Diagnostic reference levels for fluoroscopically guided procedures in a South African tertiary hospital

Malan, Leon; Pitcher, R; Silva, Michelle da; Breuninger, Sharlene; Groenewald, Wilhelm

doi:10.1177/0284185120938371

Cited by 5 publications

(10 citation statements)

References 25 publications

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“…The study identified the current scope of IR procedures carried out at a single institution while simultaneously determining procedures not performed or those performed with low frequency. Hepatobiliary (liver and pancreas) IR has room for growth through adding procedures such as TIPS, portal vein embolisation, transarterial chemo-embolisation (TACE), radio-embolisation with radioactive microspheres and radiofrequency ablation, a similar outcome to what another local study 13 at a public sector hospital found. This reflects the limited IR expertise in public sector hospitals and should improve with time as more radiologists and registrars are trained in IR.…”

Section: Discussionmentioning

confidence: 69%

“…Uterine artery embolisation recorded the highest DAP doses (selective abdominal vessel interventional angiogram was the second highest), in keeping with findings from other studies. Based on published literature, abdominal and pelvic angiographic interventions 13 , 17 typically have the highest recorded DAP.…”

Section: Discussionmentioning

confidence: 99%

“…As far as the authors are aware, there are only two articles establishing DRLs for IR in sub-Saharan Africa. The most recent study is from South Africa by Malan et al 13 at Stellenbosch University. It was published in 2020 and sought to determine the local diagnostic reference levels (LDRLs) for common fluoroscopically-guided procedures in the South African context and to compare those to published international data.…”

Section: Introductionmentioning

confidence: 99%

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An audit of patient radiation doses in interventional radiology at a South African hospital

Slave

Mahomed

2023

South African Journal of Radiology

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Background: Interventional radiology (IR) is becoming more relevant in patient care and is associated with increased patient radiation exposure and radiation-induced adverse effects. Diagnostic reference levels (DRLs) are crucial for radiation control. There is a paucity of published DRLs for IR in South Africa and sub-Saharan Africa.Objectives: This study aimed to determine local DRLs for fluoroscopically-guided IR procedures and compare the achieved DRLs with published local and international DRLs.Method: Retrospective, descriptive, single-centre study. Kerma air product (KAP), reference point air kerma (Ka,r) and fluoroscopy time (FT) were collected for patients (12 years and older) who underwent IR procedures at a university hospital from 01 January 2019 to 31 December 2019. The 75th percentile of the distribution of each dose parameter (KAP, Ka,r and FT) per procedure was calculated and taken as the local diagnostic reference levels (LDRL). The established LDRLs were compared to published DRLs.Results: A total of 564 cases were evaluated. The 13 most frequent procedures (with 15 or more cases) represented 86.1% (487/564). Percutaneous transhepatic biliary drainage was the most common procedure (n = 146, 25.9%). Diagnostic cerebral angiogram DRLs exceeded the published DRL data ranges for all parameters (DRL 209.3), and interventional cerebral angiogram exceeded published ranges (DRL 275). Uterine artery embolisation (UAE) exceeded these ranges for KAP and Ka,r. (KAP-954.9 Gy/cm2, Ka,r-2640.8 mGy).Conclusion: The LDRLs for diagnostic cerebral angiogram, interventional cerebral angiogram and UAE exceeded published international DRL ranges. These procedures require radiation optimisation as recommended by the International Commission on Radiological Protection (ICRP).Contribution: In addition to informing radiation protection practices at the level of the institution, the established LDRLs contribute towards Regional and National DRLs.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An audit of patient radiation doses in interventional radiology at a South African hospital

Slave

Mahomed

2023

South African Journal of Radiology

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“…Upon completion of the measurements, the KAP readings were corrected with the k KM TP measured using Accu-Gold 2.0 software. Finally, k KM Q,Q 0 were obtained as a function of the combination of the tube potential and spectral filter using Equation (8).…”

