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Preliminary reference levels in interventional cardiology

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Abstract.

This article describes the European DIMOND approach to defining reference levels (RLs) for radiation doses delivered to patients during two types of invasive cardiology procedures, namely coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Representative centres of six European countries recorded patients' doses in terms of dose-area product (DAP), fluoroscopy time and number of radiographic exposures, using X-ray equipment that has been subject to constancy testing. In addition, a DAP trigger level for cardiac procedures which should alert the operator to possible skin injury, was set to 300 Gy×cm2. The estimation of maximum skin dose was recommended in the event that a DAP trigger level was likely to be exceeded. The proposed RLs for CA and PTCA were for DAP 45 Gy×cm2 and 75 Gy×cm2, for fluoroscopy time 7.5 min and 17 min and for number of frames 1250 and 1300, respectively. The proposed RLs should be considered as a first approach to help in the optimisation of these procedures. More studies are required to establish certain "tolerances" from the proposed levels taking into account the complexity of the procedure and the patient's size.

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References

  1. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) (2000) Sources and effects of ionising radiation. Report to the General Assembly, with Scientific Annexes. United Nations, New York

  2. Padovani R, Rodella CA (2001) Staff dosimetry in interventional cardiology. Radiat Prot Dosim 94:99–103

    CAS  Google Scholar 

  3. Padovani R, Malisan MR, Bernardi G, Vano E, Neofotistou V (2001) Optimisation of patient and staff exposure in interventional cardiology In: Proc Int Conf on Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy, Malaga, Spain, 26–30 March, IAEA-CN-85–147:338–342

  4. Fong RYL, Ryan E, Alonso-Arrizabalaga S (2001) A study on the annual equivalent doses received by cardiologists in a UK hospital. In: Proc Int Conf on Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy, Malaga, Spain, 26–30 March, IAEA-CN-85–72:347–351

  5. U.S. Food and Drug Administration (1994) Avoidance of serious X-ray-induced skin injuries to patients during fluoroscopically-guided procedures. Med Bull 24:7–17

    Google Scholar 

  6. Faulkner K, Vano E (2001) Deterministic effects in interventional radiology. Radiat Prot Dosim 94:95–98

    CAS  Google Scholar 

  7. Vano E, Gonzalez L, Ten JI, Fernandez JM, Guibelalde E, Macaya C (2001) Skin dose and dose-area product values for interventional cardiology procedures. Br J Radiol 74:48–55

    CAS  PubMed  Google Scholar 

  8. Vano E, Goicolea J, Galvan C, Gonzalez L, Meiggs L, Ten J, Macaya C (2001) Skin radiation injuries in patients following repeated coronary angioplasty procedures. Br J Radiol 74:1023–1031

    CAS  PubMed  Google Scholar 

  9. Stone M, Robson K, Le Boit P (1998) Subacute radiation dermatitis from fluoroscopy during coronary artery stenting. Evidence of cytotoxic lymphocyte mediated apoptosis. J Am Acad Dermatol 38:333–336

    CAS  PubMed  Google Scholar 

  10. Lobotessi H, Karoussou A, Neofotistou V, Louisi A, Tsapaki V (2001) Effective dose to a patient undergoing coronary angiography. Radiat Prot Dosim 94:173–176

    CAS  Google Scholar 

  11. Broadhead DA, Chapple CL, Faulkner K, Davies ML, McCallum H (1997) The impact of cardiology on the collective effective dose in the north of England. Br J Radiol 70:492–497

    CAS  PubMed  Google Scholar 

  12. Leung KC, Martin CJ (1996) Effective doses for coronary angiography. Br J Radiol 69:426–431

    CAS  PubMed  Google Scholar 

  13. Koenig TR, Wolff D, Mattler FA, Wagner LK (2001) Skin injuries from fluoroscopically guided procedures. Part 1. Characteristics of radiation injury. Am J Roentgenol 177:3–11

    CAS  Google Scholar 

  14. Koenig TR, Mattler FA, Wagner LK (2001) Skin injuries from fluoroscopically guided procedures. Part 2. Review of 73 cases and recommendations for minimizing dose delivered to patient. Am J Roentgenol 177:13–20

    CAS  Google Scholar 

  15. Faulkner K (2001) Dose displays and record keeping. Radiat Prot Dosim 94:143–145

    CAS  Google Scholar 

  16. Sajben FP (1999) Fluoroscopic-induced radiation dermatitis. Cutis 64:57–59

    CAS  PubMed  Google Scholar 

  17. Hansson B, Karambatsakidou A (2000) Relationships between entrance skin dose, effective dose and dose area product for patients in diagnostic and interventional cardiac procedures. Radiat Prot Dosim 90:141–144

    Google Scholar 

  18. International Commission on Radiological Protection (1990) Recommendations of the International Commission on Radiological Protection. ICRP Publ 60, Ann ICRP 21 (1–3)

  19. International Commission on Radiological Protection (1996) Radiological Protection and Safety in Medicine. ICRP Publ 73, Oxford, Pergamon Press, Ann ICRP 26 (2)

  20. International Commission on Radiological Protection (2000) Avoidance of radiation injuries from medical interventional procedures. ICRP Publ 85, Oxford, Pergamon Press, Ann ICRP 30 (2)

