title: Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures.
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.
  
  
  CONCLUSIONS
  Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions.
authors.affiliation: Institut de Veille Sanitaire, Saint-Maurice, France. njourny@gmail.com
authors.forename: N
authors.initials: N
authors.lastname: Journy
authors.forename: S
authors.initials: S
authors.lastname: Sinno-Tellier
authors.forename: C
authors.initials: C
authors.lastname: Maccia
authors.forename: A
authors.initials: A
authors.lastname: Le Tertre
authors.forename: P
authors.initials: P
authors.lastname: Pirard
authors.forename: P
authors.initials: P
authors.lastname: Pagès
authors.forename: D
authors.initials: D
authors.lastname: Eilstein
authors.forename: J
authors.initials: J
authors.lastname: Donadieu
authors.forename: O
authors.initials: O
authors.lastname: Bar
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015992:Body Mass Index; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011829:Radiation Dosage; D012867:Skin / Q000528:radiation effects*