Radiation dose to nurses, cardiologists, and patients during coronary angiography: a comparison of femoral and radial access.

Background – Exposure to radiation during fluoroscopically guided cardiac procedures is a cause for concern for both the patient and staff. Aims – This study sought to compare the occupational and patient radiation dose during femoral and radially accessed invasive coronary angiography. Methods – Occupational dose (microSievert) was measured at the left temple of the cardiologist (n=17), scrub (n=27) and circulator nurse (n=27) during 761 femoral and 671 radially accessed diagnostic coronary angiograms and percutaneous coronary intervention (PCI) procedures. Patient dose parameters of dose area product (DAP)(Gy.cm2) and air kerma (AK)(Gy) were also measured. Results - Coronary angiography performed via the radial artery is associated with greater mean dose to the cardiologist, with the exception of procedures including only PCI. Results demonstrated that scrub nurses are exposed to higher mean doses than the cardiologist when using femoral access and similar doses during radial cases. Both AK and DAP were associated with a higher average dose for femoral PCI than radial, with DAP being significantly higher. Conclusions – Awareness of factors that increase the dose to staff and patients is vital to inform and improve practice. This study has demonstrated that access route during diagnostic coronary angiography and PCI influences both patient and staff dose. Radiation dose to in-room staff other than the fluoroscopic operator should be a focus of future research. In addition, all staff present during x-ray guided procedures should be provided with radiation education and adopt dose minimisation strategies to reduce occupational exposures.