Radiation Protection Dosimetry Advance Access published online on October 30, 2009
Radiation Protection Dosimetry, doi:10.1093/rpd/ncp237
PATIENT RADIATION DOSES IN THE MOST COMMON INTERVENTIONAL CARDIOLOGY PROCEDURES IN CROATIA: FIRST RESULTS
1,* Rama
17
kovi8
1 Department of Radiology, University Hospital Merkur, Zajeva 19, 10000 Zagreb, Croatia
2 Department of Radiology, University Hospital Sisters of Mercy, Vinogradska 36, 10000 Zagreb, Croatia
3 Department of Radiotherapy, University Hospital of Osijek, J. Huttlera 4, 31000 Osijek, Croatia
4 State office for Radiation Protection, Frankopanska 11, 10000 Zagreb, Croatia
5 Ekoteh dosimetry Co., V. Ru
djaka 22, 10000 Zagreb, Croatia
6 Department of Cardiology, University Hospital of Osijek, J. Huttlera 4, 31000 Osijek, Croatia
7 School of Medicine, University of Zagreb, 
alata 3b, 10000 Zagreb, Croatia
8 Department of Radiology, University Hospital for Infectious Diseases, Mirogojska 8, 10000 Zagreb, Croatia
* Corresponding author: zoran.brnic{at}zg.t-com.hr
Received May 4, 2009, amended September 2, 2009, accepted September 23, 2009
Apart from its benefits, the interventional cardiology (IC) is known to generate high radiation doses to patients and medical staff involved. The European Union Medical Exposures Directive 97/43/Euroatom strongly recommend patient dosimetry in interventional radiology, including IC. IC patient radiation doses in four representative IC rooms in Croatia were investigated. Setting reference levels for these procedures have difficulties due to the large difference in procedure complexity. Nevertheless, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high-dose procedures. Local and national diagnostic reference levels (DRLs) were proposed as a guidance. A total of 138 diagnostic (coronary angiography, CA) and 151 therapeutic (PTCA, stenting) procedures were included. Patient irradiation was measured in terms of kerma–area product (KAP), fluoroscopy time (FT) and number of cine-frames (F). KAP was recorded using calibrated KAP-meters. DRLs of KAP, FT and F were calculated as third quartile values rounded up to the integer. Skin doses were assessed on a selected sample of high skin dose procedures, using radiochromic films, and peak skin doses (PSD) were presented. A relative large range of doses in IC was detected. National DRLs were proposed as follows: 32 Gy cm2, 6.6 min and 610 frames for CA and 72 Gy cm2, 19 min and 1270 frames for PTCA. PSD <1 Gy were measured in 72 % and PSD >2 Gy in 8 % of selected patients. Measuring the patient doses in radiological procedures is required by law, but rarely implemented in Croatia. The doses recorded in the study are acceptable when compared with the literature, but optimisation is possible. The preliminary DRL values proposed may be used as a guideline for local departments, and should be a basis for radiation reduction measures and quality assurance programmes in IC in Croatia.