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1 Department of Cardiology, Klinik Fraenkische Schweiz, Feuersteinstr. 2, D-91320 Ebermannstadt and 2 Department of Cardiology, Ernst Moritz Arndt University, Friedrich-Loeffler Str. 23, D-17487 Greifswald, Germany
Correspondence: Dr Eberhard Kuon
The goal of this study was to improve radiation dose reduction techniques in invasive cardiology and after patients' radiation data had approached minimal levels, to evaluate predictors of their radiation exposure resulting from invasive cardiac procedures. Over the course of 1 year (and 1996 procedures) we minimized cinegraphic frames and runs, as well as fluoroscopy time, and trained ourselves to achieve effective fluoroscopy-saving positioning of blinds and filters toward the regions of interest. We were consequently able to reduce the mean dose–area products (DAP) for coronary angiography and angioplasty, combined interventions, high-frequency rotational atherectomy, and excimer laser angioplasty: from levels of 53.9 Gy cm2, 79.6 Gy cm2, 112.3 Gy cm2, 119.4 Gy cm2, and 168.0 Gy cm2 as currently reported in the literature, to 12.9 Gy cm2, 13.3 Gy cm2, 25.9 Gy cm2, 33.0 Gy cm2, and 27.1 Gy cm2, respectively. The mean DAP due to interventions in acute myocardial infarction was 38.3 Gy cm2. DAP was influenced by body mass index, complexity of coronary artery disease, tube angulation, documented structure, coronary recanalization, emergency circumstances, and the percutaneous transluminal coronary angioplasty (PTCA) target vessel involved, but not by stent implantation. By favouring radiation-reducing cranial posteroanterior views over standard left anterior oblique views for visualization of the left anterior descending and the diagonal artery, we consequently achieved mean PTCA-DAPs of 10.4 Gy cm2 and 8.6 Gy cm2, respectively: levels significantly lower than those for PTCA of the right coronary artery (13.3 Gy cm2), left circumflex artery (13.7 Gy cm2), and obtuse marginal branch (16.9 Gy cm2). In conclusion, enhanced knowledge of radiation dose-reduction techniques significantly reduces patient radiation hazards in invasive cardiology.
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