title: Radiation exposure with the radial approach for diagnostic coronary angiography in a centre previously performing purely the femoral approach.
abstract: BACKGROUND
  Use of the radial approach for coronary angiography and percutaneous coronary intervention (PCI) is known to improve many patient outcome measures. However, there is some concern that it may be associated with increased patient radiation exposure. This study explores radiation exposure with the radial approach compared with the femoral approach in a centre previously performing purely femoral approach.
  
  
  METHODS
  Data was collected retrospectively for all patients undergoing diagnostic coronary angiography over a six month period. PCIs and procedures with inherent technical difficulty or use of additional techniques (graft studies, optical coherence tomography, fractional flow reserve) were excluded. Dose area product (DAP) and fluoroscopy time (FT) were analysed for all remaining procedures (n=389), comparing radial (n=109) and femoral (n=280) approaches.
  
  
  RESULTS
  The overall mean FT for transradial cases (7.45 mins) was significantly higher than for transfemoral cases (4.59 mins; p<0.001). The overall mean DAP for transradial cases (95.64 G Gycm(2)) was significantly higher than for transfemoral cases (70.25 Gycm(2), p<0.05)). Neither the FT nor the DAP decreased over the six month period.
  
  
  CONCLUSIONS
  The radial approach was associated with significantly higher DAP and FT compared to the femoral approach during an initial introductory phase which was likely insufficient to develop radial proficiency. The results of this study are consistent with previous studies and may influence choice of access for non-emergent diagnostic coronary angiography before radial proficiency has been established, particularly for patients more susceptible to radiation risks.
authors.affiliation: Cardiology Department, The Northern Hospital, Epping, Victoria, Australia; Radiology Department, The Northern Hospital, Epping, Victoria, Australia. Electronic address: a.vlachadis.castles@gmail.com.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vlachadis Castles
authors.affiliation: Cardiology Department, The Northern Hospital, Epping, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Asrar Ul Haq
authors.affiliation: Cardiology Department, The Northern Hospital, Epping, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Barlis
authors.affiliation: Cardiology Department, The Northern Hospital, Epping, Victoria, Australia.
authors.forename: Francis A
authors.initials: FA
authors.lastname: Ponnuthurai
authors.affiliation: Cardiology Department, The Northern Hospital, Epping, Victoria, Australia.
authors.forename: Chris C S
authors.initials: CC
authors.lastname: Lim
authors.affiliation: Cardiology Department, The Northern Hospital, Epping, Victoria, Australia.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Cardiology Department, The Northern Hospital, Epping, Victoria, Australia; Radiology Department, The Northern Hospital, Epping, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia.
authors.forename: William J
authors.initials: WJ
authors.lastname: van Gaal
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011829:Radiation Dosage
keywords: Coronary angiography; Coronary artery disease; Femoral artery; Radial artery; Radiation dosage