Fluoroscopy Pulse Rate Reduction during Diagnostic and Therapeutic Imaging in the Cardiac Catheterization Laboratory: An Evaluation of Radiation Dose, Procedure Complications and Outcomes

Objectives: To evaluate radiation reduction by reducing fluoroscopy pulse rate in diagnostic cardiac catheterizations and percutaneous coronary interventions (PCI) as well as outcomes at 30 days and six months. Background: Radiation exposure to the public at large has increased dramatically over the past three decades, and the cardiac catheterization laboratory is a large contributor. Fluoroscopy pulse rate is one way to decrease radiation exposure. Methods: Fluoroscopy pulse rate was reduced from 10 pulses/sec (p/s) to 7.5 p/s as part of an internal quality improvement project. A retrospective analysis of all cardiac catheterizations was performed, evaluating Air KERMA at the interventional reference point (K-a, (r)), Air KERMA area product (PKA), procedural complications and major adverse cardiac events at 30 days and 6 months. Results: In diagnostic catheterization median PKA (mu mGy.m(2)) and K-a, (r) (mGy) were significantly reduced (P-KA - 5,613.3 vs. 4,400, P< 0.001; K-a,K- r - 703.0 vs. 621.0, P50.041). In PCI, median PKA and Ka, r were further reduced (P-KA -13,481.6 vs. 10,648.0, P < 0.001; K-a,K- r - 1787.0 vs. 1,459.0, P50.002). There was no difference in complications, fluoroscopy time or number of stents placed. There was no difference in MACE after adjustment for number of STEMIs. Conclusions: Reducing fluoroscopy pulse rates to 7.5 from 10 is an effective way to reduce patient radiation exposure across meaningful dose indices. A pulse rate of 7.5 p/s is safe, with no difference in complications or outcomes. A fluoroscopy pulse rate of 7.5 p/s should be given strong consideration for a new standard.(C) 2016 Wiley Periodicals, Inc.