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First published online January 5, 2009
British Journal of Radiology (2009) 82, 303-312
© 2009 British Institute of Radiology
doi: 10.1259/bjr/29449648
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British Journal of Radiology 82 (2009),303-312 ©2009 The British Institute of Radiology

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

E BOGAERT, MSc 1 K BACHER, MSc 1 K LEMMENS, MSc 1 M CARLIER, MD 2 W DESMET, MD, PhD 3 X DE WAGTER, MD 4 D DJIAN, MD 5 C HANET, MD, PhD 6 G HEYNDRICKX, MD 7 V LEGRAND, MD, PhD 8 Y TAEYMANS, MD, PhD 9 and H THIERENS, PhD 1

1 Department of Medical Physics and Radiation Protection, Ghent University, Gent, 2 Department of Interventional Cardiology, Hôpital St Joseph, Gilly, 3 Universitair Ziekenhuis Gasthuisberg, Leuven, 4 Algemeen Ziekenhuis Maria Middelares, St Jozef, Gent, 5 Centre Hospitalier Namur, Namur, 6 Cliniques Universitaires Saint Luc, Bruxelles, 7 Onze Lieve Vrouwziekenhuis, Aalst, 8 Centre Hospitalier Universitaire, Liège,, 9 Universitair Ziekenhuis, Gent, Belgium

Correspondence: E Bogaert, Medical Physics and Radiation Protection, Ghent University, Gent, Belgium. E-mail: Evelien.Bogaert{at}ugent.be

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 cm2 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 cm2 corresponding to the 3 Gy skin dose would imply a systematic follow-up. Dose reference levels — 71.3 Gy cm2 for diagnostic and 106.0 Gy cm2 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.




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