title: Reducing radiation exposure during invasive coronary angiography and percutaneous coronary interventions implementing a simple four-step protocol.
abstract: BACKGROUND
  With an increasing number of complex and repeated percutaneous coronary interventions (PCI), radiation-induced hazards for patients and operators remain an important issue in fluoroscopy-guided procedures. Our objective was to evaluate radiation exposure during coronary angiographic procedures and assess the efficacy of a four-step program to reduce radiation exposure during coronary angiography (CAG) and PCI.
  
  
  RESULTS
  A retrospective single-center analysis was performed in patients undergoing CAG or PCI in the first 6 months of 2012 vs. the first 6 months of 2014 (n = 3,107 procedures). During 2013, a four-step protocol was established in our hospital. It contained measures to reduce radiation exposure, including a frame rate reduction from 15 to 7.5 frames per second, the use of fluoroscopy storage, strict use of beam collimation, and repeat training on radiation safety. After adjustment for confounding variables, a dose-area product (DAP) reduction of 54.2% was observed subsequent to implementation of the four-step protocol. Independent predictors of DAP were age [odds ratio (OR) 1.01], body surface area (OR 5.47), prior coronary artery bypass grafting (OR 1.44), radial access (OR 1.16), PCI (OR 2.36), female gender (OR 0.91), and the implementation of the four-step program (OR 0.46).
  
  
  CONCLUSIONS
  A simple four-step protocol led to a significant reduction in radiation exposure in diagnostic and interventional coronary procedures without significant drawbacks in image quality. Hence, radiation safety programs are of paramount importance and should be established to improve patient and operator safety with regard to radiation-induced hazards.
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Seiffert
authors.forename: Francisco
authors.initials: F
authors.lastname: Ojeda
authors.forename: Kai
authors.initials: K
authors.lastname: Müllerleile
authors.forename: Elvin
authors.initials: E
authors.lastname: Zengin
authors.forename: Christoph
authors.initials: C
authors.lastname: Sinning
authors.forename: Christoph
authors.initials: C
authors.lastname: Waldeyer
authors.forename: Edith
authors.initials: E
authors.lastname: Lubos
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.forename: Karsten
authors.initials: K
authors.lastname: Sydow
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: Dirk
authors.initials: D
authors.lastname: Westermann
mesh_terms: D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis / Q000517:prevention & control*; D011832:Radiation Injuries / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors