title: Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: insights from the NCDR(®).
abstract: OBJECTIVE
  Identifying the distributions and determinants of fluoroscopy time for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  ICA and PCI are significant contributors to radiation exposure from medical imaging in the US. Fluoroscopy time is a potentially modifiable determinant of radiation exposure for these procedures, but has not been well characterized in contemporary practice.
  
  
  METHODS
  We evaluated the distribution of fluoroscopy time in patients undergoing ICA and/or PCI in the CathPCI Registry(®) , stratifying patients by numerous clinical scenarios. Hierarchical models were used to determine patient, procedure, operator and hospital-level factors associated with fluoroscopy time for these procedures.
  
  
  RESULTS
  Our study included a total of 3,295,348 ICA and PCI procedures performed by 9,600 operators from January 2005 through June 2009. There was wide variation in fluoroscopy times for these procedures with median [IQR] fluoroscopy times of 2.6 [1.7-4.5] minutes for ICA, 6.7 [4.2-10.8] minutes for ICA in patients with prior coronary artery bypass grafting (CABG), 10.1 [6.0-17.4] minutes for PCI, 10.7 [7.0-16.9] minutes for PCI with ICA, and 16.0 [10.6-24.0] minutes for PCI and ICA in patients with prior CABG. Prolonged fluoroscopy times (>30 minutes) were rare for ICA, but occurred in 6.7% of PCIs and 14.7% of PCIs in patients with prior CABG. After accounting for patient characteristics and procedure complexity, operator and hospital-level factors explained nearly 20% of the variation in fluoroscopy time.
  
  
  CONCLUSIONS
  Fluoroscopy times vary widely during ICA and PCI with operator and hospital-level factors contributing substantially to these differences. A better understanding of potentially modifiable sources of this variation will elucidate opportunities for enhancing the radiation safety of these procedures.
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Reza
authors.initials: R
authors.lastname: Fazel
authors.forename: Jeptha
authors.initials: J
authors.lastname: Curtis
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith-Bindman
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D017023:Coronary Angiography / Q000009:adverse effects; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods; D012042:Registries; D012307:Risk Factors; D013997:Time Factors
keywords: CATH-diagnostic cardiac catheterization; PCI-percutaneous coronary intervention; RDA-radiation physics