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British Journal of Radiology (2005) 78, 803-809
© 2005 British Institute of Radiology
doi: 10.1259/bjr/14000648
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Skin dose alarm levels in cardiac angiography procedures: is a single DAP value sufficient?

A Karambatsakidou, MSc P Tornvall, MD, PhD N Saleh, MD T Chouliaras, MSc P-O Löfberg, Dipl.Ing and A Fransson, PhD

Department of Medical Physics, Karolinska University Hospital, Stockholm, 171 76, Sweden



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  		Figure 1. The distribution of optical density of the Kodak EDR2 film of a patient who has undergone a coronary angiography (CA) procedure (left image). The crosses show the position of the diodes. The maximum entrance skin dose (MESD) was 71 mGy and was for this patient located on the right shoulder (Dx), which is also illustrated by the isodose map (right image). The area of the MESD (100% dose level) is approximately 5 cm2. (Dx, Right; Sin, left).

 


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  		Figure 2. The distribution of optical density of two cases of percutaneous transluminal coronary angiography (PTCA) procedures (left images) performed by the same operator. The maximum entrance skin dose (MESD) for these two patients was 0.22 Gy (the 100% dose level covers approximately 30 cm2 and is located on the left (Sin) side of the patient's back) and 0.32 Gy (right (Dx) and left (Sin) area of MESD (100% dose level) are approximately 70 cm2 and 20 cm2, respectively).

 


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  		Figure 3. Calibration of optical film density (OD) versus film dose (FD) as obtained from phantom measurements (FDcalibration=36.7 x e1.1055 x OD), and from the series of patient measurements, respectively. A linear fit (up to 200 mGy) yields for the phantom data: FDcalibration=140.5 x OD–14.6 [r=0.99], and for the patient data: FDpatient=137.4 x OD–4.2 [r=0.96].

 


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  		Figure 4. The distributions of conversion factors for the two operators yielded median values of maximum entrance skin dose/dose–area product (MESD/DAP) of 4.1 mGy(Gycm2)–1 (operator A: 2 years experience) and 3.4 mGy(Gycm2)–1 (operator B: 10 years experience), respectively. The boxes in the figure enclose 50% of the MESD/DAP values of each operator. The upper and lower MESD/DAP values are indicated by the endpoints of the lines extending from each box.

 


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  		Figure 5. Correlation between the conversion factor (average lung dose/dose–area product) and body mass index (BMI). (There were no percutaneous transluminal coronary angiography (PTCA) patients having a BMI >30 in this study).

 




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