D9.144 – Investigation of skin dose determinants and optimisation of medical practice

In the VERIDIC (Validation and Estimation of Radiation skIn Dose in Interventional Cardiology) project, medical practices for high-dose, cardiac procedures and the resulting skin doses werere analysed. Through investigating the relations between procedure parameters and skin dose, skin dose reduction strategies were defined. Reference and alert levels in terms of DAP, AK and PSD were established. Three types of IC procedures were identified for data collection: PCI (Percutaneous Coronary Intervention), CTO (Chronic Total Occlusion Percutaneous Coronary Intervention) and TAVI (Trans catheter Aortic Valve Implantation) as these therapeutic procedures are associated with non-negligible doses to the patient. A comprehensive questionnaire was jointly developed by experienced participating partners. It includes 62 clinical parameters divided into 10 subsections as well as dosimetric information. The questionnaire was filled for each procedure. For the hospitals and rooms in which it was available, the Radiation Dose Structured Reports (RDSR) for each patient was collected. RDSR was also used with Python code to extract technical parameters. Univariate and multivariate statistical analysis was performed using clinical determinants and extracted technical parameters; DRL were suggested and predictive models were derived. Overall, technical factors were found to be more influential on skin dose than clinical factors. For PCI, fluoroscopy time, tube voltage and current as well as distance source to detector were major factors increasing PSD. For CTO, age, BMI, sex, number of fluoro/cine acquisitions as well as sheath size were determinant factors for an increase in PSD. For TAVI, sex, age, fluoroscopy time and stationary acquisition (cine mode) were most prominent in depicting an increase in PSD. Frequency of high dose procedures was determined over 3-6 months in participating sites and accounted for 2.65 % of total procedures having an AK between 3 and 5 Gy and 0.75 % having a PSD between 3 and 5 Gy.