The Comparison of Radiation Exposure between Application of Ultralow Dose Radiation Settings and Conventional Radiation Settings in Coronary CTO Intervention

Introduction: The purpose of this study is to measure the cumulative doses and dose-area products exposed in chronic totally occluded coronary (CTO) interventions performed under ultra-low dose radiation procedure. Materials and Methods: 47 patients were included to our study. Three experienced CTO operators and team were performed these procedures, one of whom was working with ALARA principles (Operator Group 1, 31 (66%) patients), the remaining operators were working in standard cine mode (Operator Group 2, 16 (34%) patients). Total fluoroscopy time, number of cineangiographic runs, cumulative dose, the dose area product were reviewed for each procedure. ALARA (As Low As Reasonably Achievable) modifications were used by Operator 1, such as reduced pulse width and exposure dose, filter protection, a longer lines for Y connector, pedaling technical as well as low frame rate. Results: Comparison of total fluoroscopy time and the number of cineangiographic runs were not significant. But, on the other hand, cumulative doses and dose area products were significantly lower for the Operator Group 1 (p<0.001 for both parameters). Mean dose area product of CTO procedures were lower than reference levels in the literature in operator Group1. Conclusion: Besides frame rate and fluoroscopy time, the usage of ALARA principles resulted with low radiation exposure compared with conventional techniques during CTO interventions. All catheterization laboratories should strictly apply ALARA principles.