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

Abstract

IntroductionRadiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals.MethodsData were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (PKA), skin surface entrance dose (KAR), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the PKA.Results2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median KAR = 581 mGy (374–876). Median PKA = 3908 uGym2 (2489–5865) DRL = 5865 uGym2. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median KAR = 1501 mGy (928–2224). Median PKA = 8736 uGym2 (5449–12,900) DRL = 12,900 uGym2.ConclusionThis study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.

Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography

“…A local, multicentre diagnostic reference level (DRL) for CA was developed in 2013 and published in 2014 . The 75th percentile of 61.4 Gycm 2 in this study appears to be similar to that studies’ DRL for CA of 58.65 Gycm 2 and importantly, the median P KA value appears to be lower than that studies’ 75th percentile DRL .…”

Ultra‐low radiation dose during electrophysiology procedures using optimized new generation fluoroscopy technology

“…Local, multicenter radiation dose benchmarking for coronary angiography and intervention was performed in 2014, demonstrating a median dose of 39.08 Gycm 2 for coronary angiography and 87.36 Gycm 2 for coronary intervention . This is 29.2 and 65.2 times higher respectively than that of the RFA group in this study with the new system and is 3.6 and 7.9 times higher than the RFA group with the older system used in this study.…”

Assessment of Local Dose Reference Values for Recanalization of Chronic Total Occlusions and Other Occlusions in a High-Volume Catheterization Center

“…For the CA and PCI groups, this work found similar values to RAY'ACT but again much lower than GACI and Queenland studies, especially for PCI. 6,7,19 Procedure-specific DRLs may be preferred in interventional cardiology to better match the complexity of procedures. For example, different DRLs have been published for CAs and PCIs.…”

“…For example, different DRLs have been published for CAs and PCIs. 7,19 DRLs were defined for recanalization of all occlusions types and CTOs. For CTOs, 2 different levels were even advocated for, one for the antegrade approach and one for the retrograde approach, considering they were of increased difficulty compared with other angioplasties.…”