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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Updating national diagnostic reference levels for interventional cardiology and methodological aspects

Roberto Sánchez1, Eliseo Vañó1, José M Fernández Soto2

  • 1Hospital Clínico San Carlos, Madrid, Spain; Universidad Complutense de Madrid, Spain.

Physica Medica : PM : an International Journal Devoted to the Applications of Physics to Medicine and Biology : Official Journal of the Italian Association of Biomedical Physics (AIFB)
|February 8, 2020
PubMed

Insights

This study proposes national diagnostic reference levels (DRLs) for interventional cardiology procedures in Spain. Findings highlight the need for dose optimization strategies beyond X-ray settings, emphasizing training and technology.

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.

Keywords:
Diagnostic reference levelsInterventional cardiologyOptimizationPatient doses

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