Dose Conversion Factors in Coronary Diagnostic and Therapeutic Interventions: The Good, the Bad, and the challenges of Dose Estimation

Interventional cardiology procedures, particularly coronary angiography (CA) and percutaneous coronary intervention (PCI), are among the most radiation-intensive medical imaging techniques. Accurate estimation of patient radiation dose is essential for risk assessment, dose optimization, and the development of diagnostic reference levels. This scoping review critically analyzes the current literature on dose conversion factors based on kerma-area product (KAP) for estimating effective (E) and organ-specific (HT) doses in adult patients undergoing CA and PCI. A total of 14 studies meeting defined eligibility criteria were included, encompassing methodologies such as Monte Carlo simulations (e.g., PCXMC, Geant4), physical phantoms, and clinical measurements. Reported E/KAP factors varied from 0.14 to 0.33 mSv/Gy·cm², with PCI generally yielding higher values. HT/KAP values were notably highest for lungs and varied based on sex, anatomy, and procedural parameters. Technical factors such as X-ray filtration also significantly influenced dose estimation. The findings highlight substantial methodological heterogeneity and emphasize the need to standardize conversion factor recommendations across settings. Future efforts should focus on integrating personalized dosimetry, artificial intelligence tools, and real-time dose monitoring to enhance radiological safety and ensure consistent practice in interventional cardiology.