Patient Effective Dose profile in CATHLAB

Volume 5, Issue 3, June 2021     |     PP. 16-33      |     PDF (280 K)    |     Pub. Date: July 28, 2021
DOI: 10.54647/pm31129    107 Downloads     5757 Views  

Author(s)

Jibon Sharma, Department of Radiation Oncology,State Cancer Institute,Gauhati Medical College, India
Jogesh Sarma, Department of Pulmonary Medicine, Gauhati Medical College, India

Abstract
The intervention procedures are performed under fluoroscopic guidance and become increasingly common because of their obvious benefits to patients. Patient dose during cardiologic procedures is high due to lengthy procedure and the prolonged exposure time to the patient. Objective: The primary objective of the study was to evaluate the level of radiation dose received by the patients in order to estimate local diagnostic reference levels during cardiac catheterization procedures individually in terms of E (effective dose). Effective dose and doses to various organs estimated with the help of Monte Carlo PCXMC software.Material and Methods: A total of 123 patients were included in these studies, who were admitted to Cardiology department, and the data were collected retrospectively in a designed format during both diagnostic and therapeutic procedure.Results: The estimated patient dose rate as a whole in the Cath-Lab was found to be 96.45mGy/min which is considered lower than the recommended DRL (dose reference level) for the continuous high mode fluoroscopy used in interventional radiology (100mGy/min) given by IAEA. The effective dose was calculated and found respectively for CA-TFA, CA-TRA and CA-PTCA as 6.13mSv (range2.4-17.33), 10.97mSv (range 5.56-29.03) and 34.68mSv (range 10.64-70.21). We observed strong correlation between total duration of procedure (both fluoroscopy and cine time) with effective dose(R=0.95, p<0.00001) and a weak although statistically significant correlation between BMI (body mass index) with effective dose(R=0.526, p<0.00001) wasobserved. A significant increase of doses in TRA procedure in regard to TFA procedure was also noticed in our study.Conclusions: It is anticipated that this study is going to assist the institutions having Cath-Lab facilities of this region in encouraging the standardization of procedure, which may help increase awareness and aims to serve as guidance for Cardiologist.

Keywords
CA-TFA, CA-TRA, CA-PTCA, Effective Dose

Cite this paper
Jibon Sharma, Jogesh Sarma, Patient Effective Dose profile in CATHLAB , SCIREA Journal of Medicine. Volume 5, Issue 3, June 2021 | PP. 16-33. 10.54647/pm31129

