Physica Medica: European Journal of Medical Physics
Volume 26, Issue 4 , Pages 224-232, October 2010

Coronary angiography and percutaneous transluminal coronary angioplasty procedures: Evaluation of patients' maximum skin dose using Gafchromic films and a comparison of local levels with reference levels proposed in the literature

  • C. Giordano

      Affiliations

    • Department of Medical Physics, AUSL di Piacenza, 29100 Piacenza, Italy
    • Corresponding Author InformationCorresponding author. Tel.: +39 0523302695; fax: +39 0523302680.
    • ,
  • L. D'Ercole

      Affiliations

    • Department of Medical Physics, Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy
    • ,
  • R. Gobbi

      Affiliations

    • Department of Medical Physics, AUSL di Piacenza, 29100 Piacenza, Italy
    • ,
  • M. Bocchiola

      Affiliations

    • Department of Medical Physics, Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy
    • ,
  • F. Passerini

      Affiliations

    • Department of Cardiology, AUSL di Piacenza, 29100 Piacenza, Italy

Received 26 March 2009; received in revised form 28 December 2009; accepted 8 January 2010. published online 01 February 2010.

Abstract 

The aim of this study was to evaluate the maximum skin dose (MSD) in patients undergoing interventional cardiology procedures, obtaining local reference levels and comparing these with the reference levels proposed in the literature.

The patients' MSD was measured using Gafchromic XR type R films. In order to evaluate reference levels, the number of images acquired, the fluoroscopy times and the KAPTOTAL were recorded for each procedure.

For the evaluation of the MSD, 8 coronary angiography (CA) and 16 percutaneous transluminal coronary angioplasty (PTCA) procedures, carried out in the period from May to June 2008, were analyzed.

For the CA procedures the MSD values were below 0.5 Gy.

For the PTCA procedures, we found a fairly good correlation between fluoroscopy time and MSD (r = 0.80, p = 0.0002) and between MSD and WFP (r = 0.863, p < 0.0001); there was a strong correlation between KAPTOTAL and MSD (r = 0.904, p < 0.0001). Since the correlation between KAPTOTAL and MSD is more striking than that with fluoroscopic time and the WFP, KAP measurements are suitable for online skin dosimetry and may, therefore, be used to avoid radiation-induced skin injuries. A MSD greater than 3 Gy occurred in only one procedure.

For calculus of the local reference levels, we extended the data-gathering to 30 procedure CA and to 40 PTCA: we compared local practice with that in other centers using the guidance levels proposed by Balter et al. Our median KAP values were below these proposed guidance levels; our mean KAP values were above these proposed action levels. From a first application of the proposed reference levels, it appears that, according to the recommendations of Balter et al. an investigation into local practice is not necessary.

Keywords: Dose-area product, Entrance skin dose, Interventional cardiology, Guidance level

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PII: S1120-1797(10)00003-7

doi:10.1016/j.ejmp.2010.01.001

Physica Medica: European Journal of Medical Physics
Volume 26, Issue 4 , Pages 224-232, October 2010

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