Abstract
Backgrounds: Reducing radiation exposure is the basic principle for performing percutaneous coronary intervention (PCI). Many studies have confirmed the effect of radiation protection for medical staff, but studies about the effectiveness of protection for patients and real measurement of radiation dose in patients’ specific organs are lacking. Aim: To measure the radiation doses absorbed by patients’ radiosensitive organs during PCI and the effectiveness of radiation protection. Methods: A total of 120 patients were included and allocated into three groups as the ratio of 1:1:2. A total of 30 patients received PCI at 15 frames rate per second (fps), 30 patients at 7.5 fps, and 60 patients wore radiation protective hat and glasses during PCI at 7.5 fps. The radiation doses were measured at right eyebrow (lens), neck (thyroid), back (skin), and inguinal area (genital organs) by using thermoluminescent dosimeters (TLDs). Results: Dose-area product (DAP) reduced by 58.8% (from 534,454 ± 344,660 to 220,352 ± 164,101 mGy·cm2, p < 0.001) after reducing the frame rate, without affecting successful rate of PCI. Radiation doses measured on skin, lens, genital organs, and thyroid decreased by 73.3%, 40.0%, 40.0%, and 35.3%, respectively (from 192.58 ± 349.45 to 51.10 ± 59.21; 5.29 ± 4.27 to 3.16 ± 2.73; 0.25 ± 0.15 to 0.15 ± 0.15; and 17.42 ± 12.11 to 11.27 ± 8.52 μSv, p < 0.05). By providing radiation protective equipment, radiation doses at lens and thyroid decreased further by 71.8% and 65.9% (from 3.16 ± 2.73 to 0.89 ± 0.79; 11.27 ± 8.52 to 3.84 ± 3.49 μSv, p < 0.05). Conclusions: By lowering the frame rate and providing protective equipment, radiation exposure in radiosensitive organs can be effectively reduced in patients.
Highlights
Cardiovascular disease is one of the leading causes of death globally and is the second most common cause of death in Taiwan [1]
Despite the dose of radiation exposure during Percutaneous coronary intervention (PCI) rarely exceed the threshold of causing immediate clinical damage, our study recently demonstrates the radiation of PCI is associated with the increased risks for lens surgery for cataract [4]
There were no differences in the prevalence of bleeding or major adverse cardiovascular events (MACE) following PCI (Table 1)
Summary
Cardiovascular disease is one of the leading causes of death globally and is the second most common cause of death in Taiwan [1]. Percutaneous coronary intervention (PCI), with approximately one million cases per year in the U.S.A., utilizes radiation to visualize coronary arteries and has been the primary treatment for coronary artery disease. While performing PCI, the skin of the patient’s upper back usually receives the largest radiation dose. Despite the dose of radiation exposure during PCI rarely exceed the threshold of causing immediate clinical damage, our study recently demonstrates the radiation of PCI is associated with the increased risks for lens surgery for cataract [4]. Reducing radiation exposure as much as possible is the mandatory principle while performing PCI. According to guidelines of performing PCI [5], interventional cardiologists and catheterization lab staff are advised to reduce the radiation exposure of radiosensitive organs as well as record the radiation dose in every procedure. Avoiding unnecessary radiation exposure and putting protection equipment outside of the operative view can further reduce radiation dose
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