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Accueil Tous les numéros Volume 60 / Numéro 2 (Avril-Juin 2025) Radioprotection, 60 2 (2025) 134-143 Full HTML
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Numéro
Radioprotection
Volume 60, Numéro 2, Avril-Juin 2025
Page(s) 134 - 143
DOI https://doi.org/10.1051/radiopro/2024053
Publié en ligne 13 juin 2025

© R. Ghosn et al., Published by EDP Sciences 2025

Licence Creative CommonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1 Introduction

Interventional cardiology (IC) procedures provide several advantages over traditional open-heart surgeries. These minimally invasive techniques involve smaller incisions or catheters, resulting in faster recovery times, reduced complications, and shorter hospital stays. Providing both diagnostic and therapeutic advantages in one session, IC allows for repeatable procedures, facilitating ongoing management and adjustments according to a patient’s evolving cardiovascular condition. Consequently, there is a substantial annual increase in the number of interventional procedures globally, as reported in the UNSCEAR 2020/2021 Report (UNSCEAR, 2022). The estimated annual total of about 24 million interventional radiology procedures represents an approximately six fold increase from the 3.6 million procedures documented in the UNSCEAR 2008 Report. The annual global average frequency has increased from 0.6 to 3.2 procedures per 1,000 population (UNSCEAR, 2010).

Meanwhile, the advancement in imaging equipment, medical devices and the introduction of new technologies have facilitated the performance of sophisticated IC procedures which may result in high radiation exposure for patients and occupationally exposed workers (Tsapaki  et al., 2009; Balter et al., 2017). IC has been associated with high patient skin doses, reaching up to a few Gray, posing a significant risk of tissue reactions (IAEA, 1996; ICRP, 2000; Valentin, 2000 ICRP, 2000; Balter et al., 2010; ICRP, 2012). Therefore, it is crucial to ensure that the patient radiation exposure in IC suites is kept as low as reasonably achievable (ALARA) for the safety of both patients and staff.

However, adhering to the optimization principle, keeping doses as low as possible while maintaining the desired image quality, poses a considerable challenge. In response, the International Commission on Radiological Protection (ICRP) recommends the establishment and utilization of diagnostic reference levels (DRLs) as part of a quality assurance program to optimize patient radiation exposure (ICRP, 2017). At a local level, patient dosimetry surveys need to be performed for IC procedures to determine typical doses/values. These typical doses/values should then be compared with the established DRLs for the State or region (IAEA, 2014). During the comparison process, if the typical dose/value for the facility exceeds the DRL or is substantially below the DRL and it is evident that the exposures are not producing images of diagnostic usefulness, a review of optimization of protection and safety for that particular procedure becomes necessary.

2 Literature review

DRLs for IC procedures have been established at national levels by several authors across multiple countries (Korir et al., 2013 ; Crowhurst et al., 2014; Rizk et al., 2019; Schegerer et al., 2019; Kataria et al., 2021; Kidoń et al., 2022; Srimahachota et al. et al., 2022; Ramanathan et al., 2023; Slave et al., 2023). Siiskonen et al. (2018) extended this establishment to a regional context. Yet DRLs for new techniques, such as transcatheter aortic valve implantation (TAVI), are still scarce and lacking in the literature (Ryckx  et al., 2016; Järvinen et al., 2019; Kidoń et al., 2022). Moreover, it is crucial to note that typical values/doses should be determined independently by each health facility, rather than adopting them from other facilities. This is because these values reflect the specific equipment technology, level of complexity, and radiation protection practices unique to each health facility.

Thus, this study aims to establish typical values for IC procedures at the Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH) and compare them with the Lebanese national and international DRLs to define future optimization steps, if need. Upon the completion of this study, recommendations will be provided that are crucial for implementing optimization measures at the Interventional Cardiology department − LAUMC-RH and other IC department to optimize patients’ and staff’ exposures.

