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What are the clinical and technical factors that influence the kerma–area product in percutaneous coronary intervention?

Departments of ¹ Medical Physics and, ² Computed Tomography, Konstantopoulio Hospital, ³ First Clinic of Onassis Cardiac Surgery Center, ⁴ Department of Cardiology, Konstantopoulio Hospital, ⁵ Department of Biology, University of Athens, Greece ⁶ Med Physics Service and Radiology Department, San Carlos University Hospital and Complutense University, Madrid, Spain

Correspondence: Virginia Tsapaki, Medical Physics Department of the Konstantopoulio Hospital, 1 Ifaistou Str, 14569 Anixi, Athens, Greece. E-mail: virginia{at}otenet.gr

The purpose of the paper is to define predictors of the kerma–area product (KAP) in percutaneous coronary intervention (PCI). Two new digital X-ray interventional cardiology systems recently installed were included. A total of 398 PCI procedures were carried out by 6 board-certified senior interventional cardiologists with more than 15 years' experience and good knowledge of radiation protection measures. Clinical, radiation and procedural data were collected based on a detailed protocol developed by the SENTINEL cardiology subgroup. Correlation with clinical and procedure factors was then investigated. A significant correlation was found between fluoroscopy time and (i) lesion classification, (ii) the level of tortuosity and (iii) the number of vessels treated. No statistically significant differences were observed in the complexity of the case between operators. However, large differences were found in the KAP among operators, which were mostly attributed to the different number of frames taken by each operator. There was no statistically significant correlation between complexity and the total number of frames. The study showed that, in certain circumstances, the clinical need to successfully perform PCI takes precedence over radiation safety concerns.