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Abstract: 60-1

60-1

Continuous monitoring of doses in interventional cardiological procedures

Authors:
Patricia Lopes Barbosa (UNIFESP - Universidade Federal de Sao Paulo) ; Adriano Henrique Pereira Barbosa (UNIFESP - Universidade Federal de Sao Paulo) ; Marcos Cesar Florian (UNIFESP - Universidade Federal de Sao Paulo) ; Pedro Memrava Romanini (UNIFESP - Universidade Federal de Sao Paulo) ; Heiglon Estevao Bonella Denti (UNIFESP - Universidade Federal de Sao Paulo) ; Regina Bitelli Medeiros (UNIFESP - Universidade Federal de Sao Paulo)

Abstract:

Interventional cardiological procedures bring great benefits to patients, especially when protocols are optimized based on their specificities and needs. Optimizing protocols is not a simple process, considering the complexity of these procedures and the daunting clinical conditions of the patients. However, it is necessary to reinforce its importance among specialists due to the risks of late skin injuries of the patients attributed to high doses of radiation. A metric considered suitable for evaluating skin injuries or deterministic effects is the air kerma indicator obtained at the reference point (Ka,r). Fluoroscopy time, number of images or even area-air kerma product are identified as poor indicators for evaluating possible skin reactions. Our objective is to present data from 2018 to 2022 obtained from monitoring patients who received doses with skin damage potential. The patient follow-up protocol was established for Substantial Dose Level (SDL) in which values are equal to or greater than 5 Gy kerma accumulated or kerma- area product  ≥ 500 Gy.cm2 or fluoroscopy time ≥ 60 min are recorded. In case of accumulated kerma greater than 3 Gy or kerma-area product ≥300Gy.cm2 or fluoroscopy time ≥ 30 min, the values were recorded as Notification Level (NL). In cases of SDL, continuous monitoring of patients are carried out through face-to-face appointments or by photos of the skin irradiated region. The contact with the patient is maintained by whatsApp, cellphone, e-mail or scheduled appointments and if a suspicious lesion is identified, the patient is referred  to the dermatology department for evaluation.

Specialists and interventional cardiology residents get aware of the patient dose values and fluoroscopy time at the end of the procedure. Between 2018 and 2022, 10,176 procedures were performed, including diagnostic catheterizations followed by angioplasties (ad hoc angioplasty) and primary and planned angioplasties (ATCPR and/or ATCPL), recording 2.01% of patients with NL and 0.52% with SDL. Among the 53 procedures identified with SDL, 42 patients are under active follow-up (3 patients underwent 2 procedures, 6 died due to heart problems and 2 have never responded to any attempted contacts. Eight patients who presented some degree of skin injury were referred to the dermatology team for evaluation and are kept under clinical follow-up. The prognoses for the therapeutic option were calculated by a specialist using the SYNTAX score values, to assess the complexity of the coronary lesions. Considering the 8 patients the lowest SYNTAX value was 7 and the highest was 36. Two patients underwent two procedures within a period of 2 weeks. Based on the results, we verified that it is possible to maintain active monitoring of patients, offering assistance and encouraging the optimization of radiological protection. Monitoring over time has contributed to greater counciousness among cardiologist residents about the importance of precision dose management received by patients and what it represents in terms of risks and benefits for both, that is to say, patients and professionals.

Keywords:
  doses monitoring, skin injuries, interventional cardiology