Establishment of Local Diagnostic Reference Levels for Interventional Radiology Procedures in a Major Hospital in Brazil: A Step Towards National Standardization

Fluoroscopically guided interventional procedures can be related to high values of radiation doses for both patients and clinical staff. Diagnostic reference levels (DRL) are used to investigate radiation doses associated with procedures performed during practice. Purpose: Our study aimed to determine local diagnostic reference levels (LDRLs) for interventional procedures in a large hospital in Brazil. Analysis was carried out over three months and involved two interventional angiography systems: Artis Zee, from Siemens, and Innova, from GE Healthcare. A total of 606 procedures were collected with the following information: types of procedures, air kerma-area product (PKA), fluoroscopic time, and patient information. The LDRL was defined as the 75th percentile distribution of PKA values. Demonstrated that the more frequent procedures were cardiac catheterization, cerebral angiography, and coronary angioplasty. The highest mean fluoroscopic times were for cerebral angiography, with a mean of 17.06 min, and mammary angiography, with a mean of 19.30. The highest third quartile values of PKA were found for hepatic chemoembolization with a mean of 110.3 Gy.cm2 and mammary arteriography at 85.76 Gy.cm2. Most procedures demonstrated lower DRLs than those already published. This study represents an essential contribution to the first effort to establish reference levels in interventional radiology and to be the beginning of establishing national diagnostic references for our country and enabling international comparisons.