Clinical Determinants of Radiation Dose in Percutaneous Coronary Interventional Procedures

Abstract

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.

Clinical and Procedural Characteristics Associated With Higher Radiation Exposure During Percutaneous Coronary Interventions and Coronary Angiography

“…Also, when treating complex or CTO lesions, especially in patients with high BMI or previous CABG, radiation management can be incorporated into preprocedure planning as well as in defining maximum levels that could guide physicians in decision making during the procedure accordingly. Finally, we and Fetterly et al 11 have demonstrated that individual PCI operators have a substantial influence on patient dose. Therefore, all staff and trainee physicians should be well trained in behavioral and technical methods to minimize radiation dose.…”

“…11 Other factors that were associated with increased radiation exposure were body mass index, previous CABG, and peripheral vascular disease. However, in that study, exposure in air values (R, type 1) and the air kerma values (Gy, type 2) were measured and were converted to cumulative skin dose.…”

Effect of Reduction of the Pulse Rates of Fluoroscopy and CINE-Acquisition on X-Ray Dose and Angiographic Image Quality During Invasive Cardiovascular Procedures

“…17 In fact, technical and anatomic factors during procedures likely have the largest effect on an individual case x-ray exposure. 18,19 As the principal determinant of occupational radiation exposure for operators is patient scatter, reducing total energy to patients directly affects physician and staff exposures as well. 20 Clearly, efforts to reduce radiation exposure for both patient and staff need to be a critical part of every catheterization laboratory's quality improvement mission.…”

Controlling Radiation Exposure in Interventional Cardiology

“…Several studies have shown body mass index to be highly associated with exposure. 18 In addition, chronic total occlusion and bifurcation PCI and number of lesions treated increase exposure. 18,19 With respect to procedure type, endovascular procedures, particularly pelvic and below the, have greater radiation exposure to the operator than coronary procedures.…”

“…18 In addition, chronic total occlusion and bifurcation PCI and number of lesions treated increase exposure. 18,19 With respect to procedure type, endovascular procedures, particularly pelvic and below the, have greater radiation exposure to the operator than coronary procedures. 20 This is because of the higher dose per frame rate required for digital subtraction and difficulty with shielding.…”