Operator Radiation Dose Comparing Left Radial Artery and Right Radial Artery Approaches Among Patients With Subclavian Tortuosity

Operator radiation exposure (ORE) is one of the most adverse occupational hazards faced by interventional cardiologists. The presence of subclavian tortuosity can influence ORE. This single-center retrospective study compared the cumulative radiation (CR) exposure in μSv and normalized radiation exposure (CR/DAP) of the primary operator during cardiac catheterization of all patients with subclavian tortuosity from left (LRA) and right radial artery approaches (RRA). ORE was measured at 4 anatomical locations: thorax, abdomen, left eye, and right eye. CR dose was significantly higher in the RRA group than in the LRA group at the left eye (P = .004), right eye (P = .01), thorax (P = .01) and abdomen (P = .01). CR/DAP dose was significantly higher in the RRA group than in the LRA group at the left eye (P = .04) and right eye (P = .03). In cases with subclavian tortuosity, the LRA was associated with less CR to the operator than the RRA. The LRA was also associated with less CR/DAP that persisted at the anatomical location of the left eye. The authors recommend operators have time thresholds to exchange for appropriate catheters in patients with subclavian tortuosity. Furthermore, operators should consider time thresholds to change access sites to avoid potential procedural complications and excessive fluoroscopic times.