title: Effectiveness of fluorography versus cineangiography at reducing radiation exposure during diagnostic coronary angiography.
abstract: Coronary angiography is the gold standard for defining obstructive coronary disease. However, radiation exposure remains an unwanted hazard. Patients referred for coronary angiography with abdominal circumference<45 inches and glomerular filtration rate>60 ml/min were randomized to the fluorography (n=25) or cineangiography (n=25) group. Patients in the fluorography group underwent coronary angiography using retrospectively stored fluorography with repeat injection under cineangiography only when needed for better resolution per operator's discretion. Patients in the cineangiography group underwent coronary angiography using routine cineangiography. The primary end point was patient radiation exposure measured by radiochromic film. Secondary end points included the radiation output measurement of kerma-area product and air kerma at the interventional reference point (Ka,r) and operator radiation exposure measured by a dosimeter. Patient radiation exposure (158.2 mGy [76.5 to 210.2] vs 272.5 mGy [163.3 to 314.0], p=0.001), kerma-area product (1,323 μGy·m2 [826 to 1,765] vs 3,451 μGy·m2 [2,464 to 4,818], p<0.001), and Ka,r (175 mGy [112 to 252] vs 558 mGy [313 to 621], p<0.001) were significantly lower in the fluorography compared with cineangiography group (42%, 62%, and 69% relative reduction, respectively). Operator radiation exposure trended in the same direction, although statistically nonsignificant (fluorography 2.35 μGy [1.24 to 6.30] vs cineangiography 5.03 μGy [2.48 to 7.80], p=0.059). In conclusion, the use of fluorography in a select group of patients during coronary angiography, with repeat injection under cineangiography only when needed, was efficacious at reducing patient radiation exposure.
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York. Electronic address: binita.shah@nyumc.org.
authors: Binita
authors: B
authors: Shah
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: Xingchen
authors: X
authors: Mai
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: Lakshmi
authors: L
authors: Tummala
authors: Division of Structural and Congenital Heart Disease, Department of Cardiovascular Medicine, Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York.
authors: Chad
authors: C
authors: Kliger
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: Sripal
authors: S
authors: Bangalore
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: Louis H
authors: LH
authors: Miller
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York.
authors: Steven P
authors: SP
authors: Sedlis
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: Frederick
authors: F
authors: Feit
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: Michael
authors: M
authors: Liou
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: Michael
authors: M
authors: Attubato
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: John
authors: J
authors: Coppola
authors: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors: James
authors: J
authors: Slater
mesh_terms: D000368:Aged; D002932:Cineangiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods*; D012189:Retrospective Studies