3 Materials and methods

This study was conducted at the Interventional Cardiology department − LAUMC-RH. Approval for the study was obtained from the Lebanese American University Medical Center. Data were collected for various IC procedures including coronary angiography (CA), percutaneous coronary intervention (PCI), CA + PCI and TAVI. The procedures were performed using the Innova 2100 from GE HealthCare. Routine quality control tests are performed by GE HealthCare engineers for the equipment including verification of beam collimation and beam geometry, verification of different field sizes, patient entrance surface air kerma rate, image receptor entrance surface air kerma rate, kerma–area product meter accuracy, leakage radiation and scattered radiation.

The online dose indicators/exposure parameters are generated by the equipment for each examination, displaying air kerma-area product (PKA) in Gy cm2, cumulative air kerma at the patient entrance reference point (Ka,r) in mGy, fluoroscopy time (FT) in minutes.

3.1 Patient selection

This study exclusively enrolled adults patients aged more than 18 yr. A minimum of 50 patients was needed for each type of procedure (ICRP, 2017). According to the LAUMC-RH health research committee/ethics committee, informed consent was waived for studies aiming to anonymously review the medical records and exposure parameters of patients. This is because such studies involved no direct contact with the patients, the patients’ information will not be identifiable and will not affect their clinical care.

3.2 Data collection

Data were collected from the Interventional Cardiology department − LAUMCRH using an excel sheet. The sheet included details such as the date and the type of procedures performed and relevant patient demographics such as gender, age, height and weight. Additionally, online dose indicators/exposure parameters such as FT, Ka,r, PKA, total number of images (NoI) and total number of exposure (NoE), were recorded. The data collection period spanned from May 2022 to November 2023, providing a comprehensive timeframe for the study’s analysis.

3.3 Establishment of typical values and statistical analysis

The average, minimum, and maximum values of the exposure parameters were calculated. Additionally, the median and interquartile range (IQR) were computed for each type of procedure. The Kruskal-Wallis test was used to compare the median values of the exposure parameters among the four types of procedures CA, PCI, CA+PCI and TAVI. A p-value < 0.01 was considered as significant. All calculations were performed using the QI Macros software. The Kruskal-Wallis test was employed to compare the four independent procedures (CA, PCI, CA+PCI, and TAVI). This non-parametric test was chosen to evaluate differences in fluoroscopy time, radiation dose (Ka,r), dose-area product (PKA), and number of images (NoI) among the four unpaired procedure types.

Typical values were established for each type of procedure as the median value (2nd quartile) of the distribution of FT, Ka,r, PKA, NoE and NoI. These typical values were then compared with relevant National DRLs and those reported in the literature to assess the need for optimization.

In addition, linear regression analysis were conducted to study the correlations between the Body Mass Index (BMI), FT and NoI and the online dose indicators (PKA and Ka,r) during each type of procedure. This approach aimed to clarify factors that might affect the patient dose and will help in giving recommendations in order to improve the local practice.

4 Results

A dataset comprising 950 procedures was compiled, involving 700 patients who have undergone CA procedures, 100 patients who have undergone PCI, 100 patients who have undergone CA + PCI and 50 patients who have undergone TAVI.

The demographic characteristics of the sample population, including the mean, minimum and maximum values of age, height and weight corresponding to each type of IC procedures are presented in Table 1.

Table 2 presents the number of procedures along with the mean, minimum and maximum values of FT, Ka,r, PKA, NoE and NoI. Additionally, the table includes the median and interquartile range for each parameter and the results of the statistical analysis. In addition, the P-value results from the Kruskal-Wallis test for the four procedures (CA, PCI, CA+PCI, and TAVI) were also presented. For all variables compared (FT, Ka,r, PKA, NoE, NoI), the p-values are consistently <0.01. The ratios of the maximum to the minimum values of the FT for CA, PCI, CA+ PCI and TAVI were found to be equal to 32, 83, 15 and 4, respectively. Correspondingly, in terms of Ka,r, the ratios were 28, 28, 11 and 4 and in terms of PKA, the ratios were 36, 25, 8 and 7 (cf. Tab. 2).

