title: Measures to reduce radiation in a modern cardiac catheterization laboratory.
abstract: BACKGROUND
  X-ray use in the catheterization laboratory is guided by the principle of as low as reasonably achievable. In accordance with this principle, we reduced the default fluoroscopic frame rate from 10 to 7.5 frames/s and increased the emphasis on the use of low-dose acquisition starting January 1, 2013. We aimed to study the impact of these measures on the total air kerma during diagnostic catheterization (DC) and percutaneous interventions (PCI).
  
  
  RESULTS
  Propensity matching based on age, sex, body surface area, total fluoroscopy time, and total acquisition time was used to select matched patients for 2012 and 2013, further stratified by DC or PCI. The total air kerma was subsequently compared between 2012 and 2013, separately for DC and PCI. Median total air kerma during DC in 2013 was 625 mGy, which was significantly lower than the corresponding values in 2012 (median, 798 mGy; P<0.001). Similarly, median total air kerma during PCI in 2013 was 1675 mGy, which was significantly less than corresponding values in 2012 (median 2463 mGy, P<0.001). On comparison of air kerma rates between corresponding projections in 2 years, we observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates in 2013, after institution of radiation reduction measures in all projections.
  
  
  CONCLUSIONS
  With reduction in the default fluoroscopic frame rate and a greater use of low-dose acquisition, there has been a marked reduction in the total air kerma and air kerma rates for DC and PCI.
authors.affiliation: From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH.
authors.forename: Akhil
authors.initials: A
authors.lastname: Parashar
authors.affiliation: From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.affiliation: From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Heupler
authors.affiliation: From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH.
authors.forename: Evan
authors.initials: E
authors.lastname: Lau
authors.affiliation: From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH. kapadis@ccf.org.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000532:radiotherapy*; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007755:Laboratories, Hospital; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods*; D058996:Quality Improvement; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D015641:Radiography, Interventional
keywords: ionizing radiation; radiation; radiation effects; radiation protection