Skin dose and dose–area product values for interventional cardiology procedures

Vañó, Eliseo; González, L.; Ten, J. I.; Fernández, J.; Guibelalde, E.; Macaya, Carlos

doi:10.1259/bjr.74.877.740048

Cited by 106 publications

(66 citation statements)

References 29 publications

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“…The average DAP of 158.2 Gycm 2 found in this study is within the range reported in the literature (28.5-370.6 Gycm 2 ) [24,[36][37][38][39][40][41], but higher than the reference dose level of 75 Gycm 2 established by the European Cardiology research programme DIMOND [37]. A 300 Gycm 2 threshold has also been set for probable induction of skin injury by the European DIMOND research programme.…”

Section: Discussionsupporting

confidence: 82%

Impact of biplane versus single-plane imaging on radiation dose, contrast load and procedural time in coronary angioplasty

Sadick¹,

Reed²,

Collins³

et al. 2010

BJR

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ABSTRACT. Coronary angioplasties can be performed with either single-plane or biplane imaging techniques. The aim of this study was to determine whether biplane imaging, in comparison to single-plane imaging, reduces radiation dose and contrast load and shortens procedural time during (i) primary and elective coronary angioplasty procedures, (ii) angioplasty to the main vascular territories and (iii) procedures performed by operators with various levels of experience. This prospective observational study included a total of 504 primary and elective single-vessel coronary angioplasty procedures utilising either biplane or single-plane imaging. Radiographic and clinical parameters were collected from clinical reports and examination protocols. Radiation dose was measured by a dose-area-product (DAP) meter intrinsic to the angiography system. Our results showed that biplane imaging delivered a significantly greater radiation dose (181.4¡121.0 Gycm 2 ) than single-plane imaging (133.6¡92.8 Gycm 2 , p,0.0001). The difference was independent of case type (primary or elective) (p50.862), vascular territory (p50.519) and operator experience (p50.903). No significant difference was found in contrast load between biplane (166.8¡62.9 ml) and single-plane imaging (176.8¡66.0 ml) (p50.302). This non-significant difference was independent of case type (p50.551), vascular territory (p50.308) and operator experience (p50.304). Procedures performed with biplane imaging were significantly longer (55.3¡27.8 min) than those with single-plane (48.9¡24.2 min, p50.010) and, similarly, were not dependent on case type (p50.226), vascular territory (p50.642) or operator experience (p50.094). Biplane imaging resulted in a greater radiation dose and a longer procedural time and delivered a non-significant reduction in contrast load than single-plane imaging. These findings did not support the commonly perceived advantages of using biplane imaging in single-vessel coronary interventional procedures.

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Section: Discussionsupporting

confidence: 82%

Impact of biplane versus single-plane imaging on radiation dose, contrast load and procedural time in coronary angioplasty

Sadick¹,

Reed²,

Collins³

et al. 2010

BJR

View full text Add to dashboard Cite

show abstract

“…Some authors claim that the DAP is not a suitable quantity for such a monitoring task because of the weak correlation between the DAP and the entrance surface dose [29], and that the latter should be measured directly on the patient. But in the absence of a direct measurement, conversion factors published in the literature [19,[30][31][32][33] may be used to establish the maximum (peak) skin dose from the DAP.…”

Section: Introductionmentioning

confidence: 99%

How to set up and apply reference levels in fluoroscopy at a national level

et al. 2006

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A nationwide survey was launched to investigate the use of fluoroscopy and establish national reference levels (RL) for dose-intensive procedures. The 2-year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on 12 examination types: 6 diagnostic and 6 interventional. A total of 1,000 examinations was registered. Information including the fluoroscopy time (T), the number of frames (N) and the dose-area product (DAP) was provided. The data set was used to establish the distributions of T, N and the DAP and the associated RL values. The examinations were pooled to improve the statistics. A wide variation in dose and image quality in fixed geometry was observed. As an example, the skin dose rate for abdominal examinations varied in the range of 10 to 45 mGy/min for comparable image quality. A wide variability was found for several types of examinations, mainly complex ones. DAP RLs of 210, 125, 80, 240, 440 and 110 Gy cm 2 were established for lower limb and iliac angiography, cerebral angiography, coronary angiography, biliary drainage and stenting, cerebral embolization and PTCA, respectively. The RL values established are compared to the data published in the literature.

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“…As the DAP does not depend on the patient-to-focus distance, it can be readily measured through a transmission chamber placed at the tube housing level that fully intercepts the incident primary X-ray beam. However, although DAP meters are almost routinely available on radiographic equipment, some authors demonstrated that the DAP value is not an accurate predictor of MSD and deterministic risks [16][17][18][19][20]. It is, however, a relevant indicator to estimate stochastic risks [1].…”

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confidence: 99%

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Journy

Sinno‐Tellier²,

Maccia³

et al. 2012

BJR

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Objective: The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. Methods: We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. Results: The mean MSD and DAP were respectively 389 mGy and 65 Gy cm 22 for CAs, and 916 mGy and 69 Gy cm 22 for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r50.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. Conclusion: Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions. Interventional cardiology procedures such as repeated diagnostic coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) may cause radio-induced skin damage. Deterministic skin effects might occur as soon as the dose to the patient's skin exceeds 2 Gy and might correspond to a range of lesions from erythema to necrosis [1]. In relation to the risk of skin lesions, the X-ray dose depends on clinical, therapeutic and technical factors. First of all, the dose to the patient increases with increasing body mass index (BMI) [1][2][3]. Second, dose, fluoroscopy time and number of cine frames might differ depending on the number of treated vessels and/or stenoses [4][5][6], localisation and severity of lesions [2,7], stage of occlusion [7,8], tortuosity of treated vessels [6][7][8], number of stents and balloons [2,4,[7][8][9], and artery approach [10,11]. With the aim of optimising the interventional cardiology procedures (i.e. minimising the X-ray dose to the patient while preserving the quality of treatment), the use of low fluoroscopy pulse rate, image intensifier field size and collimation are recommended [1,12,13]. However, the studies that concluded that there was an impact on dose of some technical parameters had mostly used descriptive or univariate analyses and/or were carried out on a phantom [2,...

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Skin dose and dose–area product values for interventional cardiology procedures

Cited by 106 publications

References 29 publications

Impact of biplane versus single-plane imaging on radiation dose, contrast load and procedural time in coronary angioplasty

Impact of biplane versus single-plane imaging on radiation dose, contrast load and procedural time in coronary angioplasty

How to set up and apply reference levels in fluoroscopy at a national level

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

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