Radiation risk to patients from percutaneous transluminal coronary angioplasty

Department of Medicine, University of Ottawa, Ontario, Canada.

OBJECTIVES. This retrospective study sought to estimate patient radiation exposure during percutaneous transluminal coronary angioplasty, the corresponding organ doses and the resulting cancer mortality risk. Patient demographic data were also examined. BACKGROUND. Coronary angioplasty is commonly used as an intervention for coronary atherosclerosis, and repeated application in the same patient is now common. The combined use of fluoroscopy and cineradiography in this complicated, delicate and, hence, lengthy procedure induced us to investigate the patient radiation exposures and resulting risks. METHODS. All complete records for angioplasty procedures performed over a 3-year period were entered into a data base. The data comprised 1,893 procedures performed in a total of 1,503 patients, of whom 21% had two or more procedures in the 3-year period. Fluoroscopy time was converted to entrance exposures, assuming a rate of 520 muC kg-1 min-1 (2.0 R min-1). Cineradiographic film lengths were determined for a smaller number of procedures (200) and converted to exposures at 7.7 muC kg-1 frame-1 (30 mR frame-1). In addition, fluoroscopy and cineradiographic times and, hence, exposures for 91 diagnostic angiograms performed in these patients were obtained. Exposures were converted to organ doses using the Monte Carlo results of the Rosenstein group and then to cancer mortality risks using the latest rates of the International Commission on Radiological Protection. RESULTS. The mean age was 56.0 years; men constituted 77.5% of the patients. Radiation doses varied considerably owing to a large spread in exposure times (e.g., fluoroscopy time per angioplasty case averaged 19 min but for some cases exceeded 1 h). The average patient skin entrance exposure per angioplasty procedure was 32.0 mC kg-1 (124 R), of which 69.7% was from cineradiography. The resulting cancer mortality risk per angioplasty procedure is approximately 8 x 10(-4). CONCLUSIONS. The skin exposures estimated for angioplasty are on average higher than for other X-ray procedures. The cancer mortality risk does not exceed the mortality risk of bypass surgery. Good professional practice requires maximization of the benefit/risk ratio through quality assurance in all aspects of the procedure.

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