A pilot experience launching a national dose protocol for vascular and interventional radiology

Abstract

The design of a national dose protocol for interventional radiology has been one of the tasks during the European SENTINEL Coordination Action. The present paper describes the pilot experience carried out in cooperation with the Spanish Society on Vascular and Interventional Radiology (SERVEI). A prospective sample of procedures was initially agreed. A common quality control of the X-ray systems was carried out, including calibration of the air kerma area product (KAP) meters. Occupational doses of the radiologists involved in the survey were also included in the survey. A total of 10 Spanish hospitals with interventional X-ray units were involved. Six hundred and sixty-four patient dose data were collected from 397 diagnostic and 267 therapeutic procedures. Occupational doses were evaluated in a sample of 635 values. The obtained KAP median/mean values (Gy.cm2) for the gathered procedures were: biliary drainage (30.6/68.9), fistulography (4.5/9.8), lower limb arteriography (52.2/60.7), hepatic chemoembolisation (175.8/218.3), iliac stent (45.9/73.2) and renal arteriography (39.1/59.8). Occupational doses (mean monthly values, in mSv) were 1.9 (over apron); 0.3 (under apron) and 4.5 (on hands). With this National experience, a protocol was agreed among the SENTINEL partners to conduct future similar surveys in other European countries.

Reference Levels for Patient Radiation Doses in Interventional Radiology: Proposed Initial Values for U.S. Practice

“…In European surveys, dose data are often given only for KAP. Table 4 shows the comparison of size-corrected and uncorrected 75th percentile dose data from this study with 75th percentile dose data from other countries and Europe (16,17,19,42,44,45). Substantial variability is evident.…”

“…Researchers in various studies have presented reference levels or radiation doses for cardiovascular procedures (12)(13)(14)(15) and a limited number of interventional radiologic procedures (16)(17)(18)(19)(20)(21).…”

Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity

“…However, radiation dose in purely diagnostic procedures is lower than when an intervention is performed. 12,14,15,17,[19][20][21][22][23][27][28][29] Our results can be viewed in the context of radiation doses associated with other imaging studies patients commonly undergo. The mean DAP value obtained in this study for interventional pelvic procedures (179.6 Gy*cm 2 ) was higher than the patient mean DAP reported Percentages for patient and procedure characteristics were calculated from the total number of available data for any respective dataset.…”

“…Indeed, the radiation doses measured in percutaneous transhepatic billiary drainage insertion and therapeutic dialysis arteriovenous fistulography performed by our operators compare favorably to the best of previously published data. 15,[20][21][22][23]26 Next, we used DAP as a measure of patient radiation exposure. DAP is calculated by the integration of the AK across the entire X ray beam, but it does not include backscatter.…”

“…11 Also, radiation exposure during lower extremity endovascular interventions have been reported. [12][13][14][15][16][17][18][19][20][21][22][23][24] Factors found to be associated with radiation in these procedures included operator skill, the equipment being used and patient clinical characteristics. 7 Radiation dose has not been reported in relation to lesion distribution or to specific procedure characteristics.…”