Evaluation of Patient and Staff Doses During Various Ct Fluoroscopy Guided Interventions

Abstract

As CT scanners are more routinely used as a guidance tool for various types of interventional radiological procedures, concern has grown for high patient and staff doses. CT fluoroscopy provides the physician immediate feedback and can be a valuable tool to dynamically assist various types of percutaneous interventions. However, the fixed position of the scanning plane in combination with high exposure factors may lead to high cumulative patient skin doses that can reach deterministic threshold limits. The staff is also exposed to a considerable amount of scatter radiation while standing next to the patient during the procedures. Although some studies have been published dealing with this subject, data of patient skin doses determined by direct in vivo dosimetry remains scarce. The purpose of this study is to quantify and to evaluate both patient and staff doses by direct thermoluminescent dosimetry during various clinical CT fluoroscopy guided procedures. Patient doses were quantified by determining the entrance skin dose with direct thermoluminescent dosimetry and by estimating the effective dose (E). Staff doses were quantified by determining the entrance skin dose at the level of the eyes, thyroid, and both the hands with direct thermoluminescent dosimetry. For a group of 82 consecutive patients, the following median values were determined (data per procedure): patient E (19.7 mSv), patient entrance skin dose (374 mSv), staff entrance skin dose at eye level (0.21 mSv), thyroid (0.24 mSv), at the left hand (0.18 mSv), and at the right hand (0.76 mSv). The maximum recorded patient entrance skin dose stayed well below the deterministic threshold level of 2 Gy. Poor correlation between both patient/staff doses and integrated procedure mAs emphasizes the need for in vivo measurements. CT fluoroscopy doses are markedly higher than classic CT-scan doses and are comparable to doses from other interventional radiological procedures. They consequently require adequate radiation protection management. An important potential for dose reduction exists by limiting the fluoroscopic screening time and by reducing the tube current (mA) to a level sufficient to provide adequate image quality.

Prospective Evaluation of the Radiologist's Hand Dose in CT-Guided Interventions

“…This means that it would take over 2000 CT interventions to reach the annual limit value. In the study by Buls et al (2003), the median hand dose for the right hand was 0.76 mSv which is significantly higher than our measured values [19]. However, our values were significantly higher than those of Stoeckelhuber et al…”

Radiation-Induced Cataractogenesis: A Critical Literature Review for the Interventional Radiologist

“…A topic of interest in future lens dose research is CT fluoroscopy, which is known to deliver higher radiation doses than single-slice CT acquisition [43]. One study found that, over 82 consecutive procedures, CT fluoroscopy delivered a median per procedure eye level dose of 0.21 mSv [44]. Another study analyzing 220 CT fluoroscopy procedures found a low operator lens dose of 0.010 mSv/procedure, likely due to selection of a low milliampere value and usage of a quick-check technique similar to conventional CT [45].…”

Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting

“…Since the introduction of CT fluoroscopy, operator radiation exposure during CT fluoroscopy-guided intervention has been investigated in a number of studies, most commonly biopsy and drainage procedures [2][3][4][5][6][7][8][20][21][22][23][24]. Although some investigators estimated operator radiation dose using data from phantom measurements [20][21][22][23][24], the estimated dose may not represent actual radiation dose because the distance between the operator and CT gantry often changes during procedures.…”

“…On the other hand, operator radiation exposure is a substantial disadvantage of CT fluoroscopy-guided procedures. Operator radiation dose has been measured in previous studies for various CT fluoroscopy-guided interventional procedures, most commonly biopsy and drainage [2][3][4][5][6][7][8]. However, data on operator dose during ablation procedures are lacking.…”