Shedding Light on Radiation Exposure: Emergency vs. Elective Catheterization Procedures in a Prospective Cohort Study

Background and Objectives: Cardiac catheterization employs ionizing radiation, which carries risks for patients and providers. The influence of procedural urgency on radiation exposure has rarely been investigated. This study compares radiation parameters in elective versus emergency cardiac catheterizations.

Methods: This prospective cohort study examined 108 patients (elective: 27; emergency: 81) undergoing cardiac catheterization at Shamir Medical Center between October 2014 and March 2015. All procedures were performed by a single operator utilizing the Allura Clarity X-ray system, reducing variability. Radiation metrics such as fluoroscopy time, cine time, Dose Area Product (DAP), and Air Kerma Product (KAP) were registered. Dosimeters were placed at the level of patients’ heads and at the level of operators’ chests. Multiple linear regression was employed to adjust for confounding factors including male, number of diseased vessels, stenting, and Balloon inflations.

Results: In the crude analysis, cine time was significantly higher in emergency procedures than elective procedures, with a difference of 22.69 ms (P = 0.009). In contrast, KAP demonstrated an inverse relationship, indicating a reduction of 770.48 mGy in emergency procedures (P = 0.021). Moving to the adjusted analysis, cine time remained significant. Additionally, DAP became significant, with a coefficient of 38,394.88 mGy·cm² (P = 0.028). Meanwhile, KAP shifted to a direct relationship, showing an increase of 680.96 mGy in emergency procedures (P = 0.027). Confidence intervals improved following adjustment and became even narrower. Interestingly, the dosimeter under the lead aprons measured lower radiation exposition in the first operator (0.1 mSv) compared with the second operator (0.41 mSv).

Conclusions: Procedure urgency is a significant factor in radiation exposure in cardiac catheterization. Technologies for dose reduction and protocol standardization are essential for minimizing risks to patients and providers. Future studies should evaluate advanced imaging systems and long-term radiation effects across diverse populations.