Patient radiation exposure and influencing factors at interventional cardiology procedures

Introduction Interventional cardiology (IC) procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. Purpose To calculate the radiation burden of patients undergoing various IC procedures and to study the contribution of various influencing factors such as doctor experience, angiography unit type and patient body habitus. Materials and methods We retrieved patient and procedural data from the Catheterization and Electrophysiology Laboratory of Athens Euroclinic for IC procedures performed during a prolonged period (1998–2015), specifically: type of IC procedure, type of angiography unit, identity of primary interventional cardiologist, patient sex, weight and height, total Kerma Air Product (KAP) and fluoroscopy time. Patient radiation burden was assessed by effective dose which was calculated from KAP and procedure specific conversion factors. Results We considered 6960 hemodynamic procedures, 949 electrophysiology procedures, 908 device implantations and 20 transcatheter aortic valve replacements (TAVR). The mean effective doses were 7.6 ± 6.0 mSv for coronary angiography (including procedures with ventruculography, IVUS, OCT or FFR), 21.5 ± 18.6 mSv for angioplasty, 22.4 ± 16.5 mSv for coronary angiography plus angioplasty, 2.0 ± 3.3 mSv for electrophysiology studies, 13.3 ± 15.7 mSv for ablation procedures, 4.6 ± 9.8 mSv for pacemaker implantations, 11.1 ± 16.1 mSv.for defibrillator implantation and 25.6 ± 6.2 mSv for TAVR. Operator experience had a statistically significant impact on patient exposure since the total KAP of procedures performed by experienced operators was significantly lower and, additionally, procedural KAP of initially inexperienced operators reduced with time. The replacement of an angiography system with image intensifier to a modern system with a flat panel detector reduced procedural KAP. Patient body habitus significantly affected procedural KAP. Conclusion The radiation burden of IC procedures varies considerably and it is significantly affected by factors such as operator experience, angiography system type and patient body habitus.