Table 3 displays a comparison of typical values (e.g., median values) alongside with the National DRLs for each exposure parameter and values obtained from relevant literature.

Figures 1 through 6 depict the relationships between various parameters: BMI and PKA, BMI and Ka,r, FT and PKA, FT and Ka,r, NoI and PKA and NoI and Ka,r for CA, PCI, CA+ PCI and TAVI.

Figure 1  shows a scatter plot illustrating the relationship between BMI and PKA during cardiac procedures. The CA + PCI procedure demonstrates a positive slope, while both the PCI and CA procedures also show positive trends, with PCI appearing to have a slightly steeper slope than CA. TAVI, however, has the least pronounced slope, indicating a minimal increase in PKA with increasing BMI. Although a slight trend is observed across these procedures, the weak correlation suggests that BMI alone may not be a critical factor influencing radiation dose.

Figure 2 illustrates the linear relationship between Ka,r and BMI, showing a moderate positive trend in CA procedures, where increased BMI is associated with a higher radiation dose (Ka,r). For PCI, the association is weaker, suggesting that BMI has minimal impact on Ka,r, with other procedural factors playing a larger role. Similarly, in CA+PCI, BMI’s influence on radiation dose remains relatively small. In TAVI, the relationship between BMI and Ka,r is particularly weak, indicating that other procedural and patient factors are more significant.

Figure 3 shows a positive correlation between FT and Ka,r across all procedures, with scatter points trending upwards as FT increases. TAVI has the steepest slope, indicating a stronger increase in radiation dose with longer fluoroscopy times. CA+PCI and PCI also show significant increases but to a lesser extent, while CA has the shallowest slope, suggesting only modest increases in dose with FT. CA points are clustered at lower FT and Ka,r values, reflecting shorter procedures and lower radiation exposure, while TAVI shows a strong linear increase with fewer procedures. PCI and CA+PCI are more dispersed across a broad FT and Ka,r range, indicating greater variability in time and dose. Regression analysis further emphasizes that TAVI procedures require more radiation per minute of fluoroscopy than other procedures, with CA showing the lowest radiation exposure per minute, while PCI and CA+PCI fall in between, with dose increasing alongside fluoroscopy time.

Figure 4 illustrates a positive correlation between FT and PKA across all procedures, with scatter points trending upwards as FT increases. The PCI procedure has the steepest slope, indicating that it results in a larger increase in PKA per minute of fluoroscopy compared to other procedures. TAVI follows closely, showing a strong positive slope, while CA+PCI demonstrates a moderate increase in PKA with increasing FT, similar to TAVI. CA has the lowest slope, indicating a smaller increase in PKA with FT. The CA procedures cluster at the lower FT and PKA range, reflecting shorter procedures with lower radiation exposure. PCI and CA+PCI are more dispersed across a wide range of FT and PKA values, showing greater variation in time and dose. TAVI has fewer cases but a consistent correlation between FT and PKA, indicating a predictable increase in radiation with time.

Figure 5 shows the linear regression lines for each procedure, illustrating varying relationships between NoI and PKA. The CA + PCI procedure demonstrates a strong positive correlation, with a steep slope indicating a significant increase in PKA as the NoI rises. PCI also shows a positive trend but with a gentler slope than CA + PCI. TAVI presents a unique pattern with the least steep slope, suggesting a slower increase in PKA as NoI increases, while CA has a similar trend to TAVI but with a slightly more pronounced slope.

Figure 6 displays linear regression lines for each procedure, illustrating varying degrees of correlation between NoI and Ka,r. The CA+PCI procedure has the strongest correlation, with a steep slope, while PCI also shows a noticeable positive trend. CA exhibits a weaker correlation with a less steep dotted line, and TAVI presents a unique pattern, showing a positive relationship though less clearly defined compared to CA and PCI. These distinct linear relationships suggest that radiation exposure varies across procedures based on NoI, potentially reflecting differences in procedural complexity or technique.

