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Multiple procedures and cumulative individual radiation exposure in interventional cardiology: A long-term
Birgitta M Weltermann1, Thomas Rock, Gunnar Brix
1Institute for General Medicine, University Hospital, University of Duisburg-Essen, Hufelandstr. 55, 45145, Essen, Germany, birgitta.weltermann@uk-essen.de.
Insights
Nearly 30% of coronary angiography procedures lacked clear justification, leading to significant radiation exposure for patients. Adhering to cardiology guidelines can reduce these potentially avoidable risks.
Area of Science:
- Cardiology
- Medical Imaging
- Radiation Safety
Background:
- Discrepancies exist between coronary angiography guideline recommendations and clinical practice.
- While appropriateness of recurrent angiographies has been studied, patient history and radiation exposure remain less understood.
Purpose of the Study:
- To analyze the appropriateness of coronary angiographies in relation to patient history and radiation exposure.
- To exemplify the benefits of guideline adherence in reducing patient radiation exposure.
Main Methods:
- Retrospective analysis of 147 patients with coronary artery disease (CAD) undergoing angiography between 2004-2009.
- Physician rating of 441 procedures for appropriateness based on cardiology guidelines.
- Estimation of individual radiation exposure using literature data.
Main Results:
- 27.6% of procedures had low or no appropriateness.
- Potentially avoidable radiation exposure reached up to 186 mSv for individual patients.
- Prior bypass surgery and initial treatment at a tertiary center were predisposing factors for inappropriate procedures.
Conclusions:
- A significant proportion of coronary angiographies may not align with guidelines, leading to unnecessary radiation exposure.
- Guideline adherence offers a clear benefit in minimizing patient radiation doses.
- Targeted interventions for high-risk patients could further mitigate cumulative radiation exposure.
Introduction:
Various studies address discrepancies between guideline recommendations for coronary angiographies and clinical practice. While the issue of the appropriateness of recurrent angiographies was studied focusing on the role of the cardiologist, little is known about individual patients' histories and the associated radiation exposures.
Methods:
We analyzed all patients with coronary artery disease (CAD) in an academic teaching practice who underwent at least one angiography with or without intervention between 2004 and 2009. All performed angiographies in these patients were analyzed and rated by three physicians for appropriateness levels according to cardiology guidelines. Typical exposure data from the medical literature were used to estimate individual radiation exposure.
Results:
In the cohort of 147 patients, a total of 441 procedures were analyzed: between 1981 and 2009, three procedures were performed per patient (range 1-19) on average. Appropriateness ratings were 'high/intermediate' in 71%, 'low/no' in 27.6% and data were insufficient for ratings in 1.4%. Procedures with 'low/no' ratings were associated with potentially avoidable exposures of up to 186 mSv for single patients.
Conclusions:
Using retrospective data, we exemplify the potential benefit of guideline adherence to decrease patients' radiation exposures.
Key Points:
• A cohort study of 147 patients showed 27.6% low appropriateness procedures. • Potentially avoidable radiation exposure cumulated up to about 186 mSv for single patients. • Predisposing factors were prior bypass surgery and first treatment in a tertiary centre. • 7.5% of the patients received 58% of the potentially avoidable radiation exposure. • The benefits of guideline adherence in decreasing patient radiation exposure are exemplified.
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