Skip to main content
SpringerLink
Log in

La gestione della dose in radiologia interventistica

  • Chapter
Book cover La dose al paziente in diagnostica per immagini

Part of the book series: Imaging & Formazione ((IMAG))

  • 747 Accesses

Riassunto

Le procedure di radiologia interventistica a guida fluoroscopica studiano la vascolarizzazione e le potenziali patologie ad essa connesse utilizzando le radiazioni ionizzanti per guidare piccoli strumenti, quali i cateteri, attraverso i vasi sanguigni. La tecnica fluoroscopica è diventata parte integrante della pratica radiologica sin dall’inizio del XX secolo. Inizialmente le procedure di fluoroscopia erano, per la maggior parte, di tipo diagnostico, miravano cioè solo a identificare un problema clinico, e comportavano rischi relativamente piccoli per i pazienti e il personale coin volto. Tuttavia, negli ultimi 20 anni, la percentuale di procedure terapeutiche è aumentata progressivamente [1]. Si è assistito negli ultimi decenni a un crescente ampliamento delle possibilità procedurali nell’ambito dell’interventistica fluoroscopica, anche grazie allo sviluppo di sempre nuove tecnologie. Trattamenti quali vertebroplastiche, ablazioni a radiofrequenza, chemioterapie intra-arteriose, endoprotesi aortiche e rivascolarizzazioni arteriose periferiche costituiscono oggi parte integrante della pratica clinica in numerosi centri a livello mondiale per i trattamenti in ambito vascolare e oncologico. Di fronte alla crescita della richiesta di prestazioni interventistiche, la ricerca industriale ha implementato progressivamente la strumentazione, introducendo sistemi a basso profilo (quali catereri, palloncini e guide) specifici per ciascun distretto vascolare e non. Tale strumentazione consente oggi il trattamento di strutture sempre più periferiche e di piccolo calibro, a fronte di una minore incidenza di complicanze e di un maggior successo procedurale.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 44.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 59.95
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliografia

  1. Miller DL (2008) Overview of contemporary interventional fluoroscopy procedures. Health Phys 95:638–644

    Article  PubMed  CAS  Google Scholar 

  2. Stecker MS, Balter S, Towbin RB et al for the SIR Safety and Health Committee and CIRSE Standards of Practice Committee (2009) Guidelines for patient radiation dose management. J Vasc Interv Radiol 20:S263–S273

    Article  PubMed  Google Scholar 

  3. Miller DL, Vañó E, Bartal G et al for the Cardiovscular and Interventional Radiology Society of Europe and Society of Interventional Radiology (2010) Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cardiovasc Intervent Radiol 33:230–239

    Article  PubMed  Google Scholar 

  4. Steele JR, Jones AK, Ninan EP (2012) Quality initiatives: establishing an interventional radiology patient radiation safety program. Radiographics 32:277–287

    Article  PubMed  Google Scholar 

  5. International Commission on Radiological Protection (2000) Publication 85: Avoidance of radiation injuries from medical interventional procedures. Ann. ICRP. Pergamon Press, Oxford

    Google Scholar 

  6. Miller DL, Balter S, Schueler BA et al (2010) Clinical radiation management for fluoroscopically guided interventional procedures. Radiology 257:321–332

    Article  PubMed  Google Scholar 

  7. Pierce DA, Preston DL (2000) Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 154:178–186

    Article  PubMed  CAS  Google Scholar 

  8. Wagner LK, Eifel PJ, Geise RA (1994) Potential biological effects following high X-ray dose interventional procedures. Vasc Interv Radiol 5:71–84

    Article  CAS  Google Scholar 

  9. Koenig TR, Mettler FA, Wagner LK (2001) Skin injuries from fluoroscopically guided procedures: part 2, review of 73 cases and recommendations for minimizing dose delivered to patient. AJR Am J Roentgenol 177:13–20

    Article  PubMed  CAS  Google Scholar 

  10. Limacher MC, Douglas PS, Germano G et al (1998) ACC expert consensus document. Radiation safety in the practice of cardiology. American College of Cardiology. J Am Coll Cardiol 31:892–913

    Article  PubMed  CAS  Google Scholar 

  11. Mettler FA, Koenig TR, Wagner LK, Kelsey CA (2002) Radiation injuries after fluoroscopic procedures. Semin Ultrasound CT MR 23:428–442

    Article  PubMed  Google Scholar 

  12. International Commission on Radiological Protection (1992) The biological basis for dose limitation in the skin. Pergamon, Oxford

    Google Scholar 

  13. Wagner LK (2000) Management of patient skin dose in fluoroscopically guided interventional procedures. J Vasc Interv Radiol 11:25–33

