A pilot study exploring the possibility of establishing guidance levels in x-ray directed interventional procedures

Balter, Stephen; Miller, Donald L.; Vañó, Eliseo; López, P. Ortiz; Bernardi, Guglielmo; Cotelo, E; Faulkner, K.; Nowotny, R.; Padovani, R.; Ramírez, Augusto V.

doi:10.1118/1.2829868

Cited by 98 publications

(90 citation statements)

References 15 publications

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“…A reason for the more significant correlation between ESD skin,max and P KA in our work compared to, for example, Balter et al [17] may be that in our work the large majority of the procedures were performed by one very experienced radiologist. We therefore agree with Balter and Moses [9] who proposed that both ESD and P KA could be used as key dosimetric quantities to avoid patient overexposure.…”

Section: Tablementioning

confidence: 50%

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Local skin and eye lens equivalent doses in interventional neuroradiology

2009

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Abstract:The aim of this work was to assess patient skin and eye lens doses in interventional neuroradiology and to assess both stochastic and deterministic radiation risks. Kerma-area product, P KA was recorded and skin doses measured using thermoluminescence dosimeters. Estimated dose at interventional reference point, IRP, was compared with measured absorbed doses. The average and maximum fluoroscopy times were 32 and 189 min for coiling and 40 and 144min for embolisation. The average and maximum P KA for coiling were 121 and 436 Gycm 2 respectively and 189 and 677 Gycm 2 for embolisation. The average and maximum values of the measured maximum absorbed skin doses were 0.72 and 3.0Sv respectively for coiling and 0.79 and 2.1Sv for embolisation. Two out of the 52 patients received skin doses in excess of 2Sv. The average and maximum doses to the eye lens (left eye) were 51 and 51mSv (coiling) and 71 and 289mSv (embolisation). The ratio between the measured dose and the dose at the IRP was 0.44±0.18mSv/mGy indicating that the dose displayed by the x-ray unit overestimates the maximum skin dose but is still a valuable indication of the dose. The risk in our hospital skin erythema and lens cataract is therefore small.

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Section: Tablementioning

confidence: 50%

“…But is has also been suggested for use in interventional cardiology [15]. Others [16][17][18] have also suggested using P KA as an indicator for high skin doses.…”

Section: Introductionmentioning

confidence: 99%

Local skin and eye lens equivalent doses in interventional neuroradiology

2009

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“…Radiation doses, such as represented by 10th percentile, may require investigation into adequacy of image quality. The 10th percentile is the appropriate action level (AL) at which to initiate an evaluation of the image quality as recommended by International Atomic Energy Agency 36 , 37 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of dose‐area product of common radiographic examinations towards establishing a preliminary diagnostic reference levels (PDRLs) in Southwestern Nigeria

Jibiri

Olowookere

2016

J Applied Clin Med Phys

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In Nigeria, a large number of radiographic examinations are conducted yearly for various diagnostic purposes. However, most examinations carried out do not have records of doses received by the patients, and the employed exposure parameters used are not documented; therefore, adequate radiation dose management is hindered. The aim of the present study was to estimate the dose‐area product (DAP) of patients examined in Nigeria, and to propose regional reference dose levels for nine common examinations (chest PA, abdomen AP, pelvis AP, lumbar AP, skull AP, leg AP, knee AP, hand AP, and thigh AP) undertaken in Nigeria. Measurement of entrance surface dose (ESD) was carried out using thermoluminescent dosimeter (TLD). Measured ESDS were converted into DAP using the beam area of patients in 12 purposely selected hospitals. Results of the study show that the maximum/minimum ratio ranged from 3 for thigh AP to 57 in abdomen AP. The range of determined mean and 75th percentile DAPs were 0.18–17.16, and 0.25–28.59 Gy cm2, respectively. Data available for comparison show that 75th percentile DAPs in this study (in chest PA, abdomen AP, pelvis AP, lumbar AP) are higher than NRPB‐HPE reference values. The DAP in this study is higher by factor of 31.4 (chest PA), 9.9 (abdomen AP), 2.2 (pelvis AP), and 2.1 (lumbar AP) than NRPB‐HPE values. The relative higher dose found in this study shows nonoptimization of practice in Nigeria. It is expected that regular dose auditing and dose optimization implementation in Nigeria would lead to lower DAP value, especially in abdomen AP. The 75th percentile DAP distribution reported in this study could be taken as regional diagnostic reference level in the Southwestern Nigeria; however, a more extensive nationwide dose survey is required to establish national reference dose.PACS number(s): 87.53.Bn, 87.59.B

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“…Recently, the rapid increase in the frequency of diagnostic coronary angiography procedures has prompted radiation protection concerns [6], and studies have been performed to determine patient radiation doses in a number of countries [1,3,5,7]. The radiation dose of diagnostic coronary angiography is often presented in the form of a diagnostic reference level (DRL) [8], which is established at the 75th percentile dose-area product (DAP) value of the distributions of doses observed for a particular examination [9].…”

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confidence: 99%

“…It is the most common invasive cardiac procedure and is used for both the initial diagnosis of coronary artery disease (CAD) and the follow-up examinations of patients after coronary interventional procedures, coronary bypass surgery or cardiac transplantation [3,4]. It is a standardised procedure that involves several cine-fluorographic series of the right and left coronary artery systems, with or without a left ventriculogram [5].…”

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confidence: 99%

Optimisation of coronary angiography exposures requires a multifactorial approach and careful procedural definition

Lin

Brennan²,

Sadick³

et al. 2013

BJR

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Objective: This study investigates the factors associated with higher doses for both single-plane and biplane procedures and establishes centre-specific 75th percentile levels. Methods: 602 patients undergoing coronary angiography in a large hospital at Sydney were recruited to the study, and causal agents for high radiation doses were investigated: gender, procedural complexity, severity of coronary artery disease, presence of coronary bypass grafts, entry approach (radial or femoral), level of operator experience; and a single-plane or a biplane imaging system was employed. Results: The 75th percentile levels were calculated. The results demonstrated that, for both systems, higher exposures were associated with patients who were male (p,0.001), had coronary vessel disease (p,0.001) and had a history of coronary bypass grafts (p,0.001). In addition, for biplane systems, procedural complexity (p,0.001), types of entry approach (p,0.001) and levels of operator experience (p,0.001) significantly impacted upon the dose. Biplane examinations recorded higher doses than single-plane procedures (p,0.001) and the inclusion of left-sided ventriculography contributed to the overall dose by up to 10%. Conclusion: The 75th percentile levels in this study represent the tentative reference levels and are 48.9, 44.2 and 56 Gy cm 2 for all exposures, single-plane-and biplane-specific exposures, respectively, and compare favourably with the diagnostic reference level values established elsewhere internationally, with only the UK and Irish data being lower. Advances in knowledge: Specific agents have been identified for dose-reducing strategies and the importance of operator training is highlighted. The assumption that biplane procedures may reduce the patient dose should be treated with caution.

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A pilot study exploring the possibility of establishing guidance levels in x-ray directed interventional procedures

Cited by 98 publications

References 15 publications

Local skin and eye lens equivalent doses in interventional neuroradiology

Local skin and eye lens equivalent doses in interventional neuroradiology

Evaluation of dose‐area product of common radiographic examinations towards establishing a preliminary diagnostic reference levels (PDRLs) in Southwestern Nigeria

Optimisation of coronary angiography exposures requires a multifactorial approach and careful procedural definition

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