Patient radiation dose audits for fluoroscopically guided interventional procedures

Abstract

Analysis of the two data sets (ADS and FDS) and of the percent of instances that exceed the SRDL provides a means for the facility to better manage radiation dose (and therefore both deterministic and stochastic radiation risk) to the patient during FGI procedures.

Patient radiation doses in interventional cardiology in the U.S.: Advisory data sets and possible initial values for U.S. reference levels

“…An alternate approach, dose audits, can be used to characterize and analyze patient radiation dose for IC procedures, without consideration of procedure complexity or patient characteristics, and without the need for clinical data. 5, 21 Because it does not incorporate a means to normalize the radiation dose data to account for procedure complexity, a dose audit requires information on cumulative patient dose estimates for all instances of the particular procedure as well as the uncertainty of that distribution of cumulative patient dose estimates. 22 Dose audits require collection and analysis of data from a greater number of cases than are needed to determine RLs or DRLs, and also employ a trigger value (related to the need for patient follow-up) for the evaluation of high dose cases.…”

“…The dose audit process provides a benchmark, in the form of an advisory data set (ADS), which consists of the radiation dose estimates for all of the cases of that procedure done in a large number of facilities. 16,21 (This is different from the limited number of cases used to define RLs.) As of 2012, no published ADS data are available for the U.S.…”

Recurrent Painful Abdominal Rash

“…2 Acute radiation dermatitis typically presents 7 to 14 days after radiation exposure, from skin doses in the range of 2 to 5 Gy. 3,8 Symptoms include erythema, epilation, bullae, ulceration, and skin necrosis. The clinical differential diagnosis includes herpes zoster, immunobullous diseases, fixed drug eruption, cellulitis, and a reaction from an arthropod or spider bite.…”

“…Radiation skin doses in fluoroscopic procedures can range from less than 1 mGy/min to as high as several Gy per minute in angiography cases. 3 Percutaneous coronary angiography or intervention is the most common cause of FIRD 2 and was first described in this setting in 1996. 4 Risk of developing FIRD correlates directly with length and complexity of the procedure, and efforts to shorten procedures and shield patients can reduce patients' risk.…”

Concepts to Reduce X-Ray Radiation in Interventional Radiology

“…Technical advice for radiation exposure reduction can be found in relevant standards (e.g., for interventional fluoroscopic equipment see IEC 60601-2-54:2009 and IEC 60601-2-43:2010) and related literature (Hirshfeld et al 2004;Balter et al 2009). However, most of the features described there may already be included in the latest versions of equipment on the market.…”