Local diagnostic reference levels and effective doses: single institution levels for interventional cardiology procedures for adult patients

Abstract Introduction: The current regulations in Poland in the field of interventional radiology only include diagnostic reference levels (DRL) for five procedures, containing only two for cardiological (hemodynamic) procedures, and only for adults. Given the insufficient number of DRLs, the need to introduce local levels based on the intervention procedures performed was identified. The purpose of this research was the evaluation of radiation doses (DRL, effective dose) received by patients in cardiological interventional procedures. Material and methods: The DRL level was defined as the 75th percentile of the distribution of dosimetric parameters KAP and Kair,ref for each type of cardiological procedure. Data include three different X-ray units and 27 interventional cardiologists, derived from February 2019 to June 2019 and from August 2021 to December 2021. In order to estimate the effective dose, the appropriate conversion factors for cardiological procedures were used. The total number of analyzed procedures was 3818. Results: The proposed local DRL levels were found to be mostly lower than data found in literature and in the current Polish national requirements (60%-70% lower for coronary angiography (CA) and percutaneous coronary angioplasty (PCI) procedures). Median equivalent doses for cardiological procedures were estimated at 2.66 mSv, 6.11 mSv and 7.22 mSv for CA, PCI and combined PCI with CA procedure, respectively. Conclusions: The proposed local/institutional DRLs seem to be suitable for use and could be utilized by other centers for comparison purposes.