Comparison of Fluoro and Cine Coronary Angiography

Balancing Acceptable Outcomes With a Reduction in Radiation Dose

Ayhan Olcay, MD; Ekrem Guler, MD; Ibrahim Oguz Karaca, MD; Mehmet Onur Omaygenc, MD; Filiz Kizilirmak, MD; Erkam Olgun, MD; Esra Yenipinar, RN; Huseyin Altug Cakmak, MD; Dursun Duman, MD


J Invasive Cardiol. 2015;27(4):199-202. 

In This Article

Abstract and Introduction


Use of last fluoro hold (LFH) mode in fluoroscopy, which enables the last live image to be saved and displayed, could reduce radiation during percutaneous coronary intervention when compared with cine mode. No previous study compared coronary angiography radiation doses and image quality between LFH and conventional cine mode techniques.

Methods We compared cumulative dose-area product (DAP), cumulative air kerma, fluoroscopy time, contrast use, interobserver variability of visual assessment between LFH angiography, and conventional cine angiography techniques. Forty-six patients were prospectively enrolled into the LFH group and 82 patients into the cine angiography group according to operator decision.

Results Mean cumulative DAP was higher in the cine group vs the LFH group (50058.98 ± 53542.71 mGy•cm2 vs 11349.2 ± 8796.46 mGy•cm2; P<.001). Mean fluoroscopy times were higher in the cine group vs the LFH group (3.87 ± 5.08 minutes vs 1.66 ± 1.51 minutes; P<.01). Mean contrast use was higher in the cine group vs the LFH group (112.07 ± 43.79 cc vs 88.15 ± 23.84 cc; P<.001). Mean value of Crombach's alpha was not statistically different between visual estimates of three operators between cine and LFH angiography groups (0.66680 ± 0.19309 vs 0.54193 ± 0.31046; P=.20).

Conclusion Radiation doses, contrast use, and fluoroscopy times are lower in fluoroscopic LFH angiography vs cine angiography. Interclass variability of visual stenosis estimation between three operators was not different between cine and LFH groups. Fluoroscopic LFH images conventionally have inferior diagnostic quality when compared with cine coronary angiography, but with new angiographic systems with improved LFH image quality, these images may be adequate for diagnostic coronary angiography.


Cardiologists are responsible for about 40% of the entire cumulative radiation to the United States population from all medical sources excluding radiotherapy.[1] Radiation given during coronary angiography (CA) and percutaneous coronary intervention (PCI) may have some deleterious effects. The dose area product (DAP), related to the effective dose, is a measure of stochastic risk and a potential quality indicator. Angiographic systems used for interventional procedures have a digital acquisition or "cine" mode. A high radiation dose rate is used to obtain a series of high-resolution images with reduced image noise. The radiation dose per frame for digital acquisitions can be 15 times greater than for fluoroscopy. The number and length of digital acquisition or cine "runs" may be the greatest source of patient radiation dose in interventional cardiology procedures.

Last fluoroscopy hold (LFH) is a new advanced feature that dynamically stores only the last current sequence of fluoroscopy images for instant replay, editing, and storage in angiography systems without the need for operator presetting.[2–9] LFH could reduce the fluoroscopy time to half compared to when it is not used and enables the operator to examine the image as long as necessary without the use of radiation. There is no previous study about feasibility of LFH use in coronary angiography.

In our study, we compared cumulative DAP, cumulative air Kerma, fluoroscopy time, and interobserver variability in visual and quantitative coronary angiography (QCA) assessment of coronary stenoses during coronary angiography in LFH and cine angiography techniques.