Measures to Reduce Radiation in a Modern Cardiac Catheterization Laboratory

Abstract

Background— X-ray use in the catheterization laboratory is guided by the principle of as low as reasonably achievable . In accordance with this principle, we reduced the default fluoroscopic frame rate from 10 to 7.5 frames/s and increased the emphasis on the use of low-dose acquisition starting January 1, 2013. We aimed to study the impact of these measures on the total air kerma during diagnostic catheterization (DC) and percutaneous interventions (PCI). Methods and Results— Propensity matching based on age, sex, body surface area, total fluoroscopy time, and total acquisition time was used to select matched patients for 2012 and 2013, further stratified by DC or PCI. The total air kerma was subsequently compared between 2012 and 2013, separately for DC and PCI. Median total air kerma during DC in 2013 was 625 mGy, which was significantly lower than the corresponding values in 2012 (median, 798 mGy; P <0.001). Similarly, median total air kerma during PCI in 2013 was 1675 mGy, which was significantly less than corresponding values in 2012 (median 2463 mGy, P <0.001). On comparison of air kerma rates between corresponding projections in 2 years, we observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates in 2013, after institution of radiation reduction measures in all projections. Conclusions— With reduction in the default fluoroscopic frame rate and a greater use of low-dose acquisition, there has been a marked reduction in the total air kerma and air kerma rates for DC and PCI.

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

“…Increasing the distance from the direct or scatter x-ray source is one of the most effective means to reduce the exposure dose: even a distance of a few centimetres away from the x-ray tube and the patient makes a substantial difference in the dose received by the operator [8,14]. Power injectors or extension manifolds enable operators to move further aside from the radiation source during contrast injection, and are a good investment in radiation safety when equipping contemporary cardiac catheterization laboratories.…”

Predictors of patient radiation exposure during transcatheter aortic valve replacement

“…Given that most of the factors predictive of greater patient radiation exposure during TAVR in our study include non‐modifiable patient and procedural characteristics, operators must rely on established radiation mitigation strategies recommended for all interventional procedures, focusing on time, distance, and shielding . As TAVR procedures continue to evolve, patient radiation exposure may be further reduced through the use of radiation‐free imaging modalities such as echocardiography and magnetic resonance imaging (MRI) .…”

Radiation dose reduction during neurointerventional procedures by modification of default settings on biplane angiography equipment

“…Fluoroscopy time and contrast use were similar. Another single-center study by Agarwal et al 19 examined radiation dose in patients undergoing elective left heart catheterization before and after changing the default fluoroscopic frame rate from 10 to 7.5 FPS, while keeping a CINE acquisition frame rate of 10 FPS. For diagnostic catheterization, median total X-ray dose was 625 vs 798 mGy (p<0.001) and for percutaneous coronary intervention 1675 vs 2463 mGy (p<0.001).…”