title: Evaluation of coronary angiographic projections to balance the clinical yield with the radiation risk.
abstract: OBJECTIVE
  Radiation safety principles dictate that imaging procedures should minimise the radiation risks involved, without compromising diagnostic performance. This study aims to define a core set of views that maximises clinical information yield for minimum radiation risk. Angiographers would supplement these views as clinically indicated.
  
  
  METHODS
  An algorithm was developed to combine published data detailing the quality of information derived for the major coronary artery segments through the use of a common set of views in angiography with data relating to the dose-area product and scatter radiation associated with these views.
  
  
  RESULTS
  The optimum view set for the left coronary system comprised four views: left anterior oblique (LAO) with cranial (Cr) tilt, shallow right anterior oblique (AP-RAO) with caudal (Ca) tilt, RAO with Ca tilt and AP-RAO with Cr tilt. For the right coronary system three views were identified: LAO with Cr tilt, RAO and AP-RAO with Cr tilt. An alternative left coronary view set including a left lateral achieved minimally superior efficiency (<5%), but with an ~8% higher radiation dose to the patient and 40% higher cardiologist dose.
  
  
  CONCLUSIONS
  This algorithm identifies a core set of angiographic views that optimises the information yield and minimises radiation risk. This basic data set would be supplemented by additional clinically determined views selected by the angiographer for each case. The decision to use additional views for diagnostic angiography and interventions would be assisted by referencing a table of relative radiation doses for the views being considered.
authors.affiliation: St. Andrew's Medical Institute, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia. ismith@sawmh.com.au
authors.forename: I R
authors.initials: IR
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Cameron
authors.forename: K L
authors.initials: KL
authors.lastname: Mengersen
authors.forename: J T
authors.initials: JT
authors.lastname: Rivers
mesh_terms: D000465:Algorithms; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity