Radioprotection 61-2 | Page 54

M. Azeddou et al.: Radioprotection 2026, 61( 2), 121 – 125 123

Table 2. Third quartile values of DAP, FT, and Kair for interventional procedures( LLA, CA, CVAD, PM), compared with published DRLs.

The variability in dose metrics reflects the complexity of the procedure, which can differ depending on the clinical indication, even for the same type of procedure( Vañó et al., 2017). Additionally, this variability was influenced by the performance of the X-ray equipment and the patient’ s size, which directly impact the exposure parameters( Crowhurst et al., 2019). The DAP differences, even with the same equipment, are largely influenced by operator factors. Since this study was conducted in an academic context, the critical aspect was the variability in radiologist experience. Distinctions between senior and junior practitioners impacted the outcomes, particularly in interventional settings( Crowhurst et al., 2019).

Comparison with previous studies highlights variations in radiation exposure across different healthcare systems and imaging protocols. For LLA procedures, the 3 rd quartile DAP in this study( 107.98 Gy · cm 2) was higher than values reported in France( 75 Gy · cm 2), Belgium( 75 Gy · cm 2), and Spain( 73 Gy · cm 2) but lower than those in Switzerland( 210 Gy · cm 2). Conversely, the FT in this study( 2.73 min) is shorter than those reported in France( 6 min) and the UK( 5.9 min).

For CA procedures, the 3 rd quartile DAP( 232.18 Gy · cm 2) was largely higher than values from France( 90 Gy · cm 2) and the UK( 61 Gy · cm 2), but relatively higher than Switzerland( 125 Gy · cm 2). The FT( 11.4 min) was within the range reported in France( 11 min) and lower than Switzerland and Tristram et al. values. The large FT difference was within the Rizk et al. study( Tristram et al., 2022). The K air( 1.08 Gy) also exceeded values in France( 0.63 Gy), Tristram et al.( 0.34 Gy), and Rizk et al.( 0.34 Gy) studies.

In CVAD procedures, the recorded 3 rd quartile DAP( 2.26 Gy · cm 2) was slightly higher than previous studies except from the UK( 3 Gy · cm 2), while FT( 1.15 min) was comparable to international values. The K air( 0.0075 Gy) remains low, aligning with literature that supports the minimal radiation burden associated with peripheral angioplasty.

For PM procedures, the 3 rd quartile DAP( 27.10 Gy · cm 2) was higher than the UK( 7 Gy · cm 2) and other reported studies, while the FT( 7.98 min) was comparable to international standards. The K air( 0.1268 Gy) was also within the range reported in previous studies.

The 3 rd quartile comparison revealed that the highest DAP difference was observed in PM procedures( þ287 %) and the lowest difference was found in CVAD procedures(-24.67%). When comparing FT, The highest difference was observed in LLA procedures( þ82 %). The lowest difference occurred in CA procedures( þ3.64 %). This trend was not surprising because of the absence of a radiation protection program based on DRL assessment. Studies conducted across multiple countries indicate that variations in regulatory frameworks can impact how DRLs are set and implemented( Siiskonen et al., 2018).

The results demonstrate the inconsistency between DAP and FT across almost all procedures. Similarly, the literature outlined a poor FT and strong DAP and revealed that the correlation between FT and dose metrics is very poor( Heilmaier et al., 2017). This was attributed to differences in imaging modes: acquisition mode increases the DAP and K air without affecting FT, whereas fluoroscopic mode primarily contributes to FT without significantly increasing DAP and K air( Tristram et al., 2022). The FT parameter is not a reliable measure of radiation damage and is less