ALARA Without Modern Equipment: Aging Cardiac Catheterization Laboratory Fluoroscopy Infrastructure in Illinois and California

The principle of As Low As Reasonably Achievable (ALARA) is the cornerstone of radiation safety in the cardiac catheterization laboratory. Adopted by the International Commission on Radiological Protection and reflected across regulatory frameworks, ALARA requires that radiation exposure to patients and personnel be minimized to the extent practicable, consistent with procedural objectives.1 In practice, however, ALARA has been operationalized almost exclusively through operator behavior, placing onus on the optimization of fluoroscopy time, frame rates, collimation, and angulation, while the dose-reduction capability of the imaging equipment itself receives little to no attention.