Main Clinical, Therapeutic and Technical Factors Related to Patient's Maximum Skin Dose in Interventional Cardiology Procedures

Overview

Journal Br J Radiol

Publisher Oxford University Press

Specialty Radiology

Date 2012 Mar 30

PMID 22457404

Citations 4

Authors

N Journy

S Sinno-Tellier

C Maccia

A Le Tertre

P Pirard

P Pages

D Eilstein

J Donadieu

O Bar

Affiliations

Soon will be listed here.

Abstract

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(-2) for CAs, and 916 mGy and 69 Gy cm(-2) 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 (r=0.93), 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.

Citing Articles

Radiation doses during cardiac catheterisation procedures in India: a multicentre study: Radiation dose study.

Subban V, Amelot S, Victor S, Potdar A, Yadav V, Patel T AsiaIntervention. 2021; 6(1):25-33.

PMID: 34912981 PMC: 8525728. DOI: 10.4244/AIJ-D-18-00044.

Understanding and Minimising Occupational Radiation in the Catheterisation Laboratory with PISAX and the ACIST CVi® Contrast Delivery System.

Bar O Interv Cardiol. 2018; 8(1):36-40.

PMID: 29588748 PMC: 5808475. DOI: 10.15420/icr.2013.8.1.36.

Novel X-ray image noise reduction technology reduces patient radiation dose while maintaining image quality in coronary angiography.

Ten Cate T, van Wely M, Gehlmann H, Mauti M, Camaro C, Reifart N Neth Heart J. 2015; 23(11):525-30.

PMID: 26369914 PMC: 4608924. DOI: 10.1007/s12471-015-0742-1.

Patient's Radiation Exposure in Coronary Angiography and Angioplasty: The Impact of Different Projections.

Farajollahi A, Rahimi A, Khayati Shal E, Ghaffari S, Ghojazadeh M, Tajlil A J Cardiovasc Thorac Res. 2015; 6(4):247-52.

PMID: 25610557 PMC: 4291604. DOI: 10.15171/jcvtr.2014.020.

References

Delichas M, Psarrakos K, Hatziioannou K, Giannoglou G, Molyvda-Athanasopoulou E, Papanastassiou E . The dependence of patient dose on factors relating to the technique and complexity of Interventional Cardiology procedures. Phys Med. 2008; 21(4):153-7. DOI: 10.1016/S1120-1797(05)80004-3. View

Geijer H, Beckman K, Andersson T, Persliden J . Radiation dose optimization in coronary angiography and percutaneous coronary intervention (PCI). I. Experimental studies. Eur Radiol. 2002; 12(10):2571-81. DOI: 10.1007/s00330-001-1237-6. View

Kuon E, Glaser C, Dahm J . Effective techniques for reduction of radiation dosage to patients undergoing invasive cardiac procedures. Br J Radiol. 2003; 76(906):406-13. DOI: 10.1259/bjr/82051842. View

Brasselet C, Blanpain T, Tassan-Mangina S, Deschildre A, Duval S, Vitry F . Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes. Eur Heart J. 2007; 29(1):63-70. DOI: 10.1093/eurheartj/ehm508. View

Kuon E, Dahm J, Empen K, Robinson D, Reuter G, Wucherer M . Identification of less-irradiating tube angulations in invasive cardiology. J Am Coll Cardiol. 2004; 44(7):1420-8. DOI: 10.1016/j.jacc.2004.06.057. View

Kuon E, Dorn C, Schmitt M, Dahm J . Radiation dose reduction in invasive cardiology by restriction to adequate instead of optimized picture quality. Health Phys. 2003; 84(5):626-31. DOI: 10.1097/00004032-200305000-00008. View

Bogaert E, Bacher K, Lemmens K, Carlier M, Desmet W, De Wagter X . A large-scale multicentre study of patient skin doses in interventional cardiology: dose-area product action levels and dose reference levels. Br J Radiol. 2009; 82(976):303-12. DOI: 10.1259/bjr/29449648. View

