title: Clinical determinants of radiation dose in percutaneous coronary interventional procedures: influence of patient size, procedure complexity, and performing physician.
abstract: OBJECTIVE
  The objectives of this work were to establish the primary clinical determinants of patient radiation dose associated with percutaneous coronary interventional (PCI) and to identify opportunities for dose reduction.
  
  
  BACKGROUND
  Use of X-ray imaging and associated radiation dose is a necessary part of PCI. Potential adverse consequences of radiation dose include skin radiation injury and predicted increase in lifetime cancer risk.
  
  
  METHODS
  Cumulative skin dose (CSD) (measured in gray [Gy] units) was selected as a measurement of patient radiation burden. Several patient-, disease-, and treatment-related variables, including 15 performing physicians, were analyzed in a multiple linear regression statistical model with cumulative skin dose CSD as the primary end point. The model results provide an estimate of the relative CSD increase (decrease) attributable to each variable.
  
  
  RESULTS
  Percutaneous coronary interventions performed on 1,287 male and 540 female patients were included. Median patient age was 68.6 years, median body mass index was 29.7 kg/m(2), and median weight was 88 kg. Median CSD was 1.64 Gy per procedure for male and 1.15 Gy for female patients. Increasing body mass index, patient sex, lesion complexity, lesion location, and performing physician were significantly associated with CSD. Physicians who performed more procedures were associated with lower CSD.
  
  
  CONCLUSIONS
  Several primary determinants of patient radiation dose during PCI were identified. Along with physician development of radiation-sparing methods and skills, pre-procedure dose planning is proposed to help minimize radiation dose for PCI.
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. fetterly.kenneth@mayo.edu
authors: Kenneth A
authors: KA
authors: Fetterly
authors: Ryan J
authors: RJ
authors: Lennon
authors: Malcolm R
authors: MR
authors: Bell
authors: David R
authors: DR
authors: Holmes
authors: Charanjit S
authors: CS
authors: Rihal
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001822:Body Burden; D015992:Body Mass Index; D049628:Body Size; D002983:Clinical Competence; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011835:Radiation Protection; D015641:Radiography, Interventional / Q000009:adverse effects; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012867:Skin / Q000528:radiation effects*