Distal transradial approach (dTRA) is safe and effective for coronary angiography and PCI. However, its impact on radiation exposure in the catheterization laboratory has not been characterized. We performed a systematic review and meta-analysis of the scientific literature by searching the PubMed, Embase, and Cochrane Library databases with relevant terms until October 13, 2022. Randomized controlled trials (RCTs) comparing dTRA and traditional radial approach (TRA) were selected. The primary outcome was radiation exposure (fluoroscopy time, air kerma, or kerma dose product). The standard mean difference (SMD) and its 95% confidence interval [95% CI] were used for continuous variables analysis. A random effect and meta-regression were used for analyses. Of the 484 studies identified, we obtained data from 7 RCTs with a total of 3427 patients (1712 in dTRA group and 1715 in TRA). There was no difference in radiation exposure regarding fluoroscopy time and air kerma between the two groups. The overall estimate favored lower kerma area product in the TRA (figure). Meta-regression showed no correlation between fluoroscopy time and the year of publication (p=0.82). dTRA was associated with an increase in kerma area product, but no differences in fluoroscopy time and air kerma compared to TRA.