1. Skin doses in cardiac intervention at St. Olav`s hospital Norway
ECR 2016
Skin doses in cardiac intervention at St. Olav`s hospital Norway
- Based on my master project from the University College of Southeast Norway in 2014
Tommy Berglund – Quality assurance
Radiographer St. Olav`s University Hospital
Norway

2. Question of research
How is the correlation between the given dose indicators and actual maximum skin dose (MSD) during cardiac interventional procedures?
Procedures investigated:
PCI (Percutaneous Coronary Interventions)
RFA (RadioFrequency Ablations)
TAVR (Transcatheter Aortic Valve Replacement)  2016

3. Aim of the project
Develop local follow – up procedures after high radiation doses to the patients in interventional cardiology, using either:
DAP (Dose Area Product)
AK (Air Kerma – Patient entrance reference point – IEC 2010) values

4. Radiochromic film
Radiochromic film was chosen as preferred method for measuring skin doses based on a literature study on the subject
The amount of radiation is determined by the grade of density on the film after been exposed
The film is placed so it covers the area on the patient that are exposed to radiation during an interventional procedure
Range Gafchromic® XR – RV3  10 mGy – 15 Gy

5. Collecting patient data
FILM
“Detector”
X – ray tube

6. Correlation between MSD and DAP from PCI procedures – 22 patients
Good correlation  DAP can be used for establishing trigger values
r value – 0,907
Threshold value for follow up:
3 Gy
DAP Gycm²
1 Gy
DAP – 100 Gycm²
3 Gy – 228 Gycm2
1 Gy – 91 Gycm2
r = 0,91
R² = 0,82

7. Correlation between MSD and DAP from RFA procedures – 21 patients
Very good correlation  DAP can be used for establishing trigger values
Threshold value for follow up :
3 Gy
DAP Gycm²
1 Gy
DAP – 120 Gycm²
r-value = 0,984
3 Gy – 339 Gycm2
1 Gy – 116 Gycm2
r = 0,98
R² = 0,97

8. Correlation between MSD and AK from TAVR procedures – 11 patients (From 2016)
Threshold value for follow up :
3 Gy
AK – 3500 mGy
1 Gy
AK – 1300 mGy
r = 0,93
R² = 0,87

9. Conclusion
Radiochromic film is an excellent tool for measuring skin doses in cardiac intervention
A good correlation between MSD and both dose indicators was found
Local follow – up procedures based on trigger values from the study is established

10. Reduction in dose levels SCA/PCI  2013 vs 2015
0,9 % above 3 Gy
13,6 % above 1 Gy
2015
0,27 % above 3 Gy
1,88 % above 1 Gy

11. DRL`s (Diagnostic Reference Levels) - SCA procedures 2006 - 2015

12. Personal dosimetry 5 cardiologists 2013 - 2015
2013 – 166,75 mSv total, highest 51,26 mSv
2015 – 73,63 mSv total, highest 18,31 mSv

13. Thank you for your attention 