title: Analysis of a Low Dose Protocol to Reduce Patient Radiation Exposure During Percutaneous Coronary Interventions.
abstract: The cardiac catheterization laboratory is an important source of radiation for patients and operators and it is good practice to limit exposure as much as possible. The purpose of this study was to evaluate the effectiveness and impact of a radiological low dose protocol (LDP) in terms of reduction in patient radiation exposure during percutaneous coronary interventions (PCIs). From November 2014 to October 2015, 906 consecutive patients who underwent PCI were evaluated. Of these, 571 patients (63%) were treated with the standard dose protocol (SDP) of 15 frames per second for cine acquisition and standard settings for fluoroscopy, and 335 patients (37%) with the LDP of 7.5 frames per second for cine acquisition and low-dose settings for fluoroscopy. In the LDP group, we observed a significant reduction of kerma area product (53.3 LDP vs 115 SDP Gycm2, p <0.0001) and air kerma at interventional reference point (0.79 LDP vs 1.976 SDP Gy, p <0.0001). Marked differences were observed regarding the exceeding of International Commission on Radiological Protection and National Council on Radiation Protection and Measurements' air kerma at interventional reference point trigger level (cutoff for potential skin injuries), which were significantly lower in the LDP group (1.8% vs 7.2%, p <0.0001). Such difference was more relevant in complex PCI. In conclusion, the implementation of LDP allowed a marked reduction in patient dosimetric parameters for PCI and significantly reduced the risk of exceeding the International Commission on Radiological Protection/National Council on Radiation Protection and Measurements trigger levels for potential skin injuries.
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy; Italian Association of Interventional Radiographers (AITRI), Milan, Italy. Electronic address: maccagni.davide@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Maccagni
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Azzalini
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pazzanese
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D017023:Coronary Angiography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control*; D012189:Retrospective Studies