Determinants of Radiation Exposure in the Cardiac Catheterization Laboratory: Influence of Procedure Type, Vascular Access, and Lesion Complexity in a Tertiary Care Center
DOI:
https://doi.org/10.58889/PJCVI.5.2.46.54Keywords:
Radiation Exposure, Fluoroscopy, Coronary Angiography, Percutaneous Coronary Intervention, Radial Access, Femoral AccessAbstract
Background: Radiation exposure in the cardiac catheterization laboratory represents a critical concern for both patient safety and occupational health. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) rely on fluoroscopic imaging, resulting in variable radiation doses influenced by procedural and anatomical factors.
Methodology: This retrospective observational study was conducted at Lady Reading Hospital, Peshawar, Pakistan, and included 300 consecutive adult patients (≥18 years) who underwent CAG or PCI between December 2024 and May 2025. Radiation exposure parameters, including fluoroscopy time and dose–area product (DAP), were automatically recorded by the angiography system. Patients were stratified according to procedure type (CAG vs. PCI), vascular access site (radial vs. femoral), and PCI complexity based on ACC/AHA lesion classification and procedural characteristics.
Results: PCI procedures were associated with significantly higher radiation exposure compared with diagnostic CAG, with longer fluoroscopy times (34.1 ± 3.1 vs. 4.5 ± 1.0 minutes) and higher DAP (152.4 ± 14.9 vs. 18.1 ± 2.8 Gy·cm²; p < 0.001). Overall radiation exposure was comparable between radial and femoral access. However, within the PCI subgroup, radial access was associated with significantly higher fluoroscopy time and DAP compared with femoral access (p < 0.001). Lesion complexity demonstrated a strong association with radiation exposure, with ACC/AHA B2/C lesions showing substantially higher fluoroscopy time (44.0 vs. 22.1 minutes) and DAP (201.9 vs. 108.9 Gy·cm²; p < 0.001).
Conclusion: Radiation exposure in the cardiac catheterization laboratory is primarily driven by procedure type and lesion complexity. While vascular access site does not significantly influence radiation exposure overall, radial access is associated with higher radiation burden within PCI procedures. These findings highlight the importance of targeted radiation-reduction strategies, particularly during complex interventions.
