Radiation exposure to patients undergoing percutaneous coronary interventions: are current reference values too high?

Area of Science:

• Cardiology
• Medical Physics
• Radiology

Background:

• Percutaneous coronary interventions (PCI) involve patient exposure to ionizing radiation.
• Establishing reliable predictors and reference levels for radiation exposure is crucial for patient safety.
• European guidelines propose preliminary reference levels for dose area kerma product (DAP), fluoroscopy time (T(F)), and cinegraphic frames (F).

Purpose of the Study:

• To identify predictors of patient radiation exposure during PCI.
• To compare radiation exposure levels with proposed European reference levels.
• To establish reliable scoring for patient radiation exposure based on PCI complexity and target vessel.

Main Methods:

• A retrospective analysis of 642 PCI procedures, excluding diagnostic catheterization.
• Measurement of total DAP, cinegraphic (DAP(C)) and fluoroscopic (DAP(F)) fractions, cinegraphic frames, runs, and T(F).
• Calculation of DAP(C)/F and DAP(F)/s to assess focusing quality.

Main Results:

• Mean total DAP varied significantly based on PCI type: elective (6.7–19.4 Gy.cm(2)), in-stent restenosis (4.2–19.4 Gy.cm(2)), chronic occlusions (16.0 Gy.cm(2)), and acute myocardial infarction (17.3 Gy.cm(2)).
• Stent implantation and target vessel significantly influenced DAP, with saphenous vein grafts showing the highest mean DAP (11.6 Gy.cm(2)).
• 95th percentiles for elective PCI, chronic occlusions, and emergency PCI suggest reference levels of 22, 32, and 42 Gy.cm(2) for DAP, respectively.

Conclusions:

• Consistent use of radiation-reducing techniques allows for reliable scoring of patient radiation exposure.
• The study proposes updated reference levels for DAP, T(F), and cinegraphic frames for various PCI scenarios.
• These findings aid in optimizing radiation safety protocols during percutaneous coronary interventions.