Innovations in Radiation Safety During Cardiovascular Catheterization
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Interventional cardiovascular procedures are rapidly evolving, allowing treatment of increasingly complex patients such as those with chronic total occlusions, bifurcations, calcified vessels, multivessel coronary artery disease, aortic aneurysms, and valvular heart disease. This increase in complexity can lead to higher patient and operator radiation dose, thereby increasing the risk for complications such as radiation skin injury, cataracts, and cancer. The risk for radiation injury is likely to worsen given the progressive increase in the population undergoing cardiovascular procedures and the steady climb in patients’ body mass index. Reducing radiation dose to patients, operators,1,2 or ideally both has been the aim of several innovative technologies (Table).
Reducing Patient Radiation Dose
Newer x-ray machines can significantly reduce patient radiation dose through improved x-ray tubes and flat panel detectors, enhanced image processing, and use of lower frame rates. However, differences remain between systems, and few standardized comparisons have been performed.3 Moreover, image quality varies widely even between different settings of the same system, often requiring multiple system calibrations for image optimization.
Only a small part of the x-ray image is actually viewed by the operator at any given time. Two systems (which are not currently commercially available in the United States) use a fast-moving x-ray collimator to maintain excellent image quality in a limited portion of the screen only. One system focuses …