Patient peak skin doses from cardiac interventional procedures

Area of Science:

• Medical Physics
• Radiology
• Cardiology

Background:

• Interventional cardiac procedures deliver significant radiation doses to patients.
• High patient skin doses can lead to deterministic effects, such as skin burns.
• Accurate assessment of peak skin dose (PSD) is crucial for patient safety.

Purpose of the Study:

• To compare cumulative dose at the interventional reference point (CD(IRP)) with measured peak skin dose (PSD) in patients undergoing percutaneous transluminal coronary angioplasty (PTCA).
• To evaluate the reliability of CD(IRP) as a predictor of PSD and identify potential risks of deterministic effects.

Main Methods:

• Data on CD(IRP) were collected for 161 patients from three cardiac catheterization rooms.
• Peak skin doses (PSD) were measured using Gafchromic dosimetry films for a subset of 16 patients.
• Correlation analysis was performed between CD(IRP), PSD, kerma area product, and fluorography time.

Main Results:

• CD(IRP) provided a useful but conservative estimation of PSD, often leading to overestimation.
• The median and third quartile CD(IRP) values were 0.64 Gy and 0.92 Gy, respectively.
• Nine patients exceeded the 2 Gy threshold for deterministic effects.
• A strong correlation was observed between CD(IRP) and kerma area product, but a weak correlation with fluorography time.

Conclusions:

• CD(IRP) is a valuable tool for estimating patient PSD in interventional cardiology, but its overestimation potential should be recognized.
• Monitoring CD(IRP) can help identify patients at risk of deterministic skin effects.
• Kerma area product is a better correlate of CD(IRP) than fluorography time for assessing radiation dose in PTCA procedures.