THE EFFECT OF ARTERIAL ACCESS ON THE ABSORBED DOSE OF RADIATION IN PATIENTS UNDERGOING DIAGNOSTIC CORONARY ANGIOGRAPHY

Cilj: Cilj ovog istraživanja je utvrditi postoji li razlika u dozi zračenja kod transfemoralnog u odnosu na transradijalni pristup, uzevši u obzir razliku u iskustvu operatera. Hipoteza istraživanja: Iskustvo operatera predstavlja najvažniji čimbenik u smanjenju doze zračenja kod dijagnostičkih koronarnih angiografija, neovisno o radijalnom ili femoralnom pristupu. Uzorak ispitanika i metode: Riječ je o presječnom, retrospektivnom istraživanju kojom su obuhvaćeni bolesnici kod kojih je učinjena dijagnostička koronarografija kod sumnje na koronarnu bolest srca, liječenih na Zavodu za bolesti srca i krvnih žila, Kliničke bolnice „Sveti Duh“. U istraživanje je uključeno 90 bolesnika (64 muškarca i 26 žena), kojima je koronarografiju obavio isti operater u različitim razdobljima svog djelovanja. Bolesnici su podijeljeni u tri skupine, po trideset bolesnika, koje se razlikuju prema metodi vaskularnog pristupa i razlici u iskustvu jednog te istog operatera prema razdoblju njegovog djelovanja. Podaci su prikupljeni iz elektroničke pismohrane (baze) podataka i protokola obrađenih bolesnika, a analizirani su sljedeći podatci: dob, spol, indeks tjelesne mase (BMI kg/m2), broj akvizicija (F), vrijeme fluoroskopije (FT,) doza zračenja nakon snimanja (mGy). Podaci parametara rendgenskog zračenja (apsorbirana doza za pojedinačnog pacijenta) očitavani su izravno, s aplikacije uređaja i upisivani u Excel tablice. Rezultati: Razlika u dozi zračenja između triju skupina nije bila značajna. Razlike nije bilo ni u usporedbi pojedinih skupina zasebno: Rezultat Mann-Whitney U testa ne nalazi razlike između doze zračenja skupina F-2009 u usporedbi s F-2013 (p = 0,3478), F-2009 u usporedbi s R-2017 (p = 0,3403), kao i F-2013 u usporedbi s R-2017 (p = 0,9352). Ukupni raspon u skupini F-2009 iznosi 76 – 1299 mGy, u skupini F-2013 iznosi 70 – 467 mGy, a u skupini R-2017 iznosi 52 – 819 mGy. Za razliku od ukupne doze zračenja, trajanje fluoroskopije se statistički znatno razlikuje prema iskustvu operatera i vaskularnom pristupu. Mann-Whitney U test potvrđuje visoko signifikantnu razliku jasno uočljive razlike između skupina F-2009 i F-2013 (p < 0,0001), i skupina F-2009 i R-2017 (p = 0,0001). Značajna je međutim bila i razlika između skupina F-2013 i R-2017, pri čemu je nešto, ali statistički ipak značajno duže trajala fluoroskopija u potonje skupine (Mann-Whitney U test, p = 0,0077), što se može tumačiti novim, zahtjevnijim vaskularnim pristupom iako je sam operater u proceduri koronarografije već iskusan. Zaključak: Za razliku od ukupne doze zračenja, postoji statistički značajna povezanost između trajanja fluoroskopije i iskustva operatera. Na kraju možemo ponoviti da ovi podatci sugeriraju da vaskularni pristup , a još više iskustvo operatera, određuju ako ne ukupnu dozu zračenja, ali svakako određuju trajanje snimanja.Aim: The aim of this study is to determine whether there is a difference in the radiation dose in transfemoral approach compared to the transradial approach, taking into account the difference in operator experience. Hypothesis of the study: Operator experience is the most important factor in reducing radiation dose in diagnostic coronary angiography irrespective of radial or femoral approach. Sample of examinees and methods: This is a cross-sectional, retrospective study involving patients who underwent diagnostic coronarography with suspected coronary heart disease, treated at the Department of Heart and Blood Vessels Diseases of 'Sveti Duh' Clinical Hospital. The study included 90 patients (64 men and 26 women), who underwent coronarography carried out by the same operator in different time periods. Patients were divided into three groups, thirty patients in each, which differ according to the vascular approach and differences in the experience of the same operator according to the period of his activity. The data were collected from the electronic database and protocol of the treated patients, and the following data were analyzed: age, sex, body mass index (BMI kg/m2), number of acquisitions (F), time of fluoroscopy (FT), radiation dose after recording (mGy). X-ray radiation parameters (absorbed dose for a single patient) were read directly from the system application and entered in the Excel table. Results: The difference in the radiation dose between the three groups was not significant. There even weren't any differences when individual groups were compared separately: Mann-Whitney U test result does not find any differences in radiation dose of group F-2009 when compared to F-2013 (p = 0,3478), F-2009 when compared to R-2017 (p = 0,3403), as well as F-2013 when compared to R-2017 (p = 0,9352). The total range in group F-2009 is 76 – 1299 mGy, in group F-2013 70 – 467 mGy, and in group R-2017 52 – 819 mGy. Unlike the total radiation dose, the duration of fluoroscopy statistically significantly differs according to the operator's experience and the vascular approach. Mann-Whitney U test confirms the highly significant difference between groups F-2009 and F-2013 (p < 0,0001), and groups F-2009 and R-2017 (p = 0,0001). Significant was also the difference between the groups F-2013 and R-2017, where the duration of fluoroscopy in the latter group (Mann-Whitney U test, p = 0,0077) was some longer, but statistically significant, which can be interpreted as a new, more demanding vascular approach although the operator himself is already experienced in the coronarography procedure. Conclusion: Unlike the total radiation dose, there is a statistically significant association between the duration of fluoroscopy and operator experience. Finally, we may repeat that these data suggest that the vascular approach, and even more operator experience, determine if not the total radiation dose, but definitely the duration of the recording