title: Radiation safety and vascular access: attitudes among cardiologists worldwide.
abstract: OBJECTIVE
  To determine opinions and perceptions of interventional cardiologists on the topic of radiation and vascular access choice.
  
  
  BACKGROUND
  Transradial approach for cardiac catheterization has been increasing in popularity worldwide. There is evidence that transradial access (TRA) may be associated with increasing radiation doses compared to transfemoral access (TFA).
  
  
  METHODS
  We distributed a questionnaire to collect opinions of interventional cardiologists around the world.
  
  
  RESULTS
  Interventional cardiologists (n=5332) were contacted by email to complete an on-line survey from September to October 2013. The response rate was 20% (n=1084). TRA was used in 54% of percutaneous coronary interventions (PCIs). Most TRAs (80%) were performed with right radial access (RRA). Interventionalists perceived that TRA was associated with higher radiation exposure compared to TFA and that RRA was associated with higher radiation exposure that left radial access (LRA). Older interventionalists were more likely to use radiation protection equipment and those who underwent radiation safety training gave more importance to ALARA (as low as reasonably achievable). Nearly half the respondents stated they would perform more TRA if the radiation exposure was similar to TFA. While interventionalists in the United States placed less importance to certain radiation protective equipment, European operators were more concerned with physician and patient radiation.
  
  
  CONCLUSIONS
  Interventionalists worldwide reported higher perceived radiation doses with TRA compared to TFA and RRA compared to LRA. Efforts should be directed toward encouraging consistent radiation safety training. Major investment and application of novel radiation protection tools and radiation dose reduction strategies should be pursued.
authors: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois. Electronic address: miv@uic.edu.
authors: Mladen I
authors: MI
authors: Vidovich
authors: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors: Asrar A
authors: AA
authors: Khan
authors: Division of Epidemiology and Biostatistics and Cancer Center, University of Illinois at Chicago, Chicago, Illinois.
authors: Hui
authors: H
authors: Xie
authors: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors: Adhir R
authors: AR
authors: Shroff
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D002309:Cardiology / Q000592:standards / Q000639:trends; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005263:Femoral Artery / Q000528:radiation effects; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D017534:Radial Artery / Q000528:radiation effects; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods; D015641:Radiography, Interventional / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D011795:Surveys and Questionnaires
keywords: Cardiac catheterization; Femoral access; Radial access; Radiation