Anthropometric parameters and radiation doses during percutaneous coronary procedures

• Published in: Physica medica 2022-08, Vol.100, p.164-175
• Main Authors: Manicardi, Marcella, Nocetti, Luca, Brigidi, Alessio, Cadioli, Cecilia, Sgreccia, Daria, Valenti, Anna Chiara, Vitolo, Marco, Arrotti, Salvatore, Monopoli, Daniel Enrique, Sgura, Fabio, Rossi, Rosario, Guidi, Gabriele, Boriani, Giuseppe
• Format: Article
• Language: English
• Subjects: Body surface area; Coronary angiography; Dose area product; Radiation exposure
• ISSN: 1120-1797; 1724-191X
• DOI: 10.1016/j.ejmp.2022.06.013

•BSA explains the higher variance of patient’s radiation dose compared to BMI.•Procedure type, number of treated vessels are associated to highest radiation doses.•Female sex and increasing height are associated with lower radiation doses.•Radiation management should be part of pre-procedure planning esp for complex ones. Body size is a major determinant of patient’s dose during percutaneous coronary interventions (PCI). Body mass index, body surface area (BSA), lean body mass and weight are commonly used estimates for body size. We aim to identify which of these measures and which procedural/clinical characteristics can better predict received dose. Dose area product (DAP, Gycm2), fluoroscopy DAP rate (Gycm2/min), fluoroscopy DAP (Gycm2), cine-angiography DAP (Gycm2), Air Kerma (mGy) were selected as indices of patient radiation dose. Different clinical/procedural variables were analysed in multiple linear regression models with previously mentioned patient radiation dose parameters as end points. The best model for each of them was identified. Overall 6623 PCI were analysed, median fluoroscopy DAP rate was 35 [IQR 2.7,4.4] Gycm2, median total DAP was 62.7 [IQR 38.1,107] Gycm2. Among all anthropometric variables, BSA showed the best correlation with all radiation dose parameters considered. Every 1 m2 increment in BSA added 4.861 Gycm2/min (95% CI [4.656, 5.067]) to fluoroscopy DAP rate and 164 Gycm2 (95% CI [145.3, 182.8]) to total DAP. Height and female sex were significantly associated to a reduction in fluoroscopy DAP rate and total DAP. Coronary angioplasty, diabetes, basal creatinine and the number of treated vessels were associated to higher values. Main determinants of patient radiation dose are: BSA, female sex, height and number of treated vessels. In an era of increasing PCI complexity and obesity prevalence, these results can help clinicians tailoring X-ray administration to patient’s size.