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Optimized radiological alert thresholds based on device dosimetric information and peak skin dose in vascular fluoroscopically guided intervention

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The National Council on Radiation Protection (NCRP) report no. 168 recommended that during fluoroscopically guided interventions (FGIs), each patient should be monitored when one of the following thresholds is reached: an air kerma > 5 Gy, a kerma area product (KAP) > 500 Gy.cm2, a fluoroscopy time > 60 min, or a peak skin dose (PSD) > 3 Gy. Whereas PSD is the most accurate metric regarding the prevention of radiological risks, it remains the most difficult parameter to assess. We aimed to evaluate the relevance of the other, more accessible metrics and propose new optimized threshold (OT) for improved patient follow-up.

Methods

Overall, 108 patients who underwent FGI in which at least one NCRP threshold was reached and PSD was measured were considered. The correlation between all metrics was assessed using principal component analysis (PCA). ROC curves and the sensitivity/specificity of both NCRP and OT to predict PSD > 3 Gy were evaluated.

Results

The PCA shows that FGI can be decomposed with two components based on time and dose variables. Only KAP and kerma were correlated with PSD. The overall sensitivity and specificity of the new OT regarding KAP (67.6/93.0), kerma (97.3/81.7), and time (62.2/62.0) were better compared with NCRP thresholds (97.3/16.9, 40.5/95.4, and 21.6/74.7).

Conclusions

This study shows that fluoroscopy time is not a relevant metric when used to predict PSDs > 3 Gy. By adapting KAP and kerma thresholds to predict PSD over 3 Gy, patient follow-ups following vascular FGI can be improved.

Key Points

• In vascular fluoroscopically guided interventions, principal component analysis demonstrates that between fluoroscopy time, KAP, and kerma, only the two last were correlated to the peak skin dose.

• Optimized thresholds replacing NRCP ones obtained with ROC curves analysis were 85,451 μGy.cm2, 2938 mGy, and 41 min for KAP, kerma, and fluoroscopy time respectively.

• Improvements to trigger patient follow-up after vascular fluoroscopically guided interventions may be obtained by using the optimized thresholds.

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Abbreviations

ACR:

American College of Radiology

AUC:

Area under the curve

CE:

Chemoembolization

DICOM:

Digital Imaging and Communications in Medicine

EM:

Embolization

FB:

Foreign body extraction

FGI:

Fluoroscopically guided intervention

FN:

False negative

FP:

False positive

KAP:

Kerma area product

KERMA:

Kinetic energy released per unit mass

NCRP:

National Council on Radiation Protection

NPV:

Negative predictive value

OT:

Optimized threshold

PC:

Principal component

PCA:

Principal component analysis

PPV:

Positive predictive value

PSD:

Peak skin dose

RDSR:

Radiation dose structured report

RE:

Recanalization

RVS:

Renal vein sampling

TIPS:

Transjugular intrahepatic portosystemic shunt

TN:

True negative

TP:

True positive

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Florian Magnier

    Present address: Service de radiothérapie, Centre Saint Jean, 18230, Bourges, France

Authors and Affiliations

  1. Plateforme régionale de physique médicale, Centre de Lutte Contre le Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont-Ferrand Cedex 1, France

    Nicolas Sas, Florian Magnier, Eléonore Pouget & Véronique Dedieu

  2. Pôle Interhospitalier d’Imagerie Diagnostique et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France

    Joël Guersen, Pascal Chabrot, Louis Boyer & Lucie Cassagnes

  3. TGI, Institut Pascal, UMR 6602, UCA/CNRS/SIGMA, Aubière, France

    Louis Boyer & Lucie Cassagnes

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  1. Nicolas Sas
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Correspondence to Nicolas Sas.

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Guarantor

The scientific guarantor of this publication is Louis Boyer, Pôle Interhospitalier d’Imagerie Diagnostique et de Radiologie Interventionnelle.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because of its retrospective character and the analysis being based only on data acquired during clinical routine.

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Institutional Review Board approval was not required because this is a retrospective study and all data are anonymized. Thereby, no ethical approval is required.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Sas, N., Magnier, F., Pouget, E. et al. Optimized radiological alert thresholds based on device dosimetric information and peak skin dose in vascular fluoroscopically guided intervention. Eur Radiol 31, 3027–3034 (2021). https://doi.org/10.1007/s00330-020-07422-3

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  • DOI: https://doi.org/10.1007/s00330-020-07422-3

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