Effectiveness of Low Rate Fluoroscopy at Reducing Operator and Patient Radiation Dose During Transradial Coronary Angiography and Interventions

• DOI: 10.1016/j.jcin.2014.02.005
• Publication Date: 2014-04-16T20:03:32Z
• Authors: Eltigani Abdelaal; Guillaume Plourde; Jimmy MacHaalany; Jean Arsenault; Goran Rimac; Jean-Pierre Déry; Gérald Barbeau; Eric Larose; Robert De Laroche...; Can M. Nguyen; Ricardo Allende; Henrique Ribeiro; Olivier Costerousse; Rosaire Mongrain; Olivier F. Bertrand
• Keywords: Male; Cardiac Catheterization; Coronary Angiography; Radiation Dosage; Radiography, Interventional; 03 medical and health sciences; Percutaneous Coronary Intervention; Radiation Protection; 0302 clinical medicine; Radiation Monitoring; Risk Factors; Occupational Exposure; Humans; Radiation Injuries; Aged; dosimetry; percutaneous coronary intervention; Quebec; imaging; transradial; Dose-Response Relationship, Radiation; Middle Aged; Occupational Injuries; 3. Good health; radiation; Fluoroscopy; Radial Artery; Cineangiography; Cardiology and Cardiovascular Medicine

This study sought to determine the efficacy of low rate fluoroscopy at 7.5 frames/s (FPS) versus conventional 15 FPS for reduction of operator and patient radiation dose during diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) via the transradial approach (TRA).TRA for cardiac catheterization is potentially associated with increased radiation exposure. Low rate fluoroscopy has the potential to reduce radiation exposure.Patients undergoing TRA diagnostic angiography ± ad-hoc PCI were randomized to fluoroscopy at 7.5 FPS versus 15 FPS prior to the procedure. Both 7.5 and 15 FPS fluoroscopy protocols were configured with a fixed dose per pulse of 40 nGy. Primary endpoints were operator radiation dose (measured with dosimeter attached to the left side of the thyroid shield in μSievert [μSv]), patient radiation dose (expressed as dose-area product in Gy·cm(2)), and fluoroscopy time.From October 1, 2012 to August 30, 2013, from a total of 363 patients, 184 underwent DCA and 179 underwent PCI. Overall, fluoroscopy at 7.5 FPS compared with 15 FPS was associated with a significant reduction in operator dose (30% relative reduction [RR], p < 0.0001); and in patient's dose-area product (19% RR; p = 0.022). When stratified by procedure type, 7.5 FPS compared with 15 FPS was associated with significant reduction in operator dose during both DCA (40% RR; p < 0.0001) and PCI (28% RR; p = 0.0011). Fluoroscopy at 7.5 FPS, compared with 15 FPS, was also associated with substantial reduction in patients' dose-area product during DCA (26% RR; p = 0.0018) and during PCI (19% RR; p = 0.13). Fluoroscopy time was similar in 7.5 FPS and 15 FPS groups for DCA (3.4 ± 2.0 min vs. 4.0 ± 4.7 min; p = 0.42) and PCI (11.9 ± 8.4 min vs. 13.3 ± 9.7 min; p = 0.57), respectively.Fluoroscopy at 7.5 FPS, compared with 15 FPS, is a simple and effective method in reducing operator and patient radiation dose during TRA DCA and PCI.