RESUMEN
AIM: To explore the factors that may influence the radiation dose imparted to the patient in PCI, and investigate whether the use of the latest digital X-ray system based on FP detector technology can have an impact on dose. MATERIALS AND METHOD: Demographic and clinical data such as number of lesions treated, number of stents placed, grade of tortuosity, and stage of occlusion, as well as use of double wire and double balloon technique, ostial stenting or bifurcation stenting, and presence of major complications were recorded, together with radiation parameters. RESULTS: The factors that increased patient radiation dose were (1) patient gender, as men exhibited higher doses than women; (2) complex lesion; (3) increasing number of stents; (4) position of stent; (5) grade of tortuosity; and (6) stage of occlusion. The FP digital system appeared to be settled in a lower-dose rate for fluoroscopy (a factor of 6) and higher for dose per frame in cine (a factor of 3) in comparison with the image intensifier (II) system. There was a marked reduction of DAP when the FP technology was introduced. CONCLUSION: More extensive studies should be performed in the future so as to further investigate the influence of the FP detector in IC.
Asunto(s)
Angioplastia Coronaria con Balón/métodos , Enfermedad de la Arteria Coronaria/radioterapia , Dosis de Radiación , Enfermedad de la Arteria Coronaria/terapia , Femenino , Fluoroscopía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
The purpose of the study was to evaluate the dose performance of a flat-panel (FP) and an image intensifier (II) charge coupled device (CCD) digital fluoroscopy X-ray systems newly installed in an Interventional Cardiology (IC) department. Filter entrance dose rate, detector dose rate (during fluoroscopy) and filter entrance dose per image were measured at 70 cm from the focus using 2 mm copper sheets to mimic normal size patient. Image quality was also evaluated. The patient dose survey included 277 patients, which had either a Coronary Angiography (CA) or a Percutaneous Transluminal Coronary Angioplasty (PTCA). Dose area product (DAP), fluoroscopy time (T) and total number of frames (F) values were also collected. The results showed that both systems performed within international recommendations with the exception of higher cine radiation doses, stressing the fact that neither specific protocols of measurement nor reference values for digital equipment were provided by the official bodies.
Asunto(s)
Cardiología/instrumentación , Análisis de Falla de Equipo/métodos , Seguridad de Equipos/métodos , Fluoroscopía/instrumentación , Intensificación de Imagen Radiográfica/instrumentación , Radiografía Intervencional/instrumentación , Radiometría/métodos , Pantallas Intensificadoras de Rayos X , Dosis de Radiación , Protección Radiológica/métodos , Medición de Riesgo/métodos , Factores de Riesgo , Rayos XRESUMEN
Radiation fields involved in angiographic suites are most uneven with intensity and gradient varying widely with projection geometry. The European Commission DIMOND III project addressed among others, the issues regarding optimization of staff doses with an attempt to propose preliminary occupational dose constraints. Two thermoluminescent dosemeters (TLD) were used to assess operators' extremity doses (left shoulder and left foot) during 20 coronary angiographies (CAs) and 20 percutaneous transluminal coronary angioplasties (PTCAs) in five European centres. X-ray equipment, radiation protection measures used and the dose delivered to the patient in terms of dose-area product (DAP) were recorded so as to subsequently associate them with operator's dose. The range of staff doses noted for the same TLD position, centre and procedure type emphasizes the importance of protective measures and technical characteristics of x-ray equipment. Correlation of patient's DAP with staff shoulder dose is moderate whereas correlation of patient's DAP with staff foot dose is poor in both CA and PTCA. Therefore, it is difficult to predict operator's dose from patient's DAP mainly due to the different use of protective measures. A preliminary occupational dose constraint value was defined by calculating cardiologists' annual effective dose and found to be 0.6 mSv.