JACC: Radial access causes more rad exposure than femoral

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Radial artery access cardiac catheterization was associated with increased radiation exposure to the patient when compared with femoral access, according to a study in this month’s Journal of the American College of Cardiology: Interventions.

Although previous studies have demonstrated a relationship between radial access and increased radiation exposure to the patient during fluoroscopy-guided cardiac procedures, such studies did not account for differences in operator technique or clustering of patients, procedure complexity or patient size, according to the study authors, who added that those “studies included data from few operators.”

Therefore, Mathew Mercuri, PhD, from the Hamilton Health Sciences in Hamilton, Ontario, and colleagues sought to determine whether radial artery access is associated with increased radiation exposure during cardiac catheterization and whether this relationship differs between operators, after adjustment for clinical and patient characteristics associated with greater radiation exposure.

The researchers collected data prospectively on 5,954 diagnostic cardiac catheterizations performed at Hamilton Health, a tertiary cardiac center. They used a multi-level regression analysis to determine the relationship between radial artery access and radiation exposure.

After adjustment for multiple factors, the authors reported that the radial access was associated with increased exposure (beta = 0.22) when compared with the use of femoral access, as measured using the logarithmically transformed air kerma (LogAK).

On average, they found that the radial access accounted for a 23 percent increase in measured AK, which was consistent between operators. There were observed differences in the mean LogAK between operators (p = 0.0158), as well as substantial variation in measured LogAK between patients within each operator's practice.

“Some attribute the increase in radiation exposure associated with the use of radial access during cardiac catheterization/PCI to lack of experience by the physician with this technique,” the authors wrote. “If this were true, the results observed in this study would suggest that each of the physicians observed is equally inexperienced with the radial technique. This seems improbable given the volume of cases per physician and the differing levels of training/experience within the group (e.g., some physicians are not trained in interventional procedures, when and where the physicians trained varies).”

Therefore, the authors do not “believe” increased experience will diminish the difference between techniques to an insignificant level.