Determination of reference levels of ionizing radiation in interventional radiology

Advances in technology broaden the range of conditions that can be treated avoiding surgery. Application of minimally invasive diagnostic and therapeutic interventional radiologic procedures performed under medical imaging guidance, including X-ray fluoroscopy, is continuing to expand. However, radiation dose to patients undergoing invasive coronary angiography is relatively high. Recent study in interventional cardiology detected some problems related to improper usage of criteria for selection of cardiac angiography as method of choice and unjustified levels of radiation dose delivered to a patient. To investigate the problem in details we have collected and analyzed data on radiation doses delivered to patients underwent x-ray endovascular procedures in Moscow hospitals. Statistical treatment of collected data allowed us to estimate reference levels for dose area product, cumulative dose, duration of radiography procedure and the number of x-ray images to be saved for further diagnostic aortic angiography, coronary angiography, transluminal angioplasty of lower extremities and percutaneous coronary intervention. The evaluated reference levels cannot be used to limit a delivered dose and it is impossible to use them to prevent deterministic effects. The reference levels can be used for comparison with the dose delivered to a patient.