Slower can be better

Reducing radiation exposure during heart catheterization procedures

cardiac cath reducing radiationA cardiac catheterization is a procedure performed by a cardiologist to diagnose and often treat heart conditions. Many patients with congenital heart disease require cardiac catheterizations. During catheterization procedures, we use fluoroscopy to obtain real-time moving images of your heart.

Fluoroscopy is basically a series of x-rays that are played very quickly. It’s similar to how movies work – when the still images are played back quickly, they produces a moving image.

Because fluoroscopy uses x-rays, patients are exposed to radiation during catheterization procedures. Just like with an x-ray of your arm or leg – the radiation from a cath procedure poses very little risk to the patient. Most people do not know that they are exposed to very, very small amounts of radiation every day. For example, the sun’s radiation and radiation from the elements in the soil contribute to what is called natural background radiation exposure. While radiation exposure during catheterization procedures can often be more than this background radiation exposure, the radiation dose is still very low.

With that said, our patients are children – some very young – and they have a whole life ahead of them. The cumulative exposure to repeated radiation may place patients at risk of radiation-related health problems as they get older. So while a cath procedure presents very little risk from a radiation perspective, we are always eager to find ways to lower radiation exposure even further.

My colleagues and I recently explored one way to lower radiation during cath procedures by modifying the fluoroscopy rate.

As mentioned above, fluoroscopy works by using little pulses of radiation over a short period of time to give us moving images of your heart. The more frequent the number of pictures (or frames) we take per second, the better quality movie we get. But, higher frames-per-second also result in higher exposure to radiation.

We wanted to determine if we could adjust the fluoroscopy rate (lower the frames per second) without impacting the quality of picture the cardiologist sees – which is very important to allow him or her to perform these delicate procedures.

What we found was that we were able to cut the frames per second by half with no impact on the image quality or level of difficulty the cardiologist experienced performing the procedure. More importantly, this small change resulted in a dramatic reduction of radiation exposure.

Since then, we’ve transitioned to using a lower fluoroscopy rate for all of our cardiac cath procedures at Mott Children’s Hospital. We have also partnered with the companies that make the cath lab equipment to set the radiation doses as low as possible. As newer equipment and technology becomes available, we hope to continue to reduce radiation exposure to our patients. There may even be ways to perform cardiac catheterizations without using any radiation in the future.

At the U-M Congenital Heart Center, we are part of two nationwide efforts currently underway to evaluate how we can further reduce radiation exposure to our patients. We believe it is extremely important to be on the cutting edge and make every effort to perform catheterization procedures with as little risk to our patients as possible.

The fact that we were able to find a way to improve the quality of care we deliver for our patients with something as simple as changing a setting on a machine has been very rewarding. Certainly not every quality improvement initiative we take on is as straightforward as this, but every step we can take to better protect and care for our patients is a step worth taking.

Take the next step:

Jeff Zampi, MD, Pediatric CardiologistJeff Zampi, MD, is a pediatric cardiologist at C.S. Mott Children’s Hospital at the University of Michigan, specializing in both interventional cardiac catheterization and cardiac critical care. Dr. Zampi’s research interests include novel approaches to interventional pediatric cardiology, hybrid procedures and percutaneous valve implantation. In addition, Dr. Zampi has taken a lead role in quality improvement efforts within the cardiac catheterization laboratory and is involved in several national data registries to improve the care of patients who undergo cardiac catheterization procedures within the Congenital Heart Center at U-M.

best children's hospitalsUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.