Advertisement

European Radiology

, Volume 26, Issue 1, pp 79–86 | Cite as

Real-time eye lens dose monitoring during cerebral angiography procedures

  • M. J. Safari
  • J. H. D. Wong
  • K. A. A. Kadir
  • N. K. Thorpe
  • D. L. Cutajar
  • M. Petasecca
  • M. L. F. Lerch
  • A. B. Rosenfeld
  • K. H. NgEmail author
Vascular-Interventional

Abstract

Objectives

To develop a real-time dose-monitoring system to measure the patient’s eye lens dose during neuro-interventional procedures.

Methods

Radiation dose received at left outer canthus (LOC) and left eyelid (LE) were measured using Metal-Oxide-Semiconductor Field-Effect Transistor dosimeters on 35 patients who underwent diagnostic or cerebral embolization procedures.

Results

The radiation dose received at the LOC region was significantly higher than the dose received by the LE. The maximum eye lens dose of 1492 mGy was measured at LOC region for an AVM case, followed by 907 mGy for an aneurysm case and 665 mGy for a diagnostic angiography procedure. Strong correlations (shown as R2) were observed between kerma-area-product and measured eye doses (LOC: 0.78, LE: 0.68). Lateral and frontal air-kerma showed strong correlations with measured dose at LOC (AKL: 0.93, AKF: 0.78) and a weak correlation with measured dose at LE. A moderate correlation was observed between fluoroscopic time and dose measured at LE and LOC regions.

Conclusions

The MOSkin dose-monitoring system represents a new tool enabling real-time monitoring of eye lens dose during neuro-interventional procedures. This system can provide interventionalists with information needed to adjust the clinical procedure to control the patient’s dose.

Key Points

Real-time patient dose monitoring helps interventionalists to monitor doses.

Strong correlation was observed between kerma-area-product and measured eye doses.

Radiation dose at left outer canthus was higher than at left eyelid.

Keywords

Interventional radiology Cerebral angiography Eye lens Real-time dose monitoring 

Abbreviations

AK

Air kerma

FT

Fluoroscopic time

IRP

Interventional reference point

KAP

Kerma-area-product

LE

Left eyelid

LOC

Left outer canthus

MOSFET

Metal-Oxide-Semiconductor Field-Effect Transistor

Notes

Acknowledgments

The authors acknowledge and thank the personnel at the following institutions for their technical support in this study: C.C. Lee and M. Mozaker, radiographers at the University of Malaya Medical Centre (UMMC) and K.H. Lam from Philips Healthcare Malaysia. The current research project was approved by the medical ethics committee of the University of Malaya Medical Centre (UMMC), no 1024.22. The scientific guarantor of this publication is Prof. Kwan-Hoong Ng. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study received funding from a High Impact Research (HIR) grant, UM.C/625/1/HIR/MOHE/MED/38, account no: H-20001-00-E000077 and PPP grant, PG035-2013A from the University of Malaya. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: prospective, experimental, performed at one institution.

