Shedding light on radiation exposure: Emergency vs. elective catheterization procedures in a prospective cohort study

Background and objectives

Cardiac catheterization employs ionizing radiation, although imaging technologies have improved safety, the influence of procedural urgency on radiation exposure has rarely been investigated. This study compares radiation parameters in elective versus emergency cardiac catheterizations.

Methods

This prospective cohort study examined 108 patients (elective: 27; emergency: 81) undergoing cardiac catheterization at University Hospital between October 2014 and March 2015. All procedures were performed by a single operator utilizing the Allura Clarity X-ray system, reducing variability. Radiation metrics such as fluoroscopy time, cine time, Dose Area Product (DAP), and Air Kerma Product (KAP) were registered. Dosimeters were placed at the level of patients' heads and the level of operators' chests.

Results

In the crude analysis, cine time was significantly higher in emergency procedures than in elective procedures, with a difference of 22.69 ms (P = 0.009). In contrast, KAP demonstrated an inverse relationship, indicating a reduction of 770.48 mGy in emergency procedures (P = 0.021). Moving to the adjusted analysis, cine time remained significant. Additionally, DAP became significant, with a coefficient of 38,394.88 mGy·cm² (P = 0.028). Meanwhile, KAP shifted to a direct relationship, showing an increase of 680.96 mGy in emergency procedures (P = 0.027). Confidence intervals improved following adjustment and became even narrower.

Conclusions

Procedure urgency is a significant factor in radiation exposure in cardiac catheterization. Technologies for dose reduction and protocol standardization are essential for minimizing risks to patients and providers.