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Submitted by AUBERT Bernard, IRSN (Institute of Radiation protection and Nuclear Safety)
   Commenting as an individual
Document Patient and Staff Radiological Protection in Cardiology
General comment: "Risk of stochactic effect" is more suited than ''Stochastic risk" (lines 192, 1744, 2247, 2257 and 2259)

Page 9, § 8: Occupational exposure is included in QAP. In general, QA concerns only image quality and patient dose. Moreover it is written (l 320 and 321) that cardiologist and medical physicist are in charge of QAP. If occupational exposure is included in QAP, RPe and/or RPO must be added.

Some figures in Table 2.1 and in Table 7.1 are not at the right place or must be cancelled.

Lines 1435 to 1443: the unit of the dose is in Sv. It is better to use Gy, in order to avoid confusion with effective dose and to be coherent with the other values of organ dose expressed in Gy.

l 2032: correct "radiological"

l 2220: it is not possible the know the total patient dose, replace it by the total KAP.

l 2228: "...dose from the procedure is high". It will be useful to precise an order of magnitude (i.e; skin dose > 2 Gy)

l 2256: " relatively high" Is it possible to precide (abovr 50, 60 ?)

l 2260: Children have longer lifeexpectancies... and acts are often iterative.

l 2284: Optimisation does not concern only obese patients. A medical physicist can provide useful advice whatever the patient age or weight.

l 2319: Is the value "100 Gy" correct?

l 2338: Complete "Table 5.1 provides some practical advices to reduce patient doses".

p 67, table 5.1: add a line "Minimize the pulse rate for fluoroscopy series".

p 79, Table 6.1: It would be interesting to complete the table 6 with the recent recommendations of ORAMED.

l 3536: complete "Dose from cardiac CT...on time per rotation...".

l 3557: I do not think that "CT attenuationcorrection of nuclear cardiology image data" is widely used in practice. It can be cancelled from the sentence.

§ 8.5: It would be useful to complete this paragraph with organ dose values (in mGy) in particular for breast.

l 3837-3840: "For all patients, with the possible exception of patients scanned on a multiple-source scanner with variable pitch, rate-control agents should be given as needed with the goal of decreasing heart rate to approximately 60 beats per minute." Rate-control agents can be given to each patient. This advice is not linked to the optimisation process.

§9.3.2: Here again the recommendationsof ORAMED concerning the training could be mentionned.

l 4422_4424: The sentences "For CT examinations....... administered activity" are nor consistent with the paragraph.