The Study Of Personnel And Patient Dosimetry During Coronary Angiography

Catheter-based coronary angiography is still the gold standard for thediagnosis of coronary artery disease (CAD),which is the leading cause ofmorbidity and mortality worldwide. As a sort of interventional operations,operators and patients also suffer X-ray radiation at different extents.Conventional angiography displays coronary artery at five to seven fixedpositions and dual-axis rotational angiography can reaveal lesions only twotimes by a automatic programme which can be controled by a set has thepotential to reduce procedure time and radiation dose.Some experiments alsoconfirmed this point by comparing DAP and AK. But strictly speaking,DAPand AK which can only evaluate radiation dose of patients roughly can notrepresent skin entrance dose. In this experiment,we investigated patients' skinentrance dose of conventional angiography and dual-axis rotationalangiography by simulating patients using a phantom and comparing DAP,AKand data of TLD system which is the classical method of testing skin entrancedose.Compared with the femoral approach for coronary angiography,theradial approach was shown to be associated with smaller trauma,lowercomplication rates and costs.In the meantime,some experiments demonstratedthat transradial operation would increase radiation dose of patients andoperators.For this,another experiments did not come to a unanimousconclusion then.These experiments can not explain the difference objectivelybecause they are clinical trials which have a lot of interference factors such aslarge variations of puncture point and site of operators.In this experiment,weobjectively evaluated dose difference in coronary angiography of differentapproaches by simulating patients using a phantom which can avoid interference factors above all.Part1The comparison of radiation dose between rational angiography and standard angiographyObjective:To compare radiation dose of patient between rationalangiography and standard angiography.Methods:According to different modes,our experiment was divided intoRA(Dual-axis Rotational Angiography)group and SA(Standard Angiography)group.The latter was divided into3subgroups(SA1,SA2,SA3) due todifferent time of cine.The procedure time and the positions was controled bythe order preinstalled into the machine. Each group consisted of10repeatedoperations with an unique phantom to imitate the true patients.The radiationdose was measured by dose meter of machine and TLD system and then themeans of the data above was compared.Results:1The data measured by machine1.1The mean of total accumulated DAP in group RA(3290.6mGycm2)reduced by70%,100%,260%respectively compared with group SA1(5583.9mGycm2),SA2(6436.0mGycm2),SA3(11753.4mGycm2),with a reduction of60%,60%,200%respectively of the mean of accumulated AK(67.7mGy VS105.5mGy,110.2mGy,207.7mGy).1.2The means of DAP and AK in group RA reduced by100%,80%respectively compared with group SA in fluoroscopy time.(DAP489.6mGycm2VS1005.0mGycm2,AK9.8mGy VS17.8mGy)1.3The mean of accumulated DAP in cine time in group RA(2801.0mGycm2)reduced by60%,100%,290%respectively compared withgroup SA1(4577.4mGycm2),SA2(5581.3mGycm2),SA3(10812.6mGycm2),with a reduction of50%,70%,230%respectively of the mean of accumulatedAK(57.9mGy VS87.5mGy,96.3mGy,92.1mGy).1.4The mean of accumulated DAP in cine time of left coronary artery ingroup RA(1743.1mGycm2) reduced by100%,140%,370%respectivelycompared with group SA1(3486.5mGycm2),SA2(4224.1mGycm2), SA3 (8203.8mGycm2),with a reduction of90%,100%,310%respectively of themean of accumulated AK(35.3mGy VS66.5mGy,72.0mGy,145.8mGy).1.5The