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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

View larger version (142K): [in a new window]   Figure 1 Catheterization laboratory with an Alderson-Rando phantom (A) simulating the patient: position of the tube (B) in undercouch and the image intensifier (C) in overcouch 60°/0° left anterior oblique position. The Diamentor M4 display (D) and the Szintomat 6134 A system (E) were used to measure fluoroscopic dose-area product, applied to the phantom, and the operator's personal dose.

View larger version (27K): [in a new window]   Figure 2 Calculated isodose lines in a three-dimensional graph of time-adjusted fluoroscopic dose-area product (DAP) (DAPF/time [mGy x cm2/s]), as a function of tube angulation. LAO = left anterior oblique; RAO = right anterior oblique.

View larger version (38K): [in a new window]   Figure 3 Calculated isodose lines in a three-dimensional graph of the operator's mean personal dose per time (µSv/h), as a function of tube angulation. LAO = left anterior oblique; PA = posteroanterior; RAO = right anterior oblique.

View larger version (100K): [in a new window]   Figure 4 Ostial lesion of the left coronary main stem (arrowhead): cranial posteroanterior (PA) 0°/30°+ and PA 0°/0° angulations enable personal dose levels much lower than those obtained with the typical caudal left anterior oblique (LAO) 60°/20°– angulation.

View larger version (116K): [in a new window]   Figure 5 Bifurcation (arrowheads) into the left anterior descending and diagonal artery: cranial posteroanterior (PA) 0°/30°+ enables operator dose levels considerably lower than those obtained with the typical cranial left anterior oblique (LAO) 60°/20°+ angulation.

View larger version (132K): [in a new window]   Figure 6 The left anterior descending artery lesion (arrowhead): right anterior oblique (RAO) 90°/0° angulation enables operator dose levels significantly lower than those obtained with the typical left anterior oblique (LAO) 90°/0° view.

View larger version (114K): [in a new window]   Figure 7 Right coronary artery: right anterior oblique (RAO) 100°/0° angulation enables operator dose levels significantly lower than those obtained the typical left anterior oblique (LAO) 60°/0° view.