Identification of less-irradiating tube angulations in invasive cardiology Original Research Article

Objectives We sought to identify tube angulations in invasive cardiology, which promise minimal radiation exposure to patients and operators. Background Radiation exposure in invasive cardiology is high. Methods We mapped the fluoroscopic dose-area product per second (DAP/s), applied to an anthropomorphic Alderson-Rando phantom and, in absence of radiation protection devices, the mean personal dose in the operatorʹs position in 10° steps from the 100° right anterior oblique (RAO) to the 100° left anterior oblique (LAO) projection, as well as for all geometrically feasible craniocaudal tube angulations. Results For our specific setting conditions RAO 20°/0° tube angulation generated the lowest DAP/s and operatorʹs personal dose. The mean patient DAP/s and operator personal dose for all postero-anterior (PA) projections, cranialized and caudalized together, rose significantly: 3.7 and 10.6 times the PA 0° baseline values toward LAO 100° and 3.7 and 2.4 times toward RAO 100°, respectively. Patient and operator values for all PA projections, angulated to the right and left, increased not, vert, similar2.5 times toward 30° craniocaudal angulations. Caudal PA 0°/30°− angulation instead of caudal LAO 60°/20°− angulation for the left coronary main stem and cranial PA 0°/30°+ view in place of cranial LAO 60°/20°+ view for the left anterior descending coronary artery bifurcation enable 2.6-fold dose reductions to the patient and eight- and five-fold dose reductions to the operator, respectively. Conclusions The PA views and RAO views ≥40°, heretofore unconventional in clinical routine, should be favored over steep LAO projections ≥40° whenever possible. Tube angulations that are radiation intensive to the patient exponentially increasethe operatorʹs radiation risk.