Abstract
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.