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



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.

Related Content

Philips Launches Azurion With FlexArm
Technology | Angiography | January 17, 2019
Philips announced the launch of Azurion with FlexArm, designed to enhance positioning flexibility for image-guided...
Videos | Angiography | December 12, 2018
This is a quick walk around of a GE Healthcare Image Guided System (IGS) angiography system cath lab room display at
Shimadzu Medical Systems Teams With Change Healthcare Cardiology
News | Angiography | October 17, 2018
Shimadzu Medical Systems USA and Change Healthcare have entered a partnership through which Shimadzu will offer Change...
Osprey Medical and GE Healthcare Launch Acute Kidney Injury Educational Program
News | Angiography | September 21, 2018
Osprey Medical announced a collaboration with GE Healthcare on Osprey’s Be Kind to Kidneys campaign. The campaign aims...
Philips Azurion angiography system, image-guided therapy system.

The Philips Azurion angiography system offers several imaging and software enhancements to aid guidance during complex interventional procedures.

Feature | Angiography | February 07, 2018 | Dave Fornell
Five new angiography systems were launched in 2017 that included improvements to speed workflow and improve both imag
Philips Azurion Platform Improves Clinical Workflow and Staff Experience Benefits
News | Angiography | December 04, 2017
Philips recently announced the results of a comprehensive, independent, two-year study demonstrating the clinical...
Videos | Angiography | November 22, 2017
Shimadzu demonstrated its Trinias Interventional X-ray System at the 2017 Transcatheter Cardiovascular Therapeutics (
Philips Azurion Image-Guided Therapy Platform Improves Clinical Workflow for Interventional Procedures
News | Angiography | November 15, 2017
Philips announced the results of a comprehensive, independent, two-year study demonstrating the clinical workflow...
Mississippi Surgical and Vascular Center Uses Toshiba Ultimax-i FPD to Save Patients' Limbs
News | Angiography | September 14, 2017
The southern U.S. sees some of the highest numbers of chronic medical conditions, such as peripheral artery disease...
Siemens Healthineers Announces First U.S. Install of Artis Pheno Angiography System
News | Angiography | July 05, 2017
Michigan Medicine recently became the first healthcare institution in the United States to install the Artis pheno, the...
Overlay Init