    Article  PubMed  CAS  Google Scholar 

  14. Shope TB (1996) Radiation-induced skin injuries from fluoroscopy. Radiographics 16:1195–1199

    PubMed  CAS  Google Scholar 

  15. Wagner LK, McNeese MD, Marx MV, Siegel EL (1999) Severe skin reactions from interventional fluoroscopy: case report and review of the literature. Radiology 213:773–776

    PubMed  CAS  Google Scholar 

  16. Neofotistou V, Vano E, Padovani R et al (2003) Preliminary reference levels in interventional cardiology. Eur Radiol 13:2259–2263

    Article  PubMed  CAS  Google Scholar 

  17. Committee on the Biological Effects of Ionizing Radiations. National Research Council (1990) Health effects of exposure to low levels of ionizing radiation. National Academy Press, Washington, DC

    Google Scholar 

  18. Van Dam J, Bosmans H, Marchal G, Wambersie A (2005) Characteristics of dosemeter types for skin dose measurements in practice. Radiat Prot Dosimetry 117:185–189

    PubMed  Google Scholar 

  19. Balter S (2006) Methods for measuring fluoroscopic skin dose. Pediatr Radiol 36:136–140

    Article  PubMed  Google Scholar 

  20. Toivonen M (2001) Review of dosimetry instrumentation in digital and interventional radiology. Radiat Prot Dosimetry94:147–150

    Article  PubMed  CAS  Google Scholar 

  21. Delle Canne S, Carosi A, Bufacchi A et al (2006) Use of GAFCHROMIC XR Type R films for skin-dose measurements in interventional radiology: Validation of a dosimetric procedure on a sample of patients undergone interventional cardiology. Phys Med 22:105–110

    Article  Google Scholar 

  22. Johnson PB, Borrego D, Balter S et al (2011) Skin dose mapping for fluoroscopically guided interventions. Med Phys 38:5490–5499

    Article  PubMed  Google Scholar 

  23. Hirshfeld JW, Balter S, Brinker JA et al (2005) ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: A report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Circulation 111:511–532

    Article  PubMed  Google Scholar 

  24. Miller DL, Balter S, Noonan PT et al (2002) Minimizing radiation induced skin injury in interventional radiology procedures. Radiology 225:329–336

    Article  PubMed  Google Scholar 

  25. Miller DL, Balter S, Wagner LK et al (2004) Quality improvement guidelines for recording patient radiation dose in the medical record. J Vasc Interv Radiol 15:423–429

    Article  PubMed  Google Scholar 

  26. Tsapaki V, Kottou S, Kollaros N et al (2004) Dose perfomance evaluation of a charge coupled device and a flat-panel digital fluoroscopy system recently installed in an interventional cardiology laboratory. Radiat Prot Dosimetry 111:297–304

    Article  PubMed  Google Scholar 

  27. Vano E, Geiger B, Schreiner A et al (2005) Dynamic flat panel detector versus image intensifier in cardiac imaging: dose and image quality. Phys Med Biol 50:5731–5742

    Article  PubMed  CAS  Google Scholar 

  28. Trianni A, Bernardi G, Padovani R (2006) Are new technologies always reducing patient dose in cardiac procedures? Radiat Prot Dosimetry 11:97–101

    Article  Google Scholar 

  29. Davies AG, Cowen AR, Kengyelics SM et al (2007) Do a flat detector cardiac x-ray systems convey advantages over image-intensifier-based systems? study comparing x-ray dose and image quality. Eur Radiol 17:1787–1794

    Article  PubMed  Google Scholar 

  30. Bogaert E, Bacher K, Lapere R, Thierens H (2009) Does digital flat detector technology tip the scale towards better image quality or reduced patient dose in interventional cardiology?. Eur J Radiol 72:348–353

    Article  PubMed  CAS  Google Scholar 

  31. Kuon E, Glaser C, Dahm JB (2003) Effective techniques for reduction of radiation dosage to patients undergoing invasive cardiac procedures. Br J Radiol 76:406–413

    Article  PubMed  CAS  Google Scholar 

  32. Koenig TR, Wolff D, Mettler FA et al (2001) Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. AJR Am J Roentgenol 177:3–11

    Article  PubMed  CAS  Google Scholar 

  33. Vlietstra RE, Wagner LK, Koenig T et al (2004) Radiation burns as a severe complication of fluoroscopically guided cardiological interventions. J Interv Cardiol 17:131–142

    Article  PubMed  Google Scholar 

  34. Vano E, Arranz L, Sastre JM et al (1998) Dosimetric and radiation protection considerations based on some cases of patient skin injuries in interventional cardiology. Br J Radiol 71:510–516

