Clinical Determinants of Radiation Dose in Percutaneous Coronary Interventional Procedures: Influence of Patient Size, Procedure Complexity, and Performing Physician

Mar 21, 2011
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Authors:
Fetterly KA, Lennon RJ, Bell MR, Holmes DR Jr, Rihal CS.
Citation:
JACC Cardiovasc Interv 2011;4:336-343.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What are the primary clinical determinants of patient radiation dose associated with percutaneous coronary intervention (PCI) and opportunities for dose reduction?

Methods:

Cumulative skin dose (CSD; measured in gray [Gy] units) was selected as a measurement of patient radiation burden. Several patient-, disease-, and treatment-related variables, including 15 performing physicians, were analyzed in a multiple linear regression statistical model with cumulative skin dose CSD as the primary endpoint. The model results provide an estimate of the relative CSD increase (decrease) attributable to each variable.

Results:

PCIs performed on 1,287 male and 540 female patients were included. Median patient age was 68.6 years, median body mass index was 29.7 kg/m2, and median weight was 88 kg. Median CSD was 1.64 Gy per procedure for male patients, and 1.15 Gy for female patients. Increasing body mass index, patient sex, lesion complexity, lesion location, and performing physician were significantly associated with CSD. Physicians who performed more procedures were associated with lower CSD.

Conclusions:

The authors concluded that along with physician development of radiation-sparing methods and skills, preprocedure dose planning helps minimize radiation dose for PCI.

Perspective:

The study suggests that lesion complexity, PCI of the left circumflex artery, number of lesions treated, patient body habitus, previous coronary artery bypass grafting, and peripheral vascular disease correlate with higher cumulative skin dose, with radiation dose reduction associated with higher-volume operators. Overall, this study demonstrates that patient radiation dose varies substantially among physicians, and that there is an inverse correlation of patient dose with operator volume. Furthermore, clinicians should consistently implement radiation-sparing methods, and do preprocedure planning for dose management, to help minimize radiation dose.

Keywords: Body Mass Index, Radiation Dosage, Peripheral Vascular Diseases, Percutaneous Coronary Intervention


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