3:00 PMAbstract No. 316 - ▪ FEATURED ABSTRACT Radiation exposure in radial versus femoral artery access in interventional radiology

Abstract

Radial artery access has slowly been gaining popularity due to reduced complication rates and improved patient comfort compared to femoral artery access. However, studies have demonstrated a substantial increase (up to 100% [1]) in operator radiation exposure for radial access. We implemented a unique radial approach using a mobile lead wall placed between the operator and patient. Operator exposure with this shielded radial approach was compared to a standard femoral approach. Dose data for the principal operator and scrub technologist were measured using the RaySafe i2 staff dosimetry system for 25 interventional radiology cases: 11 radial and 14 femoral artery access. Standard radiation protection including lead aprons, table drapes, and a “floating” acrylic shield were used for all cases. For radial cases, a 1.5 mm lead equivalent mobile wall further protected the operator. For each case, staff doses (in μSv) were normalized by the total fluoroscopy reference point dose (in mGy) in order to account for differences in case complexity. Normalized staff doses were averaged for radial and femoral cases. A t-test was used for statistical significance. Radial and femoral approaches were also simulated by irradiating an anthropomorphic phantom. Dosimeters were placed at typical staff positions both with and without shielding. For each approach, shielding efficacy was determined via the ratio of shielded to unshielded doses. Operator exposure was reduced by 78% for radial access with a mobile lead wall compared to femoral access (0.009 μSv/mGy vs 0.041 μSv/mGy, p=0.03). However, there was no significant difference in radiation exposure for the scrub technologist (0.032 μSv/mGy vs 0.023 μSv/mGy, p=0.42). Phantom data revealed an average dose reduction of 99% for shielded radial cases with the addition of a mobile lead wall, versus 53% for femoral cases utilizing standard shielding. Radial artery access allows the placement of a mobile lead wall between the operator and patient, which can substantially reduce operator exposure compared to femoral access. Interventional radiologists should consider the benefits of radial access to both patients and staff when appropriate.