Heart, Lung and Circulation

Impact of Patient BMI on Patient and Operator Radiation Dose During Percutaneous Coronary Intervention

Published:October 12, 2021DOI:


      This study sought to investigate patient and operator radiation dose in patients undergoing percutaneous coronary intervention (PCI) and the impact of body mass index (BMI) on patient and operator dose.


      In patients undergoing PCI, radiation dose parameters, baseline characteristics and procedural data were collected in a tertiary centre for 3.5 years. Operators wore real time dosimeters. Patients were grouped by BMI. Dose area product (DAP) and operator radiation dose were compared across patient BMI categories. Multivariable analysis was performed to investigate the impact of patient BMI and other procedural variables on patient and operator dose.


      2,043 patients underwent 2,197 PCI procedures. Each five-unit increase in BMI increased patient dose (expressed as DAP) by an average 31% (95% CI: 29–33%) and operator dose by 27% (95% CI: 20–33%). Patient dose was 2.3 times higher and operator dose was 2.4 times higher in patients with a BMI>40 than for normal BMI patients. Multivariable analysis indicated that there were many procedural factors that were predictors for increasing operator dose and patient dose but that patient BMI was a major contributor for both operator dose and patient dose.


      Increasing BMI increases the DAP and operator dose for PCI procedures and BMI is demonstrated to be a major factor that contributes to both patient and operator radiation dose.


