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. 2018 Dec;65(4):252-258.
doi: 10.1002/jmrs.293. Epub 2018 Jul 16.

Feasibility of using ultra-low pulse rate fluoroscopy during routine diagnostic coronary angiography

Mohamed Khaldoun Badawy  1   2 , Matthew Scott  3 , Omar Farouque  4   5 , Mark Horrigan  4 , David J Clark  4   5 , Robert K Chan  4
Affiliations

Feasibility of using ultra-low pulse rate fluoroscopy during routine diagnostic coronary angiography

Mohamed Khaldoun Badawy et al. J Med Radiat Sci. 2018 Dec.

Abstract

Introduction: Coronary angiogram, while a powerful diagnostic tool in coronary artery disease, is not without an associated risk from ionising radiation. There are a number of factors that influence the amount of radiation the patient receives during the procedure, some of which are under the control of the operator. One of these is an adjustment of the fluoroscopic pulse rate. This study aims to assess the feasibility of using ultra-low pulse rate (3 pulses per second(pps)) fluoroscopy during routine diagnostic coronary angiogram procedures and the effect it has on fluoroscopy time, diagnostic clarity and radiation dose.

Methods: A retrospective study of three operators each undertaking 50 coronary angiogram procedures was performed. One of the operators used a pulse rate of 3 pps and 6 pps for fluoroscopic screening while the control groups used the standard 10 pps mode utilised at this centre.

Results: Results demonstrated no reduction of diagnostic clarity, up to a 58% reduction in Dose Area Product and no increase in fluoroscopy time with the 3 pps setting.

Conclusions: Findings from this pilot study suggest that utilisation of ultra-low pulse rate fluoroscopy in routine transfemoral diagnostic coronary angiography in the catheterisation laboratory is feasible.

Keywords: Fluoroscopy; interventional cardiology; radiation dose optimisation; radiation protection.

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Figures

Figure 1
Figure 1
Comparison of fluoroscopy time between operators utilising the 3 pps, 6 pps and 10 pps setting. There is a significant difference between Operator C and all the other study groups.
Figure 2
Figure 2
Comparison of the static image quality using the standard 10 pps setting and the modified 3 pps setting and the CIRS Model 901 phantom.
Figure 3
Figure 3
Comparison of the temporal image quality using the standard 10 pps setting and the modified 3 pps setting and the CIRS model 901 phantom. Note the reduction in image ghosting in the modified 3 pps setting through the k‐factor correction.
Figure 4
Figure 4
Comparison of DAP values between operators utilising the 3 pps, 6 pps and 10 pps setting. Operator A1 is statistically significantly lower than Operators A2, B and C. Operator A2 is statistically significantly lower than Operator C.
Figure 5
Figure 5
Comparison of reference air kerma values between operators utilising the 3 pps, 6 pps and 10 pps setting. Operator A1 is statistically significantly lower than Operator A2, B and C. Operator A2 is statistically significantly lower than Operator C.
See this image and copyright information in PMC

References

    1. Hart D, Wall BF. Radiation Exposure of the UK Population from Medical and Dental X‐ray Examinations. NRPB W‐Series Reports. 2002;(March):41. Available from: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1247816602523.
    1. National Research Council . Health Risks from Exposure to Low Levels of Ionizing Radiation 2006. 10.17226/11340 - DOI
    1. Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. Fluoroscopically guided interventional procedures: A review of radiation effects on patients’ skin and hair. Radiology 2010; 254: 326–42. - PubMed
    1. Ciraj‐Bjelac O, Rehani MM, Sim KH, Liew HB, Vano E, Kleiman NJ. Risk for radiation‐induced cataract for staff in interventional cardiology: Is there reason for concern? Catheter Cardiovasc Interv 2010; 76: 826–34. - PubMed
    1. Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol 2013; 111: 1368–72. - PubMed

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