The goal of our study was to clarify the effect of low pulse rate fluoroscopy applying in percutaneous coronary intervention (PCI) on devices' visibility and radiation dose. Four types of fluoroscopy conditions combined with two pulse rates (7.5 and 15 pulses/s) and two types of adaptive temporal filters (ATFs) (weak and strong) were used. Samples for visibility evaluation were acquired with moving phantom and devices such as stent, balloon, and guidewire. Trailing artifacts and the visibility of stent were evaluated by Scheffe's method of paired comparisons. Incident air kerma (Ka,r) and kerma area product (PKA) in the clinic were obtained under two fluoroscopic pulse rate conditions (7.5 and 15 pulses/s). As a result, in 7.5 pulses/s fluoroscopy, trailing artifacts were decreased by using weak ATF with the median value of PKA and Ka,r reduced by about 50%, but stent visibility was decreased compared to 15 pulses/s. Therefore, a combination of 7.5 pulses/s fluoroscopy and suitable ATF can bring dose reduction with avoiding trailing artifacts, but dose per pulse should be adjusted to maintain the stent visibility.
Keywords: air kerma at the patient entrance reference point (Ka,r); air kerma–area product (PKA); fluoroscopy optimization; low pulse rate; percutaneous coronary intervention.