OBJECTIVES: To present a national survey that was performed for the establishment of national reference levels (RLs) for interventional cardiology (IC) procedures and to estimate the effective dose (E) received by the patient during these procedures.METHODS: Data concerning the fluoroscopy time and air kerma-area product (P KA) during coronary angiography (CA), percutaneous coronary intervention (PCI), pacemaker implantation (PMI) and radiofrequency cardiac ablation (RFCA) from 26 centres were collected. Moreover, measurements concerning the performance of X-ray systems used in IC were performed in order to set system-related reference levels. P KA to E conversion factors were also calculated.RESULTS: The suggested P KA RLs for CA, PCI, PMI and RFCA are 53 Gycm(2), 129 Gycm(2), 36 Gycm(2) and 146 Gycm(2), respectively, and the estimated E to the patient from these procedures is 9.7 mSv, 26.8 mSv, 5.5 mSv and 20.4 mSv, respectively. Reference levels for the fluoroscopic dose rate and dose per frame during image acquisition at the entrance of a water phantom are 29 mGy/min and 0.23 mGy/frame, respectively.CONCLUSIONS: The suggested RLs are comparable to those suggested by other studies. Additional information concerning the complexity of the procedures and patient pathology should be collected for future reevaluation of the suggested RLs.KEY POINTS: • The radiation dose imparted during fluoroscopically guided interventional procedures can be high • Understanding of reference levels might help optimise interventional cardiological procedures • Optimisation by changing the systems' settings seems feasible in some cases • Procedure complexity and the patient's clinical problem should be taken into account.