Aims and objectives
Percutaneous Coronary Intervention (PCI) procedures are extensively used for unblocking diseased coronary arteries.
Depending on the complexity and number of PCI procedures,
the patient radiation dose can be high enough to cause skin injury (1).For the range of PCI studies carried out intwo busy cardiac cath labs in a single centre,
the aim of this study was to:
1.
Obtainlocal dose reference levels,
( i.e.
median and 75th percentiles of Dose Area Product (DAP) and Reference Point Air Kerma (RPAK)),
for comparison with literature (2)...
Methods and materials
Radiation dose metric data for 880 PCI studies (197 females and 683 males (male:female=3.5:1)) were captured from two dedicated interventional cardiac machines (2 x GE Innova IGS 520) using GE DoseWatch (v3.1.0).
The data was exported to MS Excel (2016)for analysis.
For each of the three different PCI procedure types,
in ascending order of complexity,
i.e.
PCI (single vessel),
PCI MV (multivessel) and PCI CTO (Chronic Total Occlusion),
descriptive statistics were obtained for the captured dose metrics shown in Table 1.
Additionally,
Dose Reference Levels...
Results
Fig. 1 provides an overview of the dose metrics andpatient parametersfor all 880 PCI procedures.
The table shows the ranges of the relevant parameters for male and female patientsfor PCI,
PCI MV,
and PCI CTO.
Fig. 2 shows the local dosereference levels (percentiles Q2 & Q3)) for Peak Skin Dose (mGy),
RPAK(mGy) and DAP (Gycm2) for all PCI studies in each of the three categories: PCI,
PCI MV,
PCI CTO.
The dataincludes the mean values of age,
weight,
height and BMI for patients in each...
Conclusion
For CTO procedures,
the dose metric ranges (Fig. 1) and local dose referencelevels (Fig. 2),
(RPAK = 4945 mGy and DAP=307 Gycm2),
compare favourably with values published by Macciaet al (2),
however they are higher than those suggested by Siiskonen et al (3).
Comparisons with published data are complicatedby the fact thatdifferent centers use different classifications of CTO complexity.
The local method of classification,
currently based on national exam codes,
ideally should facilitate the distinction betweendifferent levels of complexity within CTO procedures,
e.g.
antegrade vs...
Personal information
Thomas HearyM.Sc
Medical Physics & Clinical Engineering Department,
Beaumont Hospital,
DublinD09 FT51,
IRELAND
Phone: +35318093375
email:
[email protected]
Ronan Faulkner Ph.D
Medical Physics & Clinical Engineering Department,
Beaumont Hospital,
DublinD09 FT51
IRELAND
Phone: +35318092798
email:
[email protected]
References
Stecker MS et al.
Guidelines for Patient Radiation Dose Management.
Journal of Vascular Interventional Radiology.
2009 Jul; 20(7 Suppl): S263-73.
Maccia C et al. Assessment of local Dose Reference Values for recanalization of Chronic Total Occlusions and other occlusions in a high-volume catheterization center (Am J Cardiol 2015;116:1179-1184)
Siiskonen T.
et al. Establishing the European diagnostic reference levels for interventional cardiology.
Physica Medica: European Journal of Medical Physics,
2018: Volume 54 ,
42 - 48.
Jones,
A K et al.
“Calculating the peak skin dose...