An audit of patient radiation doses in interventional cardiology

Abstract

Many interventional cardiology procedures result in substantial radiation doses to the patient. It is difficult to conclude from the literature optimal DRLs for common procedures such as coronary angiograms, PTCA and pacemaker insertions. A study by Vano et al. (2012) quotes 57 Gy.cmˆ2 as an ideal DRL for a coronary angiogram, while a publication by the IAEA quotes 29 Gy.cmˆ2. The same sources quote 94 Gy.cmˆ2 and 58 Gy.cmˆ2 for PTCA exams respectively. In this study, a patient dose audit was performed for 2012 and 2013 for the six most common cardiac angiographic procedures, including coronary angiogram (1945), PTCA(172), Coronary angiogram + PTCA(218), pacemaker insertion(27), box/lead change(36) and defibrillator implant(38), with a total of 2436 procedures. The DAP per procedure was compared to DRLs presented in the literature by Vano et al and the IAEA. The 75th percentile and average DAP per procedure were compared to quoted DRLs. For some procedures (Angiograms, PTCA, and Angiogram +PTCA) the DAP exceeded the diagnostic reference levels by significant amounts (28.8%, 49.7% and 16%) and (34.4%, 86% and 58%) for each procedure in 2012 and 2013 respectively. Other procedures such as the pacemaker insertion, box/lead change, and defibrillator implant showed DAP’s much less than quoted DRL’s (44.1%, 83.24% and 23.6%) and (0.14%, 17% and 22%) in 2012 and 2013 respectively. This study indicates a clear need for local DRLs to be developed specifically for each procedure and perhaps the implementation of new strategies to reduce the DAPs closer to the quoted DRLs.