Casazza Richard, Malik Bilal, Hashmi Arsalan, Fogel Joshua, Montagna Enrico, Frankel Robert, Borgen Elliot, Ayzenberg Sergey, Friedman Michael, Moskovits Norbert, Verma Shivani, Meng Jamie, Chang Nailun, Huang Yili, Rodriguez Carlos, Chera Habib Hymie, Raj Shiv, Chaterjee Saurav, Gibson Daren, Palacios Andres, Agarwal Chirag, Nene Maria Victoria, Shani Jacob
Department of Cardiology, Maimonides Medical Center, Brooklyn, NY (R.C., B.M., A.H., E.M., R.F., E.B., S.A., M.F., N.M., S.V., J.M., N.C., Y.H., C.R., H.H.C., S.R., S.C., D.G., A.P., C.A., M.V.N., J.S.).
Department of Management, Marketing, and Entrepreneurship, Brooklyn College, Brooklyn, NY (J.F.).
Circ Cardiovasc Interv. 2025 Apr;18(4):e014602. doi: 10.1161/CIRCINTERVENTIONS.124.014602. Epub 2025 Mar 19.
Radiation exposure is one of the most adverse occupational hazards faced by interventional cardiologists. Various arterial access sites have shown to yield different operator radiation exposure during diagnostic cardiac catheterization.
This single-center randomized controlled trial assessed the cumulative radiation exposure and normalized radiation exposure at 4 different anatomic locations (thorax, abdomen, left eye, and right eye) of the primary operator when using the left radial artery (LRA) approach compared with a uniform hyper-adducted right radial artery (HARRA) approach. Patients (n=534) were randomized to LRA (n=269) or HARRA (n=265). During diagnostic catheterization, real-time radiation dosimeters were placed on the thorax, abdomen, left eye, and right eye of each operator.
Cumulative radiation measurements were as follows: thorax (LRA, 9.66±8.57 microsieverts [μSv] versus HARRA, 12.27±7.09 μSv; <0.001); abdomen (LRA, 27.46±21.20 μSv versus HARRA, 36.56±23.72 μSv; <0.001); left eye (LRA, 2.65±2.59 μSv versus HARRA, 3.77±2.67 μSv; <0.001); and right eye (LRA, 1.13±1.69 μSv versus HARRA, 1.44±1.62 μSv; =0.01). Normalized radiation measurements were: thorax (LRA, 0.38±0.35 versus HARRA, 0.49±0.24; <0.001); abdomen (LRA, 1.06±0.72 versus HARRA, 1.38±0.69; <0.001); left eye (LRA, 0.10±0.09 versus HARRA, 0.15±0.10; <0.001); and right eye: (LRA, 0.04±0.06 versus HARRA, 0.05±0.06; =0.02). LRA had lower subclavian tortuosity than HARRA (15.6% versus 32.5%, <0.001).
The LRA was associated with significantly less cumulative and normalized radiation exposure to the thorax, abdomen, left eye, and right eye of the primary operator compared with HARRA during diagnostic cardiac catheterization. Operators should consider using LRA more frequently than HARRA for diagnostic cardiac catheterization as this approach can reduce occupational radiation exposure.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT05833516.
辐射暴露是介入心脏病专家面临的最不利的职业危害之一。在诊断性心导管插入术中，不同的动脉穿刺部位已显示出会使术者受到不同程度的辐射暴露。
这项单中心随机对照试验评估了与统一的超内收右桡动脉（HARRA）入路相比，使用左桡动脉（LRA）入路时术者在4个不同解剖位置（胸部、腹部、左眼和右眼）的累积辐射暴露和标准化辐射暴露。患者（n = 534）被随机分为LRA组（n = 269）或HARRA组（n = 265）。在诊断性导管插入术期间，将实时辐射剂量计放置在每位术者的胸部、腹部、左眼和右眼上。
累积辐射测量结果如下：胸部（LRA组，9.66±8.57微西弗[μSv] 对比HARRA组，12.27±7.09 μSv；<0.001）；腹部（LRA组，27.46±21.20 μSv对比HARRA组，36.56±23.72 μSv；<0.001）；左眼（LRA组，2.65±2.59 μSv对比HARRA组，3.77±2.67 μSv；<0.001）；右眼（LRA组, 1.13±1.69 μSv对比HARRA组，1.44±……此处原文有误，应为1.62 μSv；P = 0.01）。标准化辐射测量结果为：胸部（LRA组，0.38±0.35对比HARRA组，0.49±0.24；<0.001）；腹部（LRA组，1.06±0.72对比HARRA组，1.38±0.69；<0.001）；左眼（LRA组，0.10±0.09对比HARRA组，0.15±0.10；<0.001）；右眼：（LRA组，0.04±0.06对比HARRA组，0.05±0.06；P = 0.02）。LRA组的锁骨下迂曲程度低于HARRA组（15.6% 对比32.5%，<0.001）。
在诊断性心导管插入术中，与HARRA相比，LRA使术者胸部、腹部、左眼和右眼的累积辐射暴露和标准化辐射暴露显著减少。术者在诊断性心导管插入术中应考虑比HARRA更频繁地使用LRA，因为这种方法可以减少职业辐射暴露。
网址：https://www.clinicaltrials.gov；唯一标识符：NCT05833516 。 （注：原文中“右眼（LRA, 1.13±1.69 μSv versus HARRA, 1.44±1.62 μSv; =0.01）”中“1.44±1.62 μSv”后面的分号及等号表述有误，推测原文可能是“1.44±1.62 μSv; P = 0.01”，翻译时按此理解进行了修正）
