Feature | Angiography | June 06, 2018| Dave Fornell, Editor

Dose-Lowering Practices for Cath Lab Angiography

10 simple suggestions to lower X-ray dose outlined in a new consensus document jointly issued by several cardiology societies

How to reduce radiation exposure in the cath lab fluoroscopy. Imaging system in photo is a Philips XperFlex.

June 6, 2018 — Here is a checklist of dose-sparing practices for angiographic X-ray imaging used in the cath lab. This list was included in a new 2018 consensus document to guide the optimal use of ionizing radiation in cardiovascular imaging.[1] 

The consensus document was issued in May 2018 jointly by the American College of Cardiology (ACC), Heart Rhythm Society (HRS), North American Society for Cardiovascular Imaging (NASCI), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the Society of Cardiovascular Computed Tomography (SCCT). It includes input from experts from a total of nine cardiology societies and includes best practices for safety and effectiveness when using computed tomography (CT), nuclear imaging and angiographic/fluoroscopic imaging. The document also includes a section on what is needed for radiation dose recording and monitoring for both patients and staff.

One section includes a the following checklist to help lower dose in X-ray fluoroscopy angiography:

 

Case Selection:

   • Consider patient age, comorbidities, natural life expectancy

   • Consider appropriateness and utility of nonradiation-based imaging techniques

 

Equipment Calibration:

    • Use fluoroscopic and cine doses as low as compatible with diagnostic image quality

 

Procedure Conduct:

   • Minimize beam-on time

   • Use lowest-dose fluoroscopy setting suitable for a particular task

   • Collimate imaging field size to the area of interest

   • Use the slowest framing rates suitable for a particular task

   • Minimize cine acquisition run durations

   • Minimize patient-detector distance

   • Maximize employment of operator shielding

 

Related Content on Cath Lab Radiation Safety:

Cardiology Societies Call for Better Radiation Dose Tracking

Defining the Cath Lab Workplace Radiation Safety Hazard

14 Ways to Reduce Radiation Exposure in the Cath Lab

Regulatory Requirements: The Impact on Cardiac Imaging and Dose Management

Role of Dose Tracking Systems in Radiation Safety Programs

5 Technologies to Reduce Cath Lab Radiation Exposure

VIDEO: Heart Surgeon Shares Effects of Fluoroscopic Radiation Exposure

Dose-Lowering Practices for Nuclear Cardiology

 

Reference:

1. John W. Hirshfeld Jr., Victor A. Ferrari, Frank M. Bengel, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Journal of the American College of Cardiology. May 2018. DOI: 10.1016/j.jacc.2018.02.016.

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