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


In our prospective study, a total of 46 patients were enrolled into the LFH group and 82 patients were enrolled into the cine angiography group according to operator decision during a 6-month period. All angiographic images were taken at similar angles by all operators. Frame rate for both cine and fluoroscopy was 15 frames/second and constant for all operators and all studies. The study was approved by the ethics committee of the institutional review board and informed consent was obtained from all patients. All investigators were experienced and the least experienced cardiologist had experience with >100 PCIs. Imaging data were digitized and stored in DICOM format. Each angiogram was reviewed independently by three interventional cardiologists using the Philips Inturis Suite Lite version 2.1.1 DICOM viewer on a high resolution 19" TFT flat screen and stenoses were visually assessed. The reviewers were blinded to clinical data and clinical outcome. Based on visual assessment alone, each investigator was asked to classify the percent stenosis of each lesion. All procedures were undertaken on a Philips Integris Allura FD10 angiographic system. Prior to the study, quality control tests were carried out to assess the system performance and to calibrate the DAP meter installed on the machine. Cumulative DAP value, cumulative air kerma product, fluoroscopy time, total amount of contrast used, and operator's name were collected for each patient. Additional measured parameters were sex, age, weight, height, body mass index (BMI), presence of diabetes mellitus, creatinine level, history of coronary artery disease, history of PCI, history of coronary artery bypass grafting (CABG), in-hospital mortality and morbidity, and image quality as assessed by two cardiologists.


Air kerma was defined as the energy extracted from an x-ray beam per unit mass of air in a small irradiated air volume. Air kerma is measured in grays. For diagnostic radiographs, air kerma is the dose delivered to that volume of air. Fluoroscopy time (FT) was defined as the total time that fluoroscopy was used during an imaging or interventional procedure. Kerma-area product (PKA) was defined as the integral of air kerma across the entire x-ray beam emitted from the x-ray tube. PKA is a surrogate measurement for the entire amount of energy delivered to the patient by the beam, and is measured in Gy • cm2. Air kerma is measured at a specific point 15 cm on the gantry side from isocenter. PKA is usually measured without scatter. This quantity was previously called dose-area product, and earlier publications used the abbreviations "KAP" and "DAP" for this quantity.

Statistical Analysis

All statistical analyses were done with the SPSS for Windows program, version 11.0 (SPSS, Inc). Continuous variables were compared by student t-test. Categorical variables were compared by Chi-square test. Values are expressed as mean ± standard deviation and percentages. The agreement in lesion assessment between reviewers was assessed by intraclass correlation coefficient and Cronbach's alpha. Statistical measures were calculated at observer- and vessel-segment level. For every single observer, the diameter stenosis estimates were compared for all 13 vessel segments. All tests were two-tailed and differences were considered significant at P-value <.05.