title: Radiation dose reduction in the cardiac catheterization laboratory utilizing a novel protocol.
abstract: OBJECTIVE
  This study reports the results a novel radiation reduction protocol (RRP) system for coronary angiography and interventional procedures and the determinants of radiation dose.
  
  
  BACKGROUND
  The cardiac catheterization laboratory is an important source of radiation and should be kept in good working order with dose-reduction and monitoring capabilities.
  
  
  METHODS
  All diagnostic coronary angiograms and percutaneous coronary interventions from a single catheterization laboratory were analyzed 2 months before and after RRP implementation. The primary outcome was the relative dose reduction at the interventional reference point. Separate analyses were done for conventional 15 frames/s (FPS) and at reduced 7.5 FPS post-RRP groups.
  
  
  RESULTS
  A total of 605 patients underwent coronary angiography (309 before RRP and 296 after RRP), with 129 (42%) and 122 (41%) undergoing percutaneous coronary interventions before and after RRP, respectively. With RRP, a 48% dose reduction (1.07 ± 0.05 Gy vs. 0.56 ± 0.03 Gy, p < 0.0001) was obtained, 35% with 15 FPS RRP (0.70 ± 0.05 Gy, p < 0.0001) and 62% with 7.5 FPS RRP (0.41 ± 0.03 Gy, p < 0.001). Similar dose reductions for diagnostic angiograms and percutaneous coronary interventions were noted. There was no change in the number of stents placed or vessels intervened on. Increased dose was associated with male sex, radial approach, increasing body mass index, cine runs, and frame rates. Using a multivariable model, a 48% relative risk with RRP (p < 0.001), 44% with 15 FPS RRP and 68% with 7.5 FPS RRP was obtained.
  
  
  CONCLUSIONS
  We demonstrate a highly significant 48.5% adjusted radiation dose reduction using a novel algorithm, which needs strong consideration among interventional cardiology practice.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Anthony W A
authors.initials: AW
authors.lastname: Wassef
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Ravandi
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Ducas
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Kunal
authors.initials: K
authors.lastname: Minhas
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Minh
authors.initials: M
authors.lastname: Vo
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Malek
authors.initials: M
authors.lastname: Kass
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Parmar
authors.affiliation: Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: fhussain@sbgh.mb.ca.
authors.forename: Farrukh
authors.initials: F
authors.lastname: Hussain
mesh_terms: D000368:Aged; D000465:Algorithms; D015992:Body Mass Index; D006328:Cardiac Catheterization / Q000009:adverse effects; D002932:Cineangiography; D017023:Coronary Angiography / Q000009:adverse effects; D019091:Critical Pathways; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007753:Laboratories; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D015397:Program Evaluation; D017534:Radial Artery / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D011834:Radiation Monitoring; D011835:Radiation Protection / Q000379:methods*; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D012737:Sex Factors
keywords: diagnostic coronary angiography; frame rate; percutaneous coronary intervention; radiation; x-ray