Modifying fluoroscopic views reduces operator radiation exposure during coronary angioplasty

Area of Science:

• Interventional Cardiology
• Medical Physics
• Radiation Safety

Background:

• Increasing caseloads and complexity in coronary angioplasty lead to higher radiation scatter doses for cardiologists.
• Developing techniques to reduce operator radiation exposure is crucial for interventional cardiology practice.

Purpose of the Study:

• To assess the feasibility of reducing operator radiation exposure during coronary angioplasty.
• To identify key factors contributing to operator radiation dose and evaluate methods for reduction.

Main Methods:

• Assessed determinants of operator dose by measuring scatter dose with different camera views.
• Quantified the relative contribution of fluoroscopy versus cine imaging to radiation exposure.
• Provided feedback on radiation dose data to operators and evaluated subsequent technique modifications.

Main Results:

• Left anterior oblique (LAO) views significantly increased operator dose compared to right anterior oblique (RAO) views.
• Steepness of LAO views directly correlated with increased operator dose.
• Fluoroscopy accounted for the majority of radiation exposure (6.3:1 ratio over cine).
• Post-feedback, LAO fluoroscopy use decreased significantly (40% to 5% for LAD/Circ, angle reduced for RCA).
• Average operator radiation dose reduced from 32.6 to 14.3 microSv/operator/week.
• Procedure success rates and screening times remained unchanged.

Conclusions:

• Fluoroscopy is the primary source of radiation exposure during coronary angioplasty.
• Left anterior oblique views are associated with the highest radiation doses for operators.
• Modifying fluoroscopic views is a feasible strategy for significantly reducing operator radiation dose without compromising patient outcomes.