Radiation reduction in a modern catheterization laboratory: A single-center experience

Catheter Cardiovasc Interv. 2022 Oct;100(4):575-584. doi: 10.1002/ccd.30396. Epub 2022 Sep 7.

Abstract

Background: Measures were undertaken at the Cleveland Clinic to reduce radiation exposure to patients and personnel working in the catheterization laboratories. We report our experience with these improved systems over a 7-year period in patients undergoing diagnostic catheterization (DC) and percutaneous coronary interventions (PCIs).

Methods: Patients were categorized into preinitiative (2009-2012) and postinitiative (2013-2019) groups in the DC and PCI cohorts. Propensity score matching was done between the pre- and postinitiative groups for both cohorts based on age, sex, body surface area, total fluoroscopy time, and total acquisition time. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (Ka,r ), and fluoroscopy- and acquisition-mode air kerma in patients in the two groups.

Results: In the DC cohort, there was a significant reduction in Ka,r in the postinitiative group in comparison to the preinitiative group (median, 396 vs. 857 mGy; p < 0.001). In the PCI cohort, Ka,r in the postinitiative group was 1265 mGy, which was significantly lower than the corresponding values in the preinitiative group (1994 mGy; p < 0.001). We also observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates, and air kerma area product in the postinitiative group in comparison to the preinitiative group in both matched and unmatched DC and PCI cohorts after the institution of radiation reduction measures.

Conclusion: There was a significant and sustained reduction in radiation exposure to patients in the catheterization laboratory with the implementation of advanced protocols. Similar algorithms can be applied in other laboratories to achieve a similar reduction in radiation exposure.

Keywords: catheterization; occupational safety; radiation exposure.

MeSH terms

  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / methods
  • Fluoroscopy / adverse effects
  • Fluoroscopy / methods
  • Humans
  • Laboratories
  • Percutaneous Coronary Intervention* / adverse effects
  • Radiation Dosage
  • Radiation Exposure* / adverse effects
  • Radiation Exposure* / prevention & control
  • Retrospective Studies
  • Treatment Outcome