Variations of Patient Doses in Interventional Examinations at Different Angiographic Units

  • Doğan BorEmail author
  • Türkay Toklu
  • Turan Olğar
  • Tanzer Sancak
  • Saruhan Çekirge
  • Baran Önal
  • Sadık Bilgiç



We analyzed doses for various angiographic procedures using different X-ray systems in order to assess dose variations.


Dose-area product (DAP), skin doses from thermoluminescent dosimeters and air kerma measurements of 308 patients (239 diagnostic and 69 interventional) were assessed for five different angiographic units. All fluoroscopic and radiographic exposure parameters were recorded online for single and multiprojection studies. Radiation outputs of each X-ray system were also measured for all the modes of exposure using standard protocols for such measurements.


In general, the complexity of the angiographic procedure was found to be the most important reason for high radiation doses. Skill of the radiologist, management of the exposure parameters and calibration of the system are the other factors to be considered. Lateral cerebral interventional studies carry the highest risk for deterministic effects on the lens of the eye. Effective doses were calculated from DAP measurements and maximum fatal cancer risk factors were found for carotid studies.


Interventional radiologists should measure patient doses for their examinations. If there is a lack of necessary instrumentation for this purpose, then published dose reports should be used in order to predict the dose levels from some of the exposure parameters. Patient dose information should include not only the measured quantity but also the measured radiation output of the X-ray unit and exposure parameters used during radiographic and fluoroscopic exposures.


