Establishment of national diagnostic reference levels for percutaneous coronary interventions (PCIs) in Thailand

Published:February 24, 2022DOI:


      • A large study of 22,737 Percutaneous coronary interventions in 76 Cath labs.
      • Established diagnostic reference level for lesions of different complexities.
      • Type C lesions found to have significantly higher doses than type B or A lesions.
      • Trans-radial approach showed lower doses than transfemoral approach.



      To establish national diagnostic reference levels (DRLs) for percutaneous coronary intervention (PCI) in Thailand for lesions of different complexity.


      Radiation dose quantity as kerma-area-product (KAP) and cumulative air-kerma at reference point (CAK) from 76 catheterization labs in 38 hospitals in PCI registry of Thailand was transferred online to central data management. Sixteen months data (May 2018 to August 2019) was analyzed. We also investigated role of different factors that influence radiation dose the most.


      Analysis of 22,737 PCIs resulted in national DRLs for PCI of 91.3 Gy.cm2 (KAP) and 1360 mGy (CAK). The NDRLs for KAP for type C, B2, B1 and A lesions were 106.8, 82.6, 67.9, and 45.3 Gy.cm2 respectively and for CAK, 1705, 1247, 962, and 790 mGy respectively. Thus, as compared to lesion A, lesion C had more than double the dose and B2 had nearly 1.6 times and B1 had 1.2 times CAK. Our DRL values are lower than other Asian countries like Japan and Korea and are in the middle range of Western countries. University hospital had significantly higher dose than private or public hospital possibly because of higher load of complex procedures in university hospitals and trainees performing the procedures. Transradial approach showed lower doses than transfemoral approach.


      This large multi-centric study established DRLs for PCIs which can act as reference for future studies. A hallmark of our study is establishment of reference levels for coronary lesions classified as per ACC/AHA and thus for different complexities.



      DRL (diagnostic reference levels), NDRL (national diagnostic reference levels), KAP (Kerma-area-product), CAK (cumulative air-kerma), PCI (percutaneous coronary intervention), CTO (chronic total occlusion), ICRP (International Commission on Radiological Protection), IQR (Interquartile range (covering 25th to 75th percentiles of the data)), CI (confidence interval)
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