Author + information
Significant emphasis has been placed in the treatment of chronic total occlusions (CTO). However, these procedures are longer with increased radiation (Rad) exposure. Rad exposure to the patient, operator and cath lab personnel is one of the main occupational hazards.
We developed a Rad protocol that included 3 levels of fluoro and 3 for cine (very low, low and normal). All procedures were started with very low rad for both modalities. According to image quality, the operator determined the need for increase X-ray exposure as well as the need 15F/sec or 7.5 F/sec. The cath lab technician will return to the lowest rad unless required otherwise. The fluoroscopy time (FT) and DAP (cGycm2) was automatically recorded. The aim of the study was to determine if the new approach was associated with improved rad exposure.
From 01-2016 to 05-2017, CTO PCI were done in 113 pts. A total of 45 pts had PCI prior to the implementation of the new protocol (NP) and were used as control group. The NP was used in 68 pts. Mean BMI was 29.9 + 10 vs 28.9 +11, p=0.51. Mean FT was 40.1 + 22 min in control vs. 48.7 + 30 min in the NP, p=0.09. Mean rad (DAP) was 27,569 + 19,887cGycm2 in control vs. 16,691 + 14,280 cGycm2 in the NP, p=0.001. Rad exposure adjusted to FT is shown in figure.
The study shows that X-ray protocol with active participation of the operator and cath lab staff significantly decreases Rad exposure. This was seen in all patients with greater absolute reduction in high BMI. Protocols like the one presented should be implemented in all cath labs to decrease this occupational hazard.
OTHER: Quality, Guidelines and Appropriateness Criteria