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Costa H, Espírito-Santo M, Bispo J, Guedes J, Paulo G, Mimoso J, Palmeiro H, Baptista Gonçalves R, Vinhas H. Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratory. Rev Port Cardiol 2024; 43:367-374. [PMID: 38336222 DOI: 10.1016/j.repc.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs). METHODS This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (PKA) and cumulative air kerma (Ka,r). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (Ka,r). RESULTS A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9±11.2 years and mostly male (81.4%). DRLs were set in Ka,r (3012 mGy) and PKA (162 Gy cm2) for complex PCI. ADs were also set in Ka,r (1917 mGy) and PKA (101 Gy cm2). Independent predictors of Ka,r with a positive correlation were PKA (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001). CONCLUSIONS This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in Ka,r (3012 mGy) and PKA (162 Gy cm2). ADs, values to be achieved in future assessment, were set to Ka,r (1917 mGy) and PKA (101 Gy cm2).
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Affiliation(s)
- Hugo Costa
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
| | | | - João Bispo
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - João Guedes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Coimbra, Portugal
| | - Jorge Mimoso
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Hugo Palmeiro
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Hugo Vinhas
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
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Uniyal SC, Singh V, Rawat A, Gururani K, Belwal CM. An audit of patient radiation doses during interventional cardiology procedures in Uttarakhand, India, and establishment of local diagnostic reference levels. Radiol Phys Technol 2024; 17:476-487. [PMID: 38652208 DOI: 10.1007/s12194-024-00805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
The objective of this study was to investigate patient radiation doses by a dose audit of three common interventional cardiology (IC) procedures: coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and CA-PTCA procedures performed in IC centres in the Uttarakhand state of India, for the establishment of local diagnostic reference levels (DRLs) and the estimation of average effective dose (Eav) for these procedures. For each procedure, the values of kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of cine images were recorded from 1233 CA, 458 PTCA and 736 CA-PTCA procedures performed over a 12-month period at 13 IC centres of the state. From the recorded dose data, 0.6%, 1.53% and 7.9% patients were identified to have exceeded the PKA trigger level of 500 Gy cm2 for possible skin injury for CA, PTCA and CA-PTCA procedures, respectively. The 3rd quartile of the distribution of the recorded PKA values for each type of procedure was calculated to estimate local DRL values. The estimated values of DRLs and Eav were 37, 153 and 224 Gy cm2, and 6.72, 23.97 and 34.79 mSv for CA, PTCA and CA-PTCA procedures, respectively. For about 77% of the surveyed centres, the recorded patient doses were in agreement with the international standards. The local DRLs proposed in this study may be used to achieve patient dose optimization during IC procedures and the obtained patient dose data may also be archived into national dose database for the establishment of national DRLs.
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Affiliation(s)
- Satish C Uniyal
- Department of Medical Physics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India.
| | - Vikram Singh
- Department of Medical Physics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Anurag Rawat
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Kunal Gururani
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Chandra Mohan Belwal
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
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Ubeda C, Vano E, Perez M, Jimenez P, van Deventer E, Ramirez R, Nader A, Miranda P. Optimization of Radiation Protection in Pediatric Interventional Radiology in Latin America and the Caribbean: Development, Advancements, Challenges and Achievements of the OPRIPALC Program. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1858. [PMID: 38136060 PMCID: PMC10742238 DOI: 10.3390/children10121858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
This article presents the development, advancements, challenges and achievements of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program. This international initiative is led by the World Health Organization, the Pan American Health Organization and the International Atomic Energy Agency. The main objectives of OPRIPALC are to foster a culture of radiological protection in pediatric interventions, enhance these procedures' quality, and define optimization strategies such as the use of diagnostic reference levels (DRLs). Currently, 33 centers from 12 countries participate actively in the program. Significant progress has been made towards the proposed objectives, overcoming the challenges posed by the COVID-19 pandemic. Through many virtual meetings for coordination, planning, training and follow-up, a comprehensive set of DRLs for both diagnostic and therapeutic procedures, categorized by weight and age, have been established and are in use. A consensus document on good practices is in the final stage of development. The program's continuation into at least a second phase is essential to address pending issues, including the integration of automatic dose management systems, the levels of occupational radiation doses, their correlation with pediatric patient doses, and strategies to reduce them.
