R. A. C. Guassu et al.: Radioprotection 2025, 60( 3), 221 – 233 231 Fig. 11. Bland-Altman plots for Estimated Effective Dose from dosimetry( E D) and from P KA( E f) for angiographies( left) and angioplasties( right).
importance of customizing radiological protection measures for team members, considering their specific positions and roles. The fluoroscopy time for the different modalities of procedures did not directly correlate with the other quantities: kerma, P KA, and E D. Compared with coronary angioplasty, the cerebral angiography procedure has a longer exposure time( medians: 13.4 min and 7.6 min) and P KA( medians: 175.4 Gy cm 2 and 58.8 Gy cm 2). However, when evaluating kerma( medians: 729.9 mGy and 1074.0 mGy), the E D for interventionist A( medians: 4.3 mSv and 2.0 mSv) and interventionist B( medians: 0.4 mSv and 2.2 mSv) are higher per procedure in coronary angioplasty.
When comparing peripheral angiography and angioplasty, longer exposure times did not result in a higher E D for the interventionists. When comparing procedure duration between angiography and angioplasty of the extremities( median: 9.85 and 25.60 min), angioplasty takes approximately 2.5 times longer than angiography. However, peripheral angiography presents kerma( medians: 174.6 mGy and 61.9 mGy), P KA( medians: 48.9 Gy cm 2 and 15.54 Gy cm 2), and E D( medians: interventionist A � 13.4 mSv and 7.7 mSv / interventionist B � 6.0 and 5.3 mSv) higher than angioplasty.
This greater exposure is also observed in angiography. The medians in the regions of the eye lens, thyroid, chest, abdomen, and hand for interventionist A were higher for angiography when compared with peripheral angioplasty, with equivalent doses being eye lens( medians: 160 mSv and 160 mSv), thyroid( medians: 40 mSv and 37 mSv), chest( medians: 150 mSv and 90 mSv), abdomen( median: 270 mSv and 180 mSv), hand( medians: 440 mSv and 180 mSv). Due to difference in the frame rate per second of these procedures, with peripheral angiography being on average 4 frames / s and angioplasty 2 frames / s, angiography tends to present higher exposures. Another factor influencing a higher dose level in angiography is clinical characteristics of the procedure, where evaluating the circulatory system and all involvements compromising the patient is necessary. Therefore, a higher occurrence of exposure in the pelvic region is expected, which infers a higher level of scattered radiation when compared to angioplasty, where there is a predominance of exposure of the extremities, leading to less scattered radiation.
4.6 Effective doses
When analyzing Figure 9 and Figure 10, the interquartile intervals for interventionists A and B differ between the modalities of procedures. In coronary procedures, interventionist B is positioned in a manner that the distance between them and the source is more significant than for interventionist A, as shown in Figure 2. Therefore, in coronary procedures, the dose is about 4 times lower for interventionist B. In cerebral procedures, the dose had similar interquartile intervals for interventionists A and B due to B being a resident physician who also must be near the patient, but A presents a more significant dose variation. In peripheral procedures, interventionist B is also a resident physician. However, the chest and abdomen doses would differ significantly in interventionist A, with higher medians. This generates significant changes in the calculated E D, as the organs of this region are more radiosensitive. Therefore, E D differed significantly among interventionists A and B for extremity procedures.
The factors presented in Table 2 were determined from representative values for P KA data obtained from the equipment and E D( Delichas et al., 2003; Williams, 1997). The factors also presented higher values in coronary procedures where interventionist A has higher doses. Compared with the values shown in the article by( Delichas et al., 2003), interventionist A presented higher doses and procedures with lower P KA, so the factors are higher but close. For cerebral and peripheral procedures, interventionists A and B had similar exposure profiles, as well as similar multiplicative factors f, with minor differences between them when compared to coronary procedures. The peripheral angioplasty procedure presented the highest effective dose estimation factor. This occurred because this procedure has one of the highest E D( median: 7.7 mSv for interventionist A and 5.3 mSv for interventionist B) and the lowest P KA value( median: 15.5 Gy cm 2). As the beam is directed to the peripheral regions, it requires a smaller P KA to perform the procedure. Still, the proximity of the interventionist to the beam entails one of the most significant exposures to the interventionist.
The effective dose from dosimeters( E D) and P KA is used to obtain the above-mentioned factors. The E D and P KA are