Reference levels at European level for cardiac interventional procedures.

Area of Science:

• Interventional Cardiology
• Medical Radiation Physics
• Radiological Protection

Background:

• Significant patient dose variation exists for similar interventional cardiology procedures.
• Factors contributing to dose variability include procedure complexity, equipment, protocols, and operator skill.

Purpose of the Study:

• To assess and propose new European reference levels (RLs) for patient radiation dose in common interventional cardiology procedures.
• To identify key factors influencing dose variability and propose related dose metrics.

Main Methods:

• A survey conducted by the SENTINEL consortium across nine European centers.
• Collected data on nearly 2000 procedures, including coronary angiography, angioplasty, and diagnostic electrophysiology.
• Analyzed dose metrics such as air kerma-area product, effective dose, cumulative dose, fluoroscopy time, and cine frames.

Main Results:

• New reference levels (RLs) were established for air kerma-area product (45, 85, 35 Gy cm2), effective dose (8, 15, 6 mSv), cumulative dose (650, 1500 mGy), fluoroscopy time (6.5, 15.5, 21 min), and cine frames (700, 1000 images).
• Entrance surface air kerma for fluoroscopy (13 mGy/min) and image acquisition (0.10 mGy/frame) were proposed, highlighting equipment performance as a key factor.

Conclusions:

• The established RLs provide benchmarks for optimizing patient radiation doses in interventional cardiology.
• Addressing equipment performance and setup is crucial for reducing patient dose variability and ensuring consistent radiological protection.