Radiation Exposure During Elective Coronary Angioplasty: The Effect of Flat-Panel Detection

Background

Coronary angiography and angioplasty have to date been performed using digital angiography and fluoroscopic systems which incorporate an image intensifier (II). More recently flat-panel (FP) detectors have been introduced which are thought to improve spatial resolution. However, there is limited data on the effect of flat-panel detection on radiation exposure. We sought to determine the impact of flat-panel on cumulative radiation exposure in patients undergoing elective coronary angioplasty at our institution.

Methods

Patients who underwent elective coronary angioplasty in the six months prior to and following upgrade of our Toshiba™ catheterisation laboratory from image intensifier to flat-panel were included. Demographic and radiation data were collected prospectively and the same five operators performed interventions during the 12-month period. Radiation data was obtained from the dose-area product meter intrinsic to the fluoroscopy system.

Results

One hundred and thirty seven patients underwent elective angioplasty over the 12-month period (68 II, 69 FP). Cumulative radiation exposure was increased in flat-panel cases (99, 129Gycm² versus 71, 77Gycm², p=0.001). This increase was independent of patient weight (78±15kg versus 78±17kg, p=NS), screening time (19±12min versus 18±13min, p=NS) and total number of digital acquisitions (1475, 820 versus 1668, 1365, p=NS). The total amount of contrast dye did not differ between flat-panel and image intensifier cases (195±76ml versus 194±79ml, p=NS).

Conclusions

Adoption of flat-panel detector technology increases radiation exposure. This may have important safety implications for catheterisation laboratory staff and patients undergoing multiple interventional procedures.

Keywords: Flat-panel fluoroscopy, Radiation, Coronary angioplasty