Radiation doses to patients undergoing coronary angiography and percutaneous tranluminal coronary angioplasty

Abstract

A detailed study of radiation doses received by 168 patients who underwent coronary angiography (CAG) and 102 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in two Greek hospitals is presented. Radiation dose was measured in terms of dose-area product (DAP). The contribution of fluoroscopy and cineradiography to the total DAP was examined separately for each radiological projection used in both procedures. Effective dose and doses to various organs were estimated with the help of the ODS-60 software. Total DAP was found to correlate linearly to fluoroscopy time and cine film length. Mean DAP values were found to be 80.8 +/- 28.0 Gy cm2 for CAG and 86.2 +/- 65.6 Gy cm2 for PTCAs, whereas the estimated mean values of effective dose were 20.9 +/- 7.5 and 23.2 +/- 18.1 mSv respectively. DAP to effective dose conversion coefficients were estimated to be 0.26 mSv/Gy cm2 for CAG and 0.27 mSv/Gy cm2 for PTCAs.

Radiation doses and estimated risk from angiographic projections during coronary angiography performed using novel flat detector

“…Similar finding has been reported by Farajollahi et al (24) using LAO40° compared to LAO40°‐CAU10° and LAO40°‐CRA10°. Contrary to our findings, it is reported that the maximum contribution of overall KAP during CA procedure was from RAO projection compared to LAO, LAT, and PA projections 25 , 26 . It is known that the use of steep angulations involve longer SID, thus imparting higher radiation doses to patients.…”

Patient cumulative radiation exposure in interventional cardiology

“…The procedures were all performed using the same cathetherism room, reducing dose variability linked to the equipment. As found in other studies (Pattee et al, 1993;Betsou et al, 1998;Katritsis et al, 2000;Delichas et al 2003;Efstathopoulos et al, 2004;Smith and Rivers, 2008), higher values of DAP were observed for PTCAs rather than for CAs in our study, due to the significantly increased fluoroscopy DAP values in the case of PTCA. As one might expect, the average organ dose values due to a CA or a PTCA were significantly higher than those currently observed for conventional radiology procedures, ranging from 2 to 436 mGy for the lung while the dose associated to a CT scan is around 10 mGy (UNSCEAR, 2006).…”

“…For all the patients, it was possible to calculate organ doses received during each procedure by some of the heart's neighbouring organs which are recognized as being rather radiosensitive (UNSCEAR, 2006) through a mathematical model. Organ doses are seldom considered in the field of IC (Pattee et al, 1993;Harrison et al, 1998;Delichas et al, 2003) or in other areas of medical exposure (Ruiz-Cruces et al, 2000) due to its difficult estimation. However, the absorbed dose to an organ represents a rather appropriate dosimetric indicator as compared to effective dose in order to evaluate a potential adverse effect of ionizing radiation to a specific organ.…”

“…But its relevance is less evident in cases of focused or heterogeneous exposure. The building of a mathematical model dedicated to this specific population of patients allowed us to better characterize organ doses than in previously reported studies (Pattee et al, 1993;Harrison et al, 1998;Delichas et al, 2003), taking into account operator effect and the type of procedure, both factors known to influence doses. The procedures were all performed using the same cathetherism room, reducing dose variability linked to the equipment.…”

“…Radiation dose levels greater than 2 Gy have been described in the literature (Faulkner and Vano, 2001) as producing deterministic effects such as skin injuries to patients ) while long-term effects such as cancer have been discussed for lower doses of ionizing radiation by several authors (Boice et al, 1991;Howe, 1995;Meinert et al, 1999;Doody et al, 2000;InfanteRivard et al, 2000;Preston et al, 2003;Preston et al, 2007). Despite the relatively low level of effective doses associated to ICP, rather high doses to organs surrounding the heart have been reported (Pattee et al, 1993;Harrison et al, 1998;Delichas et al, 2003). Hence, the relevance of setting up epidemiological studies on cancer risks assessment associated with exposure during ICP for specific cancer location (Malisan et al, 2008) was underlined.…”