References

  1. 1.
    Mooney RB, McKinstry CS, Kamel HA (2000) Absorbed dose and deterministic effects to patients from interventional neuroradiology. Br J Radiol 73:745–751CrossRefPubMedGoogle Scholar
  2. 2.
    Wagner LK, McNeese MD, Marx MV, Siegel EL (1999) Severe skin reactions from interventional fluoroscopy: case report and review of the literature. Radiology 213:773–776CrossRefPubMedGoogle Scholar
  3. 3.
    Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ (2010) Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology 254:326–341CrossRefPubMedGoogle Scholar
  4. 4.
    Spiker A, Zinn Z, Carter WH, Powers R, Kovach R (2012) Fluoroscopy-induced chronic radiation dermatitis. Am J Cardiol 110:1861–1863CrossRefPubMedGoogle Scholar
  5. 5.
    Jaco JW, Miller DL (2010) Measuring and monitoring radiation dose during fluoroscopically guided procedures. Tech Vasc Interv Radiol 13:188–193CrossRefPubMedGoogle Scholar
  6. 6.
    Balter S, Fletcher DW, Kuan HM et al (2002) Techniques to estimate radiation dose to skin during fluoroscopically guided procedures α. Skin Dose Measurements AAPM 1–10Google Scholar
  7. 7.
    Stewart FA, Akleyev AV, Hauer-Jensen M et al (2012) ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs–threshold doses for tissue reactions in a radiation protection context. Ann ICRP 41:1–322CrossRefPubMedGoogle Scholar
  8. 8.
    Worgul BV, Kundiyev YI, Sergiyenko NM et al (2007) Cataracts among Chernobyl clean-up workers: implications regarding permissible eye exposures. Radiat Res 167:233–243CrossRefPubMedGoogle Scholar
  9. 9.
    Chodick G, Bekiroglu N, Hauptmann M et al (2008) Risk of cataract after exposure to low doses of ionizing radiation: a 20-year prospective cohort study among US radiologic technologists. Am J Epidemiol 168:620–631PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Vano E, Kleiman NJ, Duran A, Rehani MM, Echeverri D, Cabrera M (2010) Radiation cataract risk in interventional cardiology personnel. Radiat Res 174:490–495CrossRefPubMedGoogle Scholar
  11. 11.
    Mrena S, Kivela T, Kurttio P, Auvinen A (2011) Lens opacities among physicians occupationally exposed to ionizing radiation–a pilot study in Finland. Scand J Work Environ Health 37:237–243CrossRefPubMedGoogle Scholar
  12. 12.
    Theodorakou C, Horrocks JA (2003) A study on radiation doses and irradiated areas in cerebral embolisation. Br J Radiol 76:546–552CrossRefPubMedGoogle Scholar
  13. 13.
    Meriçı N, Bor D, Ilgıt E, Öznur İ, Büget N (1998) Comparison of eye lens dose measurement techniques in imaging and interventions of the lachrymal drainage system. Phys Med 14:95–100Google Scholar
  14. 14.
    Schueler BA, Kallmes DF, Cloft HJ (2005) 3D cerebral angiography: radiation dose comparison with digital subtraction angiography. AJNR Am J Neuroradiol 26:1898–1901PubMedGoogle Scholar
  15. 15.
    Ilgit ET, Meric N, Bor D, Oznur I, Konus O, Isik S (2000) Lens of the eye: radiation dose in balloon dacryocystoplasty. Radiology 217:54–57CrossRefPubMedGoogle Scholar
  16. 16.
    Sandborg M, Rossitti S, Pettersson H (2010) Local skin and eye lens equivalent doses in interventional neuroradiology. Eur Radiol 20:725–733CrossRefPubMedGoogle Scholar
  17. 17.
    Moritake T, Matsumaru Y, Takigawa T, Nishizawa K, Matsumura A, Tsuboi K (2008) Dose measurement on both patients and operators during neurointerventional procedures using photoluminescence glass dosimeters. AJNR Am J Neuroradiol 29:1910–1917CrossRefPubMedGoogle Scholar
  18. 18.
    Kwan IS, Wilkinson D, Cutajar D et al (2009) The effect of rectal heterogeneity on wall dose in high dose rate brachytherapy. Med Phys 36:224–232CrossRefPubMedGoogle Scholar
  19. 19.
    Hardcastle N, Cutajar DL, Metcalfe PE et al (2010) In vivo real-time rectal wall dosimetry for prostate radiotherapy. Phys Med Biol 55:38–59CrossRefGoogle Scholar
  20. 20.
    Qi Z-Y, Deng X-W, Huang S-M et al (2007) Verification of the plan dosimetry for high dose rate brachytherapy using metal–oxide–semiconductor field effect transistor detectors. Med Phys 34:2007–2013CrossRefPubMedGoogle Scholar
  21. 21.
    Qi ZY, Deng XW, Huang SM et al (2009) In vivo verification of superficial dose for head and neck treatments using intensity-modulated techniques. Med Phys 36:59–70CrossRefPubMedGoogle Scholar
  22. 22.
    Qi Z-Y, Deng X-W, Huang S-M et al (2011) Real-time in vivo dosimetry with MOSFET detectors in serial tomotherapy for head and neck cancer patients. Int J Radiat Oncol Biol Phys 80:1581–1588CrossRefPubMedGoogle Scholar
  23. 23.
    Safari MJ, Wong JHD, Ng KH, Jong WL, Cutajar DL, Rosenfeld AB (2015) Characterization of MOSkin detector for in vivo skin dose measurement during interventional radiology procedures. Med Phys 42:2550–2559Google Scholar
  24. 24.
    Church CA, Kuhn FA, Mikhail J, Vaughan WC, Weiss RL (2008) Patient and surgeon radiation exposure in balloon catheter sinus ostial dilation. Otolaryngol Head Neck Surg 138:187–191CrossRefPubMedGoogle Scholar
  25. 25.
    Miller DL, Balter S, Cole PE et al (2003) Radiation doses in interventional radiology procedures: the RAD-IR study: part II: skin dose. J Vasc Interv Radiol 14:977–990CrossRefPubMedGoogle Scholar
  26. 26.
    Stecker MS, Balter S, Towbin RB et al (2009) Guidelines for patient radiation dose management. J Vasc Interv Radiol 20:263–273CrossRefGoogle Scholar
  27. 27.
    Vano E, Gonzalez L, Ten JI, Fernandez JM, Guibelalde E, Macaya C (2001) Skin dose and dose-area product values for interventional cardiology procedures. Br J Radiol 74:48–55CrossRefPubMedGoogle Scholar
  28. 28.
    Balter S (2006) Methods for measuring fluoroscopic skin dose. Pediatr Radiol 36:136–140PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Johnson PB, Borrego D, Balter S, Johnson K, Siragusa D, Bolch WE (2011) Skin dose mapping for fluoroscopically guided interventions. Med Phys 38:5490–5499PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Khodadadegan Y, Zhang M, Pavlicek W et al (2011) Automatic monitoring of localized skin dose with fluoroscopic and interventional procedures. J Digit Imaging 24:626–639PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Berthelsen B, Cederblad A (1991) Radiation doses to patients and personnel involved in embolization of intracerebral arteriovenous malformations. Acta Radiol 32:492–497CrossRefPubMedGoogle Scholar
  32. 32.
    Mustafa AA, Janeczek J (1989) Organ doses from cardiac and carotid digital subtraction angiography. Br J Radiol 62:838–842CrossRefPubMedGoogle Scholar
  33. 33.
    Casselden PA (1988) Ocular lens dose in cerebral vascular imaging. Br J Radiol 61:202–204CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • M. J. Safari
    • 1
    • 2
  • J. H. D. Wong
    • 1
    • 2
  • K. A. A. Kadir
    • 1
    • 2
  • N. K. Thorpe
    • 3
  • D. L. Cutajar
    • 3
  • M. Petasecca
    • 3
  • M. L. F. Lerch
    • 3
  • A. B. Rosenfeld
    • 3
  • K. H. Ng
    • 1
    • 2
    Email author
  1. 1.Department of Biomedical Imaging, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  2. 2.University of Malaya Research Imaging Centre (UMRIC), Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  3. 3.Centre for Medical Radiation Physics (CMRP)University of WollongongWollongongAustralia

Personalised recommendations