title: Reduction of radiation exposure during complex interventions for chronic total coronary occlusions: Implementing low dose radiation protocols without affecting procedural success rates.
abstract: BACKGROUND
  The increasing complexity of percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) leads to a significant increase of radiation exposure for both patient and operator.
  
  
  OBJECTIVE
  To study the potential of modified settings of the X-ray equipment combined with operator protocols to reduce radiation dose despite increasing procedural complexity.
  
  
  METHODS
  We analyzed a consecutive cohort of 984 PCIs for CTOs in 863 patients between January 2010 and July 2015. During that period, the X-ray equipment was changed from an analog to a digital detector system, and a subsequent filter and imaging modification was implemented. The fluoroscopy settings were reduced from 15 pulses/s to 7.5, and then to 6. The cine framerate was reduced from 15 to 7.5/s. For the last time period, with optimized settings, procedural, and lesion related factors influencing the radiation exposure were analyzed.
  
  
  RESULTS
  The lesion complexity increased from a J-CTO score of 1.64 to 2.33 with an increase of retrograde procedures from 21.6 to 50.4%. With a similar fluoroscopy time, the dose area product was reduced from period 1 to 2 by 20%, and further by 7% to period 3. There was a significant reduction of Air Kerma from period 2 to 3 from 3.5 to 2.7 Gy. The operator exposure was reduced by more than half. The patient's weight and the complexity of the procedure were the main determinants of radiation exposure.
  
  
  CONCLUSIONS
  The radiation exposure for patient and operator was decreased considerably during the three observation periods despite an increase in lesion and procedural complexity. Rigorous implementation of radiation device settings did reduce radiation exposure without impeding procedural success. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Medizinische Klinik I (Cardiology and Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Werner
authors.affiliation: Medizinische Klinik I (Cardiology and Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Peggy
authors.initials: P
authors.lastname: Glaser
authors.affiliation: Medizinische Klinik I (Cardiology and Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Coenen
authors.affiliation: Medizinische Klinik I (Cardiology and Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Hiller
authors.initials: H
authors.lastname: Moehlis
authors.affiliation: Medizinische Klinik I (Cardiology and Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Tischer
authors.affiliation: Medizinische Klinik I (Cardiology and Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Koch
authors.affiliation: Medizinische Klinik I (Cardiology and Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Klingenbeck
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D016272:Occupational Health; D061214:Patient Safety; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000295:instrumentation; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: chronic coronary occlusion; percutaneous transluminal intervention; radiation exposure