Open Access

ARTICLE

Reducing radiation exposure by lowering frame rate in children undergoing cardiac catheterization: A quality improvement study

Shahnawaz M. Amdani, Robert D. Ross, Paul A. Webster, Daniel R. Turner, Thomas J. Forbes, Daisuke Kobayashi

Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children’s Hospital, Wayne State University School of Medicine, Detroit, Michigan

* Corresponding Author: Daisuke Kobayashi, M.D, Division of Cardiology, Children’s Hospital of Michigan, Carman and Ann Adams. Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, 3901 Beaubien Blvd, Detroit, MI 48201‐2119. Email:

Congenital Heart Disease 2018, 13(6), 1028-1037. https://doi.org/10.1111/chd.12677

Abstract

Introduction: 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 dos‐ age possibly at the expense of image quality, potentially resulting in higher fluoro‐ scopic time and procedural complication rate.
Methods: The data were retrospectively analyzed in three eras: era 1 (n = 234), cine‐ angiography 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, diagnos‐ tic image quality, and complication rates in the PCL was assessed.
Results: Overall radiation dosage progressively declined during these eras (70.0 vs 64.1 vs 36.6 µGym² /kg, P < .001) without a difference in significant adverse event rates. There was no significant increase in either fluoroscopy time or contrast vol‐ ume. There was no difference in the diagnostic image quality between cineangiogra‐ phy 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 in‐ crease while maintaining diagnostic image quality.
Conclusion: This quality improvement project proved successful in lowering radia‐ tion dosage without compromising the efficacy and safety of catheterizations.

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