{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T22:41:39Z","timestamp":1784155299536,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Measures were undertaken at the Cleveland Clinic to reduce radiation exposure to patients and personnel working in the catheterization laboratories. We report our experience with these improved systems over a 7\u2010year period in patients undergoing diagnostic catheterization (DC) and percutaneous coronary interventions (PCIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were categorized into preinitiative (2009\u20132012) and postinitiative (2013\u20132019) groups in the DC and PCI cohorts. Propensity score matching was done between the pre\u2010 and postinitiative groups for both cohorts based on age, sex, body surface area, total fluoroscopy time, and total acquisition time. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (<jats:italic>K<\/jats:italic><jats:sub>a,r<\/jats:sub>), and fluoroscopy\u2010 and acquisition\u2010mode air kerma in patients in the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the DC cohort, there was a significant reduction in <jats:italic>K<\/jats:italic><jats:sub>a,r<\/jats:sub> in the postinitiative group in comparison to the preinitiative group (median, 396\u00a0vs. 857\u2009mGy; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In the PCI cohort, <jats:italic>K<\/jats:italic><jats:sub>a,r<\/jats:sub> in the postinitiative group was 1265\u2009mGy, which was significantly lower than the corresponding values in the preinitiative group (1994\u2009mGy; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). We also observed a significant reduction in fluoroscopy\u2010 and acquisition\u2010based air kerma rates, and air kerma area product in the postinitiative group in comparison to the preinitiative group in both matched and unmatched DC and PCI cohorts after the institution of radiation reduction measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There was a significant and sustained reduction in radiation exposure to patients in the catheterization laboratory with the implementation of advanced protocols. Similar algorithms can be applied in other laboratories to achieve a similar reduction in radiation exposure.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.30396","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T06:44:03Z","timestamp":1662619443000},"page":"575-584","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Radiation reduction in a modern catheterization laboratory: A single\u2010center experience"],"prefix":"10.1002","volume":"100","author":[{"given":"Shashank","family":"Shekhar","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Ajay","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankit","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anirudh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manpreet","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2172-6447","authenticated-orcid":false,"given":"Toshiaki","family":"Isogai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0101-0131","authenticated-orcid":false,"given":"Anas","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1399-6487","authenticated-orcid":false,"given":"Abdelrahman I.","family":"Abushouk","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-9212","authenticated-orcid":false,"given":"Omar","family":"Abdelfattah","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4778-5461","authenticated-orcid":false,"given":"Hassan","family":"Lak","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medhat","family":"Farwati","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keerat","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beni R.","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Wunderle","sequence":"additional","affiliation":[{"name":"Department of Radiology, Imaging Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6239-9772","authenticated-orcid":false,"given":"Stephen","family":"Ellis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0315-3219","authenticated-orcid":false,"given":"Jaikirshan","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Ziada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6048-7955","authenticated-orcid":false,"given":"Amar","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-3391","authenticated-orcid":false,"given":"Samir","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"issue":"4","key":"e_1_2_11_2_1","first-page":"e38","article-title":"Heart disease and stroke statistics\u20102016 update: a report from the American Heart Association","volume":"133","author":"Writing Group M","year":"2016","journal-title":"Circulation"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-018-0462-8"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.13.12029"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.icrp.2012.09.001"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.001499"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV7I9A172"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/tcm.1030"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-011-9921-3"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-012-2656-2"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2013.11.005"},{"key":"e_1_2_11_12_1","volume-title":"Radiation Safety and Protection StatPearls","author":"Frane N","year":"2021"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.21.4.g01jl271033"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.04.041"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2014.02.005"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.15420\/icr.2013.8.1.36"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1088\/0952-4746\/33\/2\/433"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.09.044"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.312105185"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.29744"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2005.061150"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.06.057"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/82051842"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2013.12.203"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2004.048108"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acvd.2009.09.007"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0b013e31824dae76"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.06.021"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.02.026"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.30396","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.30396","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.30396","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T09:27:17Z","timestamp":1692696437000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.30396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,7]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1002\/ccd.30396"],"URL":"https:\/\/doi.org\/10.1002\/ccd.30396","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,7]]},"assertion":[{"value":"2022-01-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}