Patient Radiation Doses in Interventional Cardiology Procedures

Abstract

Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography, percutaneous coronary interventions, diagnostic electrophysiology studies and radiofrequency catheter ablation. Patient radiation dose in these procedures can be assessed either by measurements on a series of patients in real clinical practice or measurements using patient-equivalent phantoms. In this article we review the derived doses at non-pediatric patients from 72 relevant studies published during the last 22 years in international scientific literature. Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. Discrepancies of the derived results are patient-, procedure-, physician-, and fluoroscopic equipmentrelated. Nevertheless, interventional cardiology procedures can subject patients to considerable radiation doses. Efforts to minimize patient exposure should always be undertaken.

Interventional Cardiology-Eight Years of Practice: Do Increased Experience and Technological Evolution Lead to Undertaking More Difficult Cases and Higher Patient Doses?

“…CA PTCA Pantos [12] Katritsis [29] Toossi [30] Uniyal [4] Bogaert [13] Signorotto [8] mean Effective Dose (mSv) CA PTCA …”

“…However, the potential risk of patient radiation damage must be viewed in the context of the general benefit of these procedures and the likelihood of greater trauma associated with heart surgical interventions and perhaps with imminent death if the intervention was not performed. Radiation dose associated with IC procedures is a complex function of a large number of variables including the X-ray tube voltage (kVp) and the product of tube current and exposure time (mAs), the X-ray field size, the number of projections, focus-skin distance as well as practical skill of the operator [12]. Therefore, for optimizing radiation exposure in such procedures, it is essential to measure patient doses in a given set-up of cardiac catheterization laboratory.…”

Risk assessment for potential radiation-induced cancer after lung and bone marrow exposure during interventional cardiology procedures

“…A major difficulty of such an evaluation is that the values of organ doses associated with ICPs are not easily available in the literature. However, as presented by Pantos et al (2009), even for a specific IC procedure, patient doses vary a lot. Organ doses are generally derived from mathematical modelling of the dose-area product (Monte Carlo simulations), inducing another source of approximation.…”

“…During these procedures, the organs surrounding the heart are exposed to ionising radiation (Pattee et al, 1993;Harrison et al, 1998;Delichas et al, 2003), in particular the lung and bone marrow. It has been shown that patient radiation doses may markedly vary among the ICPs, but also according to patients, operators or X-ray equipment (Bar et al, 2008;Pantos et al, 2009). There is a current debate about whether the widespread use of X-rays could result in an increased incidence of long-term effects, in particular cancers, in this population; it was estimated that on average, in every 100 000 patients subjected to ICPs, about 80 patients would develop fatal cancer during the next 40 years (Efstathopoulos et al, 2004).…”

Patient Radiation Risk in Interventional Cardiology

“…The K AP values from tables 4 and 5 were used to calculate E, resulting to a range from 0.2 to 48.3 mSv for CA procedures and 1.2 to 33.1 mSv for PCI procedures. Effective doses in bibliography ranged between 0.3 to 15.8 mSv for a CA procedure and 0.9 to 44.7 mSv for a PCI procedure [30]. These wide ranges in patient doses may be attributed to the procedure complexity (due to patient anatomy, physician experience, etc.)…”