Patients' skin dose during percutaneous intervention for chronic total occlusion

ArticleinCatheterization and Cardiovascular Interventions 71(2):160-4 · February 2008with20 Reads
DOI: 10.1002/ccd.21284 · Source: PubMed
Abstract
The purpose of this research is to assess the patient's entrance skin dose (ESD) during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in six institutions. Only a few reports are available on the patients' exposure during the procedures. This study was approved by all of the six institutional review boards, and all patients gave informed consent. This study included consecutive 72 patients who underwent PCI procedures for CTO in the six institutions. They wore jackets that had 100 radiosensitive indicators adhered to the back during the PCI procedures. The patients' ESDs were calculated from the color difference of the indicators. The total fluoroscopic time, total number of cine frames, and maximal ESD were compared among institutions. To check for effects on the skin, clinical follow-up was performed at 1-2 days, 2 weeks, and 3 months after the PCI procedure. The total fluoroscopic time was 45.0 +/- 24.5 min (range: 10.3-113.0 min) and the total number of cine frames was 4,558 +/- 3,440 (range: 855-22,950). The maximum ESD for each patient was 3.2 +/- 2.1 Gy (range: 0.5-10.2 Gy, median: 2.7 Gy). The average maximum ESDs were significantly different among institutions (P = 0.0006), and they were 1.6-5.3 Gy. Radiation skin injuries were observed in 2 patients. The maximum ESDs during PCI for CTO exceed the thresholds for radiation skin injuries in many cases, although there are differences in the average maximum ESDs among institutions.
    • "The reasons are simple: 1) cardiology imaging examinations are very common, with about 1 million PCI, 10 million MPI's and 10 million MDCT's per year in the US alone; 2) each procedure involves a very large radiation exposure, which may range from 5 to 57 mSv and more, around an average reference dose of 10-15 mSv for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multi-detector coronary angiography or a myocardial perfusion imaging scintigraphy [13,202122 . In particular , effective doses of invasive cardiology procedures vary widely by a factor of 10 (Table 1), with more complex procedures such as dilation of chronic total coronary occlusion [23] or transthoracic aortic valve replacement [24] or endovascular thoraco-abdominal aneurysm repair [25] which may easily exceed the effective dose of 100 mSv. In addition, interventional cardiologists have an exposure per head per year two to three times higher than that of radiologists and their exposure has increased steadily in the past 5 years [26,27]. "
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