) principles remains crucial, with potential for improved hand protection in the feet-first position.