Time of day influences patient radiation exposure from percutaneous cardiac interventions

Abstract

The objective of this study was to investigate the influence of time of day on patient radiation exposure due to cardiac interventions. The elective interventional workload of one experienced cardiologist documented over the course of 4 months amounted to 325 diagnostic catheterizations and 145 percutaneous coronary interventions (PCI). All radiation parameters documented during diagnostic coronary angiography remained constant throughout the entire day. In contrast, for PCI measurements made from 7:00 a.m. to 1:00 p.m., our study revealed a mean overall dose-area product (DAP) of 11.8+/-6.8 Gy cm(2) (n=115). These radiation exposure levels increased significantly later in the afternoon (n=30) by 28% to a level of 15.0+/-11.1 Gy cm(2) (p<0.045). Cinegraphic DAP increased from 3.7+/-2.7 Gy cm(2) to 5.0+/-3.2 Gy cm(2) (p<0.033). The number of cinegraphic runs and frames rose from 7.9+/-2.9 to 9.1+/-3.1 (p<0.025), and from 136+/-63 to 164+/-70 (p<0.014), respectively. The following conclusion is warranted by our data and should now be confirmed in a wider multicentre study: radiation protection of the patients could be influenced by the fatigue of the cardiologist conducting the procedure. To enhance patient radiation safety, elective percutaneous angioplasty should be scheduled for the first 6 h of the interventionalist's occupational workload. Diagnostic interventions may be safely scheduled later.

Patient Radiation Doses in Interventional Cardiology Procedures

“…A recent study collected DAP values for 2265 coronary angiographies performed between 2003-2005 in seven centers and has also reported large variability of results although DAP values spanned in a narrower range of 5-130 Gy·cm 2 [88]. The wide range of reported values are evident in all IC procedures and can be attributed to operator experience [40], workload [61], use of radiation-reducing techniques [38], procedural complexity [60, 89], examination technique [11] and catheterization laboratory equipment [42, 90]. In order to compare results between older and newer studies, mean DAP, mean fluoroscopy time and mean effective dose were calculated for results published before and after the year 2000 concerning the most extensively studied procedures (CA and PCI) (Table 4 ).…”

Radiation Exposure to Patients Undergoing Percutaneous Coronary Interventions

“…However, bypass grafts, collateral pathways, slow flow phenomena, and ventricular function of patients with valve defects should be documented by longer series: diagnostic information otherwise will be compromised. Since the consistency of implementation of radiation-reducing techniques in performing PCI depends on the operator's care and concentration, a significant increase of DAP could be proven in the afternoon after the interventionalist's workload amounted to > 6 h. For obvious reason, this fatigue effect might well be absent in departments with less optimized procedures [28].…”

Radiation Dose to Patients From Cardiac Diagnostic Imaging

“…Dose in catheter angiography is highly dependent on operator experience, 78 workload, 79 use of radiation-reducing techniques, 80 procedural complexity, 81 and catheterization laboratory equipment. 75 Coronary angiography and interventions from radial artery access have been shown to be longer and associated with increased dose compared with procedures from femoral access routes.…”