Section: Evaluation Of K Kmmentioning

confidence: 99%

“…6 KAP and K a,i values are generally used to estimate the individual patient doses or establish diagnostic reference levels that are commonly defined as a percentile of KAP and K a,i distributions for specific types of procedures in a specific region within a country. 7,8 Therefore, it is imperative to obtain the accurate KAP and K a,i values, and the measurement uncertainty for the KAP meter must be within ±35%. 5,9,10 The coronary arteries run along the surface of the heart, which is surrounded by the lungs.…”

Section: Introductionmentioning

confidence: 99%

Effect of equalization filters on measurements with kerma‐area product meter in a cardiovascular angiography system

Ichikawa

Fukuda

Hayashi

et al. 2021

J Applied Clin Med Phys

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This study aimed to evaluate the effect of equalization filters (EFs) on the kerma-area product (KAP KM Q ) and incident air-kerma (K KM a,i,Q ) using a kermaarea product (KAP) meter. In addition, potential underestimations of the K KM a,i,Q values by EFs were identified. Materials and methods: A portable flat-panel detector (FPD) was placed to measure the X-ray beam area (A) and EFs dimension at patient entrance reference point (PERP). Afterward, a 6-cm 3 external ionization chamber was placed to measure incident air-kerma (K ext a,i,Q ) at PERP instead of the portable FPD. KAP reading and K ext a,i,Q were simultaneously measured at several X-ray beam qualities with and without EFs. The X-ray beam quality correction factor by KAP meter (k KM Q,Q 0 ) was calculated by A, K ext a,i,Q and KAP reading to acquire the KAP KM Q and K KM a,i,Q .Upon completion of the measurements,KAP KM Q ,K KM a,i,Q ,and K ext a,i,Q were plotted as functions of tube potential, spectral filter, and EFs dimension. Moreover, K KM a,i,Q ∕K ext a,i,Q values were calculated to evaluate the K KM a,i,Q underestimation. Results: The k KM Q,Q 0 values increased with an increase in the X-ray tube potential and spectral filter, and the maximum k KM Q,Q 0 was 1.18. KAP KM Q and K KM a,i,Q decreased as functions of EFs dimension, whereas K ext a,i,Q was almost constant. K KM a,i,Q ∕K ext a,i,Q decreased with an increase in EFs dimension but increased with an increase in tube potential and spectral filter, and the range was 0.55-1.01. Conclusions: K KM a,i,Q value was up to approximately two times lower than the K ext a,i,Q values by EFs. When using the K KM a,i,Q value, the potential K KM a,i,Q underestimation with EFs should be considered.

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An audit of published South African diagnostic reference level data

Trauernicht¹,

Pitcher²

2021

J. Radiol. Prot.

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Diagnostic reference levels (DRLs) are accepted as a dose optimisation tool for patients undergoing x-ray imaging and are required by South African (SA) legislation for 26 fluoroscopically guided procedures (FGPs). The aim of this paper is to collate all published SA data on DRLs in preparation for a project to establish national DRLs. Systematic searches were conducted of various applicable databases. All research that proposed DRLs for any imaging procedure in South Africa was included. Twenty-one works met inclusion criteria, the earliest from 2001. Two-thirds of all work reported on FGPs and five studies documented computed tomography DRLs. Three publications focussed exclusively on paediatric imaging DRLs. No studies on mammography or dental radiography were found. For clinical procedures with more than one proposed DRL, the range of proposed DRL varied by up to a factor of five. The highest proposed DRL is 373.1 Gy cm2 for endovascular aneurysm/aortic repair procedures. Data were collected in six public hospitals and two private hospital groups. Thirty-six authors contributed to the manuscripts, but only six studies had an inter-disciplinary authorship. This is the first paper to provide a comprehensive review of SA DRL data and thereby advances international radiation protection initiatives. The data suggests there is room for more interdisciplinary work and that there must be rigorous standardization of reported parameters and data collection. This audit also highlights the need for standardized terminology, particularly for FGPs.

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Diagnostic reference levels for fluoroscopically guided procedures in a South African tertiary hospital

Cited by 5 publications

References 25 publications

An audit of patient radiation doses in interventional radiology at a South African hospital

An audit of patient radiation doses in interventional radiology at a South African hospital

Effect of equalization filters on measurements with kerma‐area product meter in a cardiovascular angiography system

An audit of published South African diagnostic reference level data

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