National Diagnostic Reference Levels of Procedures in Cardiac Catheterization Laboratory in Thailand: A Multi Centers Survey
Suphot Srimahachota¹, Panruethai Trinavarat², Kanjana Sukwijit³, Waraporn Sudchai⁴, Khanittha Kaewta⁵, Marayat Chamnan⁶, Thanwa Pitaksuteepong⁷, Raksakhet Na Nan⁸, Ananya Sae-oui⁹, Artit Torpongpun¹⁰, Nikom Namkoch¹¹, Manatsanan Kupharangchotsin¹², Suthep Thungsuk¹³, Anchali Krisanachinda²
Affiliation : ¹ Cardiac Center and Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand; ² Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; ³ Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; ⁴ Thailand Institute of Nuclear Technology (Public Office), Nakhon Nayok, Thailand; ⁵ Cardiac Catheterization Laboratory, Rajavithi Hospital, Bangkok, Thailand; ⁶ Cardiac Catheterization Laboratory, Suratthani Hospital, Surat Thani, Thailand; ⁷ Cardiac Center of Excellence, King Prajadhipok Memorial Hospital, Chanthaburi, Thailand; ⁸ Cardiac Catheterization Laboratory, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand; ⁹ Cardiovascular Center, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand; ¹⁰ Department of Medicine, Chonburi Hospital, Chonburi, Thailand; ¹¹ Cardiac Catheterization Laboratory Division, Queen Sirikit Heart Center of the Northeast, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; ¹² Cardiac Catheterization Laboratory, Naresuan University Hospital, Phitsanulok, Thailand; ¹³ Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background: Diagnostic reference level (DRL) was initially introduced by the International Commission on Radiological Protection, ICRP Publication 73 in 1996. The DRL has been proven to be an effective tool that aids in optimization of protection in the medical exposure of patients for diagnostic and interventional procedures. As the data on the cardiac procedures are limited, particularly in Southeast Asian region, the DRL in cardiac procedures has never been established in this region.
Materials and Methods: The survey in cardiac procedures covered 1,102 examinations from three procedures including coronary angiography (CAG), percutaneous coronary intervention (PCI), and permanent pacemaker (PPM) at 10 cardiac centers all over Thailand during 2019.
Results: For the CAG procedures, the DRLs of kerma area product (KAP) and air kerma (AK) were 29.3 Gycm² and 395 mGy, respectively. In PCI, DRLs for KAP and AK were 83.7 Gycm² and 1397 mGy respectively. For PPM, the DRLs of KAP and AK were 5.8 Gycm² and 59.0 mGy, respectively.
Conclusion: The present report is the first national DRLs on common cardiovascular procedures in Thailand. The results will help the optimization of patient dosages in the cardiac procedures in Thailand and in the neighboring countries, which can be used as the reference.
Received 25 October 2021 | Revised 14 July 2022 | Accepted 26 July 2022
DOI: 10.35755/jmedassocthai.2022.09.13567
Keywords : Diagnostic reference level; Coronary angiography; Percutaneous coronary intervention