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Affiliation(s)
- Carlos Ubeda
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica 1000000, Chile
| | - Elise Vano
- Radiology Department, Faculty of Medicine, Complutense University, IdIS, San Carlos Hospital, 28040 Madrid, Spain;
| | - María Perez
- World Health Organization (WHO), 1202 Geneva, Switzerland (E.v.D.)
| | - Pablo Jimenez
- Pan American Health Organization (PAHO), Washington, DC 20037, USA;
| | | | - Raúl Ramirez
- International Atomic Energy Agency (IAEA), 1220 Vienna, Austria; (R.R.); (A.N.)
| | - Alejandro Nader
- International Atomic Energy Agency (IAEA), 1220 Vienna, Austria; (R.R.); (A.N.)
| | - Patricia Miranda
- Luis Calvo Mackenna’s Hospital, AntonioVaras 360, Santiago 7500000, Chile;
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Sanchez RM, Siiskonen T, Vano E. Current status of diagnostic reference levels in interventional cardiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:041002. [PMID: 36379055 DOI: 10.1088/1361-6498/aca2b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Interventional cardiology provides indisputable benefits for patients but uses a substantial amount of ionising radiation. The diagnostic reference level (DRL) is the tool recommended by the International Commission on Radiological Protection to optimise imaging procedures. In this work, a review of studies dealing with radiation dose or recommending DRL values for interventional cardiology since 2010 is presented, providing quantitative and qualitative results. There are many published papers on coronary angiography (CA) and percutaneous coronary intervention. The DRL values compiled for different continental regions are different: the DRL for CA is about 35 Gy cm2for Europe and 83 Gy cm2for North America. These differences emphasise the need to establish national DRLs considering different social and/or economic factors and the harmonisation of the survey methodology. Surveys with a large amount of data collected with the help of dose management systems provide more reliable information with less chance of statistical bias than those with a small amount of data. The complexity of procedures and improvements in technology are important factors that affect the radiation dose delivered to patients. There is a need for additional data on structural and electrophysiological procedures. The analysis of paediatric procedures is especially difficult because some studies present results split into age bands and others into weight bands. Diagnostic procedures are better described, but there is a great variety of therapeutic procedures with different DRL values (up to a factor of nine) and these require a dedicated review.
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Affiliation(s)
- Roberto M Sanchez
- Hospital Clinico Universitario San Carlos, Medical Physics, Madrid, Spain
| | - Teemu Siiskonen
- Radiation and Nuclear Safety Authority-STUK, Helsinki, Finland
| | - Eliseo Vano
- Radiology Department, Universidad Complutense de Madrid, Madrid, Spain
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Balter S, Patel A. Radiation Management in Interventional Cardiology. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Srimahachota S, Krisanachinda A, Roongsangmanoon W, Sansanayudh N, Limpijankit T, Chandavimol M, Athisakul S, Siriyotha S, Rehani MM. Establishment of national diagnostic reference levels for percutaneous coronary interventions (PCIs) in Thailand. Phys Med 2022; 96:46-53. [PMID: 35219961 DOI: 10.1016/j.ejmp.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To establish national diagnostic reference levels (DRLs) for percutaneous coronary intervention (PCI) in Thailand for lesions of different complexity. METHODS Radiation dose quantity as kerma-area-product (KAP) and cumulative air-kerma at reference point (CAK) from 76 catheterization labs in 38 hospitals in PCI registry of Thailand was transferred online to central data management. Sixteen months data (May 2018 to August 2019) was analyzed. We also investigated role of different factors that influence radiation dose the most. RESULTS Analysis of 22,737 PCIs resulted in national DRLs for PCI of 91.3 Gy.cm2 (KAP) and 1360 mGy (CAK). The NDRLs for KAP for type C, B2, B1 and A lesions were 106.8, 82.6, 67.9, and 45.3 Gy.cm2 respectively and for CAK, 1705, 1247, 962, and 790 mGy respectively. Thus, as compared to lesion A, lesion C had more than double the dose and B2 had nearly 1.6 times and B1 had 1.2 times CAK. Our DRL values are lower than other Asian countries like Japan and Korea and are in the middle range of Western countries. University hospital had significantly higher dose than private or public hospital possibly because of higher load of complex procedures in university hospitals and trainees performing the procedures. Transradial approach showed lower doses than transfemoral approach. CONCLUSIONS This large multi-centric study established DRLs for PCIs which can act as reference for future studies. A hallmark of our study is establishment of reference levels for coronary lesions classified as per ACC/AHA and thus for different complexities.
