Skip to main content
SpringerLink
Log in

Patient Dose Reference Levels for Interventional Radiology: A National Approach

  • Laboratory Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

A set of patient dose reference levels (RLs) for fluoroscopically guided interventional procedures was obtained in a survey launched by the National Society of Interventional Radiology (IR), involving 10 public hospitals, as recommended by the European Medical Exposures Directive. A sample of 1391 dose values (kerma area product [KAP]) was collected randomly during clinical procedures for seven of the most frequent procedures. Third quartiles of the KAP distributions were used to set the RLs. A regular quality control of the X-ray systems and a calibration of the dose meters were performed during the survey. The fluoroscopy time and total number of digital subtraction angiography images per procedure were also analyzed. The RL values proposed were 12 Gy cm2 for fistulography (hemodialysis access; sample of 180 cases), 73 Gy cm2 for lower limb arteriography (685 cases), 89 Gy cm2 for renal arteriography (55 cases), 80 Gy cm2 for biliary drainage (205 cases), 289 Gy cm2 for hepatic chemoembolization (151 cases), 94 Gy cm2 for iliac stent (70 cases), and 236 Gy cm2 for uterine embolization (45 cases). The provisional national RL values are lower than those obtained in a similar survey carried out in the United States from 2002 to 2004. These new values could be used to improve the practice of centers consistently working with doses higher than the RLs. This national survey also had a positive impact, as it helped increase the awareness of the members of the National Society of IR on a topic as crucial as patient dose values and programs on radiation protection.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. International Commission on Radiological Protection (2000) Avoidance of radiation injuries from medical interventional procedures. ICRP Publication 85. Ann ICRP 30:7–67

    Google Scholar 

  2. Miller DL, Balter S, Cole PE et al (2003) RAD-IR study. Radiation doses in interventional radiology procedures: the RAD-IR study: Part I: overall measures of dose. J Vasc Interv Radiol 14(6):711–727

    PubMed  Google Scholar 

  3. Aroua A, Rickli H et al (2007) How to set up and apply reference levels in fluoroscopy at a national level? Eur Radiol 17:1621–1633

    Article  PubMed  CAS  Google Scholar 

  4. Vano E, Järvinen H, Kosunen A et al (2008) Patient dose in interventional radiology: a European survey. Radiat Prot Dosimetry 129:39–45

    Article  PubMed  CAS  Google Scholar 

  5. Vano E, Segarra A, Fernandez JM et al (2008) A pilot experience launching a national dose protocol for vascular and interventional radiology. Radiat Prot Dosimetry 129:46–49

    Article  PubMed  CAS  Google Scholar 

  6. Neofotistou V, Vano E, Padovani R et al (2003) Preliminary reference levels in interventional cardiology. Eur Radiol 13(10):2259–2263

    Article  PubMed  CAS  Google Scholar 

  7. Balter S, Miller DL, Vano E et al (2008) A pilot study exploring the possibility of establishing guidance levels in X-ray directed interventional procedures. Med Phys 35(2):673–680

    Article  PubMed  CAS  Google Scholar 

  8. Padovani R, Vano E, Trianni A et al (2008) Reference levels at European level for cardiac interventional procedures. Radiat Prot Dosimetry 129(1–3):104–107

    Article  PubMed  CAS  Google Scholar 

  9. D’Helft C, McGee A, Rainford L et al (2008) Proposed preliminary diagnostic reference levels for three common interventional cardiology procedures in Ireland. Radiat Prot Dosimetry 129(1–3):63–66

    Article  PubMed  CAS  Google Scholar 

  10. Bogaert E, Bacher K, Thierens H (2008) A large-scale multicentre study in Belgium of dose area product values and effective doses in interventional cardiology using contemporary X-ray equipment. Radiat Prot Dosimetry 128(3):312–323

    Article  PubMed  CAS  Google Scholar 

  11. Paisley EM, Eatough JP, Mountford PJ et al (2004) Patient radiation doses during invasive cardiac procedures categorised by clinical code. Br J Radiol 77(924):1022–1026

    Article  PubMed  CAS  Google Scholar 

  12. Efstathopoulos EP, Karvouni E, Kottou S et al (2004) Patient dosimetry during coronary interventions: a comprehensive analysis. Am Heart J 147(3):468–475

    Article  PubMed  Google Scholar 

  13. European Commission (1997) Council Directive 97/43 Euratom on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, and repealing Directive 84/466 Euratom. Off J Eur Commun L180:22–27