    PubMed  CAS  Google Scholar 

  35. Geijer H, Beckman KW, Andersson T et al (2002) Radiation dose optimization in coronary angiography and percutaneous coronary intervention (PCI). I. Experimental studies. Eur Radiol 12:2571–2581

    Google Scholar 

  36. Fenner JW, Morrison GD, Kerry J et al (2002) A practical demonstration of improved technique factors in paediatric fluoroscopy. Br J Radiol 75:596–602

    PubMed  CAS  Google Scholar 

  37. http://www.cancer.gov/cancertopics/causes/radiation/interventionalfluoroscopy/allpages. Ultimo accesso 9 aprile 2012

  38. Hall EJ (2009) Radiation biology for pediatric radiologists. Pediatr Radiol 39:S57–S64

    Article  PubMed  Google Scholar 

  39. Sidhu MK, Goske MJ, Coley BJ et al (2009) Image gently, step lightly: increasing radiation dose awareness in pediatric interventions through an international social marketing campaign. J Vasc Interv Radiol 20:1115–1119

    Article  PubMed  Google Scholar 

  40. Bryk SG, Censullo ML, Wagner LK et al (2006) Endo vascular and interventional procedures in obese patients: a review of procedural technique modifications and radiation management. J Vasc Interv Radiol 17:27–33

    Article  PubMed  Google Scholar 

  41. Yanch JC, Behrman RH, Hendricks MJ, McCall JH (2009) Increased radiation dose to overweight and obese patients from radiographic examinations. Radiology 252:128–139

    Article  PubMed  Google Scholar 

  42. Geleijns J, Wondergem J (2005) X-ray imaging and the skin: radiation biology, patient dosimetry and observed effects. Radiat Prot Dosimetry 114:121–125

    Article  PubMed  Google Scholar 

  43. Hymes SR, Strom EA, Fife C (2006) Radiation dermatitis: clinical presentation, pathophysiology, and treatment. J Am Acad Dermatol 54:28–46

    Article  PubMed  Google Scholar 

  44. Balter S, Hopewell JW, Miller DL et al (2010) Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology 254:326–341

    Article  PubMed  Google Scholar 

  45. Bor D, Sancak T, Toklu T et al (2008) Effects of radiologists’ skill and experience on patient doses in interventional examinations. Radiat Prot Dosimetry 129:32–35

    Article  PubMed  Google Scholar 

  46. International Electrotechnical Commission (2000) Medical electrical equipment: part 2–43 — Particular requirements for the safety of X-ray equipment for interventional procedures. Report 60601. International Electrotechnical Commission, Geneva

    Google Scholar 

  47. International Electrotechnical Commission (2010) Medical electrical equipment: part 2–43 — Particular requirements for the safety of S-ray equipment for interventional procedures. Report 60601. 2nd edn. International Electrotechnical Commission, Geneva

    Google Scholar 

  48. The 2007 Recommendations of the International Commission on Radiological Protection (2007) ICRP publication 103. Ann ICRP 37(2–4):1–332

    Google Scholar 

  49. Radiation protection in medicine (2007) ICRP Publication 105. Ann ICRP 37:1–63

    Google Scholar 

  50. National Cancer Institute (2005) Interventional fluoroscopy: reducing radiation risks for patients and staff. NIH Publication No. 05-5286. National Cancer Institute, Bethesda. http://www.cancer.gov/cancertopics/interventionalfluoroscopy/allpages. Ultimo accesso 9 aprile 2012

    Google Scholar 

  51. Mahesh M (2001) Fluoroscopy: patient radiation exposure issues. Radiooraphics 21(4):1033–1045

    CAS  Google Scholar 

  52. Balter S, Moses J (2007) Managing patient dose in interventional cardiology. Catheter Cardiovasc Interv 70:244–249

    Article  PubMed  Google Scholar 

  53. Miller DL, Balter S, Wagner LK et al (2004) Quality improvement guidelines for recording patient radiation dose in the medical record. J Vasc Interv Radiol 15:423–429

    Article  PubMed  Google Scholar 

Download references

Authors
  1. A. Trianni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Negri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Bargellini
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Radiologia Diagnostica e Interventistica, Università di Pisa, Italy

    Davide Caramella , Fabio Paolicchi  & Lorenzo Faggioni ,  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Italia

About this chapter

Cite this chapter

Trianni, A., Negri, A., Bargellini, I. (2012). La gestione della dose in radiologia interventistica. In: Caramella, D., Paolicchi, F., Faggioni, L. (eds) La dose al paziente in diagnostica per immagini. Imaging & Formazione. Springer, Milano. https://doi.org/10.1007/978-88-470-2649-0_6

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2649-0_6

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2648-3

  • Online ISBN: 978-88-470-2649-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation