Patient assistance protocol based on continuous dose monitoring in interventional cardiological procedures

Our purpose is to present a monitoring protocol designed to assist patients who received radiation doses with skin damage potential based on a database collected from 2018 to 2022. This database allowed these patients to be identified and also enabled the staff to become aware of diagnostic reference level (DRL). The patients' follow-up was established when Substantial Radiation Dose Level (SRDL) was registered at the end of the exam in which cumulative air kerma values are equal to or greater than 5 Gy or area-air kerma product (PKA) ≥500 Gy.cm2 or fluoroscopy time ≥60 min. Among sample of 10,176 performed procedures including diagnostic (65-72 % CA), percutaneous coronary interventions (12-15 % PCI) and CA followed by PCI (13-21 % ad hoc angioplasty), 51 patients were identified as having received SRDL (0.52 % of procedures) and classified as overweight or obese. Continuous monitoring of these patients has been carried out through face-to-face appointments or by photos of irradiated skin region. Contact with each patient has been maintained and whenever a lesion is identified, the patient is referred to the dermatology department for treatment. Among the 53 procedures identified, 42 patients are under active follow-up (3 patients underwent 2 procedures, 6 died due to heart disease and 2 haven't answered calls). 8 patients who presented some degree of skin injury, being 3 females, were referred to the dermatology team for evaluation and have been kept under clinical follow-up. It is possible to maintain active patient monitoring, offering them assistance and encouraging the staff to optimize radiological protection.