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Affiliation(s)
- Suphot Srimahachota
- Cardiac Center and Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand.
| | - Anchali Krisanachinda
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Worawut Roongsangmanoon
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand
| | - Nakarin Sansanayudh
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Phramongkutklao Hostpital, Bangkok, Thailand
| | - Thosaphol Limpijankit
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mann Chandavimol
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siriporn Athisakul
- Cardiac Center and Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Sukanya Siriyotha
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Madan M Rehani
- Radiology Department, Massachusetts General Hospital, Boston, MA, USA
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First local diagnostic reference levels for fluoroscopically guided cardiac procedures in adult patients in Chile. NUCLEAR TECHNOLOGY AND RADIATION PROTECTION 2022. [DOI: 10.2298/ntrp2201084u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The goal of this study was to generate the first values of local diagnostic
reference levels for a range of fluoroscopically guided cardiac diagnostic
and therapeutic procedures in adult patients in Chile and to compare
radiation dose levels with others presented in the literature. The
dosimetric data collection period was conducted over the whole of 2020. The
local diagnostic reference levels were calculated as the 75th percentile
of patient dose data distributions for kerma area-product values. The sample
of collected clinical procedures (480) was divided into diagnostic and
therapeutic procedures. The kerma area-product differences found between
diagnostic and therapeutic procedures were statistically significant. The
local diagnostic reference levels were 81.6 Gy cm2 and 166.9 Gycm2 for
fluoroscopically guided cardiac diagnostic and therapeutic procedures,
respectively. A comparison of our results with results found in the
literature for the last 10 years, showed that there are no published papers
for hospitals in Latin America and the Caribbean. It becomes urgent to be
able to carry out more research of this type, given that the health
reality between countries on different continents is very different. While
in some the establishment of diagnostic reference levels is a legal obligation, in others it is a matter of good or bad will.
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Sothmann PJ, Groenewald WA, Doubell AF, Pitcher RD. TYPICAL VALUES OF DOSIMETRIC DATA FOR CARDIAC FLUOROSCOPY-GUIDED PROCEDURES IN A SOUTH AFRICAN TEACHING HOSPITAL. RADIATION PROTECTION DOSIMETRY 2021; 196:153-158. [PMID: 34595514 DOI: 10.1093/rpd/ncab143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/18/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Currently there are limited diagnostic reference level (DRL) data for South African (SA) public sector cardiac fluoroscopy-guided procedures (FGPs). A 4-y retrospective study of dosimetric data on 6265 patients determined typical values (50th percentile) of dosimetric data for the seven most frequent cardiac FGPs at a SA teaching hospital. Kerma-area-product (KAP), reference point air Kerma (Ka,r) and fluoroscopy time (FT) were, respectively, calculated for coronary angiography (CA) (n = 1935; 61Gy.cm2, 624 mGy, 5 min); CA with left ventriculography (n = 1687; 85Gy.cm2, 840 mGy, 3.9 min), valve screening (n = 129; 6Gy.cm2, 164 mGy, 2.3 min), percutaneous coronary intervention (n = 1922; 145Gy.cm2, 1569 mGy, 11.9 min), pacemaker implantation (n = 432; 9Gy.cm2, 100 mGy, 6.5 min), pericardial tap (n = 115; 1.9Gy.cm2, 18 mGy, 1.5 min) and transcatheter aortic valve implantation (n = 45; 65Gy.cm2, 658 mGy, 14.1 min). This work presents the largest SA public sector cardiac FGP dosimetric data to date and provides a key resource for future work in this domain.
