Left radial PCI reduces operators’ radiation exposure by half

Radiation exposure to the operator was nearly half when performing PCI by a left radial approach rather than right, according to a study published online June 18 in the Journal of the American College of Cardiology: Cardiovascular Interventions.

The left radial approach for PCIs has a history of being perceived as difficult, painful and risky for the operator, with most standard fluoroscopy suites designed for right-side convenience. Concerns about exposure to radiation after numerous procedures leave some interventional cardiologists leery of using a left radial approach.

A team from the University of Florida College of Medicine in Jacksonville offered data that support the use of left radial approach over right.

In a study that monitored five operators over 100 procedures, researchers found that the right radial approach exposed operators to more radiation in the thyroid and the head, particularly in the region of the eyes. The median head exposure for operators on the right radial approach was 12 mRems, while on the left radial approach the median was 6.12 mRems. Thyroid median exposure on the right radial approach was 18.70 mRems vs. 10.10 mRems on left radial approach.

In addition, researchers noted that discomfort with the left radial approach seemed to occur largely with obese patients, reported at access, but on par with right radial approach during the procedure. There was no major difference in procedural discomfort reported between left or right radial approach and no difference reported in discomfort from access through procedure in right radial approach from start to finish. Patient obesity only effected operator discomfort, not radiation exposure.

The success rate for the procedures was 96 percent on either side.

While the reason for the decrease in radiation between right and left was not fully understood, lead author Herman Kado, MD, and colleagues suggested that the difference may be due in part to the positioning of the lead glass. In right radial approach, the lead glass was placed over the right arm, while in left positioning it was placed across the patient, potentially shielding the operator better.

Also, the particular positioning the researchers used—bringing the left arm over the abdomen and toward the left groin area—may create further decrease in exposure by reducing the amount of leaning over the patient that may otherwise occur. This procedure may also be the reason for the decrease in discomfort over the longer period of the procedure while still experiencing some discomfort in the initial approach as access occurred while the arm was still on the left side.

For more on left radial access PCI, please read A Left-handed Complement to PCI