Amdani Shahnawaz M, Ross Robert D, Webster Paul A, Turner Daniel R, Forbes Thomas J, Kobayashi Daisuke
Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital, Wayne State University School of Medicine, Detroit, Michigan.
Congenit Heart Dis. 2018 Nov;13(6):1028-1037. doi: 10.1111/chd.12677. Epub 2018 Oct 2.
Reduction of radiation dosage in the pediatric cardiac catheterization laboratory (PCL) is important to reduce the risk of its stochastic effect in children with congenital heart disease. Lowering the frame rate would reduce radiation dosage possibly at the expense of image quality, potentially resulting in higher fluoroscopic time and procedural complication rate.
The data were retrospectively analyzed in three eras: era 1 (n = 234), cineangiography 30 frames/sec (f/s) and fluoroscopy 15 pulse/sec (p/s); era 2 (n = 381), cineangiography 30 f/s and fluoroscopy 6 p/s; and era 3 (n = 328), cineangiography 15 f/s and fluoroscopy 6 p/s. Also, three operators blinded to the frame rate setting evaluated cineangiography image quality. In this study, the impact of lowering the default frame rates on radiation dosage, fluoroscopic time, contrast volume, diagnostic image quality, and complication rates in the PCL was assessed.
Overall radiation dosage progressively declined during these eras (70.0 vs 64.1 vs 36.6 µGym /kg, P < .001) without a difference in significant adverse event rates. There was no significant increase in either fluoroscopy time or contrast volume. There was no difference in the diagnostic image quality between cineangiography 30 and 15 f/s. Lowering the default frame/pulse rates of both fluoroscopy and cineangiography significantly decreased the overall radiation dosage in the PCL. Importantly, fluoroscopy time, contrast volume, and complication rates did not increase while maintaining diagnostic image quality.
This quality improvement project proved successful in lowering radiation dosage without compromising the efficacy and safety of catheterizations.
降低小儿心脏导管插入实验室（PCL）的辐射剂量对于降低先天性心脏病患儿发生随机效应的风险至关重要。降低帧率可能会降低辐射剂量，但可能会牺牲图像质量，从而可能导致更高的透视时间和手术并发症发生率。
对三个时期的数据进行回顾性分析：时期1（n = 234），电影血管造影30帧/秒（f/s），透视15脉冲/秒（p/s）；时期2（n = 381），电影血管造影30 f/s，透视6 p/s；时期3（n = 328），电影血管造影15 f/s，透视6 p/s。此外，三名对帧率设置不知情的操作人员评估了电影血管造影的图像质量。在本研究中，评估了降低默认帧率对PCL中辐射剂量、透视时间、造影剂用量、诊断图像质量和并发症发生率的影响。
在这些时期，总体辐射剂量逐渐下降（70.0 vs 64.1 vs 36.6 µGym/kg，P <.001），严重不良事件发生率无差异。透视时间或造影剂用量均无显著增加。电影血管造影30 f/s和15 f/s之间的诊断图像质量无差异。降低透视和电影血管造影的默认帧/脉冲率可显著降低PCL中的总体辐射剂量。重要的是，在保持诊断图像质量的同时，透视时间、造影剂用量和并发症发生率并未增加。
该质量改进项目成功降低了辐射剂量，同时不影响导管插入术的疗效和安全性。
