Proposed preliminary diagnostic reference levels for three common interventional cardiology procedures in Ireland

Abstract

This study has gathered data across Ireland to determine the range of radiation doses received during interventional cardiology (IC) investigations. Radiation doses for three common types of IC examinations where investigated: coronary angiography (CA), percutaneous coronary intervention (PCI) and pacemaker insertions (PPI). A total of 22 cardiac imaging suites participated in the study. Radiation dose was monitored for 1804 adult patients using dose area product (DAP) meters. Individual patient DAP values ranged from 136-23,101 cGy cm2, 475-41,038 cGy cm2 and 45-17,192 cGy cm2 for CA, PCI and PPI respectively, with third quartile values of 4654 cGy cm2, 10,650 cGy cm2 and 1686 cGy cm2. The importance of optimising radiation dose, while not compromising diagnostic efficacy is clear. Although setting reference levels for these complex procedures has some difficulties, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high dose procedures. The third quartile values as described by this paper may offer such guidance.

A national patient dose survey and setting of reference levels for interventional radiology in Bulgaria

“…The reference level for P KA proposed in the present study is in agreement with most of the results reported during recent years [11,13,15,16]. The comparison of the reference level proposed in this study for the combined cardiac procedure (CA+PCI) with data in the literature was hindered by the fact that almost all reference sources provided values either for the angioplasty procedure (PTCA) or for percutaneous coronary intervention (PCI) and only one of them [15] had a reference value for a combined CA+PCI procedure.…”

“…Vano et al 1995 [19] Ruiz Cruces et al [18] Holm and Leitz [14] Neofotistou et al [20] Veit and Bauer [21] Hart et al [13] Aroua et al [17] Balter et al [15] Bleeser et al [22] D'Helft et al [16] Padovani et al [12] Vano et al 2008 [11] CA 40 69 80 57 60 29 80 50 42 45 CA+PCI 140 260 LLA 45 88 36 85 36 210 75 100 …”

Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi‐centre diagnostic reference level in Queensland public hospitals

“…Normalising the dose data to a reference patient weight is difficult with a large number of facilities. Most multi‐centre studies have not elected to do this and this was not performed as part of this study. A higher P KA value than some of the literature may be the result, due to the higher median patient weight of 83 kg seen in this study.…”

“…Normalising the dose data to a reference patient weight is difficult with a large number of facilities. Most multi-centre studies have not elected to do this 16,[27][28][29] and this was not performed as part of this study.…”

Contemporary angiography in the diagnosis and treatment of cardiovascular disease

“…Many multi-centre studies have not elected to do this. (20,22,25,26) A higher DAP value than some of the literature may be the result, due to a higher or lower median patient weight. Another method utilised to normalise the DAP data is to exclude patients outside a weight range of 80Kg ± 5, with the same aim (18).…”