title: The utilisation of the cardiovascular automated radiation reduction X-ray system (CARS) in the cardiac catheterisation laboratory aids in the reduction of the patient radiation dose.
abstract: OBJECTIVE
  The radiation exposure resulting from cardiovascular procedures may increase the risk of cancer, and/or cause skin injury. Whether the novel cardiovascular automated radiation reduction X-ray system (CARS) can help reduce the patient radiation dose in daily clinical practice remains unknown. The aim of this study was to evaluate the reduction in patient radiation dose with the use of CARS in the cardiac catheterisation laboratory (CCL).
  
  
  RESULTS
  This study retrospectively analysed 1,403 consecutives patients who underwent a cardiac catheterisation with coronary angiography (CA) and/or a percutaneous coronary intervention (PCI) in the Brest University Hospital over the course of one year. Patient radiation doses (dose area product and air kerma) were collected and compared between the CCL with (new CCL) and without (control CCL) CARS. Additionally, the patient radiation doses according to femoral versus radial access, procedural complexity and body mass index were compared. The radiation lesion position on the skin was assessed by automatically optimising the X-ray source to image distance (SID) and subsequently generating a radiation Dose-Map for those procedures exceeding 3 Gray of exposure. Overall, 447 patients underwent procedures in the control CCL and 956 in the new CCL. Baseline patient and procedural characteristics were similar between the two groups, with the exception of male gender and primary PCI, which were more prevalent in the new CCL group. Compared to the control CCL, the utilisation of the CARS in the new CCL resulted in a reduction of dose area product by 46% for CA, 56% for PCI alone and 54% for CA and PCI during the same procedure. Of note, radial access generated a higher radiation dose than femoral access (p<0.001). In this study, seven patients had an air kerma exceeding 3 Gray; however, only one patient had a skin dose greater than 3 Gray.
  
  
  CONCLUSIONS
  The utilisation of the CARS resulted in a significant reduction in patient radiation doses compared to the control equipment. A real-time Dose-Map may help the operator change the projection during complex procedures to reduce the patient skin dose.
authors.affiliation: Department of Cardiology, Brest University Hospital, Brest, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Didier
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.forename: Florent
authors.initials: F
authors.lastname: Leven
authors.forename: Philippe
authors.initials: P
authors.lastname: Castellant
authors.forename: Jacques
authors.initials: J
authors.lastname: Boschat
authors.forename: Yannic
authors.initials: Y
authors.lastname: Jobic
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.forename: Pierre-Philippe
authors.initials: PP
authors.lastname: Nicol
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
mesh_terms: D000368:Aged; D001331:Automation; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D005263:Femoral Artery; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods; D017534:Radial Artery; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control*; D011834:Radiation Monitoring / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies