Establishment of National Diagnostic Reference Levels for Coronary Angiography and Interventional Procedures

초록

This study aims to establish national diagnostic reference levels (DRLs) for coronary angiography (CAG) and interventional procedures in the Republic of Korea (ROK), providing objective standards to optimize patient radiation exposure. Data were collected from the second through the fourth quarter of 2024 from 20 certified medical institutions. A total of 1,980 cases involving seven major procedures-including CAG, percutaneous coronary intervention (PCI), and chronic total occlusion (CTO) procedure were analyzed. Using digital imaging and communications in medicine (DICOM) radiation dose structured reports (RDSRs) and procedure reports, the dose area product (DAP) and fluoroscopy time (FT) were evaluated. The DRLs were defined as the 75th percentile of the dose distributions. CTO showed highest values with a DAP of 106.83 Gy‧cm2 and an FT of 2,819.00 seconds, reflecting high procedural complexity. In contrast, diagnostic CAG showed the lowest values with a DAP of 18.68 Gy‧cm2 and an FT of 440.00 seconds. The DAP and FT for combined CAG+PCI was 63.40 Gy‧cm2 and 1,201.50 seconds. Overall, the derived Korean DRLs were generally lower than those reported in major developed countries. This study presents the first national DRLs for cardiac interventional procedures in the ROK based on multicenter clinical data. These findings provide a foundational baseline for the management of radiation safety and dose optimization in clinical practice. Copyright © Korea Disease Control and Prevention Agency.

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