Patient Dose Related to the Complexity of Interventional Cardiology Procedures

Abstract

In interventional cardiology (IC) the PTCA (percutaneous transluminal coronary angioplasty) procedure is the most frequent procedure with the highest dose to the patient. The procedure is usually performed by cardiologists having, in general, insufficient knowledge of radiation physics, radiation technology and radiation protection. The need for radiation protection is of paramount importance in this field of interventional radiology. Correlation between the complexity of PTCA procedure and irradiation parameters (fluoroscopy time, number of images and dose-area product--DAP) has been demonstrated. The presence of severe tortuosity and occlusion of > or = 3 months play a major role. Fluoroscopy time is better correlated with technical factors than DAP, which also includes the influence of patient size, collimation, operation modes, and X ray beam orientation. The number of acquired images is less correlated with the complexity of the PTCA procedure. A complexity index was conceived and procedures were divided into three groups, defined as: simple, medium and complex, which were significantly different in terms of patient dose.

Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures

“…Indeed, unsuitable use of protective tools or bad practice (e.g. placing the hands directly in the X-ray beam) could lead to high doses at unexpected positions and poor correlation among dosimetric data [9,10]. Thus, it is important to assess radiation doses to the upper and lower extremities and the lenses of the eyes in order to ensure that the annual dose limits are not exceeded.…”

Radiation Dose to Patients From Cardiac Diagnostic Imaging

“…Dose in catheter angiography is highly dependent on operator experience, 78 workload, 79 use of radiation-reducing techniques, 80 procedural complexity, 81 and catheterization laboratory equipment. 75 Coronary angiography and interventions from radial artery access have been shown to be longer and associated with increased dose compared with procedures from femoral access routes.…”

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

“…First of all, the dose to the patient increases with increasing body mass index (BMI) [1][2][3]. Second, dose, fluoroscopy time and number of cine frames might differ depending on the number of treated vessels and/or stenoses [4][5][6], localisation and severity of lesions [2,7], stage of occlusion [7,8], tortuosity of treated vessels [6][7][8], number of stents and balloons [2,4,[7][8][9], and artery approach [10,11]. With the aim of optimising the interventional cardiology procedures (i.e.…”