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Radiation dose reduction in the cardiac catheterization laboratory utilizing a novel protocol
Anthony W A Wassef1, Brett Hiebert1, Amir Ravandi1
1Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
A novel radiation reduction protocol (RRP) significantly decreased radiation dose during cardiac procedures by 48%. This system, particularly effective at lower frame rates, offers substantial dose reduction for interventional cardiology practice.
Area of Science:
- Cardiology
- Medical Imaging
- Radiation Safety
Background:
- Cardiac catheterization laboratories are significant sources of radiation exposure.
- Effective dose reduction and monitoring are crucial in these environments.
- Implementing new protocols is essential for patient and staff safety.
Purpose of the Study:
- To evaluate the effectiveness of a novel radiation reduction protocol (RRP) for coronary angiography and interventions.
- To identify determinants of radiation dose in these procedures.
- To quantify radiation dose reduction achieved by the RRP.
Main Methods:
- A prospective study analyzing diagnostic coronary angiograms and percutaneous coronary interventions before and after RRP implementation.
- Radiation dose was measured at the interventional reference point.
- Analyses were conducted for conventional 15 frames/s (FPS) and reduced 7.5 FPS settings.
Main Results:
- The RRP achieved a 48% overall dose reduction (0.56 ± 0.03 Gy post-RRP vs. 1.07 ± 0.05 Gy pre-RRP).
- Reduced frame rates (7.5 FPS) yielded higher dose reductions (62%) compared to 15 FPS (35%).
- Factors like male sex, radial approach, BMI, cine runs, and frame rates were associated with increased dose.
Conclusions:
- A novel RRP significantly reduces radiation dose by 48.5% in interventional cardiology.
- The RRP, especially at reduced frame rates, is a valuable tool for minimizing radiation exposure.
- This protocol warrants strong consideration for adoption in routine interventional cardiology practice.
Objectives:
This study reports the results a novel radiation reduction protocol (RRP) system for coronary angiography and interventional procedures and the determinants of radiation dose.
Background:
The cardiac catheterization laboratory is an important source of radiation and should be kept in good working order with dose-reduction and monitoring capabilities.
Methods:
All diagnostic coronary angiograms and percutaneous coronary interventions from a single catheterization laboratory were analyzed 2 months before and after RRP implementation. The primary outcome was the relative dose reduction at the interventional reference point. Separate analyses were done for conventional 15 frames/s (FPS) and at reduced 7.5 FPS post-RRP groups.
Results:
A total of 605 patients underwent coronary angiography (309 before RRP and 296 after RRP), with 129 (42%) and 122 (41%) undergoing percutaneous coronary interventions before and after RRP, respectively. With RRP, a 48% dose reduction (1.07 ± 0.05 Gy vs. 0.56 ± 0.03 Gy, p < 0.0001) was obtained, 35% with 15 FPS RRP (0.70 ± 0.05 Gy, p < 0.0001) and 62% with 7.5 FPS RRP (0.41 ± 0.03 Gy, p < 0.001). Similar dose reductions for diagnostic angiograms and percutaneous coronary interventions were noted. There was no change in the number of stents placed or vessels intervened on. Increased dose was associated with male sex, radial approach, increasing body mass index, cine runs, and frame rates. Using a multivariable model, a 48% relative risk with RRP (p < 0.001), 44% with 15 FPS RRP and 68% with 7.5 FPS RRP was obtained.
Conclusions:
We demonstrate a highly significant 48.5% adjusted radiation dose reduction using a novel algorithm, which needs strong consideration among interventional cardiology practice.
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