High patient doses in interventional cardiology due to physicians' negligence: how can they be prevented?

Area of Science:

• Interventional Cardiology
• Medical Radiation Physics
• Patient Safety

Background:

• Interventional cardiology procedures often result in high patient radiation doses.
• Deterministic radiation effects are a potential risk in these procedures.
• New digital flat panel technology is being adopted to reduce radiation exposure.

Purpose of the Study:

• To evaluate the impact of radiation protection training on patient doses in interventional cardiology.
• To compare patient doses before and after training, analyzing individual cardiologist practices.
• To assess local reference levels (LRLs) against European guidelines.

Main Methods:

• Dose measurements were collected from 1196 coronary angiographies and 506 percutaneous transluminal coronary angioplasties.
• Data was analyzed for two periods: pre- and post-radiation protection training.
• Individual cardiologist practices were assessed, and LRLs were compared with European Research Program DIMOND preliminary reference levels.

Main Results:

• Following training, patients' dose area product, fluoroscopy time, cumulative dose, and image count decreased.
• Despite training, one cardiologist consistently delivered the highest patient doses.
• Local reference levels were established and compared to European preliminary levels.

Conclusions:

• Radiation protection training can lower patient doses in interventional cardiology.
• Physician practice patterns significantly influence patient radiation exposure.
• Preventing persistent high-dose practices remains a challenge, as dose constraints are lacking for diagnostic and therapeutic procedures.