This retrospective study addresses the role of operator and fluoroscopy equipment in reducing patient radiation exposure in the Cath lab.

Data from 99,400 procedures performed in our institution between 2007 and 2019 were reviewed. Dosimetric parameters included reference point air kerma (K_a,r), Kerma Area Product (P_KA), fluoroscopic time, and contrast volume. Results are characterized by their 50th and 99th percentiles. Data from a subset of fluoroscopes that were in continuous use and a subset of operators who used the same “continuous” fluoroscope in every year of the study were also analyzed.

For all procedures, median K_a,r declined by 63%, from 1.5 to 0.5Gy; 99th percentiles declined by 44%, from 8.6 to 4.8Gy. For the 3 “continuous fluoroscopes” median K_a,r declined by 60% from 1.6 to 0.6Gy; 99th percentile by 52% from 9.1 to 4.4Gy. The all-procedure median contrast volume declined by 53%, from 150 to 70ml; 99th percentile by 42% from 600 to 350ml. The all-procedure median fluoroscopy time declined by 2%; the 99th percentile increased by 32%. In the continuous subset, median fluoroscopy time declined by 20%; 99th percentile increased by 5%. For the operator's subset, the median K_a,r declined by 43% (P = .0362); the 99th percentile decreased by 22% (P = .0481). Substantial radiation dose procedures decreased from 7% to 0.8% of the procedure volume.

There was a significant reduction in patient radiation (K_a,r and P_KA) and contrast volume during the study period driven by systematic and operator practice changes.