Suzuki S, Furui S, Isshiki T, Kozuma K, Endo G, Yamamoto Y . Factors affecting the patient's skin dose during percutaneous coronary intervention for chronic total occlusion. Circ J. 2007; 71(2):229-33. DOI: 10.1253/circj.71.229. View

Chida K, Saito H, Otani H, Kohzuki M, Takahashi S, Yamada S . Relationship between fluoroscopic time, dose-area product, body weight, and maximum radiation skin dose in cardiac interventional procedures. AJR Am J Roentgenol. 2006; 186(3):774-8. DOI: 10.2214/AJR.04.1653. View

10.

Ryan T, Faxon D, GUNNAR R, Kennedy J, King 3rd S, Loop F . Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous.... Circulation. 1988; 78(2):486-502. DOI: 10.1161/01.cir.78.2.486. View

11.

Tsapaki V, Maniatis P, Magginas A, Voudris V, Patsilinakos S, Vranzta T . What are the clinical and technical factors that influence the kerma-area product in percutaneous coronary intervention?. Br J Radiol. 2008; 81(972):940-5. DOI: 10.1259/bjr/30604628. View

12.

Geijer H, Beckman K, Andersson T, Persliden J . Radiation dose optimization in coronary angiography and percutaneous coronary intervention (PCI). II. Clinical evaluation. Eur Radiol. 2002; 12(11):2813-9. DOI: 10.1007/s00330-001-1238-5. View

13.

Van de Putte S, Verhaegen F, Taeymans Y, Thierens H . Correlation of patient skin doses in cardiac interventional radiology with dose-area product. Br J Radiol. 2000; 73(869):504-13. DOI: 10.1259/bjr.73.869.10884747. View

14.

Bor D, Olgar T, Toklu T, Caglan A, Onal E, Padovani R . Patient doses and dosimetric evaluations in interventional cardiology. Phys Med. 2008; 25(1):31-42. DOI: 10.1016/j.ejmp.2008.03.002. View

15.

Georges J, Livarek B, Gibault-Genty G, Messaoudi H, Aziza J, Hautecoeur J . [Variations of radiation dosage delivered to patients undergoing interventional cardiological procedures. A monocentric study 2002-05]. Arch Mal Coeur Vaiss. 2007; 100(3):175-81. View

16.

Stratis A, Anthopoulos P, Gavaliatsis I, Ifantis G, Salahas A, Antonellis I . Patient dose in cardiac radiology. Hellenic J Cardiol. 2009; 50(1):17-25. View

17.

Tsapaki V, Magginas A, Vano E, Kottou S, Papadakis E, Dafnomili P . Factors that influence radiation dose in percutaneous coronary intervention. J Interv Cardiol. 2006; 19(3):237-44. DOI: 10.1111/j.1540-8183.2006.00137.x. View

18.

Padovani R, Bernardi G, Malisan M, Vano E, Morocutti G, Fioretti P . Patient dose related to the complexity of interventional cardiology procedures. Radiat Prot Dosimetry. 2001; 94(1-2):189-92. DOI: 10.1093/oxfordjournals.rpd.a006469. View

19.

Suzuki S, Furui S, Kohtake H, Yokoyama N, Kozuma K, Yamamoto Y . Radiation exposure to patient's skin during percutaneous coronary intervention for various lesions, including chronic total occlusion. Circ J. 2005; 70(1):44-8. DOI: 10.1253/circj.70.44. View

20.

Bernardi G, Padovani R, Morocutti G, Vano E, Malisan M, Rinuncini M . Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: analysis in relation to radiation exposure parameters. Catheter Cardiovasc Interv. 2000; 51(1):1-9; discussion 10. DOI: 10.1002/1522-726x(200009)51:1<1::aid-ccd1>3.0.co;2-k. View