Abstract
Background
Previous studies showed a possible lower radiation dose absorbed by operators comparing LRA and RRA for percutaneous coronary procedures. The reasons of this lower radiation dose are not well known. The aim of this study was to evaluate the radiation dose absorbed by operators comparing left with right radial access (LRA and RRA respectively) during a simulated diagnostic coronary angiography using a phantom.
Methods
A coronary angiography examination was simulated on a phantom by 5 operators using eight projections with 5 seconds fluoroscopy each. Each operator was equipped with 4 electronic dosimeters placed at thorax, at left wrist, at left head and at hip level. Radiation doses were expressed in picosievert and normalized by dose area product.
Results
LRA compared to RRA was associated with a significant lower operator dose at wrist (36 pSv/cGYcm 2 [IQR 18–59 pSv/cGYcm 2 ] and 48 pSv/cGYcm 2 [IQR 22–148 pSv/cGYcm 2 ] respectively, p = 0.01) and thorax (3 pSv/cGYcm 2 [IQR 2–5 pSv/cGYcm 2 ] and 10 pSv/cGYcm 2 [6–23 pSv/cGYcm 2 ] respectively, p < 0.001) but with a significant higher radiation dose at hip level (102 pSv/cGYcm 2 [IQR 44–199 pSv/cGYcm 2 ] and 67 pSv/cGYcm 2 [IQR 39–132 pSv/cGYcm 2 ] respectively, p = 0.02). Conversely the radiation dose at left side of the head did not show significant differences between the two approaches.
Conclusions
In this phantom study simulating a diagnostic coronarography the use of LRA compared to RRA was associated with a significant lower radiation dose at wrist and thorax but with an increased dose at hip level.
Summary
To evaluate the radiation dose absorbed by operators comparing left with right radial access (LRA and RRA respectively) we simulated a diagnostic coronary angiography using a dedicated phantom. Operators were equipped with dedicated electronic dosimeters at wrist, hip, head and thorax level. LRA compared to RRA was associated with a significant lower operator dose at wrist and thorax but with a significant higher radiation dose at hip level whereas the radiation dose at left side of the head did not show significant differences between the two approaches.
Highlights
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Phantom study simulating transradial coronary angiography
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Evaluation of radiation dose absorbed by operators during right of left transradial access
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Operators equipped with electronic dosimeters at thorax, head, wrist and hip
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Higher dose at thorax and wrist during right transradial access
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Higher dose at hip during left transradial approach
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No radiation dose differences at head
1
Introduction
During diagnostic and interventional coronary procedures interventional cardiologists are routinely and chronically exposed to low doses of ionizing radiations that could pose a health hazard. Moreover the radiation dose absorbed by interventional cardiologists is the greatest registered by any medical staff exposed to X-rays and previous studies showed that interventional cardiologists have higher levels of somatic DNA damage compared with clinical cardiologists. The amount of this damage is directly correlated to the duration of professional exposure . Consequently radioprotection is an important issue for interventional cardiologists due to the possibility of long term stochastic risk of radio-induced cancer and operators should apply all efforts to reduce their exposition to radiation dose at a level that is “As Low As Reasonably Achievable” (ALARA principle).
Multiple factors can influence operator radiation exposure including procedure complexity, radiation protection employed, individual patient’s anatomy, physician’s experience and vascular access site .
Historically, the femoral artery access site is the most used all around the world for diagnostic and interventional coronary procedures but recently the use of transradial access has gaining popularity as an alternative to transfemoral access associated with reduced patient discomfort and lower rate of vascular complications . Transradial approach can be performed using the right or the left radial access with most operators using the right radial access (RRA) . However the left radial access (LRA) has some important advantages in terms of reduced learning curve for fellows reduced rate of vessel tortuosity , and higher catheter back up during percutaneous coronary interventions even if it is less comfortable for operators . Moreover recently three different randomized studies showed an unexpected possible advantage of LRA in terms of radiation dose absorbed by operators compared to RRA. A possible explanation of this advantage has been attributed to the lower (even not significant) fluoroscopy times during LRA compared to RRA but this issue is not clarified.
Numerous variable parameters affect radiation exposure during cardiac fluoroscopically guided procedures and one of the major determinants of operator absorbed dose is patient size. In order to exclude this confounding factor and directly evaluate the radiation dose according to the different vascular access a possible alternative is to simulate the procedure using a dedicated phantom, as previously shown .
The aim of our study was to evaluate the radiation dose absorbed by operators comparing RRA and LRA during a simulated diagnostic coronary angiography using a dedicated phantom.
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