title: Impact of Center Experience on Patient Radiation Exposure During Transradial Coronary Angiography and Percutaneous Intervention: A Patient-Level, International, Collaborative, Multi-Center Analysis.
abstract: The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure-a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure.
  
  
  
  Overall, 10 centers were included from 6 countries-Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose-area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted-average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=-0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=-0.8; P=0.006). Ultimately, when a center's balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent.
  
  
  
  The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency-a guiding principle for centers adopting the TR approach.
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Trevor
authors.initials: T
authors.lastname: Simard
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hibbert
authors.affiliation: Division of Cardiology, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.affiliation: Division of Cardiology, Hamilton Health Sciences, Hamilton, Ontario, Canada Division of Cardiology, Department of Medicine, Columbia University, New York, NY.
authors.forename: Mathew
authors.initials: M
authors.lastname: Mercuri
authors.affiliation: Kettering General Hospital, Kettering, United Kingdom.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Hetherington
authors.affiliation: James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Wright
authors.affiliation: Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Ronak
authors.initials: R
authors.lastname: Delewi
authors.affiliation: Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.affiliation: Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Lehmann
authors.affiliation: Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Ruzsa
authors.affiliation: Kardiologisch-Angiologische Praxis Herzzentrum Bremen, Bremen, Germany.
authors.forename: Helmut W
authors.initials: HW
authors.lastname: Lange
authors.affiliation: Department of Radiology, School of Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Geijer
authors.affiliation: Radiation Physics, Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Sandborg
authors.affiliation: Faculty of Undergraduate Medicine, University of Ottawa, Ontario, Canada.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kansal
authors.affiliation: Cardiovascular Research Methods Center, Ottawa, Ontario, Canada.
authors.forename: Jordan
authors.initials: J
authors.lastname: Bernick
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Santo
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Pourdjabbar
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: F Daniel
authors.initials: FD
authors.lastname: Ramirez
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Benjamin J W
authors.initials: BJ
authors.lastname: Chow
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Aun Yeong
authors.initials: AY
authors.lastname: Chong
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Marino
authors.initials: M
authors.lastname: Labinaz
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Michel R
authors.initials: MR
authors.lastname: Le May
authors.affiliation: Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
authors.forename: Edward R
authors.initials: ER
authors.lastname: O'Brien
authors.affiliation: Cardiovascular Research Methods Center, Ottawa, Ontario, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada dso@ottawaheart.ca.
authors.forename: Derek
authors.initials: D
authors.lastname: So
mesh_terms: D002983:Clinical Competence / Q000592:standards; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D003325:Coronary Care Units / Q000592:standards* / Q000706:statistics & numerical data; D005263:Femoral Artery / Q000528:radiation effects; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards; D017534:Radial Artery / Q000528:radiation effects; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000706:statistics & numerical data*
keywords: coronary angiography; dose‐area product; percutaneous coronary intervention; radial artery catheterization; radiation; radiation dosing; transfemoral; transradial