DOSE OPTIMISATION IN CARDIAC EXAMINATIONS DOCE Catherine DHelft

DOSE OPTIMISATION IN CARDIAC EXAMINATIONS (DOCE) Catherine D’Helft BSc, Hdip.

COLLABORATIVE STUDY • School of Diagnostic Imaging, University College Dublin • School of Health Sciences, Faculty of Life & Health Sciences, University of Ulster at Jordanstown Part funded by The Health Research Board, Dublin. University of Ulster at

• • Catherine D’Helft Allison Mc Gee Louise Rainford Patrick Brennan • Sonyia Mc Fadden • Ciara Hughes • John Winder

WHAT IS INTERVENTIONAL CARDIOLOGY • Evaluate circulatory system. • use • risks

OBJECTIVES • All Ireland study – Inter and intra hospital variations – Dose area product (DAP) – Comparison of different techniques/ procedures • DRL’s – Benchmarking • Optimisation for selected procedures – Doses – Image quality • Reduce radiation doses

WHY ? • Currently no set DRL’s • EU legislation (97/43/ EURATOM) – Passed into irish law – Ionising Radiations Regulations 2000 • Health risks – Patient – Staff • Increasing in use.

THRESHOLD DOSES • • • 500 m. Gy - impairment of haemopoiesis 2, 000 m. Gy - erythema 2, 000 m. Gy - cataract formation 7, 000 m. Gy - permanent epilation 10, 000 -12, 000 m. Gy - skin atrophy with telangiectasia • direct deterministic effects associated with cardiac interventional procedures are well documented literature.

RADIATION INDUCED SKIN BURNS 3 weeks post exam (AJR • July 2001, vol 177, no. 1, pg 3 -11 and 13 -20)

5 months

6. 5 months

METHODOLOGY • • Paediatric and adult studies Retrospective study Pilot study QA tests Data collection & analysis Image quality tests Set DRL’s Implement findings in clinical departments

PAEDIATRIC & ADULT STUDY • • Paediatric Patent ductus arteriosus Atrial septal defects Ventricular septal defects Septostomy procedures Co-arctation of the aorta Aortic valvuloplasty Occlusion of collateral vessels Pulmonary valvuloplasty/Pulmonary artery angioplasty Adult • Coronary Angiograms • Percutaneous Coronary Intervention (PCI/PTCA) • Pacemaker Insertion

CURRENT PROGRESS Retrospective study completed Pilot study findings Quality Assurance tests Start of data collection

RETROSPECTIVE STUDY • Intra- and inter- hospital data • 10 -month period • Dose area product and fluoroscopy time, were determined and compared for – coronary angiograms (CA), – percutaneous transluminal coronary angiograms (PTCA) – permanent pacemaker insertion procedures (PPI).

RESULTS: DAP • CA • Mean 7, 426 c. Gycm² • Range 1, 899 c. Gycm² -17, 930 c. Gycm² • PTCA • Mean 10, 744 c. Gycm² • Range 2, 848 c. Gycm² - 126, 252 c. Gycm² • PPI • Mean 3, 705 c. Gycm² • Range 356 c. Gycm 2 - 24, 294 c. Gycm²

FLUOROSCOPY TIMES • CA – Average 8. 7 mins. – Range 2 - 15. 5 mins. • PTCA – Average 15 mins. – Range 3. 9 - 47. 9 mins. • PPI – Average 8. 7 mins. – Range 1. 1 - 43. 1 mins. • Fluoroscopy time was a key determinant of radiation dose variation.

PILOT STUDY CA Results

PTCA Pilot Results

PI Pilot Results

FUTURE DEVELOPMENTS • Data collection – 16 hospitals + 2 paediatric – 120 patients per hospital • Data analysis • Image quality evaluation – Phantom – Clinical trials • Estimate LDRL’s

CONCLUSIONS • Wide variations exist • ALARA principle -Consistent with good image quality • Lack of standardisation must be addressed • Establish LDRL’s

If you would like anymore information please contact any member of the ‘DOCE’ team. Thank you!