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Title: Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals

Abstract

Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (P{sub KA}), skin surface entrance dose (K{sub AR}), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the P{sub KA.} 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median K{sub AR} = 581 mGy (374–876). Median P{sub KA} = 3908 uGym{sup 2} (2489–5865) DRL = 5865 uGym{sup 2}. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median K{sub AR} = 1501 mGy (928–2224). Median P{sub KA} = 8736 uGym{sup 2} (5449–12,900) DRL = 12,900 uGym{sup 2}. This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.

Authors:
 [1];  [2];  [1];  [2];  [3];  [4];  [5];  [6];  [7];  [2]
  1. The Prince Charles Hospital, Chermside, Queensland (Australia)
  2. (Australia)
  3. Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland (Australia)
  4. Allied Health Professions' Office of Queensland, Brisbane, Queensland (Australia)
  5. Royal Brisbane and Women's Hospital, Herston, Queensland (Australia)
  6. Princess Alexandra Hospital, Woolloongabba, Queensland (Australia)
  7. Cardiac Clinical Informatics Unit - Queensland Health, Herston, Queensland (Australia)
Publication Date:
OSTI Identifier:
22402357
Resource Type:
Journal Article
Resource Relation:
Journal Name: Journal of Medical Radiation Sciences (Print); Journal Volume: 61; Journal Issue: 3; Other Information: PMCID: PMC4175852; PMID: 26229649; OAI: oai:pubmedcentral.nih.gov:4175852; Copyright (c) 2014 The Authors. Journal of Medical Radiation Sciences published by Wiley Publishing Asia Pty Ltd on behalf of Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology; This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
Australia
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BENCHMARKS; CONTAINERS; CORONARIES; FLUOROSCOPY; HOSPITALS; PATIENTS; QUEENSLAND; RADIATION DOSES; RECOMMENDATIONS; SKIN; SURFACES; WEIGHT

