34 M. Alvarez et al.: Radioprotection 2025, 60( 1), 28 – 36
Table 3. KAP third quartile value and E presented in this study compared to the literature.
KAP( Gycm 2) E( ICRP 103)( mSv)( Laura 2015)( DCC E a)
Procedure Name
Coronary percutaneous transluminal angioplasty, stent placement, or radiofrequency ablation Lower limb arteriography Head and / or neck angiography Coronary angiography( diagnostic) Pelvic vein embolization Thoracic angiography of pulmonary artery or aorta Abdominal angiography or aortography Transjugular intrahepatic portosystemic shunt placement
Present study
Ref
29.8 26.0( Kicken, Kemerink, and van Engelshoven 1999)
Present study
Ref
6.9 6.4( Kicken, Kemerink, and van Engelshoven 1999)
Present Study
NCRP 160( NCRP Report 160)
Associated Error(%)
0.2315 0.2600 – 10.94 %
59.7 |
68.0( Arthur et al., 2002) |
6.1 |
6.8( Arthur et al., |
0.1022 |
0.1000 |
2.18 % |
|
|
|
2002) |
|
|
|
163.9 |
14.1( Li et al., 2020) |
11.5 |
1.2( Li et al., 2020) |
0.0702 |
0.0870 |
– 19.35 % |
58.0 25.8( Kicken, Kemerink, and van Engelshoven 1999)
5.2 3.1( Kicken, Kemerink, and van Engelshoven 1999)
0.0897 0.1200 – 25.29 %
220.7 282.2( Li et al., 2020) 59.8 71.4( Li et al., 2020) 0.2710 0.2530 7.11 % 457.5 284.2( Li et al., 2020) 89.3 73.9( Li et al., 2020) 0.1952 0.2600 – 24.93 %
98.1 284.2( Li et al., 2020) 30.5 73.9( Li et al., 2020) 0.3109 0.2600 19.58 %
25.4 108.1( Li et al., 2020) 8.6 28.1( Li et al., 2020) 0.3386 0.2600 30.22 %
KAP, Kerma-Area Product( Gy · cm 2); E, Effective Dose( mSv); Cf, Conversion Factor( Sv / Gy); DCCE, dose conversion coefficient from KAP to E( mSv Gy �1 cm �2)
The study also sheds light on the necessity for patientspecific dose considerations, as evidenced by cases with significantly higher KAP values, such as those involving bilateral uterine artery embolization. Such instances highlight the need for tailored radiation management strategies to further optimize patient safety.
Comparisons with data from the NCRP Report 160 and 172 reveal that the 75th percentile KAP values from our study are generally lower, suggesting that advances in technology and technique have potentially led to reductions in patient radiation exposure over time.
It is important to mention that, in clinical practice, the focus-skin distance and projection angle may change, and the kV may not remain constant, as Automatic Exposure Control may change the technique used. It is also essential to mention that the quantities used for simulations with PCXMC 2.0 represent a generalized average of the techniques, distances, projections, and filtrations most used in these procedures. Consequently, these values may vary when considering the wide range of patient ages and thicknesses.
The calculated conversion factors are consistent with the KAP values, and the number of radiosensitive organs irradiated in the simulation, serving as an important tool for risk estimations. Olcay et al.( 2015) measured an approximately four-fold difference in KAP values in procedures performed with cine mode imaging compared to those performed in“ last fluoro hold mode”, in which the last image obtained in fluoro mode can be saved. This technology is present in the equipment evaluated in this work and the reduction in the number of pulses is essential for the optimization of doses without a decline in image quality( Pyne et al., 2014). The evaluated equipment also has automatic filtration control, which plays an important role in reducing scattered radiation, but requires a greater operating voltage range( Martin 2007).
It’ s important to acknowledge that the LDRL methodology employed only accounts for a segment of the regional population, and the E values should be viewed as prudent estimates, influenced by individual patient factors such as age, sex, and Body Mass Index( BMI)( Wambani et al., 2014). For