@Article{chd.12677,
AUTHOR = {Shahnawaz M. Amdani, Robert D. Ross, Paul A. Webster, Daniel R. Turner, Thomas J. Forbes, Daisuke Kobayashi},
TITLE = {Reducing radiation exposure by lowering frame rate in children undergoing cardiac catheterization: A quality improvement study},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {6},
PAGES = {1028--1037},
URL = {http://www.techscience.com/schd/v13n6/39086},
ISSN = {3071-1738},
ABSTRACT = {<b>Introduction:</b> Reduction of radiation dosage in the pediatric cardiac catheterization 
laboratory (PCL) is important to reduce the risk of its stochastic effect in children 
with congenital heart disease. Lowering the frame rate would reduce radiation dos‐
age possibly at the expense of image quality, potentially resulting in higher fluoro‐
scopic time and procedural complication rate.<br/>
<b>Methods:</b> The data were retrospectively analyzed in three eras: era 1 (n = 234), cine‐
angiography 30 frames/sec (f/s) and fluoroscopy 15 pulse/sec (p/s); era 2 (n = 381), 
cineangiography 30 f/s and fluoroscopy 6 p/s; and era 3 (n = 328), cineangiography 
15 f/s and fluoroscopy 6 p/s. Also, three operators blinded to the frame rate setting 
evaluated cineangiography image quality. In this study, the impact of lowering the 
default frame rates on radiation dosage, fluoroscopic time, contrast volume, diagnos‐
tic image quality, and complication rates in the PCL was assessed.<br/>
<b>Results:</b> Overall radiation dosage progressively declined during these eras (70.0 vs 
64.1 vs 36.6 µGym<sup>2</sup>
/kg, P < .001) without a difference in significant adverse event 
rates. There was no significant increase in either fluoroscopy time or contrast vol‐
ume. There was no difference in the diagnostic image quality between cineangiogra‐
phy 30 and 15 f/s. Lowering the default frame/pulse rates of both fluoroscopy and 
cineangiography significantly decreased the overall radiation dosage in the PCL. 
Importantly, fluoroscopy time, contrast volume, and complication rates did not in‐
crease while maintaining diagnostic image quality.<br/>
<b>Conclusion:</b> This quality improvement project proved successful in lowering radia‐
tion dosage without compromising the efficacy and safety of catheterizations.},
DOI = {10.1111/chd.12677}
}