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        • Hashimoto I.
        • Sedo H.
        • Inatsugi K.
        • Nakanishi H.
        • Arase S.
        Severe radiation-induced injury after cardiac catheter ablation: a case requiring free anterolateral thigh flap and vastus lateralis muscle flap reconstruction on the upper arm.
        J Plast Reconstr Aesthet Surg. 2008; 61: 704-708
        • Hirshfeld Jr., J.W.
        • Balter S.
        • Brinker J.A.
        • Kern M.J.
        • Klein L.W.
        • Lindsay B.D.
        • et al.
        ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training.
        Circulation. 2005; 111: 511-532
        • Reichman E.F.
        Fluoroscopy-induced radiation dermatitis.
        J Emerg Med. 2014; 47: e117-e119
        • Wagner L.K.
        Radiation injury is a potentially serious complication to fluoroscopically-guided complex interventions.
        Biomed Imaging Interv J. 2007; 3: e22
      1. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103.
        Ann ICRP. 2007; 37: 1-332
        • Cousins C.
        • Miller D.L.
        • Bernardi G.
        • Rehani M.M.
        • Schofield P.
        • Vano E.
        • et al.
        ICRP PUBLICATION 120: radiological protection in cardiology.
        Ann ICRP. 2013; 42: 1-125
        • Klein L.W.
        • Goldstein J.A.
        • Haines D.
        • Chambers C.
        • Mehran R.
        • Kort S.
        • et al.
        SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory: Shifting the Paradigm for Healthcare Workers' Protection.
        J Am Coll Cardiol. 2020; 75: 1718-1724
        • Roguin A.
        • Goldstein J.
        • Bar O.
        • Goldstein J.A.
        Brain and neck tumors among physicians performing interventional procedures.
        Am J Cardiol. 2013; 111: 1368-1372
        • Andreassi M.G.
        • Borghini A.
        • Vecoli C.
        • Piccaluga E.
        • Guagliumi G.
        • Del Greco M.
        • et al.
        Reproductive outcomes and y chromosome instability in radiation-exposed male workers in cardiac catheterization laboratory.
        Environ Mol Mutagen. 2019;
        • Shah A.
        • Das P.
        • Subkovas E.
        • Buch A.N.
        • Rees M.
        • Bellamy C.
        Radiation dose during coronary angiogram: relation to body mass index.
        Heart Lung Circ. 2015; 24: 21-25
        • Vano E.
        • Miller D.L.
        • Martin C.J.
        • Rehani M.M.
        • Kang K.
        • Rosenstein M.
        • et al.
        ICRP publication 135: diagnostic reference levels in medical imaging.
        Ann ICRP. 2017; 46: 1-144
        • Madder R.D.
        • VanOosterhout S.
        • Mulder A.
        • Ten Brock T.
        • Clarey A.T.
        • Parker J.L.
        • et al.
        Patient body mass index and physician radiation dose during coronary angiography.
        Circ Cardiovasc Interv. 2019; 12: e006823
        • Crowhurst J.A.
        • Whitby M.
        • Savage M.
        • Murdoch D.
        • Robinson B.
        • Shaw E.
        • et al.
        Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography.
        J Med Radiat Sci. 2019; 66: 20-29
        • Crowhurst J.A.
        • Whitby M.
        • Thiele D.
        • Halligan T.
        • Westerink A.
        • Crown S.
        • et al.
        Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals.
        J Med Radiat Sci. 2014; 61: 135-141
        • D'Helft C.J.
        • Brennan P.C.
        • McGee A.M.
        • McFadden S.L.
        • Hughes C.M.
        • Winder J.R.
        • et al.
        Potential Irish dose reference levels for cardiac interventional examinations.
        Br J Radiol. 2009; 82: 296-302
      2. Obesity: preventing and managing the global epidemic. Report of a WHO consultation.
        World Health Organ Tech Rep Ser. 2000; 894: 1-253
        • Betsou S.
        • Efstathopoulos E.P.
        • Katritsis D.
        • Faulkner K.
        • Panayiotakis G.
        Patient radiation doses during cardiac catheterization procedures.
        Br J Radiol. 1998; 71: 634-639
        • National Council on Radiation Protection and Measurements
        Radiation dose management for fluoroscopically-guided interventional medical procedures. NCRP Report 168. National Council on Radiation Protection and Measurements, Bethesda MD USAJuly 2010
        • Australian Institute of Health and Welfare 2018
        Australia’s health 2018. Australia’s health series no. 16. AUS 221. AIHW, Canberra2018
        • Lavie C.J.
        • Milani R.V.
        • Ventura H.O.
        Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss.
        J Am Coll Cardiol. 2009; 53: 1925-1932
        • Kuon E.
        • Dahm J.B.
        • Empen K.
        • Robinson D.M.
        • Reuter G.
        • Wucherer M.
        Identification of less-irradiating tube angulations in invasive cardiology.
        J Am Coll Cardiol. 2004; 44: 1420-1428
        • Crowhurst J.A.
        • Scalia G.M.
        • Whitby M.
        • Murdoch D.
        • Robinson B.J.
        • Turner A.
        • et al.
        Radiation exposure of operators performing transesophageal echocardiography during percutaneous structural cardiac interventions.
        J Am Coll Cardiol. 2018; 71: 1246-1254
        • Sadick V.
        • Reed W.
        • Collins L.
        • Sadick N.
        • Heard R.
        • Robinson J.
        Impact of biplane versus single-plane imaging on radiation dose, contrast load and procedural time in coronary angioplasty.
        Br J Radiol. 2010; 83: 379-394
        • Smith K.
        • Crowhurst J.
        • Walters D.
        • Starkey D.
        Bi-Plane and single plane angiography: a study to compare contrast usage and radiation doses for adult cardiac patients in diagnostic studies.
        Br J Radiol. 2018; : 20180367
        • Maccia C.
        • Malchair F.
        • Gobert I.
        • Louvard Y.
        • Lefevre T.
        Assessment of local dose reference values for recanalization of chronic total occlusions and other occlusions in a high-volume catheterization center.
        Am J Cardiol. 2015; 116: 1179-1184
        • Eisenberg M.J.
        • Afilalo J.
        • Lawler P.R.
        • Abrahamowicz M.
        • Richard H.
        • Pilote L.
        Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction.
        CMAJ. 2011; 183: 430-436
        • Weisz G.
        • Metzger D.C.
        • Caputo R.P.
        • Delgado J.A.
        • Marshall J.J.
        • Vetrovec G.W.
        • et al.
        Safety and feasibility of robotic percutaneous coronary intervention: PRECISE (Percutaneous Robotically-Enhanced Coronary Intervention) Study.
        J Am Coll Cardiol. 2013; 61: 1596-1600