Shah, Binita, Xingchen Mai, Tummala, Lakshmi, Kliger, Chad, Bangalore, Sripal, Miller, Louis H., Sedlis, Steven P., Feit, Frederick, Liou, Michael, Attubato, Michael, Coppola, John, and Slater, James
Coronary angiography is the gold standard for defining obstructive coronary disease. However, radiation exposure remains an unwanted hazard. Patients referred for coronary angiography with abdominal circumference <45 inches and glomerular filtration rate >60 ml/min were randomized to the fluorography (n[25) or cineangiography (n[25) group. Patients in the fluorography group underwent coronary angiography using retrospectively stored fluorography with repeat injection under cineangiography only when needed for better resolution per operator's discretion. Patients in the cineangiography group underwent coronary angiography using routine cineangiography. The primary end point was patient radiation exposure measured by radiochromic film. Secondary end points included the radiation output measurement of kerma-area product and air kerma at the interventional reference point (Ka,r) and operator radiation exposure measured by a dosimeter. Patient radiation exposure (158.2 mGy [76.5 to 210.2] vs 272.5 mGy [163.3 to 314.0], p [ 0.001), kerma-area product (1,323 mGy$m2 [826 to 1,765] vs 3,451 mGy$m2 [2,464 to 4,818], p <0.001), and Ka,r (175mGy [112 to 252] vs 558 mGy [313 to 621], p <0.001) were significantly lower in the fluorography compared with cineangiography group (42%, 62%, and 69% relative reduction, respectively). Operator radiation exposure trended in the same direction, although statistically nonsignificant (fluorography 2.35 mGy [1.24 to 6.30] vs cineangiography 5.03 mGy [2.48 to 7.80], p[ 0.059). In conclusion, the use of fluorography in a select group of patients during coronary angiography, with repeat injection under cineangiography only when needed, was efficacious at reducing patient radiation exposure. [ABSTRACT FROM AUTHOR]