Operator radiation dose during trans-hepatic arterial chemoembolization: different patients' positions via transradial or transfemoral access.

Abstract

PURPOSE This study aimed to compare the radiation dose received by the operator among different patients' positions via transradial access (TRA) or transfemoral access (TFA) during transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). METHODS A total of 120 patients with HCC undergoing TACE for the first time between January and November 2019 were randomized into 4 groups with 30 patients in each group. In group A, patients were placed in the foot-first position with the left upper arm abducted, and TACE was performed via the left radial artery. In group B, patients were placed in the conventional headfirst position with the left hand placed at the left groin, and TACE was performed via the left radial artery. In group C, patients were placed in the conventional head-first position, and TACE was performed via the right radial artery. In group D, patients were placed in the conventional head-first position, and TACE was performed via the right femoral artery. Before each procedure, thermoluminescent dosimeters were taped at 7 different body parts of the operator and the radiation dose was measured and collected after the procedure. The normalized radiation dose was also calculated. Procedural parameters included radiation dose, fluoroscopy time (FT), dose-area product (DAP), and air kerma (AK) were recorded. Patients' demographics, tumor baseline characteristics, radiation dose, and procedural parameters were compared between groups. RESULTS No significant differences were found in patients' demographics, tumor baseline characteristics, as well as in total FT, DAP, and AK. However, significant differences were found in the total radiation dose received by the operator and the doses on the pelvic cavity and the right wrist (P < .05). In group C, the radiation doses received on the pelvic cavity, the right wrist, and the total radiation doses were relatively higher. Significant differences were also found in the normalized radiation doses received by the operator on the thyroid, chest, left wrist, right wrist, and pelvic cavity, and the total normalized doses (all P < .05). Similarly, the radiation doses received by the operator at the aforementioned parts in group C were higher, while those in group A were lower. CONCLUSION No statistically significant differences were observed in the FT, DAP, and AK in TACE via TRA when patients were placed in different positions. However, TACE via the left TRA, with patients in the feet-first position, reduced the radiation dose received by the operator, thereby reducing the radiation risk.