Which Access Method Leads to Less Radiation Exposure for Patients?

Transradial access and transfemoral access led to similar levels of patient radiation exposure during transarterial yttrium-90 (Y-90) radioembolization (TARE), researchers found.

Selective internal radiation therapy for hepatocellular carcinoma and other hepatic tumors has the potential to expose patients to significant amounts of radiation. The use of transradial access has increased in recent years, so the study’s authors decided to compare differences in patient radiation exposure between the two access options.

The study was conducted retrospectively and matched patients by using baseline factors that could affect whether an operator chooses a particular access site, such as age, weight, and number of previous procedures from the same and opposite approach. After matching, there were 2 groups in the study, each with 302 patients (604 total) who underwent consecutive TARE procedures during a period of 4 years and did not have differences in any procedure performed before the surgery.

There were no differences between the matched transradial and transfemoral groups in median fluoroscopy time (effect size, 0.068), median dose-area product (effect size, 0.054), or median air kerma (effect size, 0.110).

“The present study found that the transradial access approach was not associated with any differences in of patient radiation exposure measures compared with the transfemoral access approach,” the authors stated. They noted that their findings differ from those of Kis et al, who found greater patient exposure to radiation in patients who had transradial access, but are similar to those of other studies who found no differences in fluoroscopy time, air kerma, or dose-area product between transradial access and transfemoral access in other noncoronary interventions.

Regarding the current results, they commented, “Effect sizes render even minor differences of limited practical concern. Transradial access is similar to transfemoral access for TARE regarding patient radiation exposure, but methods to reduce overall patient radiation exposure in these procedures should be further investigated.” 

Reference

Loewenstern J, Welch C, Lekperic S, et al. Patient radiation exposure in transradial versus transfemoral yttrium-90 radioembolization: a retrospective propensity score-matched analysis. J Vasc Interv Radiol. 2018 May 9. pii: S1051-0443(18)30947-3. doi: 10.1016/j.jvir.2018.02.011. [Epub ahead of print].