Table 1

Number (#) of procedures, mean (minimum − maximum) values of the age, height and weight for each type interventional cardiology procedure.

Table 2

Number (#) of procedures, mean (minimum −maximum) and median (Q1–Q3) values of the distributions of each exposure parameter (FT, Ka,r, PKA, NoE and NoI) for interventional cardiology procedures. P-value results from the Kruskal-Wallis test for the four procedures (CA, PCI, CA+PCI, and TAVI) were also presented.

Table 3

Comparison of typical values from this study with National DRLs and other international studies.

thumbnail Fig. 1

The relationship between PKA (Gycm2) and BMI (Kg/m2) during a) CA procedures (R2 = 0.15), b) PCI procedures (R2 = 0.01), c) CA+ PCI procedures (R2 = 0.08) and d) TAVI procedures (R2 = 0.01).
thumbnail Fig. 2

The relationship between Ka,r (mGy) and BMI (Kg/m2) during a) CA procedures (R2 = 0.13), b) PCI procedures (R2 = 0.04), c) CA+ PCI procedures (R2 = 0.06) and TAVI procedures (R2 = 0.04).
thumbnail Fig. 3

The relationship between Ka,r (mGy) and FT (min) during a) CA procedures (R2 = 0.37), b) PCI procedures (R2 = 0.64), c) CA+ PCI procedures (R2 = 0.63) and TAVI procedures (R2 = 0.69).
thumbnail Fig. 4

The relationship between PKA (Gycm2) and FT (min) during a) CA procedures (R2 = 0.40), b) PCI procedures (R2 = 0.74), c) CA+ PCI procedures (R2 = 0.62) and TAVI procedures (R2 = 0.68).
thumbnail Fig. 5

The relationship between PKA (Gycm2) and NoI during a) CA procedures (R2 = 0.48), b) PCI procedures (R2 = 0.41), c) CA+ PCI procedures (R2 = 0.43) and TAVI procedures (R2 = 0.46).
thumbnail Fig. 6

The relationship between Ka,r (mGy) and NoI during a) CA procedures (R2 = 0.58), b) PCI procedures (R2 = 0.60), c) CA+ PCI procedures (R2 = 0.45) and TAVI procedures (R2 = 0.55).

5 Discussion

The study was performed at one of the biggest private university hospital in Lebanon, where a total of 950 procedures were collected. The Kruskal-Wallis test was used to compare the median values of the exposure parameters among the four types of procedures CA, PCI, CA+PCI and TAVI. For all variables compared (FT, Ka,r, PKA, NoE, NoI), the p-values are consistently <0.01, suggesting that there are statistically significant differences across the four procedures. (cf. Tab. 2). As expected, the median values of FT, Ka,r, PKA, NoE and NoI were significantly higher in interventional (e.g., PCI, CA + PCI and TAVI) compared to diagnostic procedures (e.g., CA) (cf. Tab. 2). This indicates a robust and substantial statistical association between FT, Ka,r, PKA, NoE and NoI. The extremely low p-value suggests that the observed results are highly unlikely to have occurred by chance alone. Such a low p-value underscores the reliability and significance of the observed effect, reinforcing the validity of our study’s conclusions. This is also related to the longer fluoroscopy time required and the increased number of image acquisition, both of which are associated with the complexity of the procedures. This complexity is influenced by various factors, including patient anatomy, lesion characteristics, and disease severity (IAEA, 2009 ; Ruiz-Cruces et al., 2016).

Furthermore, within interventional procedures, PCI exhibited significantly higher median values for Ka,r (p= 10−3) and PKA (p=10−4) in comparison to CA + PCI (cf. Tab. 2). This can be attributed also to the complexity of the procedure and the utilization of additional imaging techniques like intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during PCI cases (Januszek et al., 2022;  Januszek et al., 2023; Januszek et al., 2023).

