Modifying fluoroscopic views reduces operator radiation exposure during coronary angioplasty

Abstract

Fluoroscopy is the major source of total radiation exposure during coronary angioplasty, with left anterior oblique views providing the highest dose. Modification of views is feasible and will result in significant reduction of operator radiation dose.

Identification of less-irradiating tube angulations in invasive cardiology

“…Tube angulation, likewise, considerably influences patient and operator radiation exposure in invasive cardiology (i.e., steep LAO tube angulations are most radiation intensive for the patient [5,17,24] and operator [24,25,28]). These data, however, cannot be considered representative.…”

“…Tube angulation influences patient (5,17) and occupational operator radiation exposure (24,25,28,29) to an extensive degree (i.e., left anterior oblique [LAO] projections are most radiation intensive). Such data reported to date, however, cover only a small number of selected angulations favored by individual operators in experimental approaches or in clinical routine.…”

“…Such mapping, not previously described, would represent an effective tool for identification of angiographic projections that promise a significant reduction of radiation exposure in clinical routine to patients and staff. Our secondary objective was to investigate the conflict of interest, arising from the fact that the operator's scatter radiation dose does not vary as a strict function of the change in patient DAP owing to tube angulation (22,26,28).…”

Fundamentals of x‐ray imaging and radiation safety

“…Remember that the nearer one is to the X-ray tube and the tablepatient interface, the more likely for exposure to X-ray scatter. For instance, in a cranial LAO view, where the operator is near the X-ray tube, 2.6 to 6 times the exposure may occur compared to a caudal RAO view where the tube is on the other side of the table [8]. Barriers such as shields, lead aprons, thyroid collars, and eye protection glasses are all very effective in reducing total X-ray exposure.…”

“…X-ray scatter is reduced by keeping the exposure time as short as possible. While a minute of fluoroscopic radiation may result in 1/10 or so of the exposure that occurs during a minute of cineangiography, during a routine interventional catheterization the operator may receive up to sixfold greater radiation exposure from fluoroscopy than from the brief cine runs [8]. Radiation scatter also attenuates based on the inverse square law (1/d 2 ), so that distance becomes a major issue in reducing occupational radiation exposure.…”