title: Effect of reduction of the pulse rates of fluoroscopy and CINE-acquisition on x-ray dose and angiographic image quality during invasive cardiovascular procedures.
abstract: BACKGROUND
  Reducing digital pulse rates (PR) are known to reduce total energy during invasive cardiovascular procedures, which likely has benefits for patients and staff. Physicians may be reluctant to reduce these parameters because they fear a decline in image quality that could affect procedural outcomes. We sought to assess the effect of default rates of fluoroscopy (Fluoro) and CINE-acquisition (CINE) on total x-ray dose and image quality during invasive cardiovascular procedures.
  
  
  RESULTS
  We retrospectively reviewed procedures done with 2 default PRs: a standard dose cohort (PR, 15 for Fluoro and CINE), and a reduced dose cohort (PR, 10 for Fluoro and CINE). Total x-ray dose, Fluoro time, and contrast use were compared between groups. A blinded angiographic image quality assessment was then performed using an objective 10-point angiographic quality score. There were no significant differences between cohorts for fluoroscopy time or contrast use. The reduced dose cohort has a significant reduction in mean total x-ray dose (PR 15, 1763.1 mGy; PR 10, 1179.1 mGy; P<0.0001). When adjusted for potential confounders, a 38% reduction in total x-ray dose was identified (P<0.0001). There was no difference in adjusted angiographic quality score between the cohorts (PR 15, 7.90; PR 10, 8.00; P=0.67), indicating no decline in image quality with PR reduction.
  
  
  CONCLUSIONS
  Reducing default PRs during invasive cardiovascular procedures yields large and significant reductions in total x-ray energy with no decline in angiographic image quality.
authors.affiliation: From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA. Christopher.T.Pyne@Lahey.org.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Pyne
authors.affiliation: From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA.
authors.forename: Gautam
authors.initials: G
authors.lastname: Gadey
authors.affiliation: From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Jeon
authors.affiliation: From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Piemonte
authors.affiliation: From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA.
authors.forename: Sergio
authors.initials: S
authors.lastname: Waxman
authors.affiliation: From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA.
authors.forename: Frederic
authors.initials: F
authors.lastname: Resnic
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D057791:Cardiac Imaging Techniques / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D007089:Image Enhancement; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014965:X-Rays
keywords: angiography; fluoroscopy; image quality enhancement; x-rays