Various maximum to minimum ratios were identified for FT, Ka,r and PKA across the different procedures. These findings indicate that, even within the same type of procedures, various factors such as the complexity of individual cases, the techniques employed, and the expertise of the operator can influence patient exposures (Padovani et al., 2001).

Meanwhile, the typical values for PKA, Ka,r, and NoI in CA procedures were found to be lower than the national DRLs and those reported in the literature (cf. Tab. 3). However, the typical value for FT in CA procedures was similar to that reported by (Georges et al., 2017) (4 min) but higher than the national DRL (4 min compared to 3 min). For PCI and CA + PCI, the typical values for PKA and Ka,r were found to be lower than the national DRLs and literature values (cf. Tab. 3), except for the Ka,r reported in the study by (Kidoń  et al., 2022) for PCI (782 mGy compared to 724 mGy). However, the typical values for FT differed between the two procedures. During CA + PCI, the FT value was higher than the literature values, while during PCI, the FT value was higher than literature values but lower than that reported in the study by (Korir et al., 2013) (20 min compared to 28 min). Furthermore, the FT values exceeded the national DRLs for both PCI and CA + PCI (20 vs. 11min and 16 vs. 12 min, respectively). Regarding the NoI, they were higher than the national DRLs for both PCI (952 vs. 616 images) and CA + PCI (988 vs. 822 images). The NoI in PCI was also higher than that reported by (Georges et al., 2017) (952 vs. 666 images), but lower than other studies in the literature. For TAVI procedures, the typical values for PKA, Ka,r and FT were found to be lower than the national DRLs and literature values (refer to Tab. 3). This could be explained by a lower use of cine during TAVI than during PCI, the techniques employed, and the expertise of the operator can influence patient exposures. However, this was not the case for the NoI. It is worth noting that although higher typical values were observed in this study in term of FT and NoI, this did not result in increased PKA or Ka,r values. This can be attributed to the lower dose rate employed during fluoroscopy and image acquisition at LAUMC-RH, indicating a cautious approach towards radiation exposure optimization.

Yet, the reduction of FT and the NoI during IC procedures can be achieved through several key factors which, in turn, can contribute to further minimizing patient exposure. First, the expertise and experience of operators play a crucial role, as skilled practitioners with experience in IC can perform procedures efficiently, leading to shorter FT and NoI. Secondly, effective procedural planning, which involves reviewing patient history and imaging studies, and developing a clear procedural strategy, helps streamline the procedure and minimizes the need for prolonged FT and NoI. Thirdly, efficient workflow and team coordination among cardiologists, nurses, and technologists contribute to smoother procedures, optimized catheter handling, and reduced FT and NoI. Fourthly, implementing procedural modifications, such as utilizing radial access, or using guide catheters with improved support and maneuverability, can enhance efficiency and reduce FT and NoI. Finally, operator awareness and radiation safety training through continuous education help increase awareness of radiation safety practices, leading to conscious efforts in reducing FT and NoI while prioritizing patient safety. By considering these factors, IC procedures can be performed more efficiently, reducing FT and NoI and patient exposure without compromising patient care (Padmanabhan et al., 2019; IAEA, 2022).

Unexpectedly, for CA, PCI, CA+PCI and TAVI, the correlations between the PKA and Ka,r and BMI values were poor (R2 < 0.4) indicating that there was no substantial increase in exposure parameters with increasing BMI (cf. Figs. 1 and 2). It is worth considering that various factors, such as the complexity of the procedure and procedural techniques, may have influenced this weak correlation observed in the study (Januszek et al., 2022; Januszek et al., 2023).

Since BMI did not significantly affect radiation exposure, this suggests that optimized radiation protocols should not over-adjust exposure parameters solely based on patient BMI. Instead, efforts should be focused on other controllable factors, such as imaging technique and equipment settings, to ensure consistent exposure across varying patient anatomies.

