Strategies for radiation exposure-sparing in fluoroscopically guided invasive cardiovascular procedures

Minimizing radiation exposure during x-ray fluoroscopically guided procedures is critical to patients and to medical personnel. Tableside adjustment of x-ray image acquisition parameters can vary the fluoroscopic radiation exposure rate.

To determine the impact of adjusting four tableside controllable image acquisition parameters on x-ray fluoroscopic radiation exposure rate.

We made fluoroscopic exposures of a standard radiologic phantom to measure radiation exposure rates as kerma•area product per second of exposure and milligray per x-ray pulse under all possible combinations of detector zoom mode, collimated image field size, fluoroscopy dose mode, and fluoroscopy pulse frequency.

Kerma•area product per second was linearly proportional to pulse frequency. Selecting larger detector zoom modes, smaller collimated image field sizes and low dose fluoroscopy mode each decreased exposure rate. We found a > 20-fold variation in dose rates over the range of acquisition parameter combinations.

Selecting the most appropriate fluoroscopy acquisition parameters enables physician operators to adjust radiation exposure rates over a large range. Judicious selection of acquisition parameters can reduce patient and medical personnel radiation exposure by as much as 95% compared to "standard" fluoroscopy protocol settings.