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Time of day influences patient radiation exposure from percutaneous cardiac interventions

¹ Department of Cardiology, Klinik Fraenkische Schweiz, Feuersteinstr. 2, D-91320 Ebermannstadt, ² Department of Cardiology, Ernst Moritz Arndt University, Friedrich-Loeffler Str. 23, 17487 Greifswald, and ³ Institute for Computer Sciences, Biometry and Epidemiology, Friedrich Alexander University Erlangen-Nuernberg, Waldstr. 6, 91054 Erlangen, Germany

Correspondence: Dr Eberhard Kuon, Klinik Fraenkische Schweiz, Feuersteinstr. 2, D-91320 Ebermannstadt, Germany

The objective of this study was to investigate the influence of time of day on patient radiation exposure due to cardiac interventions. The elective interventional workload of one experienced cardiologist documented over the course of 4 months amounted to 325 diagnostic catheterizations and 145 percutaneous coronary interventions (PCI). All radiation parameters documented during diagnostic coronary angiography remained constant throughout the entire day. In contrast, for PCI measurements made from 7:00 a.m. to 1:00 p.m., our study revealed a mean overall dose–area product (DAP) of 11.8±6.8 Gy cm² (n=115). These radiation exposure levels increased significantly later in the afternoon (n=30) by 28% to a level of 15.0±11.1 Gy cm² (p<0.045). Cinegraphic DAP increased from 3.7±2.7 Gy cm² to 5.0±3.2 Gy cm² (p<0.033). The number of cinegraphic runs and frames rose from 7.9±2.9 to 9.1±3.1 (p<0.025), and from 136±63 to 164±70 (p<0.014), respectively. The following conclusion is warranted by our data and should now be confirmed in a wider multicentre study: radiation protection of the patients could be influenced by the fatigue of the cardiologist conducting the procedure. To enhance patient radiation safety, elective percutaneous angioplasty should be scheduled for the first 6 h of the interventionalist's occupational workload. Diagnostic interventions may be safely scheduled later.