title: Variability in fluoroscopic X-ray exposure in contemporary cardiac catheterization laboratories.
abstract: OBJECTIVE
  This study sought to assess fluoroscopic exposure rates in contemporary cardiac catheterization laboratories (CCL).
  
  
  BACKGROUND
  Increasing attention is being focused on X-ray exposure during diagnostic and therapeutic cardiovascular procedures.
  
  
  METHODS
  We measured fluoroscopic exposure rates (R/min) in 41 systems using a standardized methodology (National Electrical Manufacturers Association XR21 phantom). Measurements were obtained at 2 different phantom thicknesses to simulate varying patient body habitus.
  
  
  RESULTS
  Fluoroscopic exposure rates under medium (median 3.0 R/min, interquartile range 1.4 R/min) and large (median 12.5 R/min, interquartile range 4.8 R/min) habitus conditions showed substantial variation. Fluoroscopic exposure was associated with simulated patient habitus, X-ray system type, vendor, and geographic region. Under medium habitus conditions, only 25% of systems operated within a zone of lower than average exposure rates and satisfactory image quality; this frequency diminished to 7% under large habitus conditions (p < 0.001).
  
  
  CONCLUSIONS
  There is substantial variation (4- to 6-fold) in fluoroscopic exposure rates. This variation was not consistently associated with improved image quality. In the absence of a predictable benefit of higher (or lower) than average exposure rates, CCL quality improvement programs must minimize such potentially harmful variability in X-ray exposure.
authors.affiliation: Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA. wlaskey@salud.unm.edu
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.forename: Merrill
authors.initials: M
authors.lastname: Wondrow
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods*; D005471:Fluoroscopy; D006801:Humans; D007753:Laboratories; D011874:Radiometry; D015203:Reproducibility of Results; D018570:Risk Assessment; D014965:X-Rays