Fluoroscopy pulse rate reduction during diagnostic and therapeutic imaging in the cardiac catheterization laboratory: An evaluation of radiation dose, procedure complications and outcomes.
OBJECTIVE
To evaluate radiation reduction by reducing fluoroscopy pulse rate in diagnostic cardiac catheterizations and percutaneous coronary interventions (PCI) as well as outcomes at 30 days and six months.


BACKGROUND
Radiation exposure to the public at large has increased dramatically over the past three decades, and the cardiac catheterization laboratory is a large contributor. Fluoroscopy pulse rate is one way to decrease radiation exposure.


METHODS
Fluoroscopy pulse rate was reduced from 10 pulses/sec (p/s) to 7.5 p/s as part of an internal quality improvement project. A retrospective analysis of all cardiac catheterizations was performed, evaluating Air KERMA at the interventional reference point (Ka, r), Air KERMA area product (PKA), procedural complications and major adverse cardiac events at 30 days and 6 months.


RESULTS
In diagnostic catheterization median PKA(µGy·m2) and Ka,r(mGy) were significantly reduced (PKA- 5,613.3 vs. 4,400, P < 0.001; Ka,r- 703.0 vs. 621.0, P = 0.041). In PCI, median PKAand Ka,rwere further reduced (PKA- 13,481.6 vs. 10,648.0, P < 0.001; Ka,r- 1787.0 vs. 1,459.0, P = 0.002). There was no difference in complications, fluoroscopy time or number of stents placed. There was no difference in MACE after adjustment for number of STEMIs.


CONCLUSIONS
Reducing fluoroscopy pulse rates to 7.5 from 10 is an effective way to reduce patient radiation exposure across meaningful dose indices. A pulse rate of 7.5 p/s is safe, with no difference in complications or outcomes. A fluoroscopy pulse rate of 7.5 p/s should be given strong consideration for a new standard. © 2016 Wiley Periodicals, Inc.
Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033.
James W
JW
Hansen
Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033.
Andrew
A
Foy
Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033.
Torrey
T
Schmidt
Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033.
Mehrdad
M
Ghahramani
Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033.
Charles E
CE
Chambers
D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
CATH, catheterization, diagnostic; CEPO, comparative effectiveness/patient centered outcomes research; PCI, percutaneous coronary intervention (PCI); RADI, radiation physics/dosimetry