title: Effectiveness of the implementation of a simple radiation reduction protocol in the catheterization laboratory.
abstract: OBJECTIVE
  A reduction in radiation doses at the catheterization laboratory, maintaining the quality of procedures is essential. Our objective was to analyze the results of a simple radiation reduction protocol at a high-volume interventional cardiology unit.
  
  
  METHODS
  We analyzed 1160 consecutive procedures: 580 performed before the implementation of the protocol and 580 after it. The protocol consisted in: the reduction of the number of ventriculographies and aortographies, the optimization of the collimation and the geometry of the X ray tube-patient-receptor, the use of low dose-rate fluoroscopy and the reduction of the number of cine sequences using the software "last fluoroscopy hold".
  
  
  RESULTS
  There were no significant differences in clinical baseline features or in the procedural characteristics with the exception of a higher percentage of radial approach (30.7% vs 69.6%; p<0.001) and of percutaneous coronary interventions of chronic total occlusions after the implementation of the protocol (2.1% vs 6.7%; p=0,001). Angiographic success was similar during both periods (98.3% vs 99.2%; p=0.2). There were no significant differences between both periods regarding the overall duration of the procedures (26.9 vs 29.6min; p=0.14), or the fluoroscopy time (13.3 vs 13.2min; p=0.8). We observed a reduction in the percentage of procedures with ventriculography (80.9% vs 7.1%; p<0.0001) or aortography (15.4% vs 4.4%; p<0.0001), the cine runs (21.8 vs 6.9; p<0.0001) and the dose-area product (165 vs 71 Gyxcm(2); p<0.0001).
  
  
  CONCLUSIONS
  With the implementation of a simple radiation reduction protocol, a 57% reduction of dose-area product was observed without a reduction in the quality or the complexity of procedures.
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real. Electronic address: alfonsojuradoroman@gmail.com.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Jurado-Román
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Sánchez-Pérez
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lozano Ruíz-Poveda
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real.
authors.forename: María T
authors.initials: MT
authors.lastname: López-Lluva
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real.
authors.forename: Natalia
authors.initials: N
authors.lastname: Pinilla-Echeverri
authors.affiliation: Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real.
authors.forename: Andrea
authors.initials: A
authors.lastname: Moreno Arciniegas
authors.affiliation: Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid.
authors.forename: Pilar
authors.initials: P
authors.lastname: Agudo-Quilez
authors.affiliation: Servicio de Radiofísica y Protección Radiológica, Hospital General Universitario de Ciudad Real.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gil Agudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001027:Aortography; D006328:Cardiac Catheterization / Q000009:adverse effects; D002932:Cineangiography; D017023:Coronary Angiography; D005260:Female; D005471:Fluoroscopy; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control; D016272:Occupational Health; D009873:Operating Rooms / Q000458:organization & administration*; D061214:Patient Safety; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D015397:Program Evaluation; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000009:adverse effects; D015635:Radionuclide Ventriculography; D012984:Software; D013997:Time Factors
keywords: Interventional cardiology; Last fluoroscopy hold; Radiation