The role of a commercial radiation dose index monitoring system in establishing local dose reference levels for fluoroscopically guided invasive cardiac procedures

Zucca, S.; Solla, Ignazio; Boi, Alberto; Loi, S.; Rossi, Angélica; Sanna, Francesco; Loi, Bruno

doi:10.1016/j.ejmp.2020.04.019

Cited by 4 publications

(6 citation statements)

References 47 publications

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“…Maccia presented a survey on CTOs in an institution in France, which analysed 8931 procedures and reported different P KA 75th percentiles for antegrade 147 Gy cm 2 and retrograde 552 Gy cm 2 approaches. Similar conclusions regarding CTOs were reached by Zucca et al (2020).…”

Section: Percutaneous Coronary Interventionssupporting

confidence: 80%

“…Three national studies included patient size (Samara 2012, Georges et al 2017, Zucca et al 2020 in the estimation of DRLs, and Georges et al (2017) obtained a significant difference between male and female patients for CA from a sample size of over 50 000 cases from France (one-third of the total annual activity). Works that used automatic recording with a dose management system (Georges et al 2017, Zucca et al 2020) (Miller 2012), Oceania (Thomas 2020) and Latin America (González-López 2022).…”

Section: Coronary Angiographymentioning

confidence: 99%

“…In addition to the DRL values, other qualitative conclusions of interest have been presented. The importance of procedural complexity was analysed by several authors for PCI (Maccia et al 2015, Zanca et al 2020, Zucca et al 2020, Feghali et al 2021, Yap et al 2021 and an important dose increase of up to 150% was reported (Yap et al 2021) depending on the number of lesions to be treated or a difference of a factor of almost four in CTO between retrograde and anterograde access (Maccia et al 2015, Zucca et al 2020. Feghali (2021) performed a statistical analysis of the influence of more than 16 parameters on patient doses and concluded that the body mass index, sex, stent number/length and the number of diseased vessels were found to be the main factors affecting peak skin doses.…”

Section: Qualitative Analysismentioning

confidence: 99%

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Current status of diagnostic reference levels in interventional cardiology

2022

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Interventional cardiology provides undisputable benefits for patients but uses a substantial amount of ionising radiation. The diagnostic reference level (DRL) is the tool recommended by the International Commission on Radiological Protection to optimise imaging procedures. In this work, a review of studies dealing with radiation dose or recommending DRL values for interventional cardiology since 2010 is presented, providing quantitative and qualitative results. There are many published papers on coronary angiography and percutaneous coronary intervention. The DRL values compiled for different continental regions are different: the DRL for coronary angiography is about 35 Gy·cm2 for Europe and 83 Gy·cm2 for North America. These differences emphasise the need to establish national DRLs considering different social and/or economic factors and the harmonisation of the survey methodology. Surveys with a large amount of data collected with the help of dose management systems, provide more reliable information with less chance of statistical bias than those with a small amount of data. The complexity of procedures and improvements in technology are important factors that affect the radiation dose delivered to patients. There is a need for additional data on structural and electrophysiological procedures. The analysis of paediatric procedures is especially difficult because some studies present results split into age bands and others in weight bands. Diagnostic procedures are better described, but there is a great variety of therapeutic procedures with different DRL values (up to a factor of nine) and these require a dedicated review.

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Section: Percutaneous Coronary Interventionssupporting

confidence: 80%

Section: Coronary Angiographymentioning

confidence: 99%

Section: Qualitative Analysismentioning

confidence: 99%

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Current status of diagnostic reference levels in interventional cardiology

2022

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“…2, the val ues [15] 226.0 Sanchez et al (2011) [16] 83.0 Compagnone et al (2012) [17] 128. 6 Miller et al (2012) [18] 193.0 Samara et al (2012) (non-academic centres) [19] 120.0 Samara et al (2012) (academic centres) [19] 170.0 Ahmed et al (2013) [20] 69.5 Cui et al (2013) [21] 299.0 Simantirakis et al (2013) [22] 129.0 Crowhurst et al (2014) [23] 129.0 Uniyal et al (2017) [24] 107.0 Sciahbasi et al (2017) [31] 109.0 Ngaile et al (2018) [25] 129.4 Siiskonen et al (2018) [26] 85.0 Isoardi et al (2019) [27] 94.0 Kim et al (2019) [28] 171.3 Rizk et al (2019) [29] 131.0 Zucca et al (2020) (Standard protocol) [30] 91.0 Zucca et al (2020) (Noise reduction protocol) [30] 53.0 This study (2021) 166.9…”

Section: Discussionmentioning

confidence: 99%

“…Lo cal DRL val ues for 75 th per cen tile dis tribu tions over all pa tients un der go ing di ag nos tic and ther a peu tic pro ce dures in this study are within the data ranges re ported in the lit er a ture. The range of val ues for di ag nos tic and ther a peu tic pro ce dures was from 18 Gycm 2 [30] to 102 Gycm 2 [19], and 53 Gycm 2 [30] to 299 Gycm 2 [21], re spec tively. Now that the lo cal DRL val ues are known and, as a part of the con tin u ous im prove ment pro cess involved in the prin ci ple of pro tec tion of ra di a tion, an anal y sis of how these dose val ues can be low ered, with out com pro mis ing im age qual ity should be im plemented.…”

Section: Ta Ble 3 Com Par I Son Of 75 Th Per Cen Tile P Ka a Val Ues ...mentioning

confidence: 99%

First local diagnostic reference levels for fluoroscopically guided cardiac procedures in adult patients in Chile

Ubeda

Martínez-García²,

Ramos³

et al. 2022

NUCL TECH RAD PROT

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The goal of this study was to generate the first values of local diagnostic reference levels for a range of fluoroscopically guided cardiac diagnostic and therapeutic procedures in adult patients in Chile and to compare radiation dose levels with others presented in the literature. The dosimetric data collection period was conducted over the whole of 2020. The local diagnostic reference levels were calculated as the 75th percentile of patient dose data distributions for kerma area-product values. The sample of collected clinical procedures (480) was divided into diagnostic and therapeutic procedures. The kerma area-product differences found between diagnostic and therapeutic procedures were statistically significant. The local diagnostic reference levels were 81.6 Gy cm2 and 166.9 Gycm2 for fluoroscopically guided cardiac diagnostic and therapeutic procedures, respectively. A comparison of our results with results found in the literature for the last 10 years, showed that there are no published papers for hospitals in Latin America and the Caribbean. It becomes urgent to be able to carry out more research of this type, given that the health reality between countries on different continents is very different. While in some the establishment of diagnostic reference levels is a legal obligation, in others it is a matter of good or bad will.

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