Evaluation of Radiation Exposure and Image Quality in Congenital Catheterization Laboratory; A Single Centre Comparative Study Using Different Acquisition Modes

Abstract

Abstract Background The exposure to ionizing radiation delivered during the catheterization procedures has various negative biological effects to the patient, so concern has risen sharply about radiation hazards over the past decade.While angiography imaging system vendors have all made great strides with new technologies that reduce the amount of x-rays needed while maintaining excellent image quality, the procedures have become more complex, lasting longer and require more imaging than standard procedures. Aim of the Work To study the effect of lowering radiation dose by using a fluoro angiography on image quality in pediatric cardiac catheterization. Patients and Methods We studied 90 patients who underwent cardiac cath. for CHD at Ain Shams University hospital. Patients were randomized into three groups according to mode of acquisition used in procedure (fluro angiography only–cine angiography only–mixed). Radiation indices were measured, also image quality questionnaire was filled by operators after each procedure. Results statistically significant difference between three modalities of acquisition as regard the radiation indices (DAP, total air kemra, fluoroscopy time) with p value <0.005. While operators satisfaction with image was nearly the same in the three groups with median score 68.5 (p value 0.681). Conclusion Based on the results of the current study it can be concluded that: Mixed imaging acquisition had highest radiation exposure indices in comparison with other two acquisition modalities (fluro angiography only – cine angiography only), with statistically significant difference with fluro only mode (p value <0.005), and no statistically significant deference with cine only mode. Complexity of the procedures & increased the cath. lab machine imaging protocol to 30 fps and repeat the same injection in the cine mode after fluro mode were the most important factors that made mixed acquisition had the highest radiation indices and exposure. Image quality and operators satisfaction were nearly the same in three acquisition modes (fluro-cine-mixed) with median image score 68.5 (p value 0.681), in expense of more radiation exposure in mixed mode. Increase operators awareness to radiation and continuous monitoring of radiation exposure with application of ALARA principles is important to reduce radiation exposure.