Effective Reduction of Radiation Exposure during Cardiac Catheterization

Abstract

Exposure to ionizing radiation during cardiac catheterization can have harmful consequences for patients and for the medical staff involved in the procedures. Minimizing radiation doses during the procedures is essential. We investigated whether fine-tuning the radiation protocol reduces radiation doses in the cardiac catheterization laboratory. In January 2016, we implemented a new protocol with reduced radiation doses in the Hospital de Jerez catheterization laboratory. We analyzed 170 consecutive coronary interventional procedures (85 of which were performed after the new protocol was implemented) and the personal dosimeters of the interventional cardiologists who performed the procedures. Overall, the low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%–70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%–90.1%; P <0.001) during percutaneous coronary interventions. We also found that the annual deep (79%, P=0.026) and shallow (62.2%, P=0.035) radiation doses to which primary operators were exposed decreased significantly under the low-radiation protocol. These dose reductions were achieved without increasing the volume of contrast media, fluoroscopy time, or rates of procedural complications, and without reducing the productivity of the laboratory. Optimizing the radiation safety protocol effectively reduced radiation exposure in patients and operators during cardiac catheterization procedures.

Reduction of radiation exposure using low pulse rate fluoroscopy during neuroendovascular surgery

“…Among them, the fluoroscopic pulse rate is one of the factors that can be adjusted by the operator. 4–8 This is the first report to examine the clinical effects of a pulse rate of 4 f/s on radiation exposure and safety during neurovascular intervention. Our study suggests that using 4 f/s during the entire procedure for CAS can significantly reduce the radiation exposure while maintaining safety.…”

“…The deleterious effects of radiation exposure can be divided into two categories: deterministic and stochastic. 3,4,7 Deterministic effects, which have a threshold dose and are characterized by the dose-related increase in severity, can be evaluated by AK. 7 , 15–18 Stochastic effects that have no threshold dose and correlate linearly with the amount of exposure can be evaluated by means of DAP.…”

“…3,4,7 Deterministic effects, which have a threshold dose and are characterized by the dose-related increase in severity, can be evaluated by AK. 7 , 15–18 Stochastic effects that have no threshold dose and correlate linearly with the amount of exposure can be evaluated by means of DAP. 4 , 7 , 15 In this study, the magnitude of AK reduction was 51.1% for patients who underwent CAS using a pulse rate of 4 f/s compared with 7.5 f/s.…”

“…7 , 15–18 Stochastic effects that have no threshold dose and correlate linearly with the amount of exposure can be evaluated by means of DAP. 4 , 7 , 15 In this study, the magnitude of AK reduction was 51.1% for patients who underwent CAS using a pulse rate of 4 f/s compared with 7.5 f/s. DAP reduction effects using 4 f/s were also effective (52.6%).…”

“…1–4 There are several factors involved in radiation exposure and the pulse rate can be adjusted by the operator. 4–8 There is no report assessing whether radiation exposure can be reduced by using a low pulse rate during carotid artery stenting (CAS). The aim of this study was to evaluate whether reducing the pulse rate from 7.5 to 4 frames per second (f/s) can reduce radiation exposure while maintaining safety in CAS.…”