European Heart Journal Advance Access originally published online on June 17, 2008
European Heart Journal 2008 29(17):2180; doi:10.1093/eurheartj/ehn271
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Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes
Department of Cardiology
University Hospital of North Staffordshire
Stoke-on-Trent ST4 6QG
UK
Tel: +44 781 587 0689
Fax: +44 178 271 3071
Department of Cardiology
Freeman Hospital and Newcastle University
Newcastle-upon-Tyne NE7 7DN
UK
Department of Cardiology
Liverpool Cardiothoracic Centre
Liverpool L14 3PE
UK
Department of Cardiology
Manchester Heart Centre
Manchester M13 9WL
UK
Department of Cardiology
West of Scotland Regional Heart & Lung Centre
Golden Jubilee National Hospital
Glasgow G81 4HX
UK
Department of Cardiology
Brighton and Sussex University Hospital
Brighton BN2 5BE
UK
Department of Cardiology
University Hospital of North Staffordshire
Stoke-on-Trent ST4 6QG
UK
Email: tsnlo{at}btinternet.com
We read with great interest the article by Brasselet et al.1 The authors reported access site-specific patient and operator radiation exposure in an observational series of 420 patients undergoing diagnostic angiography or percutaneous coronary intervention, concluding that radial access increases radiation exposure. The authors stated that cardiologists should reconsider the use of radial access in the light of these findings. Although the authors should be commended for raising the important issue of radiation protection, their data add nothing new to the existing literature on access site selection and radiation exposure, and their conclusions are invalid for the following reasons.
The authors reported an increase in fluoroscopy time and procedural duration for their radial cases. This suggests that the operators were more skilled in femoral than radial procedures as this pattern does not exist for high-volume radial operators.2 This is consistent with the authors' own statement that their institution is a low to moderate volume radial centre. The authors' data indicated that patients undergoing radial procedures had a higher body weight and more complex lesion morphology. Radiographic gantry angulation is another important determinant of operator radiation exposure, and this important factor was not reported on. Increased (and unwarranted) use of LAO (left anterior oblique) cranial views in the radial group could play a major factor in the reported values. The authors reported that conventional catheter configurations were employed in their radial cases. This is sub-optimal practice, as the use of dedicated catheter configurations has already been shown to reduce procedural duration and radiation exposure for radial operators.3 Any of the above factors could explain all of the reported variation in access site-specific radiation exposure.
The individual operator data are also a cause for concern when interpreting the results. Operators 1 and 4 recorded similar values for procedural duration, fluoroscopy time, and patient radiation exposure, but Operator 4 recorded a more than two-fold increase in personal exposure compared with Operator 1. This large variation may be due to technical issues with radiation protection practice, and serves to emphasize the enormous impact of individual operator practice on the measurements obtained in this type of observational study.
The existing observational data for radiation exposure and access site practice is flawed and does not allow for any reliable conclusion. It is probable that the reported differences reflect variation in operator experience and attention to radiation protection. In support of this, our own data comparing highly skilled radial and femoral operators with strict control of above-mentioned variables demonstrated no increase in patient or operator exposure in radial cases.4 The present study underlines the need for care with radiation protection, but does not support the authors' conclusion.
References
- Brasselet C, Blanpain T, Tassan-Mangina S, Deschildre A, Duval S, Vitry F, Gaillot-Petit N, Clement JP, Metz D. Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes. Eur Heart J (2008) 29:63–70.
[Abstract/Free Full Text] - Geijer H, Persliden J. Radiation exposure and patient experience during percutaneous coronary intervention using radial and femoral artery access. Eur Radiol (2004) 14:1674–1680.[Web of Science][Medline]
- Kim SM, Kim DK, Kim DI, Kim DS, Joo SJ, Lee JW. Novel diagnostic catheter specifically designed for both coronary arteries via the right transradial approach. A prospective, randomized trial of Tiger II vs. Judkins catheters. Int J Cardiovasc Imaging (2006) 22:295–303.[CrossRef][Web of Science][Medline]
- Lo TS, Fountzopoulos E, Freestone B, Gunning M, Nolan J. Radiation exposure and procedural duration; practical implications for transradial operators. Heart (2007) 93:A89.[CrossRef]
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