Radiation risk to patients from percutaneous transluminal coronary angioplasty

Abstract

The skin exposures estimated for angioplasty are on average higher than for other X-ray procedures. The cancer mortality risk does not exceed the mortality risk of bypass surgery. Good professional practice requires maximization of the benefit/risk ratio through quality assurance in all aspects of the procedure.

Patient cumulative radiation exposure in interventional cardiology

“…The procedures were all performed using the same cathetherism room, reducing dose variability linked to the equipment. As found in other studies (Pattee et al, 1993;Betsou et al, 1998;Katritsis et al, 2000;Delichas et al 2003;Efstathopoulos et al, 2004;Smith and Rivers, 2008), higher values of DAP were observed for PTCAs rather than for CAs in our study, due to the significantly increased fluoroscopy DAP values in the case of PTCA. As one might expect, the average organ dose values due to a CA or a PTCA were significantly higher than those currently observed for conventional radiology procedures, ranging from 2 to 436 mGy for the lung while the dose associated to a CT scan is around 10 mGy (UNSCEAR, 2006).…”

“…As one might expect, the average organ dose values due to a CA or a PTCA were significantly higher than those currently observed for conventional radiology procedures, ranging from 2 to 436 mGy for the lung while the dose associated to a CT scan is around 10 mGy (UNSCEAR, 2006). Compared to others studies calculating organ doses the mean doses in our study were smaller than previously reported (Pattee et al, 1993;Delichas et al, 2003) except for one study (Harrison et al, 1998) considering only CA, which observed smaller lung doses than we did. Differences in the treated population, operator's skills, awareness of radiation protection rules and mathematical models used to calculate organ doses could explain some of these discrepancies.…”

“…But its relevance is less evident in cases of focused or heterogeneous exposure. The building of a mathematical model dedicated to this specific population of patients allowed us to better characterize organ doses than in previously reported studies (Pattee et al, 1993;Harrison et al, 1998;Delichas et al, 2003), taking into account operator effect and the type of procedure, both factors known to influence doses. The procedures were all performed using the same cathetherism room, reducing dose variability linked to the equipment.…”

“…For all the patients, it was possible to calculate organ doses received during each procedure by some of the heart's neighbouring organs which are recognized as being rather radiosensitive (UNSCEAR, 2006) through a mathematical model. Organ doses are seldom considered in the field of IC (Pattee et al, 1993;Harrison et al, 1998;Delichas et al, 2003) or in other areas of medical exposure (Ruiz-Cruces et al, 2000) due to its difficult estimation. However, the absorbed dose to an organ represents a rather appropriate dosimetric indicator as compared to effective dose in order to evaluate a potential adverse effect of ionizing radiation to a specific organ.…”

“…Radiation dose levels greater than 2 Gy have been described in the literature (Faulkner and Vano, 2001) as producing deterministic effects such as skin injuries to patients ) while long-term effects such as cancer have been discussed for lower doses of ionizing radiation by several authors (Boice et al, 1991;Howe, 1995;Meinert et al, 1999;Doody et al, 2000;InfanteRivard et al, 2000;Preston et al, 2003;Preston et al, 2007). Despite the relatively low level of effective doses associated to ICP, rather high doses to organs surrounding the heart have been reported (Pattee et al, 1993;Harrison et al, 1998;Delichas et al, 2003). Hence, the relevance of setting up epidemiological studies on cancer risks assessment associated with exposure during ICP for specific cancer location (Malisan et al, 2008) was underlined.…”