Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Science, University of Sydney, Sydney, NSW, Australia.
Br J Radiol. 2013 Jul;86(1027):20120028. doi: 10.1259/bjr.20120028.
This study investigates the factors associated with higher doses for both single-plane and biplane procedures and establishes centre-specific 75th percentile levels.
602 patients undergoing coronary angiography in a large hospital at Sydney were recruited to the study, and causal agents for high radiation doses were investigated: gender, procedural complexity, severity of coronary artery disease, presence of coronary bypass grafts, entry approach (radial or femoral), level of operator experience; and a single-plane or a biplane imaging system was employed.
The 75th percentile levels were calculated. The results demonstrated that, for both systems, higher exposures were associated with patients who were male (p<0.001), had coronary vessel disease (p<0.001) and had a history of coronary bypass grafts (p<0.001). In addition, for biplane systems, procedural complexity (p<0.001), types of entry approach (p<0.001) and levels of operator experience (p<0.001) significantly impacted upon the dose. Biplane examinations recorded higher doses than single-plane procedures (p<0.001) and the inclusion of left-sided ventriculography contributed to the overall dose by up to 10%.
The 75th percentile levels in this study represent the tentative reference levels and are 48.9, 44.2 and 56 Gy cm(2) for all exposures, single-plane- and biplane-specific exposures, respectively, and compare favourably with the diagnostic reference level values established elsewhere internationally, with only the UK and Irish data being lower.
Specific agents have been identified for dose-reducing strategies and the importance of operator training is highlighted. The assumption that biplane procedures may reduce the patient dose should be treated with caution.
本研究调查了与单平面和双平面程序更高剂量相关的因素，并确定了特定中心的第 75 百分位水平。
这项研究招募了在悉尼一家大医院进行冠状动脉造影的 602 名患者，并调查了高辐射剂量的原因：性别、程序复杂性、冠状动脉疾病严重程度、是否存在冠状动脉旁路移植术、进入途径（桡动脉或股动脉）、操作人员经验水平；并使用了单平面或双平面成像系统。
计算了第 75 百分位水平。结果表明，对于两种系统，较高的暴露量与男性患者（p<0.001）、患有冠状动脉疾病（p<0.001）和有冠状动脉旁路移植术史（p<0.001）相关。此外，对于双平面系统，程序复杂性（p<0.001）、进入途径类型（p<0.001）和操作人员经验水平（p<0.001）显著影响剂量。双平面检查记录的剂量高于单平面检查（p<0.001），并且包括左侧心室造影术会使总剂量增加高达 10%。
本研究中的第 75 百分位水平代表暂定的参考水平，分别为所有暴露、单平面特定暴露和双平面特定暴露的 48.9、44.2 和 56 Gy cm(2)，与国际其他地方建立的诊断参考水平值相比，只有英国和爱尔兰的数据较低。
已经确定了降低剂量的策略的具体因素，并强调了操作人员培训的重要性。认为双平面程序可能降低患者剂量的假设应谨慎对待。
