OBJECTIVE: To evaluate the feasibility of a new acquisition protocol to reduce radiation exposure. BACKGROUND: Percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO) are characterized by the highest radiation exposure among PCI procedures. METHODS: We analyzed 552 consecutive CTO procedures between January 2018 and October 2019. After 366 procedures (Group 1) a modified radiation acquisition protocol was implemented for the subsequent 186 procedures (Group 2). Besides a low fluoroscopy frame rate of 6/s and cine frame rate of 7.5/s for both groups, additional modifications consisted of increased copper filtering with lower entry dose in combination with a modified image postprocessing. Radiation exposure was assessed as air kerma (AK; mGy), and dose-area product (DAP; cGy*cm2 ). RESULTS: There was no significant difference in lesion or procedural complexity between the study groups with 46 and 43% of the procedures done via the retrograde approach. While fluoroscopy time remained similar (median: 32.7 vs. 34.3 min), the protocol modifications resulted in a drastic reduction of AK by 68% from 2,040 (1,321-3,339) mGy to 655 (415-1,113) mGy (p < .001) without affecting the procedural success rate. DAP was equally decreased by 71%. These considerable reductions were observed even in obese patients of BMI > 30. In Group 2, not a single procedure exceeded the 5 Gy threshold as compared to 10.4% in Group 1. CONCLUSIONS: Radiation exposure decreased considerably with a new acquisition protocol without affecting procedure duration and success. These modifications were applicable also to patients with a high BMI.
OBJECTIVE: To evaluate the feasibility of a new acquisition protocol to reduce radiation exposure. BACKGROUND: Percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO) are characterized by the highest radiation exposure among PCI procedures. METHODS: We analyzed 552 consecutive CTO procedures between January 2018 and October 2019. After 366 procedures (Group 1) a modified radiation acquisition protocol was implemented for the subsequent 186 procedures (Group 2). Besides a low fluoroscopy frame rate of 6/s and cine frame rate of 7.5/s for both groups, additional modifications consisted of increased copper filtering with lower entry dose in combination with a modified image postprocessing. Radiation exposure was assessed as air kerma (AK; mGy), and dose-area product (DAP; cGy*cm2 ). RESULTS: There was no significant difference in lesion or procedural complexity between the study groups with 46 and 43% of the procedures done via the retrograde approach. While fluoroscopy time remained similar (median: 32.7 vs. 34.3 min), the protocol modifications resulted in a drastic reduction of AK by 68% from 2,040 (1,321-3,339) mGy to 655 (415-1,113) mGy (p < .001) without affecting the procedural success rate. DAP was equally decreased by 71%. These considerable reductions were observed even in obesepatients of BMI > 30. In Group 2, not a single procedure exceeded the 5 Gy threshold as compared to 10.4% in Group 1. CONCLUSIONS: Radiation exposure decreased considerably with a new acquisition protocol without affecting procedure duration and success. These modifications were applicable also to patients with a high BMI.