Preliminary reference levels in interventional cardiology

Neofotistou, V.; Vañó, Eliseo; Padovani, R.; Kotre, John; Dowling, A.; Toivonen, M; Kottou, Sofia; Tsapaki, Virginia; Willis, S.; Bernardi, Guglielmo; Faulkner, K.

doi:10.1007/s00330-003-1831-x

Cited by 147 publications

(99 citation statements)

References 20 publications

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“…Although few data on DRLs or 75th percentiles are available in Australia, the 75th percentile levels presented here can be added to the increasing database in Australia of 75th percentiles. So, until DRLs are adopted in Australia, this will be the metric for comparison with reference values being reported worldwide [1,3,5,7,16]. In Table 5, we have collated currently existing DRLs and compared these with our data, and it is reassuring to note that our combined single-plane and biplane value is comparable to those levels established elsewhere, with only the Irish and the UK data being lower [1,16].…”

Section: Discussionmentioning

confidence: 68%

“…It is the most common invasive cardiac procedure and is used for both the initial diagnosis of coronary artery disease (CAD) and the follow-up examinations of patients after coronary interventional procedures, coronary bypass surgery or cardiac transplantation [3,4]. It is a standardised procedure that involves several cine-fluorographic series of the right and left coronary artery systems, with or without a left ventriculogram [5].…”

mentioning

confidence: 99%

“…Recently, the rapid increase in the frequency of diagnostic coronary angiography procedures has prompted radiation protection concerns [6], and studies have been performed to determine patient radiation doses in a number of countries [1,3,5,7]. The radiation dose of diagnostic coronary angiography is often presented in the form of a diagnostic reference level (DRL) [8], which is established at the 75th percentile dose-area product (DAP) value of the distributions of doses observed for a particular examination [9].…”

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confidence: 99%

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Optimisation of coronary angiography exposures requires a multifactorial approach and careful procedural definition

Lin

Brennan²,

Sadick³

et al. 2013

BJR

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Objective: This study investigates the factors associated with higher doses for both single-plane and biplane procedures and establishes centre-specific 75th percentile levels. Methods: 602 patients undergoing coronary angiography in a large hospital at Sydney were recruited to the study, and causal agents for high radiation doses were investigated: gender, procedural complexity, severity of coronary artery disease, presence of coronary bypass grafts, entry approach (radial or femoral), level of operator experience; and a single-plane or a biplane imaging system was employed. Results: The 75th percentile levels were calculated. The results demonstrated that, for both systems, higher exposures were associated with patients who were male (p,0.001), had coronary vessel disease (p,0.001) and had a history of coronary bypass grafts (p,0.001). In addition, for biplane systems, procedural complexity (p,0.001), types of entry approach (p,0.001) and levels of operator experience (p,0.001) significantly impacted upon the dose. Biplane examinations recorded higher doses than single-plane procedures (p,0.001) and the inclusion of left-sided ventriculography contributed to the overall dose by up to 10%. Conclusion: The 75th percentile levels in this study represent the tentative reference levels and are 48.9, 44.2 and 56 Gy cm 2 for all exposures, single-plane-and biplane-specific exposures, respectively, and compare favourably with the diagnostic reference level values established elsewhere internationally, with only the UK and Irish data being lower. Advances in knowledge: Specific agents have been identified for dose-reducing strategies and the importance of operator training is highlighted. The assumption that biplane procedures may reduce the patient dose should be treated with caution.

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Section: Discussionmentioning

confidence: 68%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Optimisation of coronary angiography exposures requires a multifactorial approach and careful procedural definition

Lin

Brennan²,

Sadick³

et al. 2013

BJR

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“…Few data are available that permit benchmarking for these parameters. Of the data available, recent European experience 9 suggests that procedure DAP values in excess of 100 Gy ⅐ cm 2 for a routine diagnostic coronary angiogram should be evaluated for appropriateness as part of a quality assurance review. However, the appropriateness of the 100 Gy ⅐ cm 2 value, or any other value, should be considered in the context of the type and complexity of the procedure as well as patient characteristics.…”

Section: Dap Benchmarking Datamentioning

confidence: 99%

ACCF/AHA/HRS/SCAI Clinical Competence Statement on Physician Knowledge to Optimize Patient Safety and Image Quality in Fluoroscopically Guided Invasive Cardiovascular Procedures

Hirshfeld¹,

Balter²,

Brinker³

et al. 2005

Circulation

281

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“…When as in some diagnostic procedures, for example in coronary angiography, image projections are known with reasonable accuracy in advance, P KA has been suggested as an appropriate measure [14] particularly for stochastic radiation effects. But is has also been suggested for use in interventional cardiology [15]. Others [16][17][18] have also suggested using P KA as an indicator for high skin doses.…”

Section: Introductionmentioning

confidence: 99%

Local skin and eye lens equivalent doses in interventional neuroradiology

2009

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Abstract:The aim of this work was to assess patient skin and eye lens doses in interventional neuroradiology and to assess both stochastic and deterministic radiation risks. Kerma-area product, P KA was recorded and skin doses measured using thermoluminescence dosimeters. Estimated dose at interventional reference point, IRP, was compared with measured absorbed doses. The average and maximum fluoroscopy times were 32 and 189 min for coiling and 40 and 144min for embolisation. The average and maximum P KA for coiling were 121 and 436 Gycm 2 respectively and 189 and 677 Gycm 2 for embolisation. The average and maximum values of the measured maximum absorbed skin doses were 0.72 and 3.0Sv respectively for coiling and 0.79 and 2.1Sv for embolisation. Two out of the 52 patients received skin doses in excess of 2Sv. The average and maximum doses to the eye lens (left eye) were 51 and 51mSv (coiling) and 71 and 289mSv (embolisation). The ratio between the measured dose and the dose at the IRP was 0.44±0.18mSv/mGy indicating that the dose displayed by the x-ray unit overestimates the maximum skin dose but is still a valuable indication of the dose. The risk in our hospital skin erythema and lens cataract is therefore small.

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Preliminary reference levels in interventional cardiology

Cited by 147 publications

References 20 publications

Optimisation of coronary angiography exposures requires a multifactorial approach and careful procedural definition

Optimisation of coronary angiography exposures requires a multifactorial approach and careful procedural definition

ACCF/AHA/HRS/SCAI Clinical Competence Statement on Physician Knowledge to Optimize Patient Safety and Image Quality in Fluoroscopically Guided Invasive Cardiovascular Procedures

Local skin and eye lens equivalent doses in interventional neuroradiology

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