mean of accumulated DAP in cine time of right coronary arteryin group RA(1054.1mGycm2) reduced by5%,20%,150%respectivelycompared with groupSA1(1090.9mGycm2),SA2(1252.4mGycm2),SA3(2629.0mGycm2),with areduction of5%,5%,120%respectively of the mean of accumulatedAK(21.2mGy VS22.3mGy,22.9mGy,46.5mGy).2The data measured by TLD system2.1The mean of accumulated dose in group RA(37.70mGy) reduced by30%,110%respectively compared with group SA2(46.86mGy),SA3(77.79mGy) and increased by about40%compared with groupSA1(26.56mGy).2.2The dose of9dots in group SAThe highest dose of9dots in these3groups was dot8(8.85mGy,12.34mGy,30.47mGy) which was significantly higher than others.The lowest doseof9dots in these3groups was between dot1,2and3.2.3The dose of9dots in group RAThe three highest dose of9dots in group RA was successively dot6(7.17mGy),9(6.03mGy) and5(5.91mGy),the lowest dose of9dots was alsobetween dot1(1.89mGy),2(1.44mGy) and3(1.91mGy).Conclusions:In comparison with conventional angiography, dual-axis rotational angiography which avoids continued exposure in some fixed position decreases themaximal skin entrance dose and share the skin entrance dose of patients' backwhich has the potential to reduce radiation exposure of patients significantlyso as to prevent skin injures of radiation.Part2The comparison of radiation dose in coronaryangiography through different accessesObjectives:To compare radiation dose of patients and operators incoronary angiography with the femoral and the radial approach. Methods:According to different accesses, our experiment was dividedinto group TFI(Transfemoral intervention)and group TRI (Transradialinterventio n).Based on different interference factors,group TFI was separatedinto TFI1-TFI4and group TRI was separated into TRI1-TRI8.Group TFI1andTFI2stimulated radiation dose of operator'sleft and right hands respectively.Group TFI3and TFI4stimulated radiation dose of operator's chest with andwithout the protection of lead screen(LS)respectively. Group TRI1and TRI2stimulated radiation dose of operator's left and right hands respectively. GroupTRI3and TRI4stimulated radiation dose of operator's left and right handswith the special use of radial(SR) protection. Group TRI5and TRI8stimulatedradiation dose of operator's chest with and without the protection of LS andSR respectively,TRI6and TRI7stimulated radiation dose of operator's chestwith either SR or LS respectively.Recorded each data using an uniquedosimeter and then compared the means. The procedure time and the positionswas controled by the order preinstalled into the machine.Results:1Comparisons within group TFI1.1TFI1VS TFI2(comparisons of dose of operator's left hand)Total dose,accumulated dose of fluoroscopy and cine time of groupTFI2(2.574μSv,0.493μSv,2.073μSv) reduced by150%,160%,150%comparedwith group TFI1(6.510μSv,1.312μSv,5.201μSv).1.2TFI3VS TFI4(comparisons of dose of operator's chest with andwithout the protection of lead screen)Total dose,accumulated dose of fluoroscopy and cine time of group TFI3(1.300μSv,0.168μSv,1.178μSv)reduced by350%,370%,330%comparedwith group TFI4(5.839μSv,0.796μSv,5.039μSv).2Comparisons within group TRI2.1TRI1VS TRI2(comparisons of dose of operator's left hand)Total dose,accumulated dose of fluoroscopy and cine time of groupTRI2(31.200μSv,4.476μSv,26.774μSv) reduced by30%,50%,30%comparedwith group TRI1(40.993μSv,6.692μSv,34.301μSv). 