  21. European Commission (1997) Council Directive of 30 June 1997 (97/43 /Euratom) on Health Protection of Individuals against the Dangers of Ionising Radiation in relation to Medical Exposure. Official J Eur Commun L 180:22–27

    Google Scholar 

  22. Bernardi G, Padovani R, Morocutti G, Spedicato L, Giannuleas JD, Neofotistou E, Manginas A, Goicolea JC, McNeil J, Vano E, Marzocchi A, Tsapaki V, Fioretti PM, Malone J (2001) Quality criteria for cardiac images in diagnostic and interventional cardiology. Br J Radiol 74:852–855

    CAS  PubMed  Google Scholar 

  23. Bernardi G, Padovani R, Morocutti G, Spedicato L, Giannuleas JD, Neofotistou E, Manginas A, Goicolea JC, McNeil J, Vano E (2001) A method based on DIMOND quality criteria to evaluate imaging in diagnostic and interventional cardiology. Radiat Prot Dosim 94:167–172

    CAS  Google Scholar 

  24. Neofotistou V (2001) Review of patient dosimetry in cardiology. Radiat Prot Dosim 94:177–182

    CAS  Google Scholar 

  25. Measures for optimising radiological information and dose in digital imaging and interventional radiology. European Commission. Fifth Framework Programme, 1998–2002. Programme Acronym: FP5-EAECTP C. Project Reference: FIGM-2000–00061. Project Acronym: DIMOND III. http://dbs.cordis.lu/fep/FP5/FP5_PROJl_search.html.

  26. Toivonen M (2001) Patient dosimetry protocols in digital and interventional radiology. Radiat Prot Dosim 94:105–108

    CAS  Google Scholar 

  27. Vano E, Gonzalez L (2001) Approaches to establishing reference levels in interventional radiology. Radiat Prot Dosim 94:109–112

    CAS  Google Scholar 

  28. Faulkner K (2001) Introduction to constancy check protocols in fluoroscopic systems. Radiat Prot Dosim 94:65–68

    CAS  Google Scholar 

  29. Vano E, Fernandez JM, Lopez L, Ten JI, Gonzalez L, Guibelalde E (2001) The use of constancy checks to optimise patient dose in interventional radiology systems. In: Proc Int Conf Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy, Malaga, Spain, 26–30 March, IAEA-CN-85–196: 320–324

  30. Bernardi G, Padovani R, Morocutti G, Vano E, Malisan MR, Rinuncini M, Spedicato L, Fioretti PM (2000) Clinical and technical determinants of the complexity of percutaneous trasnluminal coronary angioplasty procedures: analysis in relation to radiation exposure parameters. Cathet Cardiovasc Interv 51:1–9

    Article  CAS  Google Scholar 

  31. Watson L (1997) Radiation exposure during cardiology fellowship training. Health Phys 73:690–693

    Google Scholar 

  32. Neofotistou V (1995) Illustrating the need for education and training in radiation safety in interventional radiology. In: Proc Joint WHO/ISH Workshop on Efficacy and Radiation Safety in Interventional Radiology, Munich–Neuherberg, Germany, 9–13 October

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Acknowledgements. This study was partially supported by the European Commission's Radiation Protection Research Program DIMOND III (Measures for Optimising Radiological Information and Dose in Digital Imaging and Interventional Radiology; contract number: FIGM CT2000–00061).

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Authors and Affiliations

  1. Department of Medical Physics, Regional Athens General Hospital, 154 Mesogion Avenue, 11527 , Athens, Greece

    V. Neofotistou

  2. Department of Medical Physics, Complutense University, Madrid, Spain

    E. Vano

  3. Servizio di Fisica Medica, Ospedale S. Maria della Misericordia, Udine, Italy

    R. Padovani

  4. Department of Regional Medical Physics, Newcastle General Hospital, Newcastle, UK

    J. Kotre & S. Willis

  5. Department of Medical Physics and Bioengineering, St. James's Hospital and Haughton Institute, Dublin 8, Ireland

    A. Dowling

  6. STUK, Radiation and Nuclear Safety Authority, Helsinski, Finland

    M. Toivonen

  7. Department of Medical Physics, Medical School, Athens University, Athens, Greece

    S. Kottou

  8. Department of Bioengineering, Onassis Cardiac Surgery Center, Athens, Greece

    V. Tsapaki

  9. Unita Operativa de Cardiologia, Ospedale S. Maria d. Misericordia, Udine, Italy

    G. Bernardi

  10. Quality Assurance Reference Center, Newcastle General Hospital, Newcastle, UK

    K. Faulkner

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  1. V. Neofotistou
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  2. E. Vano
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  3. R. Padovani
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  7. S. Kottou
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  8. V. Tsapaki
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  9. S. Willis
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  10. G. Bernardi
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  11. K. Faulkner
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Correspondence to V. Neofotistou.

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Neofotistou, V., Vano, E., Padovani, R. et al. Preliminary reference levels in interventional cardiology. Eur Radiol 13, 2259–2263 (2003). https://doi.org/10.1007/s00330-003-1831-x

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  • DOI: https://doi.org/10.1007/s00330-003-1831-x

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