Abstract
Purpose
To investigate the radiation exposure in non-vascular fluoroscopy guided interventions and to search strategies for dose reduction.
Materials and Methods
Dose area product (DAP) of 638 consecutive non-vascular interventional procedures of one year were analyzed with respect to different types of interventions; gastrointestinal tract, biliary interventions, embolizations of tumors and hemorrhage. Data was analyzed with special focus on the fluoroscopy doses and frame doses. The third quartiles (Q3) of fluoroscopy dose values were defined in order to set a reference value for our in-hospital practice.
Results
Mean fluoroscopy times of gastrostomy, jejunostomy, right and left sided percutaneous biliary drainage, chemoembolization of the liver and embolization due to various hemorrhages were 5.9, 8.6, 13.5, 16.6, 17.4 and 25.2 min, respectively. The respective Q3 total DAP were 52.9, 73.3, 155.1, 308.4, 428.6 and 529.3 Gy*cm2. Overall, around 66% of the total DAP originated from the radiographic frames with only 34% of the total DAP applied by fluoroscopy (P < 0.001). The investigators experience had no significant impact on the total DAP applied, most likely since there was no stratification to intervention-complexity.
Conclusion
To establish Diagnostic Reference Levels (DRLs), there is a need to establish a registry of radiation dose data for the most commonly performed procedures. Documentation of interventional procedures by fluoroscopy “grabbing” has the potential to considerably reduce radiation dose applied and should be used instead of radiographic frames whenever possible.
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References
Miller DL (2008) Overview of contemporary interventional fluoroscopy procedures. Health Phys 95(5):638–644
Valentin J (2000) Avoidance of radiation injuries from medical interventional procedures. Ann ICRP 30(2):7–67
Chida K, Kato M, Kagaya Y et al (2010) Radiation dose and radiation protection for patients and physicians during interventional procedure. J Radiat Res 51(2):97–105
Vano E, Sanchez R, Fernandez JM et al (2009) Patient dose reference levels for interventional radiology: a national approach. Cardiovasc Interv Radiol 32(1):19–24
Strahlenschutzkommission Cfrp (2008) Interventional radiology––recommendations for radiation protection. Bull Comm Radiat Prot 56:1–58
Wall BF, Shrimpton PC (1998) The historical development of reference doses in diagnostic radiology. Radiat Prot Dosim 80(1–3):15–20
International Commission on Radiological Protection (2001) Diagnostic reference levels in medical imaging: review and additional advice. Ann ICRP 31(4):33–52
ICRP (2007) Radiological protection in medicine. ICRP Publication 105. Ann ICRP 37(6):1–63
Nosske D (2010) Updated reference levels in diagnostic and interventional radiology. In: Federal Bulletin. Federal office for Radiation protection, Salzgitter, Germany
Vano E, Jarvinen H, Kosunen A et al (2008) Patient dose in interventional radiology: a European survey. Radiat Prot Dosim 129(1–3):39–45
Aroua A, Rickli H, Stauffer JC et al (2007) How to set up and apply reference levels in fluoroscopy at a national level. Eur Radiol 17(6):1621–1633
Miller DL, Balter S, Cole PE et al (2003) Radiation doses in interventional radiology procedures: the RAD-IR study. Part I: Overall measures of dose. J Vasc Interv Radiol 14(6):711–727
Ruiz Cruces R, Garcia-Granados J, Diaz Romero FJ, Hernandez Armas J (1998) Estimation of effective dose in some digital angiographic and interventional procedures. Br J Radiol 71(841):42–47
Zweers D, Geleijns J, Aarts NJ et al (1998) Patient and staff radiation dose in fluoroscopy-guided TIPS procedures and dose decrease using dedicated fluoroscopy exposure settings. Br J Radiol 71(846):672–676
Ruiz-Cruces R, Perez-Martinez M, Martin-Palanca A et al (1997) Patient dose in radiologically guided interventional vascular procedures: conventional versus digital systems. Radiology 205(2):385–393
Kuon E, Robinson DM, Empen K, Dahm JB (2005) Fluoroscopy time––an overestimated factor for patient radiation exposure in invasive cardiology. Fortschr Geb Rontgenstrahlen Neuen Bildgeb Verfahr Erganzungsbd 177(6):812–817
Mavrikou I, Kottou S, Tsapaki V, Neofotistou V (2008) High patient doses in interventional cardiology due to physicians′ negligence: How can they be prevented? Radiat Prot Dosim 129(1–3):67–70
Miller DL, Vano E, Bartal G et al (2009) Occupational radiation protection for interventionalists: a joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. CIRSE SOP guideline, pp 1–18. http://www.cirse.org/index.php?pid=412
Stecker MS, Balter S, Towbin RB et al (2009) Guidelines for patient radiation dose management. J Vasc Interv Radiol 20(7):S263–S273
Vano E, Gonzalez L, Fernandez JM, Prieto C, Guibelalde E (2006) Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology. Radiat Prot Dosim 118(3):325–330
Miller DL, Kwon D, Bonavia GH (2009) Reference levels for patient radiation doses in interventional radiology: proposed initial values for US practice. Radiology 253(3):753–764
d’Othee BJ, Lin PJ (2007) The influence of angiography table shields and height on patient and angiographer irradiation during interventional radiology procedures. Cardiovasc Intervent Radiol 30(3):448–454
Samara ET, Aroua A, De Palma R et al (2011) An audit of diagnostic reference levels in interventional cardiology and radiology: are there differences between academic and non-academic centres? Radiat Prot Dosim
Balter S (2008) Capturing patient doses from fluoroscopically based diagnostic and interventional systems. Health Phys 95(5):535–540
Verdun FR, Aroua A, Trueb PR, Vock P, Valley JF (2005) Diagnostic and interventional radiology: a strategy to introduce reference dose level taking into account the national practice. Radiat Prot Dosim 114(1–3):188–191
Bor D, Sancak T, Toklu T, Olgar T, Ener S (2008) Effects of radiologists’ skill and experience on patient doses in interventional examinations. Radiat Prot Dosim 129(1–3):32–35
Vehmas T (1997) Radiation exposure during standard and complex interventional procedures. Br J Radiol 70:296–298
Wall BF (2001) Diagnostic reference levels––the way forward. Br J Radiol 74(885):785–788
Vano E, Gonzalez L (2001) Approaches to establishing reference levels in interventional radiology. Radiat Prot Dosim 94(1–2):109–112
Board NRP (1990) Patient dose decrease in diagnostic radiology: Report by the Royal College of Radiologists and the National Radiological Protection Board. Doc NRPB 1(3):1–46
Castellano IA, McNeill JG, Thorp NC, Dance DR, Raphael MJ (1995) Assessment of organ radiation doses and associated risk for digital bifemoral arteriography. Br J Radiol 68(809):502–507
McParland BJ (1998) A study of patient radiation doses in interventional radiological procedures. Br J Radiol 71(842):175–185
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(877):48–55
van de Putte S, Verhaegen F, Taeymans Y, Thierens H (2000) Correlation of patient skin doses in cardiac interventional radiology with dose-area product. Br J Radiol 73(869):504–513
Marshall NW, Chapple CL, Kotre CJ (2000) Diagnostic reference levels in interventional radiology. Phys Med Biol 45(12):3833–3846
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Kloeckner, R., Bersch, A., dos Santos, D.P. et al. Radiation Exposure in Nonvascular Fluoroscopy-Guided Interventional Procedures. Cardiovasc Intervent Radiol 35, 613–620 (2012). https://doi.org/10.1007/s00270-011-0206-y
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DOI: https://doi.org/10.1007/s00270-011-0206-y