Reducing radiation exposure during invasive coronary angiography and percutaneous coronary interventions implementing a simple four-step protocol

TY - JOUR

T1 - Reducing radiation exposure during invasive coronary angiography and percutaneous coronary interventions implementing a simple four-step protocol

AU - Seiffert, Moritz

AU - Ojeda, Francisco

AU - Müllerleile, Kai

AU - Zengin, Elvin

AU - Sinning, Christoph

AU - Waldeyer, Christoph

AU - Lubos, Edith

AU - Schäfer, Ulrich

AU - Sydow, Karsten

AU - Blankenberg, Stefan

AU - Westermann, Dirk

PY - 2015/6

Y1 - 2015/6

N2 - BACKGROUND: With an increasing number of complex and repeated percutaneous coronary interventions (PCI), radiation-induced hazards for patients and operators remain an important issue in fluoroscopy-guided procedures. Our objective was to evaluate radiation exposure during coronary angiographic procedures and assess the efficacy of a four-step program to reduce radiation exposure during coronary angiography (CAG) and PCI.METHODS AND RESULTS: A retrospective single-center analysis was performed in patients undergoing CAG or PCI in the first 6 months of 2012 vs. the first 6 months of 2014 (n = 3,107 procedures). During 2013, a four-step protocol was established in our hospital. It contained measures to reduce radiation exposure, including a frame rate reduction from 15 to 7.5 frames per second, the use of fluoroscopy storage, strict use of beam collimation, and repeat training on radiation safety. After adjustment for confounding variables, a dose-area product (DAP) reduction of 54.2% was observed subsequent to implementation of the four-step protocol. Independent predictors of DAP were age [odds ratio (OR) 1.01], body surface area (OR 5.47), prior coronary artery bypass grafting (OR 1.44), radial access (OR 1.16), PCI (OR 2.36), female gender (OR 0.91), and the implementation of the four-step program (OR 0.46).CONCLUSION: A simple four-step protocol led to a significant reduction in radiation exposure in diagnostic and interventional coronary procedures without significant drawbacks in image quality. Hence, radiation safety programs are of paramount importance and should be established to improve patient and operator safety with regard to radiation-induced hazards.

AB - BACKGROUND: With an increasing number of complex and repeated percutaneous coronary interventions (PCI), radiation-induced hazards for patients and operators remain an important issue in fluoroscopy-guided procedures. Our objective was to evaluate radiation exposure during coronary angiographic procedures and assess the efficacy of a four-step program to reduce radiation exposure during coronary angiography (CAG) and PCI.METHODS AND RESULTS: A retrospective single-center analysis was performed in patients undergoing CAG or PCI in the first 6 months of 2012 vs. the first 6 months of 2014 (n = 3,107 procedures). During 2013, a four-step protocol was established in our hospital. It contained measures to reduce radiation exposure, including a frame rate reduction from 15 to 7.5 frames per second, the use of fluoroscopy storage, strict use of beam collimation, and repeat training on radiation safety. After adjustment for confounding variables, a dose-area product (DAP) reduction of 54.2% was observed subsequent to implementation of the four-step protocol. Independent predictors of DAP were age [odds ratio (OR) 1.01], body surface area (OR 5.47), prior coronary artery bypass grafting (OR 1.44), radial access (OR 1.16), PCI (OR 2.36), female gender (OR 0.91), and the implementation of the four-step program (OR 0.46).CONCLUSION: A simple four-step protocol led to a significant reduction in radiation exposure in diagnostic and interventional coronary procedures without significant drawbacks in image quality. Hence, radiation safety programs are of paramount importance and should be established to improve patient and operator safety with regard to radiation-induced hazards.

KW - Age Factors

KW - Aged

KW - Coronary Angiography/adverse effects

KW - Female

KW - Fluoroscopy/adverse effects

KW - Humans

KW - Male

KW - Middle Aged

KW - Percutaneous Coronary Intervention/adverse effects

KW - Radiation Dosage

KW - Radiation Exposure/analysis

KW - Radiation Injuries/prevention & control

KW - Retrospective Studies

KW - Risk Factors

KW - Sex Factors

U2 - 10.1007/s00392-015-0814-7

DO - 10.1007/s00392-015-0814-7

M3 - SCORING: Journal article

C2 - 25608615

VL - 104

SP - 500

EP - 506

JO - CLIN RES CARDIOL

JF - CLIN RES CARDIOL

SN - 1861-0684

IS - 6

ER -