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INTERVENTIONAL CARDIOLOGY

Identification of less-irradiating tube angulations in invasive cardiology

Eberhard Kuon, MD^*,*, Johannes B. Dahm, MD, Klaus Empen, MD, Daniel M. Robinson, MD, Gereon Reuter, MD^* and Michael Wucherer, PhD

^* Department of Cardiology, Klinik Fraenkische Schweiz, Ebermannstadt, Germany
Department of Cardiology, Ernst-Moritz-Arndt University, Greifswald, Germany
Institute of Medical Physics, Clinic of Nuremberg, Nuremberg, Germany

Manuscript received April 13, 2004; revised manuscript received June 6, 2004, accepted June 22, 2004.

^* Reprint requests and correspondence: Dr. Eberhard Kuon, Klinik Fraenkische Schweiz, Feuersteinstr. 2, D-91320 Ebermannstadt, Germany (Email: Eberhard.Kuon{at}klinik-fraenkische-schweiz.de).

OBJECTIVES: We sought to identify tube angulations in invasive cardiology, which promise minimal radiation exposure to patients and operators.

BACKGROUND: Radiation exposure in invasive cardiology is high.

METHODS: We mapped the fluoroscopic dose-area product per second (DAP/s), applied to an anthropomorphic Alderson-Rando phantom and, in absence of radiation protection devices, the mean personal dose in the operator's position in 10° steps from the 100° right anterior oblique (RAO) to the 100° left anterior oblique (LAO) projection, as well as for all geometrically feasible craniocaudal tube angulations.

RESULTS: For our specific setting conditions RAO 20°/0° tube angulation generated the lowest DAP/s and operator's personal dose. The mean patient DAP/s and operator personal dose for all postero-anterior (PA) projections, cranialized and caudalized together, rose significantly: 3.7 and 10.6 times the PA 0° baseline values toward LAO 100° and 3.7 and 2.4 times toward RAO 100°, respectively. Patient and operator values for all PA projections, angulated to the right and left, increased 2.5 times toward 30° craniocaudal angulations. Caudal PA 0°/30°– angulation instead of caudal LAO 60°/20°– angulation for the left coronary main stem and cranial PA 0°/30°+ view in place of cranial LAO 60°/20°+ view for the left anterior descending coronary artery bifurcation enable 2.6-fold dose reductions to the patient and eight- and five-fold dose reductions to the operator, respectively.

CONCLUSIONS: The PA views and RAO views 40°, heretofore unconventional in clinical routine, should be favored over steep LAO projections 40° whenever possible. Tube angulations that are radiation intensive to the patient exponentially increasethe operator's radiation risk.

Abbreviations and Acronyms   DAP/s = dose-area product per second   LAD = left anterior descending coronary artery   LAO = left anterior oblique   PA = postero-anterior   RAO = right anterior oblique   SID = source-to-image distance   SOD = source-to-operator distance

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