2.2TRI3VS TRI4(comparisons of dose of operator's left hand with theprotection of special use of radial)Total dose,accumulated dose of fluoroscopy and cine time of groupTRI4(10.666μSv,1.659μSv,9.007μSv) reduced by80%,70%,80%comparedwith group TRI3(19.289μSv,2.795μSv,16.494μSv).2.3Comparisons between group TRI5,TRI6and TRI7and TRI8(comparisons of dose of operator's chest with the protection of special use of radialand lead screen)Compared with group TRI8(9.811μSv,1.263μSv,8.546μSv), TRI6(3.011μSv,0.486μSv,2.525μSv) and TRI7(3.161μSv,0.346μSv,2.814μSv), total dose,accumulated dose of fluoroscopy and cine time of group TRI5(1.574μSv,0.167μSv,1.414μSv) reduced by520%,660%,500%,90%,190%,80%and100%,100%,100%respectively.Compared with group TRI8, total dose,accumulated dose of fluoroscopyand cine time of group TRI6and TRI7reduced by230%,160%,240%and210%,270%,200%.3Comparisons between group TRI and TFI3.1TFI1VS TRI1(comparisons of dose of operator's left hand in TFI andTRI)Compared with group TFI1(6.510μSv,1.312μSv,5.201μSv), total dose,accumulated dose of fluoroscopy and cine time of group TRI1(40.993μSv,6.692μSv,34.301μSv) increased by530%,410%,560%respectively,total doseof seven positions increased by590%,360%,510%,380%,550%,680%,390%respectively.3.2TFI3VS TRI7(comparisons of dose of operator's chest in TFI andTRI with the protection of lead screen)Compared with group TRI7(3.161μSv,0.346μSv,2.814μSv), total dose,accumulated dose of fluoroscopy and cine time of group TFI3(1.300μSv,0.168μSv,1.178μSv) reduced by140%,110%,140%respectively.3.3TRI5VS TFI3(comparisons of dose of operator's chest with theprotection of lead screen and special use of radial in TRI and TFI with the protection of lead screen)Compared with group TFI3(1.300μSv,0.168μSv,1.178μSv), total dose,accumulated dose of cine time of group TRI5(1.574μSv,0.167μSv,1.414μSv)increased by about20%respectively, accumulated dose of fluoroscopy timewas the same almostly.4Influences of different positions on radiation dose in TFI and TRI4.1Influences on patients' radiation doseThe three positions of highest DAP and AK was successively position5(DAP1346.0mGycm2,AK32.1mGy),1(DAP1208.9mGycm2,AK28.9mGy)and6(DAP969.8,mGycm2,AK23.4mGy)which was all LAO positions, though the DAP and AK of RAO positions was all low relatively.4.2Influences on operators' radiation dose4.2.1Influences on radiation dose of operators' handsRadiation dose of7positions in groupTRI1(16.612μSv,3.669μSv,3.025μSv,1.929μSv,4.782μSv,7.232μSv,3.414μSv)increased by590%,360%,510%,380%,550%,680%,390%respectivelycompared with groupTFI1(2.418μSv,0.793μSv,0.497μSv,0.399μSv,0.734μSv,0.933μSv,0.686μSv).4.2.2Influences on radiation dose of operators' chestWithout protections, radiation dose of7positions in groupTRI8(4.329μSv,0.505μSv,0.227μSv,0.268μSv,1.731μSv,2.553μSv,0.502μSv)increased by160%,20%,50%,50%,5%,100%,20%respectivelycompared with group TFI4(1.662μSv,0.419μSv,0.147μSv,0.185μSv,1.675μSv,1.282μSv,0.413μSv).With the protection of lead screen, radiationdose of7positions in groupTRI7(1.664μSv,0.378μSv,0.082μSv,0.092μSv,0.241μSv,0.289μSv,0.363μSv)increased by520%,30%,2%,10%,50%,110%,20%respectively comparedwith groupTFI3(0.270μSv,0.305μSv,0.081μSv,0.0862μSv,0.156μSv,0.138μSv,0.306μSv)Conclusions:In comparison with transfemoral coronary angiography,the radiation of operator's hands and chest are significantly higher in transradial coronaryangiography and the dose difference of chest is much remarkable in position1than other positions.No matter which approach to operate,radiation dose ofpatients, operators' hands and chest are ralated to position effects.When itcomes to LAO positions,the effects is much obvious.The protection of specialuse of radial cooperated with conventional equipments has the potential tominimize operator's radiation dose when the procedure through radial which isworth spread use.