Dose radiologica : livelli di riferimento in cardiologia interventistica.

La quantificazione dell’esposizione radiologica, cosiddetta dose Rx, continua ad essere oggetto di confusione e scarsa comprensione.

La causa è probabilmente legata al persistente ed esclusivo uso di varie unità di misura, tipiche del gergo tecnico della fisica, non utilizzabili direttamente dal personale sanitario e non comprensibili ai pazienti.

La dose Rx,  in base alla normativa attuale, deve essere indicata nella documentazione rilasciata alle persone trattate. I termini usati sono diversi secondo il tipo di radiazione, DAP, DLP, rispettivamente per i raggi X da angiografo o da TAC e MBq per la medicina nucleare.

In assenza di riferimenti, le dosi indicate in questi termini, dissuadono da ogni interesse. Inoltre in caso di impiego di diversi tipi di radiazione, come spesso avviene in cardiologia, non è possibile ottenere agevolmente la dose complessiva.

Come indicato dalle società scientifiche ¹, la dose assorbita, indicata nei referti  in Gy * cm2 , deve essere convertita in dose effettiva, espressa in mSv, in modo da avere un’unica unità di misura; utile per la somma delle dosi da fonti differenti e per i confronti con le dosi di riferimento, usate in procedure analoghe, nella stessa struttura.

A questo scopo può  servire l’uso del seguente abbaco che consente:

  • conversione da DAP a dose effettiva, in mSv
  • collocazione della dose rispetto al range usato nella struttura negli anni precedenti.

Abbaco dosi Rx

 

In caso di procedure cardiologiche in serie, come spesso avviene nei casi stabili, si può avere, dopo un ECG da sforzo dubbio,  una sequenza con:

  • Scintigrafia perfusionale da sforzo e a riposo: es. dose 10 mSv
  • Coro TC: es. dose 6 mSv
  • Coronarografia + angioplastica: es.  dose  20 mSv.

Il totale, 36 mSv, si avvicina al valore di 50 mSv, considerato critico per un aumento significativo, circa 1 percento, del rischio oncologico aggiuntivo, dovuto alle radiazioni. 50 mSv possono  essere superati in caso di procedure complesse o ripetute.

Una maggior consapevolezza della dose Rx, usata nelle procedure, permette di valutare il rapporto  rischio/beneficio e quindi l’appropriatezza, che sappiamo essere in forte dubbio, in una quota di almeno il 30% dei trattati in condizione di stabilità clinica ².

Le dosi di riferimento in questa struttura, negli scorsi due anni, sono in linea o appena inferiori a quelle riportate nel più recente studio internazionale ³ sull’esposizione radiologica in cardiologia interventistica, una delle maggiori fonti mediche di esposizione Rx.

 

vedi anche:

Dose radiologica effettiva: questa sconosciuta

dose radiologica

 

References

  1. The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. Picano E, Vañó E, Rehani MM, et al. . Eur Heart J. 2014 Jan 8.
  2. Patel MR, Bailey SR, Bonow RO, et al. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization. J Am Coll Cardiol 2012; 59:1995–2027. Abstract
  3. Sciahbasi A, Frigoli E, Sarandrea A, et al. Radiation Exposure and Vascular Access in Acute Coronary Syndromes: The RADMatrix Trial, Journal of the American College of Cardiology (2017). doi:10.1016/j. J Am Coll Cardiol  2017 May 23, 2530-7.

 

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