The role of a commercial radiation dose index monitoring system in establishing local dose reference levels for fluoroscopically guided invasive cardiac procedures |
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| Institution: | 1. Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy;2. Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy;1. Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina;2. Department of Pathology and Laboratory Medicine, UNC School of Medicine, Chapel Hill, North Carolina;3. Department of Physician Assistant Studies, Elon University, Elon, North Carolina;4. Sanford School of Public Policy, Duke University, Durham, North Carolina;5. Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina;1. Center for Evidence-Based Imaging (CEBI), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;2. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;3. Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA;4. Takeda Pharmaceuticals, Boston, MA, USA;1. Dip. Fisica, Sapienza Univ. di Roma, Rome, Italy;2. INFN Sezione di Roma, Rome, Italy;3. SLAC National Accelerator Laboratory, Menlo Park, United States;4. National Center for Radiation Protection and Computational Physics, Istituto Superiore di Sanitá, Italy;5. INFN, Laboratori Nazionali del Sud, Catania, Italy;6. Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France |
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| Abstract: | PurposeThe primary goal was to evaluate local dose level for fluoroscopically guided invasive cardiac procedures in a high-volume activity catheterization laboratory, using automatic data registration with minimal impact on operator workload. The secondary goal was to highlight the relationship between dose indices and acquisition parameters, in order to establish an effective strategy for protocols optimization.MethodsFrom September 2016 to December 2018, a dosimetric survey was conducted in the 2 rooms of the catheterization laboratory of our institution. Data collection burden was minimized using a commercial Radiation Dose Index Monitoring System (RDIMs) that analyzes dicom files automatically sent by the x-ray equipment. Data were combined with clinical information extracted from the HIS records reported by the interventional cardiologist. Local dose levels were established for different invasive cardiac procedures.ResultsA total of 3029 procedures performed for 2615 patients were analyzed. Median KAP were 21 Gycm2 for invasive coronary angiography (ICA) procedures, 61 Gycm2 for percutaneous coronary intervention (PCI) procedures, 59 Gycm2 for combined (ICA+PCI) procedures, 87 Gycm2 for structural heart intervention (TAVI) procedures. A significant dose reduction (51% for ICA procedures and 58% for PCI procedures) was observed when noise reduction acquisition techniques were applied.ConclusionsRDIMs are effective tools in the establishment of local dose level in interventional cardiology, as they mitigate the burden to collect and register extensive dosimetric data and exposure parameters. Systematic review of data support the multi-disciplinary team in the definition of an effective strategy for protocol management and dose optimization. |
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