title: Comparison of fluoroscopy time during coronary angiography and interventions by radial and femoral routes- can we decrease the fluoroscopy time with increased experience? An observational study.
abstract: OBJECTIVE
  Radial route of access is increasingly being used for coronary angiograms and intervention. However, radiation exposure of operators was not known in our set up with either transfemoral or transradial procedures. The objective of the study was to compare related peripheral arterial route radiation exposure of operators by assessing fluoroscopy time. The secondary objective was to determine the relationship of operator experience with fluoroscopy time.
  
  
  METHODS
  This observational study was conducted in a tertiary care center - Cardiovascular Institute of Karachi (Pakistan) during the period of July 1(st) 2009 to September 30(th) 2009. We studied 1016 consecutive adult patients referred for coronary angiography (CA) or percutaneous coronary intervention (PCI). Patients who underwent right heart catheterization or for valvuloplasty were excluded from the study. Out of these 1016 patients, 928 were diagnostic CAs (734 via femoral route [f-CA] and 194 via radial route [r-CA]) and 88 were PCI (64 via femoral route [f-PCI] and 24 via radial route [r-PCI]). Fluoroscopy time was recorded as a surrogate of radiation exposure. Statistical analysis was performed using unpaired t, Mann-Whitney U, Chi-square and ANOVA tests.
  
  
  RESULTS
  Mean fluoroscopy time was found to be significantly higher in patients who underwent r-CA (6.3±3.8 vs 4.0±2.9 min; p<0.001) and r-PCI (15.1±11.8 vs 10.3±7.4 min; p=0.02) as compared with those underwent f-CA and f-PCI. Mean fluoroscopy time of well experienced operators was also high in r-CAs (5.4±2.9 vs 4.2±3.5 min; p=0.004).
  
  
  CONCLUSIONS
  Radial procedures are associated with longer fluoroscopy time that may result in high radiation exposure to radial operators. Even well experienced radial operators cannot minimize their fluoroscopy time to the level of well experienced femoral operators.
authors.affiliation: Catheterization Laboratory, Karachi Institute of Heart Diseases, Pakistan. tariqfarman@yahoo.com
authors.forename: Muhammad Tariq
authors.initials: MT
authors.lastname: Farman
authors.forename: Naveed Ullah
authors.initials: NU
authors.lastname: Khan
authors.forename: Jawaid Akber
authors.initials: JA
authors.lastname: Sial
authors.forename: Tahir
authors.initials: T
authors.lastname: Saghir
authors.forename: Syed Nadeem Hasan
authors.initials: SN
authors.lastname: Rizvi
authors.forename: Khan Shah
authors.initials: KS
authors.lastname: Zaman
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002983:Clinical Competence; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D016273:Occupational Exposure; D010154:Pakistan; D017534:Radial Artery; D013997:Time Factors