Establishing the European diagnostic reference levels for interventional cardiology

Research output: Contribution to journalArticlepeer-review


  • Teemu Siiskonen
  • Olivera Ciraj-Bjelac
  • A. Diklic
  • Joanna Domienik-Andrzejewska
  • Jad Farah
  • José Miguel Fernández
  • A. Gallagher
  • C. Hourdakis
  • S. Jurkovic
  • H. Järvinen
  • J. Järvinen
  • Zeljka Knezevic
  • Christina Koukorava
  • Carlos Maccia
  • Marija Majer
  • Françoise Malchair
  • L. Riccardi
  • C. Rizk
  • R. Sanchez
  • M. Sandborg
  • Marta Sans-Mercé
  • Segota D.
  • J. Sierpowska
  • G. Simantirakis
  • L. Sukupova
  • Z. Thrapsanioti
  • E. Vaño

Institutes & Expert groups

  • STUK - Radiation and Nuclear Safety Authority
  • KBCRI - University Hospital Rijeka - Clinical Hospital Center of Rijeka
  • Paris-Sud University Hospitals
  • UCM - Complutens University of Madrid - San Carlos Hospital
  • St. James's Hospital
  • University of Turku - Turku university hospital
  • IOV IRCCS - Istituto Oncologico Veneto - Italy
  • Li.U - Linköping University
  • Central Hospital of Northern Karelia, Joensuu
  • Institute for clinical an experimental medicine
  • EEAE – Greek Atomic Energy Commission
  • LEAC CNRS - National Council for Scientific Research - Lebanese Atomic Energy Commission
  • University of Belgrade - Vinča Institute of Nuclear Sciences
  • NIOM - Nofer Institute of Occupational Medicine
  • RBI - Ruđer Bošković Institute
  • Centre d’Assurance de qualité des Applications Technologiques dans le domaine de la Santé
  • IRA - Institute of Radiation Physics, University Hospital of Lausanne

Documents & links


Interventional cardiac procedures may be associated with high patient doses and therefore require special attention to protect the patients from radiation injuries such as skin erythema, cardiovascular tissue reactions or radiation-induced cancer. In this study, patient exposure data is collected from 13 countries (37 clinics and nearly 50 interventional rooms) and for 10 different procedures. Dose data was collected from a total of 14,922 interventional cardiology procedures. Based on these data European diagnostic reference levels (DRL) for air kerma-area product are suggested for coronary angiography (CA, DRL=35 Gy cm2), percutaneous coronary intervention (PCI, 85 Gy cm2), transcatheter aortic valve implantation (TAVI, 130 Gy cm2), electrophysiological procedures (12 Gy cm2) and pacemaker implantations. Pacemaker implantations were further divided into single-chamber (2.5 Gy cm2) and dual chamber (3.5 Gy cm2) procedures and implantations of cardiac resynchronization therapy pacemaker (18 Gy cm2). Results show that relatively new techniques such as TAVI and treatment of chronic total occlusion (CTO) often produce relatively high doses, and thus emphasises the need for use of an optimization tool such as DRL to assist in reducing patient exposure. The generic DRL presented here facilitate comparison of patient exposure in interventional cardiology.


Original languageEnglish
Pages (from-to)42-48
Number of pages7
JournalPhysica Medica
Publication statusPublished - 1 Oct 2018


  • Diagnostic reference levels, interventional cardiology

ID: 4752856