3D printed robotic tooling for fluoroscopy-guided vascular access: emerging implications for cardiology practice

Background/Introduction Interventional cardiologists are exposed to occupational radiation during fluoroscopy-guided procedures, because the hands are closest to the radiation source they receive the highest exposure, with the eyes being the second most exposed due to their proximity. Conventional protective measures such as lead aprons, thyroid shields, and optimised beam positioning offer partial mitigation, yet maintaining adequate working distance from the x-ray source during hands-on needle and guidewire work remains physically impractical without robotic assistance. A robotic mechanism incorporating a 3D printed needle and guidewire insertion tool has been designed to overcome this limitation. Purpose To quantify a radiation efficiency paradox in femoral arterial access, where fluoroscopy time increases modestly but operator dose rate falls, and to propose dose-per-minute metrics that better reflect staff risk. Methods Twelve fluoroscopy guided femoral arterial punctures were performed in a controlled swine model by one experienced operator, six using conventional workflow and six using a robotic 3D printed needle and guidewire platform. Per-procedure dose (mSv) was recorded at seven operator sites (fingers, wrist, eyes, left and right arms, left and right legs) using active personal dosimeters. Fluoroscopy time, access success, access-site events, and navigating hand distance from the radiation source were recorded. Radiation efficiency endpoints were derived: (1) cumulative multi-site dose per minute of fluoroscopy and (2) combined hand dose per minute (fingers plus wrist). Results Fluoroscopy time increased from 5.166 ± 1.169 to 6.511 ± 1.751 min with the platform, while navigating hand distance increased from 5 ± 1.029 to 250 ± 0.453 mm. Dose decreased significantly at every monitored site (all p ≤ 0.021). Finger and wrist doses fell from 1.071 ± 0.192 to 0.213 ± 0.052 mSv and from 0.726 ± 0.174 to 0.142 ± 0.070 mSv, respectively (both p < 0.001).When normalised to time, cumulative multi-site dose rate fell from 0.483 to 0.112 mSv/min, a 76.9% reduction, and combined hand dose rate fell from 0.348 to 0.055 mSv/min, an 84.3% reduction. Access success was 6/6 in both conditions with low, comparable complication counts. Conclusion In fluoroscopy guided femoral access, longer fluoroscopy time can coexist with markedly lower occupational exposure intensity when procedure geometry shifts the operator away from the scatter field. Including dose-per-minute metrics, especially for hand exposure, in addition to total dose and fluoroscopy time could enable clearer comparisons between devices and techniques and support more effective strategies to reduce occupational risk.3D Printed robotic platform