Dose-area product Dosimetry Interventional radiology 


  1. 1.
    Geise RA, O’Dea TJ (1999) Radiation dose in interventional fluoroscopic procedures. Appl Radiat Isotopes 50:173–184.CrossRefGoogle Scholar
  2. 2.
    Le Heron JC (1992) Estimation of effective dose to the patient during the medical X-ray examinations from measurement of the dose-area product. Phys Med Biol 37:2117–2126.CrossRefPubMedGoogle Scholar
  3. 3.
    International Electrotechnical Commission (2000) Medical electrical equipment. Part 2-43: Particular requirements for the safety of X-ray equipment for interventional procedures. IEC report 60601. Geneva, 606012–43Google Scholar
  4. 4.
    McParland BJ (1998) A study of patient radiation doses in interventional radiological procedures. Br J Radiol 71:175–185.CrossRefPubMedGoogle Scholar
  5. 5.
    Bor D, Sancak T, Olgar T, et al. (2004) Comparison of effective doses obtained from dose-area product and air kerma measurements in interventional radiology. Br J Radiol 77:315–322CrossRefPubMedGoogle Scholar
  6. 6.
    Institute of Physics and Engineering in Medicine (1997) Recommended standards for the routine performance testing of diagnostic X-ray imaging systems. IPEM report no. 77. YorkGoogle Scholar
  7. 7.
    McParland BJ (1998) Entrance skin dose estimates derived from dose-area product measurements in interventional radiological procedures. Br J Radiol 71:1288–1295.CrossRefPubMedGoogle Scholar
  8. 8.
    Jones DG, Wall BF (1985) Organ doses from medical X-ray examinations calculated using Monte Carlo techniques. NRPB report 186. HMSO, LondonGoogle Scholar
  9. 9.
    Hart D, Jones DG, Wall BF (1994) Normalized organ doses for medical X-ray examinations calculated using Monte Carlo techniques. NRPB report NRPB-SR 262. HMSO, LondonGoogle Scholar
  10. 10.
    Le Heron JC (1994) XDOSE X-ray radiography dosimetry program using NRPB SR-262 Organ Doses. National Radiation Laboratory, Christchurch. Ministry of Health, New Zealand.Google Scholar
  11. 11.
    Ruiz-Cruces R, Garcia-Granados J, Diaz Ramero FJ, et al. (1998) Estimation of effective dose in some digital angiographic and interventional procedures. Br J Radiol 71:42–47.CrossRefPubMedGoogle Scholar
  12. 12.
    Steele HR, Temperton DH (1993) Patient doses received during digital subtraction angiography. Br J Radiol 66:452-456.CrossRefPubMedGoogle Scholar
  13. 13.
    European Commission (1996) European guidelines on quality criteria for diagnostic radiographic images. EUR 16260-EN Office for Official Publications of the European Communities, Luxembourg.Google Scholar
  14. 14.
    European Commission (1998) Radiation protection in interventional radiology. ERPET (European Radiation Protection Education and Training Course). Complutense University and CIEMAT. Proceedings published by the EC (Ref. XII-237–98)Google Scholar
  15. 15.
    Marshall NW, Noble J, Faulkner K (1995) Patient and staff dosimetry in neuroradiological procedures. Br J Radiol 68:495–501CrossRefPubMedGoogle Scholar
  16. 16.
    Bergeron P, Carrier R, Roy D, et al. (1994) Radiation doses to patients in neurointerventional procedures. AJNR Am J Neuroradiol 15:1809–1812.PubMedGoogle Scholar
  17. 17.
    Mini RL, Schmid B, Schneeberger P, et al. (1999) Dose-area product measurements during angiographic X ray procedures. Radiat Prot Dosim 80:145–148.CrossRefGoogle Scholar
  18. 18.
    Ruiz-Cruces R, Perez-Martinez M, Martin-Palance A, et al. (1997) Patient dose in radiologically guided interventional vascular procedures: conventional versus digital systems. Radiology 205:385–393.CrossRefPubMedGoogle Scholar
  19. 19.
    Williams J (1997) The interdependence of staff and patient doses in interventional radiology. Br J Radiol 70:498–503.CrossRefPubMedGoogle Scholar
  20. 20.
    Kemerink GJ, Kicken PJH, Schultz FW, et al. (1999) Patient dosimetry in abdominal arteriography. Phys Med Biol 44:1133–1345.CrossRefPubMedGoogle Scholar
  21. 21.
    Kicken PJH, Koster D, Kemerink GJ (1999) Exposure conditions of patients in vascular radiology. Radiat Prot Dosim 86:129–137.CrossRefGoogle Scholar
  22. 22.
    Zoetelief J, Geleijns J, Kicken PJH, et al. (1998) Diagnostic reference levels derived from recent surveys on patient dose for various types of radiological examinations in the Netherlands. Radiat Prot Dosim 80:109–114.CrossRefGoogle Scholar
  23. 23.
    Hoskins PR, Gillespie J, Ireland HM (1996) Patient dose measurements from femoral angiography. Br J Radiol 69:1159–1164.CrossRefPubMedGoogle Scholar
  24. 24.
    Castellano IA, McNeil JG, Thorp NC, et al. (1995) Assessment of organ radiation doses and associated risk for digital femoral angiography. Br J Radiol 68:502–507.CrossRefPubMedGoogle Scholar
  25. 25.
    Gfirtner H, Giesse E, Schmidt T (1998) Dosimetric methods for and influence of exposure parameters on the establishment of reference doses for examinations using fluoroscopy. Radiat Prot Dosim 80:121–128.CrossRefGoogle Scholar
  26. 26.
    Vano E, Gonzales L, Fernandez JM, et al. (1995) Patient dose values in interventional radiology. Br J Radiol 68:1215–1220.CrossRefPubMedGoogle Scholar
  27. 27.
    Norbash AM, Busick D, Marks MP (1996) Techniques for reducing interventional neuroradiologic skin dose: tube position rotation and supplemental beam filtration. AJNR Am J Neuroradiol 17:41–49.PubMedGoogle Scholar
  28. 28.
    Berthelsen P, Cederblad A (1991) Radiation doses to patients and personal involved in embolization of intracerebral arteriovenous malformation. Acta Radiol 32:492–497.CrossRefPubMedGoogle Scholar
  29. 29.
    O’Dea TJ, Geise RA (1997) Potential for radiation induced skin damage in neurological procedures: a review of 522 cases using automated dosimetry. Med Phys 24:969–970.Google Scholar
  30. 30.
    Verdun FR, Capasso P, Valley JF, et al. (1999) Dose evaluation in fluoroscopy. Radiat Prot Dosim 80:139–141.CrossRefGoogle Scholar
  31. 31.
    Gkanatsios NA, Huda W, Peters KR (2002) Adult patient doses in interventional neuroradiology. Med Phys 29:717–723.CrossRefPubMedGoogle Scholar
  32. 32.
    International Commission on Radiological Protection (1991) 1990 recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann ICRP 21–3Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Doğan Bor
    • 1
    Email author
  • Türkay Toklu
    • 1
  • Turan Olğar
    • 1
  • Tanzer Sancak
    • 2
  • Saruhan Çekirge
    • 3
  • Baran Önal
    • 4
  • Sadık Bilgiç
    • 2
  1. 1.Department of Engineering PhysicsAnkara University Faculty of EngineeringTandoğanTurkey
  2. 2.Department of Interventional Radiologyİbni Sina Hospital, Ankara University Faculty of MedicineSıhhiyeTurkey
  3. 3.Department of RadiologyHacettepe University Faculty of MedicineSıhhiyeTurkey
  4. 4.Department of RadiologyGazi University Faculty of MedicineBeşevlerTurkey

Personalised recommendations