Pulse Fluoroscopy Radiation Reduction in a Pediatric Cardiac Catheterization Laboratory

OBJECTIVE: To determine if lower starting pulse fluoroscopy rates lead to lower overall radiation exposure without increasing complication rates or perceived procedure length or difficulty. SETTING: The pediatric cardiac catheterization laboratory at University of Michigan Mott Children's Hospital. PATIENTS: Pediatric patients with congenital heart disease. DESIGN/INTERVENTIONS: We performed a single-center quality improvement study where the baseline pulse fluoroscopy rate was varied between cases during pediatric cardiac catheterization procedures. OUTCOME MEASURES: Indirect and direct radiation exposure data were collected, and the perceived impact of the fluoroscopy rate and procedural complications was recorded. These outcomes were then compared among the different set pulse fluoroscopy rates. RESULTS: Comparing pulse fluoroscopy rates of 15, 7.5, and 5 frames per second from 61 cases, there was a significant reduction in radiation exposure between 15 and 7.5 frames per second. There was no difference in perceived case difficulty, procedural length, or procedural complications regardless of starting pulse fluoroscopy rate. CONCLUSIONS: For pediatric cardiac catheterizations, a starting pulse fluoroscopy rate of 7.5 frames per second exposes physicians and their patients to significantly less radiation with no impact on procedural difficulty or outcomes. This quality improvement study has resulted in a significant practice change in our pediatric cardiac catheterization laboratory, and 7.5 frames per second is now the default fluoroscopy rate.