ABSTRACT
X-ray exposure of patient during coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) may have some deleterious effects. The dose area product (DAP), related to the effective dose, is a measure of stochastic risk and a potential quality indicator. The aim of our study was to assess radiation exposure of patients in a large series of "real life" interventional cardiac procedures. We evaluated DAP and Fluoroscopy time (t) during CA and/or PTCA in 3600 consecutive patients from 2002 to 2005. Procedures were performed by five experienced physicians, using successively femoral and radial techniques. DAP and t significantly correlated (r = 0.73; p < 0.0001). Median [25th-75th percentiles] values for DAP and for t were 63 [40-101] Gy.cm2 and 6.3 [4-10] min for CA, 100 [62-178] Gy.cm2 and 14.0 [9-22] min for elective PTCA, and 141 [90-219] Gy.cm2 and 15.7 [11-23] min for CA immediately followed by ad hoc PTCA, respectively. Differences between operators ranged from 50% (CA) to 70% (PTCA) for both DAP and t (p < 0.001). Moving from the femoral to the radial approach resulted in a 1.5 to 2-fold increase in DAP in 2002 (p < 0.001). DAP and t then decreased toward the european DIMOND reference values (in 2005: 53.4 Gy.cm2 and 5.5 min for CA, 104.64 Gy.cm2 and 13.1 min for elective PTCA, 128.4 Gy.cm2 and 13.6 min for ad hoc PTCA). In conclusion, radiation exposure to patients and staff are strongly dependent on operators, time course, and the arterial access, due in part to the learning curve for radial approach. The enhanced knowledge of radiation dose is the first step of a radiation dose-reduction program, likely to minimize patient and operator radiation hazards in interventional cardiology. Definition of national reference values for DAP and fluoroscopy time would be helpful for appropriate comparisons.
