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A large-scale multicentre study of patient skin doses in interventional cardiology: dose–area product action levels and dose reference levels

(2009) BRITISH JOURNAL OF RADIOLOGY. 82(976). p.303-312
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Abstract
For 318 patients in 8 different Belgian hospitals, the entire skin-dose distribution was mapped using a grid of 70 thermoluminescence dosemeters per patient, allowing an accurate determination of the maximum skin dose (MSD). Dose-area product (DAP) values, exposure parameters and geometry, together with procedure, patient and cardiologist characteristics, were also registered. Procedures were divided into two groups: diagnostic procedures (coronary angiography) and therapeutic procedures (dilatation, stent, combined procedures (e.g. coronary angiography + dilatation + stent)). The mean value of the MSD was 0.310 Gy for diagnostic and 0.699 Gy for therapeutic procedures. The most critical projection for receiving the MSD is the LAO90 (left anterior oblique) geometry. In 3% of cases, the MSD exceeded the 2 Gy dose threshold for deterministic effects. Action levels in terms of DAP values as the basis for a strategy for follow-up of patients for deterministic radiation skin effects were derived from measured MSD and cumulative DAP values. Two DAP action levels are proposed. A first DAP action level of 125 Gy cm(2) corresponding to the dose threshold of 2 Gy would imply an optional radiopathological follow-up depending on the cardiologist's decision. A second DAP action level of 250 Gy cm(2) corresponding to the 3 Gy skin dose would imply a systematic follow-up. Dose reference levels - 71.3 Gy cm(2) for diagnostic and 106.0 Gy cm(2) for therapeutic procedures - were derived from the 75 percentile of the DAP distributions. As a conclusion, we propose that total DAP is registered in patient's record file, as it can serve to improve the follow-up of. patients for radiation-induced skin injuries.
Keywords
CORONARY ANGIOPLASTY, FLUOROSCOPICALLY GUIDED PROCEDURES, RADIATION-EXPOSURE, CARDIAC PROCEDURES, INJURIES, ANGIOGRAPHY, RADIOLOGY, CATHETERIZATION, VALUES

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Citation

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Chicago
Bogaert, Evelien, Klaus Bacher, Kim Lemmens, Marc Carlier, Walter Desmet, Xavier De Wagter, Dominique Djian, et al. 2009. “A Large-scale Multicentre Study of Patient Skin Doses in Interventional Cardiology: Dose–area Product Action Levels and Dose Reference Levels.” British Journal of Radiology 82 (976): 303–312.
APA
Bogaert, E., Bacher, K., Lemmens, K., Carlier, M., Desmet, W., De Wagter, X., Djian, D., et al. (2009). A large-scale multicentre study of patient skin doses in interventional cardiology: dose–area product action levels and dose reference levels. BRITISH JOURNAL OF RADIOLOGY, 82(976), 303–312.
Vancouver
1.
Bogaert E, Bacher K, Lemmens K, Carlier M, Desmet W, De Wagter X, et al. A large-scale multicentre study of patient skin doses in interventional cardiology: dose–area product action levels and dose reference levels. BRITISH JOURNAL OF RADIOLOGY. 2009;82(976):303–12.
MLA
Bogaert, Evelien et al. “A Large-scale Multicentre Study of Patient Skin Doses in Interventional Cardiology: Dose–area Product Action Levels and Dose Reference Levels.” BRITISH JOURNAL OF RADIOLOGY 82.976 (2009): 303–312. Print.
@article{727400,
  abstract     = {For 318 patients in 8 different Belgian hospitals, the entire skin-dose distribution was mapped using a grid of 70 thermoluminescence dosemeters per patient, allowing an accurate determination of the maximum skin dose (MSD). Dose-area product (DAP) values, exposure parameters and geometry, together with procedure, patient and cardiologist characteristics, were also registered. Procedures were divided into two groups: diagnostic procedures (coronary angiography) and therapeutic procedures (dilatation, stent, combined procedures (e.g. coronary angiography + dilatation + stent)). The mean value of the MSD was 0.310 Gy for diagnostic and 0.699 Gy for therapeutic procedures. The most critical projection for receiving the MSD is the LAO90 (left anterior oblique) geometry. In 3% of cases, the MSD exceeded the 2 Gy dose threshold for deterministic effects. Action levels in terms of DAP values as the basis for a strategy for follow-up of patients for deterministic radiation skin effects were derived from measured MSD and cumulative DAP values. Two DAP action levels are proposed. A first DAP action level of 125 Gy cm(2) corresponding to the dose threshold of 2 Gy would imply an optional radiopathological follow-up depending on the cardiologist's decision. A second DAP action level of 250 Gy cm(2) corresponding to the 3 Gy skin dose would imply a systematic follow-up. Dose reference levels - 71.3 Gy cm(2) for diagnostic and 106.0 Gy cm(2) for therapeutic procedures - were derived from the 75 percentile of the DAP distributions. As a conclusion, we propose that total DAP is registered in patient's record file, as it can serve to improve the follow-up of. patients for radiation-induced skin injuries.},
  author       = {Bogaert, Evelien and Bacher, Klaus and Lemmens, Kim and Carlier, Marc and Desmet, Walter and De Wagter, Xavier and Djian, Dominique and Hanet, Claude and Heyndrickx, Guy and Legrand, Victor and Taeymans, Yves and Thierens, Hubert},
  issn         = {0007-1285},
  journal      = {BRITISH JOURNAL OF RADIOLOGY},
  keywords     = {CORONARY ANGIOPLASTY,FLUOROSCOPICALLY GUIDED PROCEDURES,RADIATION-EXPOSURE,CARDIAC PROCEDURES,INJURIES,ANGIOGRAPHY,RADIOLOGY,CATHETERIZATION,VALUES},
  language     = {eng},
  number       = {976},
  pages        = {303--312},
  title        = {A large-scale multicentre study of patient skin doses in interventional cardiology: dose–area product action levels and dose reference levels},
  url          = {http://dx.doi.org/10.1259/bjr/29449648},
  volume       = {82},
  year         = {2009},
}

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