[X-Ray, false friend of the interventional cardiologist - Risks, evaluation, quality improvement - Status report from...

Area of Science:

• Cardiology
• Radiology
• Medical Physics

Background:

• Cardiac catheterization procedures involve significant radiation exposure, posing risks of deterministic and stochastic effects for both patients and interventional cardiologists.
• Maintaining radiation exposure As Low As Reasonably Achievable (ALARA) is crucial for radiation protection in interventional cardiology.
• Disseminating knowledge on safety standards and recommendations is essential to reduce radiation doses among interventionalists.

Purpose of the Study:

• To analyze dosimetric data from a large cohort of cardiac catheterization procedures in France.
• To identify variations in radiation exposure levels across different centers and procedure types.
• To inform quality improvement processes for radiation safety in interventional cardiology.

Main Methods:

• Utilized data from the France-PCI registry, collecting dosimetric information from 55,783 coronary angiographic and interventional procedures across 30 centers in 2020.
• Collected and compared data on fluoroscopy time, Patient Dose Surface (PDS), and Air Kerma.
• Stratified analysis based on procedure type, including diagnostic angiography, percutaneous coronary angioplasty, and chronic total occlusion interventions.

Main Results:

• Mean fluoroscopy time for diagnostic procedures was 4.4 minutes, with a mean PDS of 1,767 cGy.cm² and mean Air Kerma of 257 Gy.
• Coronary percutaneous angioplasty procedures resulted in 2-3 times higher mean radiation exposures compared to diagnostic procedures.
• Chronic coronary total occlusion interventions showed approximately double the mean exposure compared to non-CTO interventions, with significant inter-center disparities noted.

Conclusions:

• Significant variations in radiation exposure exist among centers performing cardiac catheterization procedures in France.
• The findings underscore the need for standardized radiation protection protocols and targeted interventions to reduce dose disparities.
• Promoting best practices and continuous monitoring of dosimetric data are vital for enhancing radiation safety in interventional cardiology.