Predialing the Number of Cinegraphic Frames Enables an Effective Patient Dose Due to Coronary Angiography of 0.8 mSv

Abstract

Purpose: To investigate the effect of a new device for predialing the number of cinegraphic frames before each coronary angiogaphy, with the objective of reducing the patient dose area product (DAP) from coronary angiography, which typically requires 1000 to 2350 cinegraphic frames. That DAP is high and stated to be between 15.6 to 106.3 Gy × cm². Applying the accepted DAP-to-ED conversion factors, for the thoracic region of approximately 0.20 mSv/Gy × cm², this corresponds to a mean effective dose (ED) in the range of 3.1 to 21.3 mSv. Material and Methods: For patients undergoing elective coronary angiography, we compared various parameters of radiation exposure obtained with judicious radiation reducing standard techniques (n = 106) and with an additional new rotary switch for predialing the number of cinegraphic frames (n = 106). Results: The patient radiation dose was significantly lower with the new device, with the mean DAP reduced to 5.5 from 9.1 Gy × cm². The corresponding reducation of the mean DAP for left ventriculography and coronary angiography was 1.3 from 1.7, and 4.2 from 7.4 Gy × cm², respectively. The number of cinegraphic frames was 98 vs. 184, whereas the number of cinegraphic runs and the fluoroscopy time were comparable. Conclusion: Predialing the cinegraphic frame number before each cinegraphic run enables a reduction of the patients effective dose from coronary angiography to 0.8 mSv, i. e. to 57 % of the baseline value and far below typically reported values.

Zusammenfassung

Ziel: Erprobung einer neuen Vorrichtung zur Vorwählbarkeit der Kinematographie-Serienlänge hinsichtlich der Patientenstrahlenexposition bei Koronarangiographie. Letztere erfordert üblicherweise 1000 - 2350 Kinematographiebilder und verursacht laut Studienlage ein Dosisflächenprodukt (DFP) zwischen 15,6 und 106,3 Gy × cm². Für in der Thorakalregion anerkannte Konversionsfaktoren von ca 0,2 mSv/Gy × cm² entspricht dies einer effektiven Patientendosis zwischen 3.1 und 21.3 mSv. Material und Methoden: Im Verlauf von 106 elektiven Koronarangiographien, durchgeführt entsprechend internationalen Strahlenschutzempfehlungen, bestimmten wir verschiedenste strahlendosisrelevante Parameter und verglichen diese mit den Daten von 106 Koronarangiographien unter zusätzlicher Anwendung einer Zeitschaltung, die die Kinematographie-Serienlänge auf eine vorwählbare Bilderanzahl begrenzte. Ergebnisse: Das Patienten-DFP war unter Verwendung der Zeitschaltung signifikant niedriger als im Vergleichskollektiv und betrug 5,5 vs. 9,1 Gy × cm²; die entsprechenden Mittelwerte für Laevokardiographie und Koronarangiographie ergaben 1,3 vs. 1,7 bzw. 4,2 vs. 7,4 Gy × cm², die Kinematographie-Bilderanzahl betrug 98 vs. 184. Hingegen waren Kinematographie-Serienanzahl und Durchleuchtungszeit vergleichbar. Schlussfolgerung: Eine vorwählbare Kinematographie-Zeitschaltung ermöglicht die Reduktion der effektiven Dosis einer hochauflösenden Koronarangiographie bei Patienten auf 0,8 mSv bzw. 57 % unserer Ausgangswerte. Sie unterschreiten damit erheblich entsprechende Literaturberichte.

Radiation dose - patient exposure - effective dose - coronary angiography

Literatur

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