Radiation Exposure in Coronary Angiography: A Comparison of Cineangiography and Fluorography

Background and Objectives: Coronary angiography (CAG) is the gold standard for diagnosing coronary artery disease. However, exposure to ionizing radiation delivered during CAG has various negative biological effects on humans. In this study, there was an evaluation of whether fluorography resulted in decreased radiation exposure, as compared with cineangiography. Subjects and Methods: Fifty-five patients were prospectively enrolled and divided into two CAG groups, in accordance with the operator's professional discretion: a conventional cineangiography group versus a fluorography group. Fluorography refers to the photography of fluoroscopic images that are retrospectively stored, e.g., using the "Store fluoro" function of the Siemens cardiac angiography system. The primary outcomes included the air kinetic energy released per unit mass {air kerma (AK) mGy} and the dose (kerma)-area product (DAP; ${\mu}Gy{\cdot}m^2$), both measured using built-in software in the Siemens system. The secondary outcomes included the total procedure time and amount of contrast agent used with each CAG method. Results: The total AK and DAP were significantly lower in the fluorography group ($159.3{\pm}64.9mGy$ and $1337.9{\pm}629.6{\mu}Gy{\cdot}m^2$, respectively) than in the cineangiography group ($326.9{\pm}107.5mGy$ and $2341.1{\pm}849.9{\mu}Gy{\cdot}m^2$, respectively; p=0.000 for both). The total procedure time (cineangiography vs. fluorography, $12.8{\pm}4.7$ vs. $12.5{\pm}2.9min$; p=0.779) and contrast agent amount ($136.1{\pm}28.3$ vs. $126.3{\pm}25.7$, p=0.214) were comparable between the two groups. Conclusion: Fluorography is a useful method to decrease the radiation exposure in selected patients requiring CAG.