Dose-area product reduction through a practice implementing low frame rate fluoroscopy and increased collimation during single-vessel percutaneous coronary interventions

Abstract

This study aims to investigate the impact of lowering fluoroscopic frame rate and increasing collimation on dose area product (DAP) during single-vessel percutaneous coronary interventions. Two patient groups that underwent such procedures were retrospectively reviewed: one treated with a standard practice employing fluoroscopy at 15 frames/s and usual collimation (standard group), and the other with a reduced practice employing fluoroscopy at 7.5 frames/s and increased collimation (reduced group). DAP, patient’s effective dose (ED), fluoroscopy time, and number of cineangiography (cine) frames were compared between groups. Multilinear analysis was performed, with DAP as a primary endpoint, to assess the impact of reduced practice in comparison to that of other variables deemed as key descriptors of radiation, patient, disease, or procedure. Relative to the standard group, the reduced group showed a significant decrease of ~37% in DAP (91.46 ± 45.08 Gy•cm2 vs. 145.23 ± 59.67 Gy•cm2, P < 0.0001) and of ~39% in ED (18.70 ± 9.00 mSv vs. 30.61 ± 12.72 mSv, P < 0.0001). While fluoroscopic time was not statistically different between groups (reduced: 10.3 ± 5.6 min vs. standard: 11.1 ± 5.3 min, P = 0.09), number of cine frames was significantly higher in the reduced (1162 ± 304 vs. 936 ± 363, P < 0.0001) due to interoperator experience variability. Multilinear analysis demonstrated that the adoption of the reduced practice was the most significant contributor to the observed DAP decrease. After adjusting for potential confounders, a reduction of ~39% in DAP was found.

Keywords

• collimation
• dose area product
• frame rate
• percutaneous coronary intervention
• radiation protection