Radiation Dose in Interventional Cardiology Procedures: Urgent Need for Monitoring Dose and Establishing Diagnostic Reference Levels

Background: Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification. Methods: Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included. Results: The median radiation dose for wrist fracture open fixation was 2.73 cGycm2, Kirschner wiring (K-wiring) procedures was 2.36 cGycm2, small joint arthrodesis was 1.20 cGycm2, small joint injections was 0.58 cGycm2, and phalangeal fracture fixation was 1.05 cGycm2. Conclusions: Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.

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Radiation Dose in Coronary Angiography and Percutaneous Coronary Intervention: Establishment of Diagnostic Reference Levels at the Philippine Heart Center

Interventional Cardiology Review ◽

10.15420/icr.2021.16.po2 ◽

2021 ◽

Vol 16 ◽

Author(s):

Emily Mae L Yap ◽

Livy P Magno ◽

Christopher A Macaraeg ◽

Gilbert E Pedroso ◽

Aeron G Ramos ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Radiation Dose ◽

Coronary Angiography ◽

Coronary Intervention ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Percutaneous Coronary ◽

Heart Center

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Development of Diagnostic Reference Levels Using a Real-Time Radiation Dose Monitoring System at a Cardiovascular Center in Korea

Journal of Digital Imaging ◽

10.1007/s10278-015-9773-9 ◽

2015 ◽

Vol 28 (6) ◽

pp. 684-694 ◽

Cited By ~ 5

Author(s):

Jungsu Kim ◽

Deoknam Seo ◽

Inseok Choi ◽

Sora Nam ◽

Yongsu Yoon ◽

...

Keyword(s):

Radiation Dose ◽

Real Time ◽

Monitoring System ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Monitoring ◽

Radiation Dose Monitoring ◽

Cardiovascular Center

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Comparison of Radiation Dose in CT Examinations At PIMS with European Commission Reference Doses

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University ◽

10.48036/apims.v17i3.511 ◽

2021 ◽

Vol 17 (3) ◽

pp. 216-221

Author(s):

Fawad Yasin ◽

Anum Rasheed ◽

Muhammad Nauman Malik ◽

Farheen Raza ◽

Ramish Riaz ◽

...

Keyword(s):

Computed Tomography ◽

Radiation Dose ◽

European Commission ◽

Large Scale ◽

Radiology Department ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Ct Dose

OBJECTIVE - The purpose of this study was to assess the radiation dose levels from common computed tomography (CT) examinations performed in Radiology Department of Pakistan Institute of Medical Sciences (PIMS), and evaluate these according to diagnostic reference levels (DRLs) proposed by European Commission (EC) guidelines, and thus contributing towards the establishment of local and national DRLs. To the best of our knowledge, this is the first study of its kind to explore radiation doses from CT examinations in Pakistan. STUDY DESIGN - This was a quantitative study conducted at PIMS, Islamabad, spanning a duration of eight weeks. Scan parameters and dose profile data of 1506 adults undergoing examinations of head, neck, chest and abdomen-pelvis regions, comprising of single- and multi-phase, contrast-enhanced and unenhanced studies. Dose indicators utilized by EC guidelines for DRLs include volume CT dose index (CTDIvol) and Dose Length Product (DLP) for single slice and complete examination radiation doses, respectively. METHOD - Values of CTDIvol, DLP and scan lengths were extracted from the CT operators console. Other control variables included gender, contrast enhancement and phasicity of study. IBM SPSS package was used to obtain descriptive statistics such as mean and quartiles. RESULTS - DRLs calculated as 75th percentile of CTDIvol, DLP for various anatomical regions are by and far comparable to European DRLs. CONCLUSION – This study describes institutional diagnostic reference levels for common CT exams in Islamabad and provides benchmark values for future reference. Our DRL values are mostly comparable to European and international DRLs. Similar, albeit large scale, surveys are recommended for establishment of local and national DRLs, eventually contributing towards development of regional DRLs. KEYWORDS: CTDIvol, DLP, Diagnostic Reference Levels, Computed Tomography, Radiation Monitoring, Scan length

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A MULTICENTRE SURVEY OF LOCAL DIAGNOSTIC REFERENCE LEVELS AND ACHIEVABLE DOSE FOR CORONARY ANGIOGRAPHY AND PERCUTANEOUS TRANSLUMINAL CORONARY INTERVENTION PROCEDURES IN KOREA

Radiation Protection Dosimetry ◽

10.1093/rpd/ncz178 ◽

2019 ◽

Vol 187 (3) ◽

pp. 378-382

Author(s):

Jung Su Kim ◽

Bong-Ki Lee ◽

Dong Ryeol Ryu ◽

Kwang Jin Chun ◽

Hyun-Hee Choi ◽

...

Keyword(s):

Coronary Angiography ◽

Interventional Cardiology ◽

Coronary Intervention ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

High Radiation ◽

Exposure Data ◽

Area Product ◽

Percutaneous Transluminal

Abstract Interventional cardiology procedures can involve relatively high radiation doses compared to general radiography. During coronary angiography (CAG) and percutaneous transluminal coronary intervention (PCI), the same area is exposed to radiation for a long period. In this study, radiation exposure data of 1071 examinations in Korean hospitals were collected, and the achievable dose (AD) and diagnostic reference levels (DRLs) in actual medical practice for two types of interventional cardiology procedures in Korea were established. In CAG, 75th percentile DRLs and AD of the total kerma-area product were 47.0 and 33.1 Gy·cm 2, respectively. In PCI, those values were 171.3 and 102.6 Gy·cm2, respectively. This is the first study to introduce the DRLs for cardiovascular interventional procedures in Korea. These results will help optimise the interventional cardiology procedures for Korean cardiac centres.

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