Operator Radiation Exposure and Physical Discomfort During a Right Versus Left Radial Approach for Coronary Interventions: A Randomized Evaluation
What is the difference in operator discomfort and radiation exposure associated with the right versus the left radial approach for catheterization?
The authors performed a randomized study in which 100 patients were randomized to a left radial approach (LRA) or a right radial approach (RRA). Randomization was stratified according to obesity status, and each operator (n = 5) had an independent randomization process. Operator radiation was measured using separate sets of radiation dosimeter badges placed externally on the head and thyroid and internally on the sternum. Operator physical discomfort was assessed using a 10-point scale at two time points: during vascular access and at the end of the procedure. Moderate to severe physical discomfort was defined as a score of >4.
There were no significant differences in baseline and procedural variables between groups. The RRA was associated with a significant increase in external radiation exposure (head: median, 6.12 [interquartile range (IQR), 2.6-16.6] mRems vs. median, 12.0 [IQR, 6.4-22.0] mRems, p = 0.02; thyroid: median, 10.10 [IQR, 4.3-25] mRems vs. median, 18.70 [IQR, 11.0-38] mRems, p = 0.001). The LRA was associated with greater discomfort. Greater moderate discomfort was reported with the LRA during access (LRA 22% vs. RRA 4%; p = 0.017), but not during the procedure (LRA 10.0% vs. RRA 4.0%, p = 0.43). This difference was almost entirely noted in obese patients (LRA 30.0% vs. RRA 3.7%, p = 0.005).
The authors concluded that RRA is associated with greater operator radiation exposure, whereas the LRA is associated with greater operator discomfort.
Radial access is increasingly being adopted across the country and is associated with reduced patient discomfort (and reduction in vascular complications). The downsides of radial access are greater operator discomfort and radiation exposure. This study suggests that there is no ideal solution; the RRA is associated with increased radiation exposure, whereas the LRA is associated with greater discomfort. Cath lab design modifications are needed to improve occupational safety and to reduce both the radiation exposure as well as the operator discomfort associated with radial catheterization.
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