Updating national diagnostic reference levels for interventional cardiology and methodological aspects

Area of Science:

• Medical Physics
• Interventional Cardiology
• Radiology

Background:

• Establishing national diagnostic reference levels (DRLs) is crucial for optimizing radiation dose in medical imaging.
• Interventional cardiology procedures, such as coronary angiography and percutaneous coronary interventions, involve significant radiation exposure.
• Previous European surveys provide a benchmark, but national DRLs require updated, specific data.

Purpose of the Study:

• To propose updated national diagnostic reference levels (DRLs) for interventional cardiology in Spain.
• To gather technical details on X-ray system settings and image quality to aid dose optimization.
• To analyze patient dose indicators and identify factors influencing radiation exposure.

Main Methods:

• Collected patient dose indicators (air kerma area product, air kerma at reference point, fluoroscopy time, cine images) from 30,024 procedures across 14 hospitals.
• Recorded X-ray system dose settings and image quality parameters.
• Involved medical physics experts and interventional cardiologists in data collection and analysis.

Main Results:

• Proposed national DRLs for coronary angiography and percutaneous coronary interventions.
• Identified that 36% of air kerma area product meters required correction factors.
• Observed significant variation (factor of 5.5) in dose per cine image, indicating optimization potential.
• Found a poor correlation between X-ray system settings and patient dose, suggesting protocol impact.

Conclusions:

• The proposed DRLs for Spain align with recent European survey results.
• Operational protocols and procedure complexity significantly impact patient dose indicators, offering optimization opportunities.
• Implementing dose reduction technology and targeted training programs are key for future dose reduction in interventional cardiology.