Alessandro Sciahbasi1, Enrico Frigoli2, Alessandro Sarandrea3, Paolo Calabrò4, Paolo Rubartelli5, Bernardo Cortese6, Francesco Tomassini7, Dennis Zavalloni8, Matteo Tebaldi9, Paolo Calabria10, Stefano Rigattieri11, Antonio Zingarelli12, Gennaro Sardella13, Alessandro Lupi14, Martina Rothenbühler15, Dik Heg15, Marco Valgimigli16. 1. Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy. Electronic address: alessandro.sciahbasi@fastwebnet.it. 2. Eustrategy Association, Forlì, Italy. 3. HSE Management, Rome, Italy. 4. Department of Cardio-Thoracic Sciences, Second University of Naples, Naples, Italy. 5. Villa Scassi Hospital, Genova, Italy. 6. Interventional Cardiology, Fatebenefratelli Hospital, Milan, Italy. 7. Department of Cardiology, Infermi Hospital, Rivoli, Italy. 8. Humanitas Research Hospital, IRCCS, Rozzano, Italy. 9. Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy. 10. Cardiology Unit, Misericordia Hospital, Grosseto, Italy. 11. Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy. 12. Interventional Cardiology Unit, IRCCS AOU San Martino, IST, Genova, Italy. 13. Departmentof Cardiovascular Sciences, Policlinico Umberto I, Rome, Italy. 14. Cardiology, ASL VCO, Domodossola, Italy. 15. CTU Bern, and Institute of Social and Preventive Medicine-University of Bern, Bern, Switzerland. 16. Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
Abstract
BACKGROUND: The RAD-MATRIX trial reported a large operator radiation exposure variability in right radial percutaneous coronary procedures. The reasons of these differences are not well understood. Our aim was to appraise the determinants of operator radiation exposure during coronary right transradial procedures. METHODS: Patient arrangement during transradial intervention was investigated across operators involved in the RAD-MATRIX trial. Operator radiation exposure was analyzed according to the position of the patient right arm (close or far from the body) and in relation to the size of the upper leaded glass. RESULTS: Among the 14 operators who agreed to participate, there was a greater than 10-fold difference in radiation dose at thorax level (from 21.5 to 267 μSv) that persisted after normalization by dose-area product (from 0.35 to 3.5 μSv/Gy*cm2). Among the operators who positioned the instrumented right arm far from the body (110.4 μSv, interquartile range 71.5-146.5 μSv), thorax dose was greater than that in those who placed the instrumented arm close to the right leg (46.1 μSv, 31.3-56.8 μSv, P = .02). This difference persisted after normalization by dose-area product (P = .028). The use of a smaller full glass shield was also associated with a higher radiation exposure compared with a larger composite shield (147.5 and 60 μSv, respectively, P = .016). CONCLUSIONS: In the context of the biggest radiation study conducted in patients undergoingtransradial catheterization, the instrumented right arm arrangement close to the leg and greater upper leaded shield dimensions were associated with a lower operator radiation exposure. Our findings emphasize the importance of implementing simple preventive measures to mitigate the extra risks of radiation exposure with right radial as compared with femoral access.
RCT Entities:
BACKGROUND: The RAD-MATRIX trial reported a large operator radiation exposure variability in right radial percutaneous coronary procedures. The reasons of these differences are not well understood. Our aim was to appraise the determinants of operator radiation exposure during coronary right transradial procedures. METHODS:Patient arrangement during transradial intervention was investigated across operators involved in the RAD-MATRIX trial. Operator radiation exposure was analyzed according to the position of the patient right arm (close or far from the body) and in relation to the size of the upper leaded glass. RESULTS: Among the 14 operators who agreed to participate, there was a greater than 10-fold difference in radiation dose at thorax level (from 21.5 to 267 μSv) that persisted after normalization by dose-area product (from 0.35 to 3.5 μSv/Gy*cm2). Among the operators who positioned the instrumented right arm far from the body (110.4 μSv, interquartile range 71.5-146.5 μSv), thorax dose was greater than that in those who placed the instrumented arm close to the right leg (46.1 μSv, 31.3-56.8 μSv, P = .02). This difference persisted after normalization by dose-area product (P = .028). The use of a smaller full glass shield was also associated with a higher radiation exposure compared with a larger composite shield (147.5 and 60 μSv, respectively, P = .016). CONCLUSIONS: In the context of the biggest radiation study conducted in patients undergoing transradial catheterization, the instrumented right arm arrangement close to the leg and greater upper leaded shield dimensions were associated with a lower operator radiation exposure. Our findings emphasize the importance of implementing simple preventive measures to mitigate the extra risks of radiation exposure with right radial as compared with femoral access.
Authors: Renato Francesco Maria Scalise; Armando Mariano Salito; Alberto Polimeni; Victoria Garcia-Ruiz; Vittorio Virga; Pierpaolo Frigione; Giuseppe Andò; Carlo Tumscitz; Francesco Costa Journal: J Clin Med Date: 2019-10-18 Impact factor: 4.241