The purpose of this study was to collect information on the practice and patient doses in a major Greek cardiac centre, investigate differences between senior cardiologists of various levels of experience and compare results with the literature, in order to optimize angiographic and interventional cardiology procedures. Radiation doses from 292 patients have been studied, 195 of which had undergone coronary angiography and 97 percutaneous transluminal coronary angioplasty. All procedures were undertaken on a Siemens Angioscop X-ray equipment. The system performed under automatic exposure control using pulsed fluoroscopy of 12.5 pulses s−1 and cine frame rate of 25 frames s−1. Dose–area product values, fluoroscopy times, total number of cine frames as well as operator's name were collected for each patient. Only senior cardiologists have participated in the study. Median values for dose–area product were 39.1 Gy cm2 for coronary angiography and 58.3 Gy cm2 for percutaneous transluminal coronary angioplasty. Median fluoroscopy time was 5.0 min and 9.7 min and median number of frames was 1588 and 1823 for coronary angiography and percutaneous transluminal coronary angioplasty, respectively. Comparison showed that patient dose–area product values were lower than other studies and fluoroscopy time values were comparable. However, the total number of frames used was much higher than other published results. Differences between cardiologists with increased experience have been found. Analysis of the patient dose values obtained initiated a program of radiation protection optimization. The need for continuous training in radiation protection for interventionalists has been verified.
1 Sources and Effects of Ionizing Radiation. United Nations Scientific Committee on the Effects of Atomic Radiation. UNSCEAR 2000 Report to the General Assembly with Scientific Annexes. New York: United Nations, 2000.
2 Balter S, Shope TB. Syllabus: A categorical course in physics: physical and technical aspects of angiography and interventional radiology. 81st Scientific Assembly, Dec 1995. RSNA’95 Scientific Program 1995:1–258.
3 World Health Organization. Efficacy and radiation safety in interventional radiology. Geneva: World Health Organization, 2000.
4 United States Food and Drug Administration (FDA). Avoidance of serious X-ray induced skin injuries to patients during fluoroscopically guided procedures. Medical Bulletin 1994;24:7–17.
5 Vano E, Gonzalez L, Fernandez JM, Guibelalde E. Patient dose values in interventional radiology. Br J Radiol 1995;68:1215–20.
6 Padovani R, Novario R, Bernardi G. Optimization in coronary angiography and percutaneous transluminal coronary angioplasty. Radiat Prot Dosim 1998;80:303–6.
7 Broadhead DA, Chapple C-L, Faulkner K, Davies ML, McCallum H. The impact of cardiology on the collective effective dose in the North of England. Br J Radiol 1997;70:492–7.
8 Zorzetto M, Bernardi G, Morocutti G, Fontanelli A. Radiation exposure to patients and operators during diagnostic catheterization and coronary angioplasty. Cathet Cardiovasc Diagn 1997;40:348–51.
9 Widmark A, Fosmark H, Einarsson G, et al. Guidance levels in the Nordic Countries: A preliminary report for selected interventional procedures. Radiat Prot Dosim 2001;94:133–5.
10 Cusma JT, Bell MR, Wondrow MA, Taubel JP, Holmes DR. Real-time measurement of radiation exposure to patients during diagnostic coronary angiography and percutaneous interventional procedures. J Am Coll Cardiol 1999;33:427–35.
11 Clark AL, Brennan AG, Robertson LJ, McArthur JD. Factors affecting patient radiation exposure during routine coronary angiography in the tertiary referral centre. Br J Radiol 2000;73:184–9.
12 Measures for optimizing radiological information and dose in digital imaging and interventional radiology. European Commission. Fifth Framework Program, 1998–2002. Program Acronym: FP5-EAECTP C. Project Reference: FIGM-CT-2000–00061.Project Acronym: DIMOND III. http://dbs.cordis.lu/fep/FP5/FP5_PROJl_search.html.
13 Dosimetry Working Party of the Institute of Physical Sciences in Medicine. National protocol for patient dose measurements in diagnostic radiology. Chilton: NRPB, 1992.
14 Watson L. Radiation exposure during cardiology fellowship training. Health Physics 1997;73:690–3.
15 Neofotistou V. Review of patient dosimetry in cardiology. Radiat Prot Dosim 2001;94:177–82.
16 Bernardi G, et al. Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: analysis in relation to radiation exposure parameters. Cath Cardiov Interv 2000;51:1–9.
17 Padovani R, Bernardi G, Malisan MR, Vano E, Morocutti G, Fioretti PM. Patient dose related to the complexity of interventional cardiology procedures. Radiat Prot Dosim 2001;94:189–92.
18 Faulkner K. Introduction to constancy check protocols in fluoroscopic systems. Radiat Prot Dosim 2001;94:65–8.
19 Betsou S, et al. Patient radiation doses during cardiac catheterization procedures. Br J Radiol 1998;71:634–9.
20 Canadillas B, Perdomo B, Perez-Martin C, Catalan-Acosta A, Armas-Trujillo D, Hernandez-Armas J. Radiation doses to patients in haemodynamic procedures. Proceedings of IAEA Conference on radiological protection of patients in diagnostic and interventional radiology, nuclear medicine and radiotherapy, Malaga 2001:281–5.
21 European Commission. Council Directive 97/43/Euratom on Health Protection of Individuals against Dangers of Ionizing Radiation in relation to Medical Exposure. Official Journal of the European Communities 1997; L 180,40.
22 Vano E, Goicolea J, Galvan C, et al. Skin radiation injuries in patients following repeated coronary angioplasty procedures. Br J Radiol 2001;74:1023–31.
23 International Commission on Radiological Protection. Avoidance of radiation injuries from medical interventional procedures. ICRP Publication 85. Annals of the ICRP 2000;30.
24 Royal Decree 1976/1999, from the Health and Consumer Affairs Department, establishing quality criteria in radiodiagnostics. In Spanish State Official Bulletin of January 29th 1999:45891–900.
25 Vano E, Gonzalez L, Faulkner K, Padovani R, Malone J. Training and accreditation in radiation protection for interventional radiology. Radiat Prot Dosim 2001;94:137–42.
26 American Association of Physicists in Medicine. Cardiac catheterization equipment performance. AAPM Report 2001:N 70.