Reference levels at European level for cardiac interventional procedures

Abstract

In interventional cardiology, a wide variation in patient dose for the same type of procedure has been recognised by different studies. Variation is almost due to procedure complexity, equipment performance, procedure protocol and operator skill. The SENTINEL consortium has performed a survey in nine european centres collecting information on near 2000 procedures, and a new set of reference levels (RLs) for coronary angiography and angioplasty and diagnostic electrophysiology has been assessed for air kerma-area product: 45, 85 and 35 Gy cm2, effective dose: 8, 15 and 6 mSv, cumulative dose at interventional reference point: 650 and 1500 mGy, fluoroscopy time: 6.5, 15.5 and 21 min and cine frames: 700 and 1000 images, respectively. Because equipment performance and set-up are the factors contributing to patient dose variability, entrance surface air kerma for fluoroscopy, 13 mGy min(-1), and image acquisition, 0.10 mGy per frame, have also been proposed in the set of RLs.

Use of performance curves in estimating number of procedures required to achieve proficiency in coronary angiography

“…Operators' performance curves indicated by curve estimates (intercept and slope) were calculated by linear regression. Subsequently, an average trainee performance curve was made from the seven trainees' means (all trainees, Table III , and use of contrast media volume <100 ml [7,8]. These intersections were calculated for each trainee's performance curves and for all trainees performance curves (Table III).…”

“…The SENTINEL consortium has another approach. They suggest cut-off levels for specific procedures, e.g., European Reference Levels of DAP <45 Gycm 2 and fluoroscopy time <6.5 min per CA procedure [8].…”

“…The aim of this study was to use performance curves for CA procedures carried out by cardiology trainees to estimate the number of CA procedures needed to approach experts' level of proficiency, and the number of CA procedures needed to approach suggested reference levels of fluoroscopy time (<6.5 min), dose area product (DAP) (<45 Gycm 2 ), and volume of contrast media (<100 ml) [7,8].…”

Controlling the Radiation Dose Received By Patients Undergoing Cardiac Imaging

“…In cardiology, 'diagnostic reference levels' have been proposed by national and European working groups [10]. These reference levels, defined as the third quartile of the mean doses of centers, are useful tools to evaluate the performance of a center for radiation delivered to a patient.…”

Working in the cardiac catheterization laboratory

“…A few microSieverts per electrophysiology 20 and similar values for catheterization procedures, [24][25][26][27] with a risk per procedure of developing a fatal cancer of the operator in the 1 in 500,000 to 1 in 1,000,000. 27 In reality, with a 100 μSv exposure per procedure, 20,[27][28][29][30] the risk of cancer (fatal and nonfatal) would be after BEIR in the range of 1 in 100,000 per procedure. However, it should be highlighted that the lack of a good radioprotection policy could increase occupational doses (and risk of cancer) in a factor of 10.…”