Srimahachota Suphot, Krisanachinda Anchali, Roongsangmanoon Worawut, Sansanayudh Nakarin, Limpijankit Thosaphol, Chandavimol Mann, Athisakul Siriporn, Siriyotha Sukanya, Rehani Madan M
Cardiac Center and Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand.
Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Phys Med. 2022 Apr;96:46-53. doi: 10.1016/j.ejmp.2022.02.013. Epub 2022 Feb 24.
To establish national diagnostic reference levels (DRLs) for percutaneous coronary intervention (PCI) in Thailand for lesions of different complexity.
Radiation dose quantity as kerma-area-product (KAP) and cumulative air-kerma at reference point (CAK) from 76 catheterization labs in 38 hospitals in PCI registry of Thailand was transferred online to central data management. Sixteen months data (May 2018 to August 2019) was analyzed. We also investigated role of different factors that influence radiation dose the most.
Analysis of 22,737 PCIs resulted in national DRLs for PCI of 91.3 Gy.cm (KAP) and 1360 mGy (CAK). The NDRLs for KAP for type C, B2, B1 and A lesions were 106.8, 82.6, 67.9, and 45.3 Gy.cm respectively and for CAK, 1705, 1247, 962, and 790 mGy respectively. Thus, as compared to lesion A, lesion C had more than double the dose and B2 had nearly 1.6 times and B1 had 1.2 times CAK. Our DRL values are lower than other Asian countries like Japan and Korea and are in the middle range of Western countries. University hospital had significantly higher dose than private or public hospital possibly because of higher load of complex procedures in university hospitals and trainees performing the procedures. Transradial approach showed lower doses than transfemoral approach.
This large multi-centric study established DRLs for PCIs which can act as reference for future studies. A hallmark of our study is establishment of reference levels for coronary lesions classified as per ACC/AHA and thus for different complexities.
为泰国不同复杂程度病变的经皮冠状动脉介入治疗（PCI）建立国家诊断参考水平（DRL）。
泰国PCI登记处38家医院的76个导管实验室的辐射剂量量（以比释动能面积乘积（KAP）表示）和参考点处的累积空气比释动能（CAK）通过网络传输至中央数据管理系统。对16个月的数据（2018年5月至2019年8月）进行分析。我们还研究了对辐射剂量影响最大的不同因素的作用。
对22737例PCI进行分析得出，PCI的国家DRL为91.3 Gy.cm（KAP）和1360 mGy（CAK）。C型、B2型、B1型和A型病变的KAP的国家DRL分别为106.8、82.6、67.9和45.3 Gy.cm，CAK分别为1705、1247、962和790 mGy。因此，与A型病变相比，C型病变的剂量增加了一倍多，B2型病变的剂量接近1.6倍，B1型病变的剂量为CAK的1.2倍。我们的DRL值低于日本和韩国等其他亚洲国家，处于西方国家的中等范围。大学医院的剂量明显高于私立或公立医院，这可能是因为大学医院复杂手术的负荷较高以及实习医生进行手术。经桡动脉途径的剂量低于经股动脉途径。
这项大型多中心研究建立了PCI的DRL，可为未来研究提供参考。我们研究的一个特点是为根据美国心脏病学会/美国心脏协会（ACC/AHA）分类的冠状动脉病变建立了参考水平，从而针对不同的复杂程度。