CA procedures show the strongest (though still weak) association with BMI, meaning that in larger patients, clinicians may need to be mindful of increased radiation exposure. In contrast, for PCI, CA+PCI, and TAVI, BMI alone is not a major factor driving increased radiation, so adjusting radiation protection strategies purely based on BMI may not be as critical.

The low R2 values across all procedures suggest that radiation exposure management should focus on multiple factors, not just patient BMI. Clinicians should remain aware of this during both planning and real-time adjustments in the procedure to optimize radiation safety.

Future studies should examine how BMI correlates with radiation exposure over time and assess whether a tailored, protocol-driven approach can reduce variability in patient outcomes and improve radiation safety.

Strong correlations (R2 > 0.6) were observed between the PKA and Ka,r and FT values for PCI, CA + PCI and TAVI indicating an increase in exposure parameters with longer FT. In contrast, the correlations between the PKA and Ka,r and FT values for CA was found to be poor (R2 < 0.4) (cf. Figs. 3 and 4). The difference in correlations can be attributed to several factors such as the nature of the procedures, source to image detector distance, source to patient distance and patient to image detector distance, the use of extreme angulations, use of collimation, varying patient anatomies, procedural variations, and different operator techniques. (Agarwal et al., 2014 Dawn Abbott J. 2014)

Reducing fluoroscopy time is critical for minimizing radiation exposure. An optimized protocol should include: Real-time dose monitoring, enhancing operator skills in minimizing FT, use of pulsed fluoroscopy, detailed pre-procedural planning to limit fluoroscopy time.

For CA, fluoroscopy time did not strongly correlate with radiation exposure. This indicates that factors other than FT may be more influential in CA. To optimize protocols, focus could be shifted to reduce cine imaging use, limit the number of cine runs or their duration could reduce dose, optimize collimation and angulation. Future research should focus on how real-time dose monitoring and adjustments to fluoroscopy time can influence radiation exposure outcomes, providing opportunities to refine optimized protocols for clinical practice.

The correlations between the PKA and Ka,r and NoI values was found to be good (0.4 < R2 < 0.6) indicating an increase in exposure parameters with increasing the NoI (cf. Figs. 5 and 6). This occurs because, during IC procedures, multiple images need to be taken from different angles or positions to obtain comprehensive information about the cardiovascular system, thereby increasing the patient radiation exposure (Agarwal et al., 2014 Dawn Abbott 2014).

Protocols should aim to reduce the NoI through Predefined imaging protocols without compromising clinical outcomes. Use of 3D imaging techniques.

By focusing on factors like minimizing fluoroscopy time, controlling the number of images, optimizing collimation and angulation, and standardizing procedural techniques, cardiac interventional radiology protocols can be refined to significantly reduce radiation exposure while maintaining clinical effectiveness. (ICRP, 2013; NCRP, 2010; Miller et al., 2010 ; Ordiales et al., 2020; ACR, 2021). Future prospective studies could assess the impact of these optimized protocols in reducing radiation exposure across different patient populations and clinical settings, providing further insights into their practical applications.

Ultimately, the development and implementation of optimized radiation protocols in interventional cardiology are essential to improving patient safety while maintaining clinical effectiveness. By focusing on factors such as minimizing fluoroscopy time, controlling the number of images taken, and employing advanced imaging techniques, it is possible to significantly reduce radiation exposure without compromising procedural outcomes. The insights gained from this study highlight the need for protocols that adapt to specific procedural requirements and patient characteristics. Future prospective studies should further investigate the impact of these optimized protocols in diverse clinical settings, offering opportunities to refine radiation safety practices and ensure consistent, high-quality care across various patient populations

6 Conclusion

Typical values for CA, PCI, CA+PCI and TAVI were established for the first time at the interventional cardiology– LAUMC-RH. These values were derived from exposure parameters collected during 950 procedures. Typical values obtained in this study were in line or lower than the national DRLs and those reported in the literature. Consequently, this study highlights a good local practice and an effective dose optimization strategy with respect to patient radiation protection. These established values can serve as a benchmark for other cardiac centers in Lebanon. Meanwhile, although low typical values for PKA and Ka,r were found in this study, it is crucial to emphasize that these results do not diminish the ongoing importance of working towards further dose optimization for both patients and staff. Finally, an update of the national DRLs is deemed necessary for the most frequent interventional cardiology procedures in Lebanon.

