title: Operator radiation exposure and physical discomfort during a right versus left radial approach for coronary interventions: a randomized evaluation.
abstract: OBJECTIVE
  This study sought to assess radiation exposure and operator discomfort when using left radial approach (LRA) versus right radial approach (RRA) for coronary diagnostic and percutaneous interventions.
  
  
  BACKGROUND
  The transradial approach is increasingly being adopted as the preferred vascular access for coronary interventions. Currently, most are performed using an RRA. This is in part due to the perceived increased operator physical discomforts as well increased radiation exposure with an LRA.
  
  
  METHODS
  One hundred patients were randomized to an LRA or RRA. Each operator (n = 5) had an independent randomization process, and patients were stratified according to obesity status. 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 surveyed at 2 time points: during vascular access and at the end of the procedure. Moderate to severe physical discomfort was defined as a score of >4.
  
  
  RESULTS
  There were no significant differences in baseline and procedural variables between groups. There was a significant increase in external radiation exposure using the RRA versus LRA (head: median: 6.12 [interquartile range (IQR): 2.6 to 16.6] mRems vs. median: 12.0 [IQR: 6.4 to 22.0] mRems, p = 0.02; thyroid: median: 10.10 [IQR: 4.3 to 25] mRems vs. median: 18.70 [IQR: 11.0 to 38] mRems, p = 0.001). More 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).
  
  
  CONCLUSIONS
  LRA is as effective as RRA, showing a safer profile with decreased radiation exposure to the operator, at the expense of more operator discomfort only during vascular access and limited to obese patients.
authors: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
authors: Herman
authors: H
authors: Kado
authors: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
authors: Ambar M
authors: AM
authors: Patel
authors: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
authors: Siva
authors: S
authors: Suryadevara
authors: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
authors: Martin M
authors: MM
authors: Zenni
authors: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
authors: Lyndon C
authors: LC
authors: Box
authors: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
authors: Dominick J
authors: DJ
authors: Angiolillo
authors: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
authors: Theodore A
authors: TA
authors: Bass
authors: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida. Electronic address: luis.guzman@jax.ufl.edu.
authors: Luis A
authors: LA
authors: Guzman
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography / Q000009:adverse effects; D005260:Female; D005373:Film Dosimetry; D005431:Florida; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000009:adverse effects; D012307:Risk Factors
keywords: operator discomfort; radial access; radiation exposure