Patient radiation doses in the most common interventional cardiology procedures in Croatia: first results

Abstract

Apart from its benefits, the interventional cardiology (IC) is known to generate high radiation doses to patients and medical staff involved. The European Union Medical Exposures Directive 97/43/Euroatom strongly recommend patient dosimetry in interventional radiology, including IC. IC patient radiation doses in four representative IC rooms in Croatia were investigated. Setting reference levels for these procedures have difficulties due to the large difference in procedure complexity. Nevertheless, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high-dose procedures. Local and national diagnostic reference levels (DRLs) were proposed as a guidance. A total of 138 diagnostic (coronary angiography, CA) and 151 therapeutic (PTCA, stenting) procedures were included. Patient irradiation was measured in terms of kerma-area product (KAP), fluoroscopy time (FT) and number of cine-frames (F). KAP was recorded using calibrated KAP-meters. DRLs of KAP, FT and F were calculated as third quartile values rounded up to the integer. Skin doses were assessed on a selected sample of high skin dose procedures, using radiochromic films, and peak skin doses (PSD) were presented. A relative large range of doses in IC was detected. National DRLs were proposed as follows: 32 Gy cm(2), 6.6 min and 610 frames for CA and 72 Gy cm(2), 19 min and 1270 frames for PTCA. PSD <1 Gy were measured in 72 % and PSD >2 Gy in 8 % of selected patients. Measuring the patient doses in radiological procedures is required by law, but rarely implemented in Croatia. The doses recorded in the study are acceptable when compared with the literature, but optimisation is possible. The preliminary DRL values proposed may be used as a guideline for local departments, and should be a basis for radiation reduction measures and quality assurance programmes in IC in Croatia.

Patient radiation doses in interventional cardiology in the U.S.: Advisory data sets and possible initial values for U.S. reference levels

“…Table VII compares P KA data from this study with P KA data from other countries. 16,23,40,46,47,[54][55][56] Substantial variability is evident, but in most cases the U.S. P KA values are substantially larger than those reported from the European countries. The 75th percentiles for P KA for both PCI and combined procedures in our study (193 Gy cm 2 and 199 Gy cm 2 ) are approximately twice the highest proposed reference level for European studies (94 Gy cm 2 and 107 Gy cm 2 ), as is the 75th percentile for K a.r for PCI procedures (3.12 Gy in our study vs 1.5 Gy in the European study).…”

“…1, 2, [43][44][45] The mean value of the radiation dose metric for the procedure at the local facility is compared to the RL (Table VI). 23,44,[46][47][48][49][50] If it exceeds the RL, investigation of the fluoroscopic equipment is appropriate. If the fluoroscopic equipment is functioning properly and within specification, procedure protocols and operator technique should be examined.…”

Radiation doses during cardiac catheterisation procedures in India: a multicentre study

“…However, lesion complexity data was not included in the study analysis as it was not available for all patients. Comparison of radiation data from the current study with international references and recent literature are shown in Figure 4 as well as in Supplementary Table 2 and Supplementary Table 3 [6][7][8][9][10][11][12][13][14][15][16] . For each procedure category, the study median DAP and 75 th percentile DAP were compared with data from previously published studies: 4 study datasets out of 31 had comparable or lower DAP for CAG and 9 out of 40 had similar outcomes for PCI.…”

Updating national diagnostic reference levels for interventional cardiology and methodological aspects

“…The DOCCACI group provided data and gave advice to the program DOPOES II [7] of the national authority to estimate collective doses and to establish DRLs. Other countries have promoted national surveys [8][9][10][11][12][13][14][15][16]29,30] to the same end. In Europe, some surveys have also been fostered at regional level [17][18][19][20].…”