Operator radiation dose during procedure. The RADIANT Trial, A Sciahbasi

1. Operator radiation dose during
percutaneous coronary procedures:
the RADIANT study
Sciahbasi A, MD, PhD,
Rigattieri S, Sarandrea A, Cera M, Di Russo C, Fedele S, Patrizi R, Romano S, Pugliese
FR, Penco M.

2. RADIANT study
I have no disclosures for my presentation
Disclosures

3. Roguin et al. Am J Cardiol 2013; 111: 1368-1372
Ciraj-Bjelac et al. CCI 2010; 76: 826-834
Introduction
RADIANT study

4. Brasselet et al. Eur Heart J 2008;29:63-70
Introduction
RADIANT study

5. Introduction
6
5
4
3
2
1
Operatorexposure(mRem)
Femoral Left
Radial
Right
Radial
Femoral vs right, p= 0.78
Femoral vs left, p= 0.001
Left vs right, p= 0.0001
2
3
3
Pancholy et al. JACC Interv 2015
24 trial included but…
Only 4 studies evaluated operator dose!!
RADIANT study

6. Aim of the study
Observational prospective study aimed
to evaluate the radiation dose absorbed
by operators during interventional
coronary procedures performed through
different vascular accesses (right or left
transradial approach or transfemoral
approach) in a center with high
experience in transradial access.
RADIANT study

7. Methods
All the procedures (diagnostic or interventional) were
included and performed by 4 different expert
operators and 2 fellows
Exclusion criteria: Haemodinamic instability
RADIANT study

8. In the radial group 422 procedures (22%) were performed using
adjunctive anti-rx drapes placed at pelvic or arm level.
Results
RADIANT study
2028
procedures in
1508 patients
Radial
94%
Femoral
6%
(1897)
(131)
Right
radial
59%
Left
Radial
41%

9. Femoral Radial P
Patients (n) 90 1418
Procedures (n) 131 1897
Male Sex 61 (68) 996 (70) 0.758
Age (years) 67 ± 11 67 ± 12 0.742
Height (cm) 166 ± 9 168 ± 9 0.040
Weight (Kg) 76 ± 16 78 ± 15 0.300
Body mass index 28 ± 5 28 ± 5 0.997
Smoking habitus 22 (24) 377 (27) 0.655
Hypertension 65 (72) 966 (68) 0.418
Diabetes 24 (27) 429 (30) 0.472
Dyslipidemia 30 (33) 456 (32) 0.817
Vascular disease 12 (13) 159 (11) 0.538
Previous infarction 26 (29) 360 (25) 0.461
Previous PCI 21 (23) 352 (25) 0.751
Previous CABG 17 (19) 52 (4) <0.001
AMI 50 (56) 601 (42) 0.014
Femoral Radial P
Patients (n) 90 1418
Procedures (n) 131 1897
Right radial access NA 1120
Coronarography 81 (62) 1251 (66) 0.337
PCI 50 (38) 646 (34) 0.337
Cine-acquisitions (Frames) 640 ± 295 586 ± 288 0.038
Projections (n) 11.5 ± 5.5 10.7 ± 5.7 0.130
Contrast dose (ml) 113 ± 70 104 ± 64 0.117
Fluoroscopy (sec) 204 (119-420) 204 (120-374) 0.898
DAP (Gy*cm2) 35 (22-56) 29 (18-48) 0.025
Clinical and procedural data
RADIANT study
22% of radial procedures were performed with adjuntive
protective drapes

