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Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates
Author(s) -
Werner Gerald S.,
Glaser Peggy,
Coenen Anja,
Moehlis Hiller,
Tischer KarlHeinz,
Koch Matthias,
Klingenbeck Reinhold
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26886
Subject(s) - medicine , fluoroscopy , kerma , percutaneous coronary intervention , conventional pci , dose area product , radiation exposure , nuclear medicine , cohort , radiation protection , radiology , dosimetry , myocardial infarction
Background The increasing complexity of percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) leads to a significant increase of radiation exposure for both patient and operator. Objective To study the potential of modified settings of the X‐ray equipment combined with operator protocols to reduce radiation dose despite increasing procedural complexity. Patients and Methods We analyzed a consecutive cohort of 984 PCIs for CTOs in 863 patients between January 2010 and July 2015. During that period, the X‐ray equipment was changed from an analog to a digital detector system, and a subsequent filter and imaging modification was implemented. The fluoroscopy settings were reduced from 15 pulses/s to 7.5, and then to 6. The cine framerate was reduced from 15 to 7.5/s. For the last time period, with optimized settings, procedural, and lesion related factors influencing the radiation exposure were analyzed. Results The lesion complexity increased from a J‐CTO score of 1.64 to 2.33 with an increase of retrograde procedures from 21.6 to 50.4%. With a similar fluoroscopy time, the dose area product was reduced from period 1 to 2 by 20%, and further by 7% to period 3. There was a significant reduction of Air Kerma from period 2 to 3 from 3.5 to 2.7 Gy. The operator exposure was reduced by more than half. The patient's weight and the complexity of the procedure were the main determinants of radiation exposure. Conclusions The radiation exposure for patient and operator was decreased considerably during the three observation periods despite an increase in lesion and procedural complexity. Rigorous implementation of radiation device settings did reduce radiation exposure without impeding procedural success. © 2017 Wiley Periodicals, Inc.