Facing radiation exposure during heart procedures? It's a serious concern for interventional cardiologists, but a new study has some surprising news. The DOSE trial, a recent multicenter study, has revealed that using left distal radial access (DRA) doesn't necessarily offer operators any radiation protection compared to the standard right transradial access (TRA). But here's where it gets controversial...
Published on October 25, 2025, this research from the TCT WorldLink Forum provides crucial insights into how we approach coronary procedures. The study, led by Yongcheol Kim, MD, PhD, highlights that while left DRA has emerged as a potentially more comfortable option for operators, reducing physical strain and simplifying catheter techniques, it doesn't translate into reduced radiation exposure.
This echoes the findings of the earlier DRAMI trial, which also didn't find radiation benefits with left DRA in STEMI patients. James Goldstein, MD, summed it up perfectly: “I love it when trials make sense.” He pointed out that the positioning of the wrists during the procedures is similar, thus the radiation exposure would also be similar.
The DOSE trial, led by Oh-Hyun Lee, MD, and Ji Woong Roh, MD, PhD, is the first major randomized study to evaluate radiation exposure with left DRA. Previous research had suggested that left TRA might offer less radiation exposure than right TRA.
So, what did the study involve? The researchers examined 1,010 patients undergoing coronary procedures at three centers in South Korea. They meticulously measured radiation exposure using dosimeters at the left wrist, head, and chest of the operators. All operators used standard radiation protection gear.
The study found that the radiation levels were similar regardless of the access route.
- Left DRA: Median Radiation Exposure: Left Wrist: 4.76 μSv, Head: 2.00 μSv, Chest: 1.28 μSv
- Right TRA: Median Radiation Exposure: Left Wrist: 5.20 μSv, Head: 1.83 μSv, Chest: 1.07 μSv
There were no differences in access-site crossover, fluoroscopy time, procedure time, or contrast volume between the two approaches.
What does this mean for the future? The researchers conclude that the radiation hazard shouldn't be a limiting factor in adopting left DRA. Goldstein added that both access routes were equally successful. But here is the part most people miss... As radiation protection gear improves, these concerns may become less relevant. Goldstein also emphasized the importance of newer products, which go beyond lower radiation exposure, including avoiding the orthopedic complications associated with traditional protective clothing.
What are your thoughts? Do you think the benefits of left DRA outweigh the lack of radiation reduction? Share your opinions in the comments below!