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Affiliation(s)
- P J Sothmann
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - W A Groenewald
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - A F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - R D Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
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Osman E, Sulieman A, Alzimami K, Tamam N, Jambi LK, Babikir E, Abd-Elghany AA, Abuzaid M, Omer H, Bradley D. Radiation exposure during therapeutic cardiac interventional procedures. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Kataria V, Yaduvanshi I, Singal G, Nair M. Establishing a diagnostic reference level of radiation dose in coronary angiography and intervention: A prospective evaluation. Indian Heart J 2021; 73:725-728. [PMID: 34861982 PMCID: PMC8642644 DOI: 10.1016/j.ihj.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Invasive Coronary Angiography (CAG) leads to significant radiation exposure to the patients. Guidelines suggest that a local landmark or Diagnostic Reference Level (DRL) for these procedures should be established for every region and country. This study attempts to create a DRL for a tertiary care hospital, acting as an interim DRL for the country/region. METHODS Radiation exposure data for all coronary procedures done at a tertiary care hospital between October 2016 to September 2018 were collected. Data was segregated into diagnostic Coronary Angiography (CAG) and single-vessel Percutaneous Intervention (PCI). The parameters collected include dose surface product (PKA), skin surface entry dose (KAR), and fluoroscopy time (FT). The 75th percentile of the PKA was used to define the DRL. RESULTS 500 Patients were included in the CAG group, in which the Median KAR was 412.05 mGy, Median PKA was 2635.7 μGysqm, and median FT was 2.25 min. The DRL for coronary angiography was calculated as 3695.1 μGysqm. Two hundred fifty patients were in the PCI group, the Median KAR was 1649 mGy, Median PKA was 8822.1 μGysqm, the median FT being 8.2 min. The DRL for single-vessel coronary intervention was calculated as 11038 μGysqm. CONCLUSION This study establishes a benchmark for radiation dose for diagnostic coronary angiography and single-vessel coronary intervention at a tertiary care hospital in NCR. It establishes an interim DRL that can be used for future studies in other institutions in the region and country and to compare with other countries.
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Affiliation(s)
- Vikas Kataria
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Ishita Yaduvanshi
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Gautam Singal
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India
| | - Mohan Nair
- Department of Cardiology, Holy Family Hospital, New Delhi, 110025, India.
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Miller DL, Kakar S, Jiang L, Spelic DC, Burk L. The U.S. Food and Drug Administration's role in improving radiation dose management for medical X-ray imaging devices. Br J Radiol 2021; 94:20210373. [PMID: 33989043 PMCID: PMC9328068 DOI: 10.1259/bjr.20210373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/15/2021] [Accepted: 05/10/2021] [Indexed: 11/05/2022] Open
Abstract
The U.S. Food and Drug Administration (FDA) has been concerned with minimizing the unnecessary radiation exposure of people for half a century. Manufacturers of medical X-ray imaging devices are important partners in this effort. Medical X-ray imaging devices are regulated by FDA under both its electronic product regulations andits medical device regulations. FDA also publishes guidance documents that represent FDA's current thinking on a topic and provide a suggested or recommended approach to meet the requirements of a regulation or statute. FDA encourages manufacturers to develop medical devices that conform to voluntary consensus standards. Use of these standards is a central element of FDA's system to ensure that all medical devices marketed in the U.S. meet safety and effectiveness requirements. FDA staff participate actively in the development and maintenance of these standards, often advancing or introducing new safety and dose management requirements. Use of voluntary consensus standards reduces the amount of time necessary to evaluate a premarket submission and reduces the burden on manufacturers. FDA interacts with industry and other stakeholders through meetings with industry groups, public meetings, public communications, and through the development of voluntary consensus standards. In these interactions, FDA staff introduce new concepts for improving the safety of these devices and provide support for similar initiatives from professional organizations. FDA works with all stakeholders to achieve its mission of protecting and promoting the public health.
