Abstract
Patient exposure to radiation from interventional coronary procedures (ICPs) is high. Dose optimization is in part based on comparison with reference levels (RLs). Current RLs, however, have been deduced from small or old multicentre studies. The purpose of this study was to evaluate current practices for patient radiation protection (RP) in French non-university public hospitals, which represent >30% of the national activity for ICPs, and 60% of the emergency cases. RAY’ACT was a nationwide, multicentre survey. RP parameters from 35,257 coronary angiographies (CAs) and 28,604 percutaneous coronary interventions (PCIs) performed at 48 centres during 2010 and routinely registered in professional software were extracted and analysed retrospectively. Dose-area product (DAP), fluoroscopy time (FT), number of acquired frames (NF) and runs (NR), and cumulative dose to interventional reference point (CD-IRP) were analysed separately for CAs and PCIs (elective and ad hoc pooled). Emergency and complex procedures, associated with a high level of radiation, were not excluded. The table shows the new RLs, based on the 75th percentiles of the values for CA and PCI, and comparison with previous RLs. RLs from RAY’ACT (2010) SENTINEL (2008) EAIA (2007) GACI-PDS (2006) DIMOND (2003) CA N 31,067 672 2,265 496 600 DAP, Gy. cm 2 45.2 45 49.4 57 56 FT, min 6.3 8 9 6 7 NF 769 700 1003 1270 876 CD-IRP, mGy 695 650 1900 – – PCI N 25,356 662 1,844 317 600 DAP, Gy. cm 2 94.6 85 122 94 110 FT, min 16.2 15 21 16 15 NF 1193 1000 1691 1355 1325 CD-IRP, mGy 1788 1500 2800 – – The RAY’ACT survey has allowed the definition of new RLs for DAP, FT, NF and CD-IRP for CA and PCI, based on a large study population. It confirms the trend toward a decrease in radiation doses and FT during CA. The lack of decrease in DAP and FT during PCI should be interpreted according to the likely increase in procedure complexity.
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