Patient Dose Reference Levels for Interventional Radiology: A National Approach

Abstract

A set of patient dose reference levels (RLs) for fluoroscopically guided interventional procedures was obtained in a survey launched by the National Society of Interventional Radiology (IR), involving 10 public hospitals, as recommended by the European Medical Exposures Directive. A sample of 1391 dose values (kerma area product [KAP]) was collected randomly during clinical procedures for seven of the most frequent procedures. Third quartiles of the KAP distributions were used to set the RLs. A regular quality control of the X-ray systems and a calibration of the dose meters were performed during the survey. The fluoroscopy time and total number of digital subtraction angiography images per procedure were also analyzed. The RL values proposed were 12 Gy cm(2) for fistulography (hemodialysis access; sample of 180 cases), 73 Gy cm(2) for lower limb arteriography (685 cases), 89 Gy cm(2) for renal arteriography (55 cases), 80 Gy cm(2) for biliary drainage (205 cases), 289 Gy cm(2) for hepatic chemoembolization (151 cases), 94 Gy cm(2) for iliac stent (70 cases), and 236 Gy cm(2) for uterine embolization (45 cases). The provisional national RL values are lower than those obtained in a similar survey carried out in the United States from 2002 to 2004. These new values could be used to improve the practice of centers consistently working with doses higher than the RLs. This national survey also had a positive impact, as it helped increase the awareness of the members of the National Society of IR on a topic as crucial as patient dose values and programs on radiation protection.

Radiation Exposure in Nonvascular Fluoroscopy-Guided Interventional Procedures

“…During the last two decades, the field of interventional radiology (IR) has shown a constantly increasing number of procedures performed throughout the world as well as an impressive expansion of the spectrum of intervention types involving increasing complexity and radiation exposure [1][2][3][4]. Currently, as a general principle of IR, stepwise documentation of the procedural steps allows for comprehensive quality and safety management based on distinct and conclusive radiographic records, making the procedure transparent to all others, particularly the patients and the referring physician.…”

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.…”

Reference levels for patient Radiation Dose in interventional radiological procedures

“…procedure Saudi [14] Arabia Turkey [15] Canary [16] Islands Switzerland [17] spain [18] Europe [19] RAD-IR [20] etc [21] TACE 136 77 -629 289 121 353 216 참고문헌…”