title: Radiation exposure during coronary angiography via transradial or transfemoral approaches when performed by experienced operators.
abstract: BACKGROUND
  Studies demonstrate an increase in radiation exposure with transradial approach (TRA) when compared with transfemoral approach (TFA) for coronary angiography. Given the learning curve associated with TRA, it is not known if this increased radiation exposure to patients is seen when procedures are performed by experienced operators.
  
  
  METHODS
  We retrospectively evaluated 1,696 patients who underwent coronary angiography with or without percutaneous coronary intervention (PCI) by experienced operators at a tertiary center from October 2010 to June 2011. Experienced operators were defined as those that perform >75 PCIs/year with >95% of cases performed using the TRA or TFA approach for ≥5 years. The outcomes of interest were dose area product (DAP) and fluoroscopy time (FT).
  
  
  RESULTS
  Of the 1,696 patients, 1,382 (81.5%) were performed by experienced femoral operators using TFA and 314 (18.5%) were performed by experienced radial operators using TRA. Most of these cases (65.4%) were diagnostic only (870 TFA and 240 TRA) with both DAP (6040 [3210-8786] vs 5019 [3377-6869] μGy·m(2), P = .003] and FT [6.2 [4.0-10.3] vs 3.3 [2.6-5.0] minutes, P < .001) significantly higher using TRA versus TFA. For procedures involving PCI, despite similar baseline patient, procedural and lesion characteristics, DAP and FT remained significantly higher using TRA versus TFA (19,649 [11,996-25,929] vs 15,395 [10,078-21,617] μGy·m(2), P = .02 and 22.1 [13.3-31.0] vs. 13.8 [9.8-20.3] minutes, P < .001).
  
  
  CONCLUSIONS
  In a contemporary cohort of patients undergoing coronary angiography by experienced operators, TRA was associated with higher radiation exposure when compared with TFA.
authors: Department of Medicine, New York University School of Medicine, New York, NY, USA. binita.shah@nyumc.org
authors: Binita
authors: B
authors: Shah
authors: Sripal
authors: S
authors: Bangalore
authors: Frederick
authors: F
authors: Feit
authors: Gregory
authors: G
authors: Fernandez
authors: John
authors: J
authors: Coppola
authors: Michael J
authors: MJ
authors: Attubato
authors: James
authors: J
authors: Slater
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011361:Professional Competence; D017534:Radial Artery / Q000000981:diagnostic imaging*; D011827:Radiation; D012189:Retrospective Studies