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

• Published in: Revista portuguesa de cardiologia 2024-07, Vol.43 (7), p.367-374
• Main Authors: Costa, Hugo, Espírito-Santo, Miguel, Bispo, João, Guedes, João, Paulo, Graciano, Mimoso, Jorge, Palmeiro, Hugo, Baptista Gonçalves, Rui, Vinhas, Hugo
• Format: Article
• Language: English
• Subjects: Achievable dose; Aged; Cardiac Catheterization; Cardiologia intervenção; Cohort Studies; Complex percutaneous coronary intervention; Diagnostic reference levels; Dose alcançáveis; Female; Humans; Intervention cardiology; Intervenção coronária percutânea complexa; Ionizing radiation; Male; Middle Aged; Níveis referência dose; Percutaneous Coronary Intervention - standards; Portugal; Radiation Dosage; Radiation Exposure; Radiation, Ionizing; Radiação ionizante; Reference Values; Retrospective Studies
• ISSN: 0870-2551; 2174-2030; 2174-2030
• DOI: 10.1016/j.repc.2023.10.010

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). 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 (PKA) and cumulative air kerma (Ka,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 (Ka,r). 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 Ka,r (3012 mGy) and PKA (162 Gy cm2) for complex PCI. ADs were also set in Ka,r (1917 mGy) and PKA (101 Gy cm2). Independent predictors of Ka,r with a positive correlation were PKA (0.893, p