Characterization and Experimental Measurements of Scatter Dose at Cardiologist's Eyes During Paediatric Interventional Cardiology Procedures in Costa Rica

Abstract

This paper presents the results of the first characterization and experimental measurements of scatter dose at cardiologist's eyes for the only X-ray system that performs all paediatric Interventional cardiology procedures in Costa Rica. Entrance surface air kerma (ESAK) and the scatter dose values were measured on phantoms of 4-20 cm thicknesses of polymethyl methacrylate slabs. Image quality was evaluated using DICOM images of a test object Leeds TOR 18-FG, through the numerical parameters signal-to-noise ratio (SNR), high-contrast spatial resolution (HCSR) and figure of merit (FOM). When PMMA thickness is increased and during a move from low fluoroscopy to cine modes, ESAK, SNR, HCSR and FOM values range from 0.44 to 391.0 μGy fr-1; 2.8 to 14.89; 3.17 to 15.54 and 0.51 to 79.94, respectively. The highest scattered dose rates recorded during the simulations were 1.79 and 8.04 mSv h-1 for the high fluoroscopy and cine modes, respectively.

Medical staff dose estimation during pediatric cardiac interventional procedures

“…On the other hand, several papers [18][19][20][21] reporting scattered doses or dose rates at the eyes of the staff by measurements performed using defined technique factors and phantoms to simulate the patient. Nevertheless, studies on real medical personnel who perform paediatric cardiological interventional procedures are scarce [18][19][20][21].…”

“…On the other hand, several papers [18][19][20][21] reporting scattered doses or dose rates at the eyes of the staff by measurements performed using defined technique factors and phantoms to simulate the patient. Nevertheless, studies on real medical personnel who perform paediatric cardiological interventional procedures are scarce [18][19][20][21]. Therefore, due to a paucity of literature addressing occupational exposures associated with paediatric cardiac interventional procedures, the aim of this study was to evaluate the occupational doses (eye lens, extremity, and whole body) in paediatric cardiac interventional and diagnostic catheterization procedures performed in a paediatric reference hospital.…”

Physical Image Quality Metrics for the Characterization of X-ray Systems Used in Fluoroscopy-Guided Pediatric Cardiac Interventional Procedures: A Systematic Review

“…Interventional cardiology procedures constitute a substantial source of medical radiation exposure globally, with the potential to subject patients to significant radiation levels [1]. This concern is particularly relevant for pediatric patients with congenital heart disease, as they may necessitate multiple imaging studies, such as cardiac catheterization, which can extend examination durations and elevate radiation exposure [2].…”

“…Children are inherently more radiation-sensitive due to factors like higher cell proliferation and percentage of undifferentiated cells, which result in increased stochastic effect risk [2]. Furthermore, their longer lifespan increases the lifetime radiogenic cancer risk [1,4]. Studies reveal 2-3 times higher cancer likelihood from radiation exposure before age 15 as compared to adults [5][6][7].…”

New Optimization Strategies on Radiation Protection in Fluoroscopy-Guided Interventional Procedures in Pediatrics

“…The basic aim of the optimization of radiological protection during a fluoroscopically guided interventional procedure is to adjust imaging parameters and institute protective measures in such a way that the required image is obtained with the lowest possible radiation dose, and net benefit is maximized [6]. Some examples of optimization strategies might be: quality assurance programs, characterization of dose and image quality of X-ray systems [7,8], quality control tests of X-ray systems, the analysis of patient dose metrics, establishment of diagnostic reference levels (DRLs) classified by ranges of weight and age, among others. Some possible concrete actions for optimization might be: reducing the radiation dose to the minimum needed ("ALARA" principle), reducing the field to the strictly necessary part of the body, avoiding unnecessary double planes, using a low-dose-rate fluoroscopy mode when possible, minimizing fluoroscopy time, using fluoroscopy only to guide devices if absolutely necessary and observe motion, using the last-image-hold image for review when possible, instead of using fluoroscopy, minimizing the number of cine series, reducing the number of personnel present in the fluoroscopically guided interventional laboratory to the minimum needed, posing careful indications, considering non-radiating alternatives if possible, etc.…”