1) The study compared radiation exposure as measured by fluoroscopy time and dose-area product between different catheter techniques for diagnostic coronary angiograms performed via the transradial approach. 2) Using a multi-catheter technique with both left and right Judkins catheters resulted in lower radiation exposure than using single catheter techniques like the Amplatz left catheter, Barbeau catheter, or multipurpose catheter. 3) The findings suggest that a multi-catheter technique may reduce radiation exposure for patients compared to single catheter techniques when performing diagnostic coronary angiography.

1. Multi- or Single-Catheter in Diagnostic
Coronary Angiogram?
Effect on Patient’s Radiation Exposure
Guillaume Plourde
M.D./M.Sc. student, Université Laval
Research intern in Dr O.F. Bertrand’s team
AimRADIAL2013

2. Disclosures
• No conflicts of interest to disclose.

3. Background
• With transradial approach (TRA),
diagnostic coronary angiogram (DCA) is
usually performed with routines using
single- or multi-catheters.
• Is there a difference in radiation exposure?

4. Objective
• To compare fluoroscopy time (FT) and
dose-area-product (DAP) during TRA DCA
using 4 different routines:
• Routine #1 - Judkins L/R
• Routine #2 - Amplatz L
• Routine #3 - Barbeau
• Routine #4 - Multipurpose
All patients had an
LV angiogram with a
Pigtail, a Barbeau or a
Multipurpose
catheter
*Catheters are from Cordis Corporation, Miami Lakes, USA

5. Study population
• All patients who underwent an elective
DCA between Nov. 2012 and July 2013
•
•
•
•
•
1,384 patients (100% TRA)
All had an LV angiogram
No PCI, no graft study
Radiation data available
Intent-to-treat analysis

6. Factors influencing radiation exposure
Patient characteristics
- Weight
- Height
- Gender
- Age
Radiation delivering/
measuring systems
- Rooms
(4 different rooms at our hospital)
Operators
Catheters
- 14 different operators (including fellows)
- Catheter routine
(JL/JR vs. AL vs. Barbeau vs. Multipurpose)
- Catheter technique
(Single- vs. Multi-catheters)

7. Factors influencing radiation exposure
Patient characteristics
- Weight
- Height
- Gender
- Age
Radiation delivering/
measuring systems
- Rooms
(4 different rooms at our hospital)
Operators
Catheters
- 14 different operators (including fellows)
- Catheter routine
(JL/JR vs. AL vs. Barbeau vs. Multipurpose)
- Catheter technique
(Single- vs. Multi-catheters)

8. Baseline characteristics
All
n = 1,384
Routine #1
(JL/JR)
n = 1,193
Routine #2
(AL)
n = 56
Routine #3
(Barbeau)
n = 90
Routine #4
(Multipurpose)
n = 45
P value
Males, n (%)
935 (68)
794 (67)
32 (57)
84 (93)
25 (56)
< 0.0001
Age (years)
64 ± 11
64 ± 11
65 ± 12
63 ± 11
67 ± 91
0.2714
Weight (kg)
81 ± 18
81 ± 18
80 ± 19
85 ± 16
79 ± 15
0.1346
Height (cm)
168 ± 9
168 ± 9
166 ± 10
172 ± 8
166 ± 10
< 0.0001
BSA (m2)
1.95 ± 0.26
1.95 ± 0.26
1.93 ± 0.28
2.03 ± 0.23
1.92 ± 0.22
0.0293

9. Factors influencing radiation exposure
Patient characteristics
- Weight
- Height
- Gender
- Age
Radiation delivering/
measuring systems
- Rooms
(4 different rooms at our hospital)
Operators
Catheters
- 14 different operators (including fellows)
- Catheter routine
(JL/JR vs. AL vs. Barbeau vs. Multipurpose)
- Catheter technique
(Single- vs. Multi-catheters)

10. Radiation data
• Radiation exposure was assessed via dose-
area-product (Gy・cm2) and fluoroscopy time
• DAP values were either estimated by the Xray system or measured by a “Diamentor”
DAP-meter integrated to the collimator
• X-ray systems: Innova 2000 (GE) and Artis
dBc & dFc (Siemens)

11. Factors influencing radiation exposure
Patient characteristics
- Weight
- Height
- Gender
- Age
Radiation delivering/
measuring systems
- Rooms
(4 different rooms at our hospital)
Operators
Catheters
- 14 different operators (including fellows)
- Catheter routine
(JL/JR vs. AL vs. Barbeau vs. Multipurpose)
- Catheter technique
(Single- vs. Multi-catheters)

12. Operator effect on radiation exposure
2.6 min

13. Factors influencing radiation exposure
Patient characteristics
- Weight
- Height
- Gender
- Age
Radiation delivering/
measuring systems
- Rooms
(4 different rooms at our hospital)
Operators
Catheters
- 14 different operators (including fellows)
- Catheter routine
(JL/JR vs. AL vs. Barbeau vs. Multipurpose)
- Catheter technique
(Single- vs. Multi-catheters)

14. Catheter routine effect on
radiation exposure
All
n = 1,384
Routine #1
(JL/JR)
n = 1,193
Routine #2
(AL)
n = 56
Routine #3
(Barbeau)
n = 90
Routine #4
(Multipurpose)
n = 45
P value
Fluoroscopy
time
(min)
2.7 [2.0-3.9]
2.7 [2.0-3.9]
4.0 [3.0-5.7]
3.0 [2.2-4.2]
2.1 [1.6-2.5]
<0.0001
Dose-areaproduct
(cGy・cm2)
3,099
[2,128-4,408]
3,007
[2,061-4,363]
3,622
[2,592-4,866]
3,874
[2,694-5,503]
3,220
[2,338-4,251]
<0.0001
“Intended”
routine only
n (%)
1,208 (87)
1,070 (90)
44 (79)
51 (57)
44 (98)
0.0004
Crossovers
n (%)
175 (13)
123 (10)
12 (21)
39 (43)
1 (2)
0.0004

15. Catheter routine effect on
radiation exposure
All
n = 1,384
Routine #1
(JL/JR)
n = 1,193
Routine #2
(AL)
n = 56
Routine #3
(Barbeau)
n = 90
Routine #4
(Multipurpose)
n = 45
P value
Fluoroscopy
time
(min)
2.7 [2.0-3.9]
2.7 [2.0-3.9]
4.0 [3.0-5.7]
3.0 [2.2-4.2]
2.1 [1.6-2.5]
<0.0001
Dose-areaproduct
(cGy・cm2)
3,099
[2,128-4,408]
3,007
[2,061-4,363]
3,622
[2,592-4,866]
3,874
[2,694-5,503]
3,220
[2,338-4,251]
<0.0001
“Intended”
routine only
n (%)
1,208 (87)
1,070 (90)
44 (79)
51 (57)
44 (98)
0.0004
Crossovers
n (%)
175 (13)
123 (10)
12 (21)
39 (43)
1 (2)
0.0004

16. Catheter routine effect on
radiation exposure
Single-catheter technique
Single-catheter technique

17. Catheter technique effect on
radiation exposure
Routine #2: AL
Routine #3: Barbeau
Routine #4: Multipurpose
Routine #1: JL/JR
Routine #2: AL
Routine #3: Barbeau
Routine #4: Multipurpose
Routine #1: JL/JR

18. Conclusions
•
Multi-catheters technique (JL/JR) decreases
radiation exposure (both DAP and FT) when
compared to other single-catheter techniques (AL,
Barbeau, Multipurpose).
•
Further studies with new type of universal catheters
(Tiger...) should evaluate the radiation parameters