Patient Radiation Exposure in Transradial versus Transfemoral Yttrium-90 Radioembolization: A Retrospective Propensity Score–Matched Analysis

Purpose: To compare differences in patient radiation exposure (PRE) during transarterial yttrium-90 (⁹⁰Y) radioembolization (TARE) between transradial access (TRA) and transfemoral access (TFA). Materials and Methods: A total of 810 consecutive first-time TARE procedures in patients from 2013 to 2017 were retrospectively reviewed. A propensity score–matching (PSM) analysis matched TRA and TFA groups on the basis of patient age, sex, weight, height, cancer type, ⁹⁰Y microsphere type, and number of previous procedures from the same and opposite approaches. Matched groups were then compared by PRE measures fluoroscopy time (FT), dose-area product (DAP), and cumulative air kerma (AK). Effect size for each PRE measure was calculated. Results: Before PSM, TRA and TFA groups differed significantly in mean age, weight, and number of previous procedures from the same and opposite approach (all P <.05). After PSM, each group consisted of 302 procedures (overall, n = 604) and no longer differed in any procedure performed before surgery measure. TRA did not differ from the matched TFA group regarding median FT (9.50 vs 9.40 minutes, P =.095), median DAP (67,066 vs 67,219 mGy·cm²; P =.19), or median AK (323.63 vs 248.46 mGy; P =.16). Effect sizes were 0.068, 0.054, and 0.110 for FT, DAP, and AK, respectively. Conclusions: No statistical differences were found for PRE measures between the matched TRA and TFA approach groups. Furthermore, practical effect sizes were considered to be small for AK and less than small for FT and DAP, and therefore, any differences in PRE between the radial and femoral approaches for TARE are minor and unlikely to be noticeable in everyday clinical practice.