Funding

This research did not receive any specific funding.

Conflicts of interest

The authors declare that they have no conflict of interest.

Data availability statement

The research data associated with this article is included within the article.

Author contribution statement

R. Ghosn, C. Massoud, D. El Khoury and C. Rizk developed the initial idea and designed the research approach. They also contributed to the conceptualization and methodology of this research project. R. Ghosn prepared the original draft of the paper. C. Massoud C. Rizk and D. El Khoury reviewed and edited the original draft. C. Massoud C. Rizk supervised the research project. R. Ghosn, C. Massoud, G. Ghanem, M. Soueidy and C. Rizk validated the results. All authors have read and agreed to the published version of the manuscript.

Informed consent

This article does not contain any studies involving human subjects.

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Cite this article as: Ghosn R, Massoud C, Ghanem G, Soueidy M, El Khoury D, Rizk C. 2025. Typical local DRL values for interventional cardiology procedures. Radioprotection 60(2): 134–143. https://doi.org/10.1051/radiopro/2024053

All Tables

Table 1

Number (#) of procedures, mean (minimum − maximum) values of the age, height and weight for each type interventional cardiology procedure.

In the text
Table 2

Number (#) of procedures, mean (minimum −maximum) and median (Q1–Q3) values of the distributions of each exposure parameter (FT, Ka,r, PKA, NoE and NoI) for interventional cardiology procedures. P-value results from the Kruskal-Wallis test for the four procedures (CA, PCI, CA+PCI, and TAVI) were also presented.

In the text
Table 3

Comparison of typical values from this study with National DRLs and other international studies.

In the text

All Figures

thumbnail Fig. 1

The relationship between PKA (Gycm2) and BMI (Kg/m2) during a) CA procedures (R2 = 0.15), b) PCI procedures (R2 = 0.01), c) CA+ PCI procedures (R2 = 0.08) and d) TAVI procedures (R2 = 0.01).
In the text
thumbnail Fig. 2

The relationship between Ka,r (mGy) and BMI (Kg/m2) during a) CA procedures (R2 = 0.13), b) PCI procedures (R2 = 0.04), c) CA+ PCI procedures (R2 = 0.06) and TAVI procedures (R2 = 0.04).
In the text
thumbnail Fig. 3

The relationship between Ka,r (mGy) and FT (min) during a) CA procedures (R2 = 0.37), b) PCI procedures (R2 = 0.64), c) CA+ PCI procedures (R2 = 0.63) and TAVI procedures (R2 = 0.69).
In the text
thumbnail Fig. 4

The relationship between PKA (Gycm2) and FT (min) during a) CA procedures (R2 = 0.40), b) PCI procedures (R2 = 0.74), c) CA+ PCI procedures (R2 = 0.62) and TAVI procedures (R2 = 0.68).
In the text
thumbnail Fig. 5

The relationship between PKA (Gycm2) and NoI during a) CA procedures (R2 = 0.48), b) PCI procedures (R2 = 0.41), c) CA+ PCI procedures (R2 = 0.43) and TAVI procedures (R2 = 0.46).
In the text
thumbnail Fig. 6

The relationship between Ka,r (mGy) and NoI during a) CA procedures (R2 = 0.58), b) PCI procedures (R2 = 0.60), c) CA+ PCI procedures (R2 = 0.45) and TAVI procedures (R2 = 0.55).
In the text

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