Occupational and Patient Doses in Interventional Cardiology in Indonesia: A Preliminary Result

Abstract

Interventional cardiology is a branch of cardiology that manages the catheter based treatment of structural heart illnesses. These minimally invasive procedures involve inserting catheters and other devices through superficial arterial and venous access sites. Due to increased reliability and advancing technology, the number and complexity of interventional cardiology procedures haves increased in recent years. The increasing complexity of the procedures, however, require longer fluoroscopic duration, leading to increased exposure time to ionizing radiation for the patient and also for the medical staff since they need to remain close to the patient throughout the procedure. This study attempts to investigate the occupational and patient doses during the course of several interventional cardiology procedures in Indonesia, i.e. CA, PCI, cathscan, PA, PTCA, TACE, PAC and peripheral vascular. Occupational doses were measured by using individually packed three chips of TLD-100 placed in over-and under-thyroid shield used by medical staff, over-and under-apron in waist position, inside a special 'eye-D' holder, and inside a ring holder, while patient doses were estimated by using individually packed three TLD-100 chips attached in the x-ray tube. All TLDs were calibrated in the Secondary Standard Dosimetry Laboratory (SSDL) Jakarta. The study was performed in three big hospitals in the cities of Jakarta, Yogyakarta and Semarang. The results show that PCI procedure was the most performed one during the course of this study and gave the highest radiation doses to the staff for all type of doses calculated and measured. The maximum effective doses, eye lens doses, extremity doses, thyroid doses and gonad/ovary doses were 0.098 mSv, 0.1967 mSv, 0.7604 mSv, 0.1760 mSv and 0.0990 mSv, respectively. In the case of patient doses, the mean value of DAP for PTCA procedure of 776.76 Gy cm 2 was the highest compared with those for other procedures. The results of measurement for occupational doses were in general similar to those reported by other authors, but not for patient doses that was found to be 4-5 times higher. Due to the involving of various parameters during the course of interventional cardiology procedures, it was difficult to establish a correlation between the doses received by medical staff and by the patients.

Patient Radiation Doses in Interventional Cardiology Procedure

“…As can be seen, the CA procedure gave the highest air kerma to the patients, while the highest KAP was received by patients who underwent PCI procedure. These results include those that have been previously reported [21].…”

Safety Assessments for Supporting the Application of Nuclear Technology in Indonesia and a Comprehensive Study on High Natural Radioactivity Area

“…Therefore, to control the infectious diseases, such as malaria vaccine (21,22) were developed with 150 Gy of gamma rays effective to attenuate malaria parasite. Furthermore, studies on the diagnoses of metabolic diseases with nuclear medicine technique (23) and Microdosimetry in Radiodiagnostic assessment have also been conducted (24). Diagnose of metabolic disease such as diabetes type 2 in the hearth with tc-99m-sestamibi (Myocardial Perfusion Imaging (MPI) and Multiple Gated Acquisition (MUGA) Methods) have been carried out and revealed as a method that plays a pivotal role in the evaluation of coronary artery disease.…”

“…Hiswara et al (24) carried out a research to determine the microdosimetry in radiodiagnostic assessment, and stated that interventional cardiology procedures represent the third largest contribution to the collective dose incurred by a population after computed tomography and nuclear medicine. The results showed that the PCI procedure was the most performed during this study, with the highest radiation doses given to the staff.…”