Establishing the European diagnostic reference levels for interventional cardiology

Area of Science:

• Medical Physics
• Radiology
• Cardiology

Background:

• Interventional cardiac procedures can lead to significant patient radiation doses.
• High doses pose risks of radiation injuries, including skin erythema, cardiovascular tissue reactions, and secondary cancers.
• Standardized radiation dose metrics are needed for patient protection in interventional cardiology.

Purpose of the Study:

• To collect and analyze patient exposure data from interventional cardiology procedures across multiple countries.
• To propose European diagnostic reference levels (DRLs) for air kerma-area product for various interventional cardiac procedures.
• To emphasize the importance of DRLs as an optimization tool for reducing patient radiation exposure.

Main Methods:

• Collected patient exposure data from 13 countries, 37 clinics, and nearly 50 interventional rooms.
• Analyzed data from 14,922 interventional cardiology procedures, covering 10 different types of interventions.
• Calculated European diagnostic reference levels (DRLs) for air kerma-area product for specific procedures.

Main Results:

• Suggested European DRLs for coronary angiography (35 Gy cm²), percutaneous coronary intervention (85 Gy cm²), and transcatheter aortic valve implantation (130 Gy cm²).
• Established DRLs for electrophysiological procedures (12 Gy cm²), single-chamber (2.5 Gy cm²), dual-chamber (3.5 Gy cm²), and cardiac resynchronization therapy pacemakers (18 Gy cm²).
• Identified newer techniques like TAVI and chronic total occlusion (CTO) interventions as associated with higher radiation doses.

Conclusions:

• The proposed European DRLs provide a benchmark for patient exposure in interventional cardiology.
• DRLs are crucial for optimizing radiation protection and minimizing patient risks.
• Continuous monitoring and comparison of patient doses using DRLs are essential for improving safety in cardiac interventions.