Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada.
JACC Cardiovasc Interv. 2014 May;7(5):567-74. doi: 10.1016/j.jcin.2014.02.005. Epub 2014 Apr 16.
This study sought to determine the efficacy of low rate fluoroscopy at 7.5 frames/s (FPS) versus conventional 15 FPS for reduction of operator and patient radiation dose during diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) via the transradial approach (TRA).
TRA for cardiac catheterization is potentially associated with increased radiation exposure. Low rate fluoroscopy has the potential to reduce radiation exposure.
Patients undergoing TRA diagnostic angiography ± ad-hoc PCI were randomized to fluoroscopy at 7.5 FPS versus 15 FPS prior to the procedure. Both 7.5 and 15 FPS fluoroscopy protocols were configured with a fixed dose per pulse of 40 nGy. Primary endpoints were operator radiation dose (measured with dosimeter attached to the left side of the thyroid shield in μSievert [μSv]), patient radiation dose (expressed as dose-area product in Gy·cm(2)), and fluoroscopy time.
From October 1, 2012 to August 30, 2013, from a total of 363 patients, 184 underwent DCA and 179 underwent PCI. Overall, fluoroscopy at 7.5 FPS compared with 15 FPS was associated with a significant reduction in operator dose (30% relative reduction [RR], p < 0.0001); and in patient's dose-area product (19% RR; p = 0.022). When stratified by procedure type, 7.5 FPS compared with 15 FPS was associated with significant reduction in operator dose during both DCA (40% RR; p < 0.0001) and PCI (28% RR; p = 0.0011). Fluoroscopy at 7.5 FPS, compared with 15 FPS, was also associated with substantial reduction in patients' dose-area product during DCA (26% RR; p = 0.0018) and during PCI (19% RR; p = 0.13). Fluoroscopy time was similar in 7.5 FPS and 15 FPS groups for DCA (3.4 ± 2.0 min vs. 4.0 ± 4.7 min; p = 0.42) and PCI (11.9 ± 8.4 min vs. 13.3 ± 9.7 min; p = 0.57), respectively.
Fluoroscopy at 7.5 FPS, compared with 15 FPS, is a simple and effective method in reducing operator and patient radiation dose during TRA DCA and PCI.
本研究旨在确定在经桡动脉途径（TRA）行诊断性冠状动脉造影（DCA）和经皮冠状动脉介入治疗（PCI）时，以 7.5 帧/秒（FPS）的低帧率透视与传统的 15 FPS 透视相比，降低操作者和患者的辐射剂量的效果。
TRA 用于心脏导管术可能会增加辐射暴露。低帧率透视有可能降低辐射暴露。
在进行 TRA 诊断性血管造影术±临时 PCI 之前，将接受治疗的患者随机分为 7.5 FPS 透视组和 15 FPS 透视组。7.5 和 15 FPS 透视方案均采用每脉冲 40 纳戈（nGy）的固定剂量进行配置。主要终点是操作者的辐射剂量（用附着在甲状腺屏蔽左侧的剂量计测量，单位为微希沃特[μSv]）、患者的辐射剂量（以剂量面积产品表示，单位为 Gy·cm²）和透视时间。
2012 年 10 月 1 日至 2013 年 8 月 30 日，共有 363 例患者，其中 184 例行 DCA，179 例行 PCI。总体而言，与 15 FPS 透视相比，7.5 FPS 透视可显著降低操作者剂量（相对减少 30%[RR]，p < 0.0001），并降低患者的剂量面积产品（RR 减少 19%；p = 0.022）。按手术类型分层，与 15 FPS 透视相比，7.5 FPS 透视可显著降低 DCA 期间（RR 减少 40%；p < 0.0001）和 PCI 期间（RR 减少 28%；p = 0.0011）操作者剂量。与 15 FPS 透视相比，7.5 FPS 透视还可显著降低 DCA 期间（RR 减少 26%；p = 0.0018）和 PCI 期间（RR 减少 19%；p = 0.13）患者的剂量面积产品。DCA 时（3.4 ± 2.0 分钟比 4.0 ± 4.7 分钟；p = 0.42）和 PCI 时（11.9 ± 8.4 分钟比 13.3 ± 9.7 分钟；p = 0.57），7.5 FPS 透视组和 15 FPS 透视组的透视时间相似。
与 15 FPS 透视相比，7.5 FPS 透视是一种简单有效的方法，可降低 TRA DCA 和 PCI 期间操作者和患者的辐射剂量。
