title: Effectiveness of low rate fluoroscopy at reducing operator and patient radiation dose during transradial coronary angiography and interventions.
abstract: OBJECTIVE
  This study sought to determine the efficacy of low rate fluoroscopy at 7.5 frames/s (FPS) versus conventional 15 FPS for reduction of operator and patient radiation dose during diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) via the transradial approach (TRA).
  
  
  BACKGROUND
  TRA for cardiac catheterization is potentially associated with increased radiation exposure. Low rate fluoroscopy has the potential to reduce radiation exposure.
  
  
  METHODS
  Patients undergoing TRA diagnostic angiography ± ad-hoc PCI were randomized to fluoroscopy at 7.5 FPS versus 15 FPS prior to the procedure. Both 7.5 and 15 FPS fluoroscopy protocols were configured with a fixed dose per pulse of 40 nGy. Primary endpoints were operator radiation dose (measured with dosimeter attached to the left side of the thyroid shield in μSievert [μSv]), patient radiation dose (expressed as dose-area product in Gy·cm(2)), and fluoroscopy time.
  
  
  RESULTS
  From October 1, 2012 to August 30, 2013, from a total of 363 patients, 184 underwent DCA and 179 underwent PCI. Overall, fluoroscopy at 7.5 FPS compared with 15 FPS was associated with a significant reduction in operator dose (30% relative reduction [RR], p < 0.0001); and in patient's dose-area product (19% RR; p = 0.022). When stratified by procedure type, 7.5 FPS compared with 15 FPS was associated with significant reduction in operator dose during both DCA (40% RR; p < 0.0001) and PCI (28% RR; p = 0.0011). Fluoroscopy at 7.5 FPS, compared with 15 FPS, was also associated with substantial reduction in patients' dose-area product during DCA (26% RR; p = 0.0018) and during PCI (19% RR; p = 0.13). Fluoroscopy time was similar in 7.5 FPS and 15 FPS groups for DCA (3.4 ± 2.0 min vs. 4.0 ± 4.7 min; p = 0.42) and PCI (11.9 ± 8.4 min vs. 13.3 ± 9.7 min; p = 0.57), respectively.
  
  
  CONCLUSIONS
  Fluoroscopy at 7.5 FPS, compared with 15 FPS, is a simple and effective method in reducing operator and patient radiation dose during TRA DCA and PCI.
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eltigani
authors.initials: E
authors.lastname: Abdelaal
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Plourde
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: MacHaalany
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Arsenault
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Goran
authors.initials: G
authors.lastname: Rimac
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Can M
authors.initials: CM
authors.lastname: Nguyen
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Allende
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Henrique
authors.initials: H
authors.lastname: Ribeiro
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.affiliation: Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada.
authors.forename: Rosaire
authors.initials: R
authors.lastname: Mongrain
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada. Electronic address: olivier.bertrand@crhl.ulaval.ca.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D002932:Cineangiography; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D060051:Occupational Injuries / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D011792:Quebec; D017534:Radial Artery / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control; D011834:Radiation Monitoring; D011835:Radiation Protection; D015641:Radiography, Interventional / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors
keywords: dosimetry; imaging; percutaneous coronary intervention; radiation; transradial