Reducing Patient Radiation Skin Dose in Percutaneous Coronary Intervention Using a Dedicated Protocol: A Single‐Center Experience

Background Percutaneous coronary interventions (PCI) expose patients and operators to ionizing radiation, posing risks of deterministic effects such as skin injury and stochastic effects including malignancy. Although real‐time dosimetry and dose alerts have been associated with radiation‐dose reductions in prior reports, the level of patient radiation reduction associated with implementing a formal, multifaceted radiation reduction program has not previously been reported in a high‐volume catheterization laboratory. Objectives To evaluate the impact of a substantial radiation dose level (SRDL) protocol on patient radiation exposure during PCI. Methods This retrospective study analyzed 19,249 PCI procedures at a tertiary center from July 2012 to December 2021. Patients were stratified into a pre‐protocol cohort (Phase 1: 17,332 procedures) and a post‐protocol cohort (Phase 2: 1917 procedures following implementation in November 2019). The SRDL protocol included real‐time radiation monitoring, alert thresholds at 5 Gy air kerma, and structured follow‐up for high‐dose cases. Study outcomes included air kerma ( K a,r ) dose‐area product (DAP), contrast volume, and fluoroscopy time. Results The study cohort (mean age 66.3 years; 28.5% female) demonstrated significant reductions in radiation exposure after implementing the protocol. Median air kerma declined from 2.6 to 2.0 Gy (23% reduction; p < 0.0001), and median DAP decreased from 158 to 125 Gy·cm 2 (20.8% reduction; p < 0.0001). Contrast volume was reduced by 15 mL (11.1% reduction; p < 0.0001), while fluoroscopy time remained unchanged (18.1 vs. 18.3 min; p = 0.094). Despite increased procedural complexity in Phase 2 (multivessel PCI: 69.5% vs. 65.2%; p < 0.001), radiation reduction remained significant. Conclusions Implementation of an SRDL protocol was associated with significant reductions in patient radiation exposure during PCI without increasing procedure time, supporting its use as a safety intervention in high‐volume catheterization laboratories.