Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratory

Abstract

Introduction and objectives

Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs).

Methods

This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (P_KA) and cumulative air kerma (K_a,r). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (K_a,r).

Results

A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9±11.2 years and mostly male (81.4%). DRLs were set in K_a,r (3012 mGy) and P_KA (162 Gy cm²) for complex PCI. ADs were also set in K_a,r (1917 mGy) and P_KA (101 Gy cm²). Independent predictors of K_a,r with a positive correlation were P_KA (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001).

Conclusions

This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in K_a,r (3012 mGy) and P_KA (162 Gy cm²). ADs, values to be achieved in future assessment, were set to K_a,r (1917 mGy) and P_KA (101 Gy cm²).