Radiation Exposure to Operators in Coronary Procedures Between Left Distal and Right Conventional Radial Access

Abstract

BACKGROUND Distal radial access (DRA) may improve vascular complications, patient comfort, and hemostasis time. DRA-associated operator radiation exposure data are limited. OBJECTIVES The aim of this study was to compare operator radiation exposure between left DRA and right transradial access (TRA). METHODS In this prospective, multicenter, open-label trial, 1,010 patients scheduled to undergo coronary procedures were randomly assigned in a 1:1 ratio to either the left DRA or right TRA group. The primary endpoint was operator radiation exposure, measured using a set of 3 real-time radiation detection dosimeters on the left wrist, head, and chest by 5 experienced DRA operators. The secondary endpoints included the incidence of access-site crossover, total fluoroscopy time, total procedure time, and total contrast volume used. RESULTS The primary endpoint analysis included 1,001 patients (501 in the left DRA group and 500 in the right TRA group). No significant differences were observed in operator radiation exposure to left wrist (4.76 mu Sv vs 5.20 mu Sv; P = 0.342), head (2.00 mu Sv vs 1.83 mu Sv; P = 0.416), and chest (1.28 mu Sv vs 1.07 mu Sv; P = 0.199) between the left DRA and right TRA groups. The incidence of crossover (6.6% vs 5.2%; P = 0.416), fluoroscopy time (4.5 minutes vs 4.2 minutes; P = 0.673), procedure time (16.0 minutes vs 15.0 minutes; P = 0.314), and contrast volume (80.0 mL vs 80.0 mL; P = 0.222) were not significantly different between the 2 groups. CONCLUSIONS During coronary procedures, no significant differences were observed in the operator radiation exposure at the left wrist, head, and chest between the left DRA and right TRA groups. (JACC Cardiovasc Interv. 2026;19:160-170) (c) 2026 by the American College of Cardiology Foundation.