Advances in cardiac catheterization procedures have revolutionized the care for children and adults with congenital heart disease. Fluoroscopic and angiographic evaluation is an essential visualization tool in catheterization laboratories. Reducing the radiation dose to “As Low As Reasonably Achievable (ALARA)” has been important to reduce the harmful effects of the radiation. Minderhoud SCS et al. in this article describe the impact of the use of a dose reduction protocol for 3-dimensional rotational angiograms. The dose reduction included: 

1. Reducing the frames per second from 60 to 30 f/s. 
2. Scanning patients with a tube voltage corresponding to a low-dose program. 
3. Using a protocol for one weight class lower than the patient’s weight. 
4. Using a thick copper filter. 
5. Using collimation as appropriate. 
6. Checking the tube current to be below 100mA before the actual run. 

The authors elegantly demonstrate that by implementing the dose reduction protocol, they achieved a 66% reduction in radiation dose without affecting the image quality. All interventional cardiologists should be aware of these findings. Hopefully, the dose-reducing steps described in this study can be a useful reproducible tool to decrease the dose without affecting the image quality or clinical outcomes. 

All editors: Varun Aggarwal, MD, MBBS, FSCAI