References

[ 1 ] International Commission on Radiological Protection. Radiological Protection and safety in Medicine; ICRP- 73, Pergamum Press ;1997
[ 2 ] E.T.Samara,A.Aroua,R.D.Palma,J.C.Stauffer,S.Schmidt,Ph.R.Trueb,A.Stuessi,R.Treier,E.Bochud, F.R.Verdun.An audit of Diagnostic reference levels in Interventional Cardiology and Radiology: are there differences between academic and non-academic centres? Radiation Protection Dosimetry 2011; 1-9.
[ 3 ] International Atomic Energy Agency .Dosimetry in diagnostic radiology: an international code of practice. Technical Reports Series No.457.IAEA, Vienna;2007
[ 4 ] Stratis A.I.,Anthopoulos P.L.,Gavaliatsis I.P.,Ifantis G.P.,Salahas A.I.et .al.;Patient dose in Cardiac Radiology;Hellenic J Cardiology 2009;50:17-25.
[ 5 ] Shrimpton P,SharpC,NeofotistouV,etal.Efficacy and radiation safety in interventional radiology.Joint WHO/Institute of Radiation Hygiene Radiology,Report by working Group 2 on Radiation safety,Munich-Neuherberg:1995.
[ 6 ] International Electrochemical Commission. Medical electrical equipment-dose area product meters, 2nd edition, 2000-01. Publication’60580, IEC, Geneva.
[ 7 ] National Radiation Protection Board. National protocol for patient dose measurements in diagnostic radiology. NRPB, Chilton; 1992.
[ 8 ] International Organisation for Standardisation (1995) Guide to the expression of uncertainty in measurement, ISO, Geneva. International Electrochemical Commission (2008) Medical electrical equipment. General requirements for radiation protection in diagnostic X-ray equipment, Publication 60601-1-3.IEC, Englewood.
[ 9 ] TriamiA.Gasparini D. Padovani R . Trigger levels to prevent tissue reaction in interventional radiology procedures. IFMBE Proceedings 2009; 25:410-413.
[ 10 ] ŹontarD,KuheljD,ŚkrkD.Zdešar U , Patient peak skin doses from cardiac interventional procedures.RadiatProt Dosimetry 2010; 139:262-265.https://doi.org/10.1093/rpd/ncq013.
[ 11 ] Dreler.G.,Panzer W.,WidenmannL.,Williams G.,ZankiM.,The calculation of dose from external photon exposures using reference human phantoms and Monte Carlo methods,part-III:Organ dose in X-ray diagnosis(revised and amended),Rep.GSF-Bericht 11/90,GSF National Research Centre for Environment and Health,Neuherberg ;1990.
[ 12 ] International Atomic Energy Agency,Dosimetry in Diagnostic Radiology:An international code of practice,AppendixVIII,Technical Reports Series,2007; No.457,IAEA,Vienna.
[ 13 ] P.W.E.Schmidt,D.R.Dance,C.L.Skinner,I.A.Castellano Smith and J.G.McNeil,Conversion factors for the estimation of effective dose in paediatric cardiac angiography,Phy.Med.Biol.2000;45:3095-107.
[ 14 ] S.S.Jolly,S.Amlani,M.Hamon,S.Yusuf,andS.R.Mehta, Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials, American Heart Journal,2009;157-1:132-40.
[ 15 ] A.G.Ziakas, K.C.Koskinas, S.Gavrilidis et.al, Radial versus femoral access for orally anti coagulated patients, Catheterization and Cardiovascular Interventions,2010;76-4:493-99.
[ 16 ] Y.J.Yang,D.E.Kandzari,Z.Gao et.al.,Transradial versus transfemoral method of percutaneous coronary revascularization for unprotected left main coronary artery disease: comparison of procedural and late-term outcomes,JACC,2010;3-10:1035-42.
[ 17 ] Harrison D,RicciardelloM,CollinsL.Evaluation of radiation dose and risk to the patient from coronary angiography.Aust NZ J Med 1998;28(5):597-603
[ 18 ] Delichas M.G.,PsarrakosK,Molyvda A.E.,GiannogluotG,HatziioannouK,PapanastassiouE.Radiation Doses to patients undergoing coronary angiography and percutaneous Transluminal coronary angioplasty.Radiation Protection Dosimetry 2003;103(2):149-54.
[ 19 ] Schultz FW,ZoeteliefJ.Dose conversion coefficients for interventional procedures.Radiation Protection Dosimetry 2005;117 (1-3):225-30.
[ 20 ] Bogaert E,BacherK,ThierensH.Interventional cardiovascular procedures in Belgium:Effective dose and conversion factors.Radiation Protection Dosimetry 2008;129 (1-3):77-82.
[ 21 ] CompagnoneG,OrtolaniP,DomenichelliS,OviV,CalifanoG,DallAraG,etal.Effective and equivalent organ doses in patients undergoing coronary angiography and percutaneous coronary interventions.Medical Physics 2011;38(4):2168-75.
[ 22 ] Hart D,JonesDG,WallBF.Estimation of effective dose in diagnostic radiology from entrance surface dose and dose area product measurements (NRPB R262).Chilton:National Radiological Protection Board;1994.
[ 23 ] Bozkurt A,BorD.Simultaneous determination of equivalent dose to organs and tissues of the patient and of the physician in interventional radiology using the Monte Carlo method.Physics in Medicine Biology 2007;52(2):317-30.
[ 24 ] Morrel RE,Rogers AT.A mathematical model for patient skin dose assessment in cardiac catheterisation procedures.British Journal of Radiology 2006;79 (945):756-61.
[ 25 ] Tapiovaara M,Siiskonen T.PCXMC-A Monte Carlo program for calculating patient doses in medical x-ray examinations.Helsinki:Finnish centre for Radiation and Nuclear Safety (STUK);2008.
[ 26 ] Jones DG,WallBF.Organ doses from medical x-ray examinations calculated using Monte Carlo techniques,NRPB-R186.London:HMSO;1985.
[ 27 ] Hart D, Jones DG,WallBF.Normalised organ doses for medical x-ray examinations calculated using Monte Carlotechniques,NRPB-SR262.Chilton:NRPB;1994.
[ 28 ] Schmidt P, Dance D, Skinner C, Castellano Smith I, McNeill K J. Conversion factors for the estimation of effective dose in paediatric cardiac angiography. Phys Med Biol 2000; 45 (10): 3095-107.
[ 29 ] Schultz FW, Geleijns J, Spoelstra F, Zoetelief J. Monte Carlo calculations for assessment of radiation dose to patients with congenital heart defects and to staff during cardiac catheterizations. Br J Radiol 2003; 76(909): 638-47.
[ 30 ] Eckerman K, Cristy M, Ryman J. Description of the mathematical phantoms. The ORNL mathematical phantom series; 1996
[ 31 ] Tapiovaara M, Siiskonen T. PCXMC 2.0 User’s Guide. Helsinki: Finnish Centre for Radiation and Nuclear Safety (STUK); 2008.
[ 32 ] AAPM.Functionality and Operation of Fluoroscopic Automatic Brightness Control/Automatic Dose rate control Logic in Modern Cardiovascular and interventional Angiography systems.American Association of Physicists in Medicine;2012.
[ 33 ] K.Nadarasa, M.C.Robertson, C.K.Wong et.al, Rapid cycle change to predominantly radial access coronary angiography and percutaneous coronary intervention: intervention effect on vascular access site complications, Catheterization and Cardiovascular Interventions, 2012; 79-4:589-94.
[ 34 ] Leung.K.C. and Martin.C.J.Effective doses for coronary angiography.Br.J.Radiology.1996;69:426-31.
[ 35 ] Broadhead.D.A.,Chapple.C.L.,FaulknerK.,Davies M.L., and McCallum.H.The impact of cardiology on the collective effective dose in the north of England.Br.J.Radiology.1997;70:492-97.
[ 36 ] Rannikko S.,Ermakov,I.,Lampinen J.S.,Toivonen M.,KarilaK.T.K.andChervjakov.A computing patient doses of X-ray examinations using a patient size and sex adaptable phantom.Br.J.Radiology.1997;70:708-18 .
[ 37 ] Betsou,S.,Efstathopoulos,E.P.,Katritsis,D.,Faulkner,K.,andPanayiotakis,G. Patient radiation dosesduring cardiac catheterization procedures.Br.J.Radiology.1998;71:634-39.