Chapter 3: Radiation Exposure and Protection: The Radial Approach

Radial cardiac catheterization and intervention has been increasing steadily worldwide due to its unique advantages associated with lower bleeding complications, decreased mortality in STEMI, lower cost, and overall greater patient satisfaction and preferences. Nonetheless, it appears that the transradial approach (TRA) may be associated with slight but demonstrable increase in radiation exposure for the patient and the operator when compared to the transfemoral approach (TFA). Perceived increase in radiation exposure associated with TRA has subsequently been proposed as one of the reasons for its slower adoption in the United States.

Femoral Versus Radial Approach

Great interest and research has been devoted to the differences in radial exposures between TRA and TFA. There is considerable heterogeneity in the studies, primarily due to a combination of numerous randomized and observational reports. Prior to the performance of a large prospective randomized trial (RIVAL), the majority of older studies demonstrated an increase in radiation with TRA with the minority showing similar or even lower doses.

Mladen I. Vidovich, MD, FACC, FSCAI