FOCUS ISSUE: CARDIAC INTERVENTION: RADIATION EXPOSURE FOR CATHETERIZATION
Variability in Fluoroscopic X-Ray Exposure in Contemporary Cardiac Catheterization Laboratories
Warren K. Laskey, MD, FSCAI, FACC*,*,
Merrill Wondrow, BA and
David R. Holmes, Jr, MD, FSCAI, FACC
* Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
Clarte Imaging Solutions, Inc., Waukesha, Wisconsin
Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Manuscript received March 28, 2006;
revised manuscript received May 25, 2006,
accepted June 6, 2006.
* Reprint requests and correspondence: Dr. Warren K. Laskey, Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, New Mexico 87131. (Email: wlaskey{at}salud.unm.edu).
OBJECTIVES: This study sought to assess fluoroscopic exposure rates in contemporary cardiac catheterization laboratories (CCL).
BACKGROUND: Increasing attention is being focused on X-ray exposure during diagnostic and therapeutic cardiovascular procedures.
METHODS: We measured fluoroscopic exposure rates (R/min) in 41 systems using a standardized methodology (National Electrical Manufacturers Association XR21 phantom). Measurements were obtained at 2 different phantom thicknesses to simulate varying patient body habitus.
RESULTS: Fluoroscopic exposure rates under medium (median 3.0 R/min, interquartile range 1.4 R/min) and large (median 12.5 R/min, interquartile range 4.8 R/min) habitus conditions showed substantial variation. Fluoroscopic exposure was associated with simulated patient habitus, X-ray system type, vendor, and geographic region. Under medium habitus conditions, only 25% of systems operated within a zone of lower than average exposure rates and satisfactory image quality; this frequency diminished to 7% under large habitus conditions (p < 0.001).
CONCLUSIONS: There is substantial variation (4- to 6-fold) in fluoroscopic exposure rates. This variation was not consistently associated with improved image quality. In the absence of a predictable benefit of higher (or lower) than average exposure rates, CCL quality improvement programs must minimize such potentially harmful variability in X-ray exposure.
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Abbreviations and Acronyms
| | ALARA = as low as reasonably achievable | | CCL = cardiac catheterization laboratory | | IQR = interquartile range | | lp = line pair | | NEMA = National Electrical Manufacturers Association |
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