OR12-1
Minimizing Radiation Exposure during Cardiac Catheterization by Utilizing Ultra-Low Fluoroscopy Frame Rate.
Presenter
Michael R Gibrael, Cedars-Sinai Health System, Anaheim, CA
Michael R Gibrael, Cedars-Sinai Health System, Anaheim, CA, Suhail Dohad, M.D., Cedars-Sinai Medical Center, Beverly Hills, CA and Jorge Corsino Espino, GE Healthcare, New York, NY
Keywords: Imaging & Physiology, Occupational Health & Safety, Quality and Radiation Safety
Background
Radiation exposure can pose occupational health hazards both for patients and operators. This study aims to assess the effectiveness of an Ultra-Low Dose protocol (ULD) with low Frames Per Second (fps) in reducing radiation exposure during cardiac catheterization procedures, compared to the site's Standard Dose Protocol (SD)
Methods:
The ULD protocol was optimized by leveraging an AI-based imaging chain and lower fps on the institution's cardiac catheterization (CC) laboratories (IGS5 with AutoRight®, GE HealthCare). The ULD protocol was set at 3.75 fps for fluoroscopy (fluoro) and 7.5 fps for cine-fluoro, while the SD protocol was set at 7.5 and 15 fps, respectively. The ULD protocol was used as default at the start of procedures. However, utilization for the entire case was left to the physician's discretion. All cardiac exams were analyzed from June 2022 to August 2023 and categorized between SD and ULD groups based on the protocol used for more than 50% of the acquisition. Total Air Kerma (AK) in mGy, Dose Area Product (DAP) in Gy.cm2, and fluoro time (FT) in min (all corrected for patient Body Mass Index (BMI)) were measured and compared between both groups. The fluoroscopy and cine AK and DAP rates, calculated in mGy/min and Gy.cm2/min respectively, defined as the ratio between fluoro AK or DAP and fluoroscopy time, and between cine AK or DAP and cine time respectively, were calculated to estimate patient delivered and absorbed dose independent of procedure. The results are expressed as a median.
Results:
Total AK, DAP, AK and DAP rates, FT, BMI, and procedure types were compared for more than 3,400 exams. Overall, the ULD protocol significantly reduced AK and DAP (145 vs. 313mGy, 12 vs. 27Gy.cm2, p<0.05). AK and DAP per min were reduced by 48% and 53% for fluoro and reduced by 50% and 58% for Cine-fluoro. These results were consistent across all procedure types. Total FT was similar regardless of protocol across all BMIs.
Conclusions
Optimized ultra-low-dose protocol leveraging AI-based imaging chain and lower frames per second for fluoro and cine is a straightforward and essential approach in reducing patient and, subsequently, operator radiation exposure during CC procedures.