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Modulated radiation protocol achieves marked reduction of radiation exposure for chronic total coronary occlusion intervention
Author(s) -
Werner Gerald S.,
Yaginuma Kenji,
Koch Matthias,
Tischer Karlheinz,
Silber Martin,
Werner Juliane,
Keuser Thomas,
Moehlis Hiller
Publication year - 2021
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.29132
Subject(s) - medicine , fluoroscopy , conventional pci , percutaneous coronary intervention , kerma , nuclear medicine , radiation exposure , dose area product , radiology , myocardial infarction , cardiology , dosimetry
Objective To evaluate the feasibility of a new acquisition protocol to reduce radiation exposure. Background Percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO) are characterized by the highest radiation exposure among PCI procedures. Methods We analyzed 552 consecutive CTO procedures between January 2018 and October 2019. After 366 procedures (Group 1) a modified radiation acquisition protocol was implemented for the subsequent 186 procedures (Group 2). Besides a low fluoroscopy frame rate of 6/s and cine frame rate of 7.5/s for both groups, additional modifications consisted of increased copper filtering with lower entry dose in combination with a modified image postprocessing. Radiation exposure was assessed as air kerma (AK; mGy), and dose–area product (DAP; cGy*cm 2 ). Results There was no significant difference in lesion or procedural complexity between the study groups with 46 and 43% of the procedures done via the retrograde approach. While fluoroscopy time remained similar (median: 32.7 vs. 34.3 min), the protocol modifications resulted in a drastic reduction of AK by 68% from 2,040 (1,321–3,339) mGy to 655 (415–1,113) mGy ( p < .001) without affecting the procedural success rate. DAP was equally decreased by 71%. These considerable reductions were observed even in obese patients of BMI > 30. In Group 2, not a single procedure exceeded the 5 Gy threshold as compared to 10.4% in Group 1. Conclusions Radiation exposure decreased considerably with a new acquisition protocol without affecting procedure duration and success. These modifications were applicable also to patients with a high BMI.