Department of Radiology, 41664Bicêtre University Hospital, Le Kremlin Bicêtre, France.
Department of Radiation and Environmental Protection, 277324Vinca Institute of Nuclear Sciences-National Institute of the Republic of Serbia, University of Belgrade, Beograd, Serbia.
Acta Radiol. 2023 Jan;64(1):108-118. doi: 10.1177/02841851211061438. Epub 2021 Dec 27.
Patients can be exposed to high skin doses during complex interventional cardiology (IC) procedures.
To identify which clinical and technical parameters affect patient exposure and peak skin dose (PSD) and to establish dose reference levels (DRL) per clinical complexity level in IC procedures.
Validation and Estimation of Radiation skin Dose in Interventional Cardiology (VERIDIC) project analyzed prospectively collected patient data from eight European countries and 12 hospitals where percutaneous coronary intervention (PCI), chronic total occlusion PCI (CTO), and transcatheter aortic valve implantation (TAVI) procedures were performed. A total of 62 clinical complexity parameters and 31 technical parameters were collected, univariate regressions were performed to identify those parameters affecting patient exposure and define DRL accordingly.
Patient exposure as well as clinical and technical parameters were collected for a total of 534 PCI, 219 CTO, and 209 TAVI. For PCI procedures, body mass index (BMI), number of stents ≥2, and total stent length >28 mm were the most prominent clinical parameters, which increased the PSD value. For CTO, these were total stent length >57 mm, BMI, and previous anterograde or retrograde technique that failed in the same session. For TAVI, these were male sex, BMI, and number of diseased vessels. DRL values for Kerma-area product (), air kerma at patient entrance reference point (), fluoroscopy time (FT), and PSD were stratified, respectively, for 14 clinical parameters in PCI, 10 in CTO, and four in TAVI.
Prior knowledge of the key factors influencing the PSD will help optimize patient radiation protection in IC.
在复杂的介入心脏病学（IC）程序中，患者可能会受到高皮肤剂量的照射。
确定哪些临床和技术参数会影响患者的辐射暴露和皮肤峰值剂量（PSD），并为 IC 程序中每个临床复杂程度级别建立剂量参考水平（DRL）。
验证和评估介入心脏病学中的辐射皮肤剂量（VERIDIC）项目前瞻性地分析了来自 8 个欧洲国家和 12 家医院的患者数据，这些医院进行了经皮冠状动脉介入治疗（PCI）、慢性完全闭塞 PCI（CTO）和经导管主动脉瓣植入术（TAVI）。共收集了 62 个临床复杂程度参数和 31 个技术参数，进行单变量回归以确定影响患者暴露的参数，并据此定义 DRL。
共收集了 534 例 PCI、219 例 CTO 和 209 例 TAVI 的患者暴露以及临床和技术参数。对于 PCI 程序，体重指数（BMI）、≥2 个支架和总支架长度>28 mm 是最显著的临床参数，它们增加了 PSD 值。对于 CTO，这些参数是总支架长度>57 mm、BMI 和在前一次相同的介入中失败的顺行或逆行技术。对于 TAVI，这些参数是男性、BMI 和病变血管数量。Kerma 面积乘积（）、患者入口参考点处的空气比释动能（）、透视时间（FT）和 PSD 的 DRL 值分别在 PCI 中按 14 个临床参数、CTO 中按 10 个临床参数和 TAVI 中按 4 个临床参数进行分层。
了解影响 PSD 的关键因素将有助于优化 IC 中患者的辐射防护。
