Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Catheter Cardiovasc Interv. 2022 Oct;100(4):575-584. doi: 10.1002/ccd.30396. Epub 2022 Sep 7.
Measures were undertaken at the Cleveland Clinic to reduce radiation exposure to patients and personnel working in the catheterization laboratories. We report our experience with these improved systems over a 7-year period in patients undergoing diagnostic catheterization (DC) and percutaneous coronary interventions (PCIs).
Patients were categorized into preinitiative (2009-2012) and postinitiative (2013-2019) groups in the DC and PCI cohorts. Propensity score matching was done between the pre- and postinitiative groups for both cohorts based on age, sex, body surface area, total fluoroscopy time, and total acquisition time. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (K ), and fluoroscopy- and acquisition-mode air kerma in patients in the two groups.
In the DC cohort, there was a significant reduction in K in the postinitiative group in comparison to the preinitiative group (median, 396 vs. 857 mGy; p < 0.001). In the PCI cohort, K in the postinitiative group was 1265 mGy, which was significantly lower than the corresponding values in the preinitiative group (1994 mGy; p < 0.001). We also observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates, and air kerma area product in the postinitiative group in comparison to the preinitiative group in both matched and unmatched DC and PCI cohorts after the institution of radiation reduction measures.
There was a significant and sustained reduction in radiation exposure to patients in the catheterization laboratory with the implementation of advanced protocols. Similar algorithms can be applied in other laboratories to achieve a similar reduction in radiation exposure.
克利夫兰诊所采取了措施，以降低导管室患者和工作人员的辐射暴露。我们报告了在接受诊断性导管检查（DC）和经皮冠状动脉介入治疗（PCI）的患者中，使用这些改进系统 7 年的经验。
在 DC 和 PCI 队列中，患者被分为干预前（2009-2012 年）和干预后（2013-2019 年）组。基于年龄、性别、体表面积、总透视时间和总采集时间，对两个队列的预干预组和后干预组进行倾向评分匹配。通过比较两组患者的总空气比释动能（K）以及透视和采集模式下的空气比释动能，评估辐射减少措施的有效性。
在 DC 队列中，与干预前组相比，干预后组的 K 值显著降低（中位数，396 与 857 mGy；p<0.001）。在 PCI 队列中，干预后组的 K 值为 1265 mGy，明显低于干预前组（1994 mGy；p<0.001）。在介入辐射减少措施实施后，无论是在匹配组还是非匹配组，DC 和 PCI 队列中，干预后组的透视和采集模式下的空气比释动能率以及空气比释动能面积乘积也显著降低。
通过实施先进的方案，导管室患者的辐射暴露显著且持续降低。类似的算法可以应用于其他实验室，以实现类似的辐射暴露降低。