    Google Scholar 

  14. SENTINEL (2005–2007) Safety and efficacy for new techniques and imaging using new equipment to support European legislation. European Coordination Action. Available at: http://www.sentinel.eu.com/. Accessed June 22, 2008 (See also: http://www.dimond3.org/. Accessed June 22, 2008)

  15. Koenig TR, Wolff D, Mettler FA, Wagner LK (2001) Skin injuries from fluoroscopically guided procedures: Part 1. Characteristics of radiation injury. AJR Am J Roentgenol 177(1):3–11

    PubMed  CAS  Google Scholar 

  16. 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(1):13–20

    PubMed  CAS  Google Scholar 

  17. 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(8):977–990

    PubMed  Google Scholar 

  18. IAEA (2008) Radiological protection of patients. Available at: http://rpop.iaea.org/RPOP/RPoP/Content/News/ArchivedNews/Reporting_system_fluoroscopic.htm. Accessed June 29, 2008

  19. Wambersie A (2005) International Commission on Radiological Units and Measurements. Patient dosimetry for X-rays used in medical imaging. ICRU Report 74. J ICRU 5(2):iv–vi

    Google Scholar 

  20. Balter S, Schueler BA, Miller DL et al (2004) Radiation doses in interventional radiology procedures: the RAD-IR Study. Part III: Dosimetric performance of the interventional fluoroscopy units. J Vasc Interv Radiol 15(9):919–926

    PubMed  Google Scholar 

  21. Bernardi G, Padovani R, Morocutti G et al (2000) Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: analysis in relation to radiation exposure parameters. Catheter Cardiovasc Interv 51(1):1–9

    Article  PubMed  CAS  Google Scholar 

  22. Tsapaki V, Vano E, Muavrikou I et al (2008) Comparison of patient dose in two-dimensional carotid arteriography and three-dimensional rotational angiography. Cardiovasc Interv Radiol 31(3):477–482

    Article  Google Scholar 

  23. Vano E, Gonzalez L, Canis M et al (2003) Training in radiological protection for interventionalists. Initial Spanish experience. Br J Radiol 76(904):217–219

    Article  PubMed  CAS  Google Scholar 

  24. European Commission (2000) Guidelines on education, training in radiation protection for medical exposures. Radiation Protection 116. Directorate General Environment, Nuclear Safety and Civil Protection. Luxembourg. Available at: http://ec.europa.eu/energy/nuclear/radioprotection/publication/doc/116_en.pdf. Accessed June 26, 2008

Download references

Acknowledgment

The present work was carried out with the partial support of Spanish grant FIS2006-08186 (Ministry of Science and Innovation).

Author information

Authors and Affiliations

  1. Department of Medical Physics, Hospital Clinico San Carlos, Madrid, Spain

    Eliseo Vano, R. Sanchez & J. M. Fernandez

  2. Department of Radiology, Hospital Clinico San Carlos, Madrid, Spain

    J. J. Gallego

  3. Department of Radiology, Hospital General Universitario de Alicante, Alicante, Spain

    J. F. Verdu

  4. Department of Radiology, Hospital de Basurto, Basurto, Spain

    M. Gonzalez de Garay

  5. Department of Radiology, Hospital Txagoritxu, Vitoria-Gasteiz, Spain

    A. Azpiazu

  6. Department of Radiology, Hospital Valle de Hebron, Barcelona, Spain

    A. Segarra

  7. Department of Radiology, Hospital Funacion Alcorcon, Alcorcon, Spain

    M. T. Hernandez

  8. Department of Radiology, Hospital Reina Sofia, Cordoba, Spain

    M. Canis

  9. Department of Radiology, Hospital Universitario de Canarias, La Laguna, Spain

    F. Diaz

  10. Hospital Juan Ramon Jiménez, Huelva, Spain

    F. Moreno

  11. Hospital Clinico de Valencia, Valencia, Spain

    J. Palmero

Authors
  1. Eliseo Vano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. M. Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. J. Gallego
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. F. Verdu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Gonzalez de Garay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Azpiazu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Segarra
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. T. Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Canis
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. F. Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. F. Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. J. Palmero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eliseo Vano.

Additional information

This paper was accepted as a scientific poster at the CIRSE annual meeting in Copenhagen, September 2008.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vano, E., Sanchez, R., Fernandez, J.M. et al. Patient Dose Reference Levels for Interventional Radiology: A National Approach. Cardiovasc Intervent Radiol 32, 19–24 (2009). https://doi.org/10.1007/s00270-008-9439-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-008-9439-9

Keywords

Search

Navigation