Abstract
IntroductionCoronary 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.MethodsA 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.ResultsResults 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.ConclusionsFindings 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.
Highlights
Coronary angiogram, while a powerful diagnostic tool in coronary artery disease, is not without an associated risk from ionising radiation
Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology
Several studies show that the typical radiation dose associated with coronary angiogram (CA) procedures is 14–63 Gy.cm2.1,9,10 Australian diagnostic reference levels for CA are not published at the time of writing to compare local radiation doses associated with CA; a large multicentre study in Australia reported a median dose area product (DAP) of 39.08 Gy.cm2.11 The median dose for the procedures using ultra-low pulse rate fluoroscopy in this study was 6.34 Gy.cm[2]
Summary
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. 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. Previous studies have suggested an occupational risk to staff with potential for development of posterior lens opacities and brain and neck tumours.[4,5] efforts need to be made to keep the radiation dose as low as reasonably achievable during the procedure, which would decrease any potential risk for staff and patients
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