10. Radial vs Femoral
RADIANT study

11. Femoral Radial P
Patients (n) 85 85
Procedures (n) 124 124
Male Sex 56 (66) 58 (68) 0.744
Age (years) 67 ± 11 68 ± 13 0.563
Height (cm) 166 ± 9 167 ± 9 0.561
Weight (Kg) 76 ± 15 76 ± 15 0.847
Body mass index 27 ± 5 27 ± 5 0.894
Smoking habitus 22 (26) 22 (26) 1
Hypertension 60 (71) 50 (59) 0.109
Diabetes 23 (27) 25 (29) 0.733
Dyslipidemia 28 (33) 18 (21) 0.084
Vascular disease 10 (12) 12 (14) 0.648
Previous infarction 22 (26) 26 (31) 0.496
Previous PCI 19 (22) 29 (34) 0.088
Previous CABG 15 (18) 152 (18) 1
AMI 48 (57) 52 (61) 0.533
Femoral Radial P
Patients (n) 85 85
Procedures (n) 124 124
Right radial access NA 74
Coronarography 77 (62) 77 (62) 1
PCI 47 (38) 47 (38) 1
Cine-acquisitions (Frames) 640 ± 299 581 ± 269 0.105
Projections (n) 11.4 ± 5.5 10.6 ± 4.7 0.238
Contrast dose (ml) 115 ± 71 117 ± 63 0.751
Fluoroscopy (sec) 198 (110-425) 252 (163-429) 0.062
DAP (Gy*cm2) 33 (21-55) 30 (17-55) 0.268
Propensity Groups
RADIANT study

12. Radial vs Femoral in propensity groups
RADIANT study

13. Right Radial Left Radial P
Patients (n) 834 584
Procedures (n) 1120 777
Male Sex 663 (72) 393 (67) 0.042
Age (years) 65 ± 12 70 ± 12 <0.0001
Height (cm) 169 ± 9 168 ± 9 0.006
Weight (Kg) 79 ± 15 77 ± 16 0.021
Body mass index 28 ± 5 27 ± 5 0.286
Smoking habitus 232 (624) 145 (25) 0.210
Hypertension 548 (66) 418 (72) 0.02
Diabetes 228 (27) 201 (34) 0.004
Dyslipidemia 248 (30) 208 (36) 0.020
Vascular disease 66 (8) 93 (16) <0.001
Previous infarction 191 (23) 169 (29) 0.01
Previous PCI 196 (24) 1562 (27) 0.168
Previous CABG 2 (0.2) 50 (9) <0.0001
AMI 338 (41) 263 (45) 0.091
Right Radial Left Radial P
Patients (n) 834 584
Procedures (n) 1120 777
Subclavian tortuosity (n) 209 (19) 50 (6) <0.0001
Coronarography 748 (67) 503 (65) 0.354
PCI 372 (33) 274 (35) 0.354
Cine-acquisitions (Frames)* 574 ± 285 602 ± 292 0.037
Projections (n)* 10.4 ± 5.6 11.1 ± 6 0.017
Contrast dose (ml)* 102 ± 61 108 ± 68 0.05
Fluoroscopy (sec) 198 (119-360) 214 (120-396) 0.262
DAP (Gy*cm2) 28 (17-46) 31 (18-50) 0.018
Radial Groups
RADIANT study

14. Right vs Left Radial
RADIANT study
13
10

15. Right vs Left Radial: propensity groups
RADIANT study
13
10

16. Operator doses
RADIANT study
Operator
Height:
1. 186 cm
2. 185 cm
3. 168 cm
4. 159 cm

17. RADIANT study
Operator doses: Left vs Right
Op 2: 185 cm
15
Op 1: 186 cm
8
Op 3: 168 cm
19
Op 4: 159 cm
34
=

18. Telini vs no telini
Adjunctive drapes
RADIANT study

19. Radial with drapes vs femoral
RADIANT study

20. Effect of tube angulation
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21. Effect of angiographic system
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4
*
36
*
*Radiologic system

22. Effect of angiographic system
RADIANT study
*Radiologic system
*

23. Radiation dose and procedure
RADIANT study

24. Conclusions
 In a high volume center for transradial procedures, the
femoral access is associated with lower operator
radiation dose compared to radial access.
 The use of dedicated anti-rx drapes and the left
radial access seem valuables tool to reduce the higher
operator radiation exposure associated with radial
access.
RADIANT study