title: Comparison of fluoro and cine coronary angiography: balancing acceptable outcomes with a reduction in radiation dose.
abstract: Use of last fluoro hold (LFH) mode in fluoroscopy, which enables the last live image to be saved and displayed, could reduce radiation during percutaneous coronary intervention when compared with cine mode. No previous study compared coronary angiography radiation doses and image quality between LFH and conventional cine mode techniques.
  
  
  METHODS
  We compared cumulative dose-area product (DAP), cumulative air kerma, fluoroscopy time, contrast use, interobserver variability of visual assessment between LFH angiography, and conventional cine angiography techniques. Forty-six patients were prospectively enrolled into the LFH group and 82 patients into the cine angiography group according to operator decision.
  
  
  RESULTS
  Mean cumulative DAP was higher in the cine group vs the LFH group (50058.98 ± 53542.71 mGy•cm² vs 11349.2 ± 8796.46 mGy•cm²; P<.001). Mean fluoroscopy times were higher in the cine group vs the LFH group (3.87 ± 5.08 minutes vs 1.66 ± 1.51 minutes; P<.01). Mean contrast use was higher in the cine group vs the LFH group (112.07 ± 43.79 cc vs 88.15 ± 23.84 cc; P<.001). Mean value of Crombach's alpha was not statistically different between visual estimates of three operators between cine and LFH angiography groups (0.66680 ± 0.19309 vs 0.54193 ± 0.31046; P=.20).
  
  
  CONCLUSIONS
  Radiation doses, contrast use, and fluoroscopy times are lower in fluoroscopic LFH angiography vs cine angiography. Interclass variability of visual stenosis estimation between three operators was not different between cine and LFH groups. Fluoroscopic LFH images conventionally have inferior diagnostic quality when compared with cine coronary angiography, but with new angiographic systems with improved LFH image quality, these images may be adequate for diagnostic coronary angiography.
authors.affiliation: Istanbul Medipol University, Department of Cardiology, Istanbul, Turkey. drayhanolcay@gmail.com.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Olcay
authors.forename: Ekrem
authors.initials: E
authors.lastname: Guler
authors.forename: Ibrahim Oguz
authors.initials: IO
authors.lastname: Karaca
authors.forename: Mehmet Onur
authors.initials: MO
authors.lastname: Omaygenc
authors.forename: Filiz
authors.initials: F
authors.lastname: Kizilirmak
authors.forename: Erkam
authors.initials: E
authors.lastname: Olgun
authors.forename: Esra
authors.initials: E
authors.lastname: Yenipinar
authors.forename: Huseyin Altug
authors.initials: HA
authors.lastname: Cakmak
authors.forename: Dursun
authors.initials: D
authors.lastname: Duman
mesh_terms: D000368:Aged; D002932:Cineangiography; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011829:Radiation Dosage
chemical_list: D003287:Contrast Media