Hugo Costa , Miguel Espírito-Santo , João Bispo , João Guedes , Graciano Paulo , Jorge Mimoso , Hugo Palmeiro , Rui Baptista Gonçalves , Hugo Vinhas
{"title":"复杂经皮冠状动脉介入治疗中的电离辐射暴露：确定导管室的本地诊断参考水平。","authors":"Hugo Costa , Miguel Espírito-Santo , João Bispo , João Guedes , Graciano Paulo , Jorge Mimoso , Hugo Palmeiro , Rui Baptista Gonçalves , Hugo Vinhas","doi":"10.1016/j.repc.2023.10.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs).</p></div><div><h3>Methods</h3><p>This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (<em>P</em><sub>KA</sub>) and cumulative air kerma (<em>K</em><sub>a,r</sub>). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (<em>K</em><sub>a,r</sub>).</p></div><div><h3>Results</h3><p>A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9±11.2 years and mostly male (81.4%). DRLs were set in <em>K</em><sub>a,r</sub> (3012 mGy) and <em>P</em><sub>KA</sub> (162 Gy cm<sup>2</sup>) for complex PCI. ADs were also set in <em>K</em><sub>a,r</sub> (1917 mGy) and <em>P</em><sub>KA</sub> (101 Gy cm<sup>2</sup>). Independent predictors of <em>K</em><sub>a,r</sub> with a positive correlation were <em>P</em><sub>KA</sub> (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001).</p></div><div><h3>Conclusions</h3><p>This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in <em>K</em><sub>a,r</sub> (3012 mGy) and <em>P</em><sub>KA</sub> (162 Gy cm<sup>2</sup>). ADs, values to be achieved in future assessment, were set to <em>K</em><sub>a,r</sub> (1917 mGy) and <em>P</em><sub>KA</sub> (101 Gy cm<sup>2</sup>).</p></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"43 7","pages":"Pages 367-374"},"PeriodicalIF":1.6000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0870255124000143/pdfft?md5=7a111485a806376712a0c3b62682cc2a&pid=1-s2.0-S0870255124000143-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratory\",\"authors\":\"Hugo Costa , Miguel Espírito-Santo , João Bispo , João Guedes , Graciano Paulo , Jorge Mimoso , Hugo Palmeiro , Rui Baptista Gonçalves , Hugo Vinhas\",\"doi\":\"10.1016/j.repc.2023.10.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction and objectives</h3><p>Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs).</p></div><div><h3>Methods</h3><p>This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (<em>P</em><sub>KA</sub>) and cumulative air kerma (<em>K</em><sub>a,r</sub>). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (<em>K</em><sub>a,r</sub>).</p></div><div><h3>Results</h3><p>A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9±11.2 years and mostly male (81.4%). DRLs were set in <em>K</em><sub>a,r</sub> (3012 mGy) and <em>P</em><sub>KA</sub> (162 Gy cm<sup>2</sup>) for complex PCI. ADs were also set in <em>K</em><sub>a,r</sub> (1917 mGy) and <em>P</em><sub>KA</sub> (101 Gy cm<sup>2</sup>). Independent predictors of <em>K</em><sub>a,r</sub> with a positive correlation were <em>P</em><sub>KA</sub> (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001).</p></div><div><h3>Conclusions</h3><p>This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in <em>K</em><sub>a,r</sub> (3012 mGy) and <em>P</em><sub>KA</sub> (162 Gy cm<sup>2</sup>). ADs, values to be achieved in future assessment, were set to <em>K</em><sub>a,r</sub> (1917 mGy) and <em>P</em><sub>KA</sub> (101 Gy cm<sup>2</sup>).</p></div>\",\"PeriodicalId\":48985,\"journal\":{\"name\":\"Revista Portuguesa De Cardiologia\",\"volume\":\"43 7\",\"pages\":\"Pages 367-374\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0870255124000143/pdfft?md5=7a111485a806376712a0c3b62682cc2a&pid=1-s2.0-S0870255124000143-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Revista Portuguesa De Cardiologia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0870255124000143\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista Portuguesa De Cardiologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0870255124000143","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratory
Introduction and objectives
Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs).
Methods
This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (PKA) and cumulative air kerma (Ka,r). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (Ka,r).
Results
A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9±11.2 years and mostly male (81.4%). DRLs were set in Ka,r (3012 mGy) and PKA (162 Gy cm2) for complex PCI. ADs were also set in Ka,r (1917 mGy) and PKA (101 Gy cm2). Independent predictors of Ka,r with a positive correlation were PKA (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001).
Conclusions
This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in Ka,r (3012 mGy) and PKA (162 Gy cm2). ADs, values to be achieved in future assessment, were set to Ka,r (1917 mGy) and PKA (101 Gy cm2).
期刊介绍：
The Portuguese Journal of Cardiology, the official journal of the Portuguese Society of Cardiology, was founded in 1982 with the aim of keeping Portuguese cardiologists informed through the publication of scientific articles on areas such as arrhythmology and electrophysiology, cardiovascular surgery, intensive care, coronary artery disease, cardiovascular imaging, hypertension, heart failure and cardiovascular prevention. The Journal is a monthly publication with high standards of quality in terms of scientific content and production. Since 1999 it has been published in English as well as Portuguese, which has widened its readership abroad. It is distributed to all members of the Portuguese Societies of Cardiology, Internal Medicine, Pneumology and Cardiothoracic Surgery, as well as to leading non-Portuguese cardiologists and to virtually all cardiology societies worldwide. It has been referred in Medline since 1987.
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