Citation Formats

Crowhurst, James A, E-mail: jimcrowhurst@hotmail.com, School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland, Whitby, Mark, Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland, Thiele, David, Halligan, Toni, Westerink, Adam, Crown, Suzanne, Milne, Jillian, and The Prince Charles Hospital, Chermside, Queensland. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals. Australia: N. p., 2014. Web. doi:10.1002/JMRS.67.
Crowhurst, James A, E-mail: jimcrowhurst@hotmail.com, School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland, Whitby, Mark, Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland, Thiele, David, Halligan, Toni, Westerink, Adam, Crown, Suzanne, Milne, Jillian, & The Prince Charles Hospital, Chermside, Queensland. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals. Australia. doi:10.1002/JMRS.67.
Crowhurst, James A, E-mail: jimcrowhurst@hotmail.com, School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland, Whitby, Mark, Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland, Thiele, David, Halligan, Toni, Westerink, Adam, Crown, Suzanne, Milne, Jillian, and The Prince Charles Hospital, Chermside, Queensland. Mon . "Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals". Australia. doi:10.1002/JMRS.67.
@article{osti_22402357,
title = {Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals},
author = {Crowhurst, James A, E-mail: jimcrowhurst@hotmail.com and School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland and Whitby, Mark and Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland and Thiele, David and Halligan, Toni and Westerink, Adam and Crown, Suzanne and Milne, Jillian and The Prince Charles Hospital, Chermside, Queensland},
abstractNote = {Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (P{sub KA}), skin surface entrance dose (K{sub AR}), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the P{sub KA.} 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median K{sub AR} = 581 mGy (374–876). Median P{sub KA} = 3908 uGym{sup 2} (2489–5865) DRL = 5865 uGym{sup 2}. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median K{sub AR} = 1501 mGy (928–2224). Median P{sub KA} = 8736 uGym{sup 2} (5449–12,900) DRL = 12,900 uGym{sup 2}. This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.},
doi = {10.1002/JMRS.67},
journal = {Journal of Medical Radiation Sciences (Print)},
number = 3,
volume = 61,
place = {Australia},
year = {Mon Sep 15 00:00:00 EDT 2014},
month = {Mon Sep 15 00:00:00 EDT 2014}
}
  • Purpose: The aim of this study was to evaluate radiation dose to patients undergoing computed tomography coronary angiography (CTCA) for prospectively gated axial (PGA) technique and retrospectively gated helical (RGH) technique. Methods: Radiation doses were measured for a 320-detector row CT scanner (Toshiba Aquilion ONE) using small sized silicon-photodiode dosimeters, which were implanted at various tissue and organ positions within an anthropomorphic phantom for a standard Japanese adult male. Output signals from photodiode dosimeters were read out on a personal computer, from which organ and effective doses were computed according to guidelines published in the International Commission on Radiological Protectionmore » Publication 103. Results: Organs that received high doses were breast, followed by lung, esophagus, and liver. Breast doses obtained with PGA technique and a phase window width of 16% at a simulated heart rate of 60 beats per minute were 13 mGy compared to 53 mGy with RGH technique using electrocardiographically dependent dose modulation at the same phase window width as that in PGA technique. Effective doses obtained in this case were 4.7 and 20 mSv for the PGA and RGH techniques, respectively. Conversion factors of dose length product to the effective dose in PGA and RGH were 0.022 and 0.025 mSv mGy{sup -1} cm{sup -1} with a scan length of 140 mm. Conclusions: CTCA performed with PGA technique provided a substantial effective dose reduction, i.e., 70%-76%, compared to RGH technique using the dose modulation at the same phase windows as those in PGA technique. Though radiation doses in CTCA with RGH technique were the same level as, or some higher than, those in conventional coronary angiography (CCA), the use of PGA technique reduced organ and effective doses to levels less than CCA except for breast dose.« less
  • Purpose: The authors compared the performance of five protocols intended to reduce dose to the breast during computed tomography (CT) coronary angiography scans using a model observer unknown-location signal-detectability metric.Methods: The authors simulated CT images of an anthropomorphic female thorax phantom for a 120 kV reference protocol and five “dose reduction” protocols intended to reduce dose to the breast: 120 kV partial angle (posteriorly centered), 120 kV tube-current modulated (TCM), 120 kV with shielded breasts, 80 kV, and 80 kV partial angle (posteriorly centered). Two image quality tasks were investigated: the detection and localization of 4-mm, 3.25 mg/ml and 1-mm,more » 6.0 mg/ml iodine contrast signals randomly located in the heart region. For each protocol, the authors plotted the signal detectability, as quantified by the area under the exponentially transformed free response characteristic curve estimator (A-caret{sub FE}), as well as noise and contrast-to-noise ratio (CNR) versus breast and lung dose. In addition, the authors quantified each protocol's dose performance as the percent difference in dose relative to the reference protocol achieved while maintaining equivalent A-caret{sub FE}.Results: For the 4-mm signal-size task, the 80 kV full scan and 80 kV partial angle protocols decreased dose to the breast (80.5% and 85.3%, respectively) and lung (80.5% and 76.7%, respectively) with A-caret{sub FE} = 0.96, but also resulted in an approximate three-fold increase in image noise. The 120 kV partial protocol reduced dose to the breast (17.6%) at the expense of increased lung dose (25.3%). The TCM algorithm decreased dose to the breast (6.0%) and lung (10.4%). Breast shielding increased breast dose (67.8%) and lung dose (103.4%). The 80 kV and 80 kV partial protocols demonstrated greater dose reductions for the 4-mm task than for the 1-mm task, and the shielded protocol showed a larger increase in dose for the 4-mm task than for the 1-mm task. In general, the CNR curves indicate a similar relative ranking of protocol performance as the corresponding A-caret{sub FE} curves, however, the CNR metric overestimated the performance of the shielded protocol for both tasks, leading to corresponding underestimates in the relative dose increases compared to those obtained when using the A-caret{sub FE} metric.Conclusions: The 80 kV and 80 kV partial angle protocols demonstrated the greatest reduction to breast and lung dose, however, the subsequent increase in image noise may be deemed clinically unacceptable. Tube output for these protocols can be adjusted to achieve a more desirable noise level with lesser breast dose savings. Breast shielding increased breast and lung dose when maintaining equivalent A-caret{sub FE}. The results demonstrated that comparisons of dose performance depend on both the image quality metric and the specific task, and that CNR may not be a reliable metric of signal detectability.« less
  • Average doses were determined on a total of 1759 patients, and studies were made in 10 different types of hospitals, and in office practice, giving information about frequency, sex- and age-distribution of the x-ray examinations of a population of about 750,000. An average gene dose of about 14 mr per year and person was found in Germany. The attainable minimum dose is 5 mr, the possible maximum dose is 160 mr. The results were compared with reperts from Denmark, England, Sweden, and the USA. The importance of good care and knowledge of a rational examination technique was pointed out. (auth)
  • We report the case of a man with an uncommon anomaly of the origin and course of the left coronary artery. Clinical, coronary angiography, magnetic resonance imaging, and multislice computed tomography findings of this intermittently symptomatic 49 year-old patient with the rare anomaly of his left coronary artery stemming from the right sinus of Valsalva and taking an interarterial and intraseptal course are presented. The diagnostic value of the different imaging modalities is discussed.