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Randomized Controlled Trial
. 2014 Apr 1;113(7):1093-8.
doi: 10.1016/j.amjcard.2013.12.013. Epub 2014 Jan 15.

Effectiveness of fluorography versus cineangiography at reducing radiation exposure during diagnostic coronary angiography

Binita Shah  1 , Xingchen Mai  2 , Lakshmi Tummala  2 , Chad Kliger  3 , Sripal Bangalore  2 , Louis H Miller  2 , Steven P Sedlis  4 , Frederick Feit  2 , Michael Liou  2 , Michael Attubato  2 , John Coppola  2 , James Slater  2
Affiliations
Randomized Controlled Trial

Effectiveness of fluorography versus cineangiography at reducing radiation exposure during diagnostic coronary angiography

Binita Shah et al. Am J Cardiol. .

Abstract

Coronary angiography is the gold standard for defining obstructive coronary disease. However, radiation exposure remains an unwanted hazard. Patients referred for coronary angiography with abdominal circumference<45 inches and glomerular filtration rate>60 ml/min were randomized to the fluorography (n=25) or cineangiography (n=25) group. Patients in the fluorography group underwent coronary angiography using retrospectively stored fluorography with repeat injection under cineangiography only when needed for better resolution per operator's discretion. Patients in the cineangiography group underwent coronary angiography using routine cineangiography. The primary end point was patient radiation exposure measured by radiochromic film. Secondary end points included the radiation output measurement of kerma-area product and air kerma at the interventional reference point (Ka,r) and operator radiation exposure measured by a dosimeter. Patient radiation exposure (158.2 mGy [76.5 to 210.2] vs 272.5 mGy [163.3 to 314.0], p=0.001), kerma-area product (1,323 μGy·m2 [826 to 1,765] vs 3,451 μGy·m2 [2,464 to 4,818], p<0.001), and Ka,r (175 mGy [112 to 252] vs 558 mGy [313 to 621], p<0.001) were significantly lower in the fluorography compared with cineangiography group (42%, 62%, and 69% relative reduction, respectively). Operator radiation exposure trended in the same direction, although statistically nonsignificant (fluorography 2.35 μGy [1.24 to 6.30] vs cineangiography 5.03 μGy [2.48 to 7.80], p=0.059). In conclusion, the use of fluorography in a select group of patients during coronary angiography, with repeat injection under cineangiography only when needed, was efficacious at reducing patient radiation exposure.

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Conflict of interest statement

Disclosures

The authors have no conflicts of interest to disclose

Figures

Figure 1
Figure 1
Screening, enrollment, and randomization of study population
Figure 2
Figure 2
A) Patient peak skin dose, B) kerma air product, and C) operator radiation exposure in the fluorography (n=25) compared with standard cineangiography(n=25) groups (data presented as median [interquartile range] or number (percentage))
Figure 2
Figure 2
A) Patient peak skin dose, B) kerma air product, and C) operator radiation exposure in the fluorography (n=25) compared with standard cineangiography(n=25) groups (data presented as median [interquartile range] or number (percentage))
Figure 2
Figure 2
A) Patient peak skin dose, B) kerma air product, and C) operator radiation exposure in the fluorography (n=25) compared with standard cineangiography(n=25) groups (data presented as median [interquartile range] or number (percentage))
Figure 3
Figure 3
Examples of A) fluorography and B) corresponding cineangiography image frames used in the quality review in the current study
Figure 3
Figure 3
Examples of A) fluorography and B) corresponding cineangiography image frames used in the quality review in the current study
See this image and copyright information in PMC

Comment in

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