Patient dosimetry during coronary interventions: a comprehensive analysis.
BACKGROUND
We performed a detailed analysis of patient radiation during coronary interventions, comparing dose measurements to established dose reference levels, assessing coronary artery doses, and estimating total radiation risk of fatal cancer.


METHODS
We prospectively examined 281 patients who were subjected to 307 percutaneous coronary interventions.


RESULTS
The mean kerma area product (KAP) per procedure was 82.1 +/- 47.9 Gy x cm2. Corresponding values for fluoroscopy and digital cineangiography were 28.3 +/- 25.5 Gy x cm2 and 53.8 +/- 35.5 Gy x cm2, respectively, and exposure times were 13.1 +/- 6.8 minutes (87%) and 2.0 +/- 1.5 minutes (13%), respectively. The right anterior oblique caudal and left anterior oblique cranial projections accounted for the highest amount of KAP (24.0% and 23.1%, respectively) compared with other projections. The maximum recorded skin-dose was 182 mGy. Performing a representative procedure on a phantom, the effective dose was 14.9 mSv. The mean coronary dose was 61.7 +/- 38.2 mGy, with a highest calculated dose of 220.1 mGy. The third quartile of KAP measurements was 105 Gy x cm2, the 95th percentile was 175 Gy x cm2, and the mean value of KAP measurements was 82 Gy x cm2. The total risk for the development of fatal cancer was calculated as 83 cases for every 100,000 patients subjected to coronary intervention.


CONCLUSIONS
A detailed analysis of patient radiation during coronary interventions is presented. Coronary doses and total radiation risk of fatal cancer are also calculated, and a method for establishing dose reference level values is proposed.
Department of Cardiology, Athens Euroclinic, Athens, Greece.
Efstathios P
EP
Efstathopoulos
Evangelia
E
Karvouni
Sofia
S
Kottou
Efthalia
E
Tzanalaridou
Socrates
S
Korovesis
Eleftherios
E
Giazitzoglou
Demosthenes G
DG
Katritsis
D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D002932:Cineangiography / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D009381:Neoplasms, Radiation-Induced; D011829:Radiation Dosage; D011874:Radiometry; D012306:Risk