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Plummeting the Radiation Curve - A 13-Year Cath Lab Experience
Session:
Sessão de Posters 13 - Intervenção coronária avançada: fisiologia, bifurcações e complicações
Speaker:
Daniel Inácio Cazeiro
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Daniel Inácio Cazeiro; João Cravo; Marta Vilela; Diogo Ferreira; Tiago Rodrigues; Ana Rita Francisco; Pedro Carrilho Ferreira; Cláudia Jorge; João Silva Marques; Pedro Cardoso; Fausto J. Pinto; Miguel Nobre Menezes
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"> Radiation exposure remains a major safety concern in fluoroscopy (FL) guided cardiovascular procedures, with substantial variability across centers and operators.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">:</span></span></span><br /> <span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">To characterize long-term trends in radiation dose and assess the impact of a comprehensive radiation-reduction initiative (RRI) in a hemodynamics laboratory.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><br /> <span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Single-center, retrospective study of all coronary procedures – diagnostic coronary angiography (CAG) with or without percutaneous coronary intervention (PCI) - and transcatheter aortic valve implantation (TAVI) procedures performed from 2012 and September 2025. Coronary procedures were performed using Siemens® Axiom Artis FC® systems until 2019 and Artis zeego® systems from 2019 onwards; TAVI procedures used Artis zee®.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Until 2020, standard FL settings with frame rates (FR) of 15 frames/second (f/s) were routinely used. From 2021 onwards, FR were standardized to 10 or 7.5 f/s and low-dose protocols became increasingly common. In 2025, an extended RRI was implemented, incorporating (1) public reporting of baseline radiation metrics; (2) semi-automated radiation data capture; (3) rigorous quarterly audits publicly released to the team and (4) a standardized protocol with low-dose presets, FR at a minimum of 4 f/s when feasible, and preferential storage of FL loops instead of cine acquisitions. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Radiation was quantified using Kerma Air Product (KAP) in mGy·cm</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"> (the only radiation metric universally present during the entire period). Temporal changes were assessed with Mann-Whitney tests across three predefined periods (2012–2016, 2017–2021, 2022–2025) and the 2025 trimesters.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br /> <span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">A total of 28906 coronary procedures (18274 CAG, 10632 CAG+PCI) and 1114 TAVI procedures were included – median KAP of 36200, 117400 and 94550 mGy·cm², respectively. Across the three periods, median KAP declined significantly in all procedures – 41800>37000>29700 in CAG; 134700>121150>91200 in CAG+PCI and 175650> 109100>70300 mGy·cm² in TAVI (all p<0.05). Following implementation of the 2025 protocol, further reductions occurred – 28122>20101 in CAG (p<0.001); 82398>66702 in CAG+PCI (p=0.011) and 82253>32215 mGy·cm² in TAVI (p<0.001).</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><br /> <span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Radiation exposure during coronary procedures and TAVI decreased substantially over the study period, reflecting improvements in operator expertise, procedural efficiency and dose-optimization strategies. Reductions were most pronounced in higher dose procedures, with decade-long relative decreases of 47% for CAG + PCI and 80% for TAVI. In 2025, the standardized protocol yielded additional reductions of 19% and 61%, respectively. These findings highlight the effectiveness of structured, team-wide radiation-optimization approaches supported by public auditing and feedback in contemporary interventional cardiology.</span></span></span></p>
Slides
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