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Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
| | - Smita Kakar
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
| | - Lu Jiang
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
| | - David C. Spelic
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
| | - Laurel Burk
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
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Malan L, Pitcher RD, da Silva M, Breuninger S, Groenewald W. Diagnostic reference levels for fluoroscopically guided procedures in a South African tertiary hospital. Acta Radiol 2021; 62:807-814. [PMID: 32640888 DOI: 10.1177/0284185120938371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burgeoning usage and complexity of fluoroscopically guided procedures (FGPs) contribute to extended examination times and increased risk of adverse radiation effects. Diagnostic reference levels (DRLs) play a pivotal role in dose optimization. There are limited DRL data for FGPs in low- and middle-income countries (LMICs). PURPOSE To determine local DRLs (LDRLs) for common FGPs in the South African (SA) context and compare these with published international data. MATERIAL AND METHODS A three-year, retrospective study of the 15 most frequently performed FGPs at a SA institution. For each procedure, the 50th and 75th percentiles of kerma area product (KAP), reference point air kerma (Ka,r), and fluoroscopy time data were derived. Published international FGP DRL data were collated and compared with the 75th percentiles of local institutional dosage parameters. RESULTS The commonest FGPs were aorto-bifemoral diagnostic angiography (n = 590), aorto-bifemoral interventional angiography (n = 287), nephrostomy (n = 265), and bronchial arterial embolization (BAE) (n = 208). Selective abdominal vessel interventional angiography (KAP = 170 Gy . cm2; Ka,r = 877 mGy) recorded the highest LDRL dosages; BAE was the longest procedure (LDRL = 38 min). Nephrostomies achieved the lowest LDRLs across all parameters (KAP = 10 Gy . cm2; Ka,r = 63 mGy, fluoroscopy time = 4.3 min). All Tygerberg Hospital LDRLs with comprehensive comparable data were within or below published ranges. CONCLUSION This study advances international radiation protection initiatives, addresses the paucity of LMIC DRL data, demonstrates broad alignment of Tygerberg Hospital FGP practice with international norms and highlights areas for optimization of institutional practice.
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Affiliation(s)
- Leon Malan
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Richard D Pitcher
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Michelle da Silva
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Sharlene Breuninger
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Wilhelm Groenewald
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
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Schegerer AA, Frija G, Paulo G, Jaschke W, Tsapaki V, Repussard J, Damilakis J. Radiation dose and diagnostic reference levels for four interventional radiology procedures: results of the prospective European multicenter survey EUCLID. Eur Radiol 2021; 31:9346-9360. [PMID: 33991223 DOI: 10.1007/s00330-021-08029-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/02/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess information reflecting radiation dose and define diagnostic reference levels (DRL) on a European basis for four interventional radiology (IR) procedures considering clinical indication, anatomical region, and procedure. METHODS A prospective European study was performed to provide data on the IR procedures percutaneous recanalization of iliac arteries, percutaneous recanalization of femoropopliteal arteries, transarterial chemoembolization of hepatocellular carcinoma, and percutaneous transhepatic biliary drainage. Hospitals were asked to complete a questionnaire giving information on procedure, equipment, and protocol. Patient size and weight, experience of the operator graded in number of procedures performed, and complexity level of each procedure were reported. Sixteen hospitals from 13 countries could be surveyed. The percentiles of the kerma-area product, fluoroscopy time, cumulative air kerma at the interventional reference point, and number of images were determined. The impact of equipment, year of installation, and complexity level of the procedure on dose were analyzed. RESULTS DRLs based on clinical indication were defined. Dose values varied considerably within hospitals, between them, and within each subgroup of complexity level. The use of state-of-the-art equipment reduced dose significantly by 52%. Although dose also varied within each subgroup of complexity level, for transarterial chemoembolization of hepatocellular carcinoma and percutaneous transhepatic biliary drainage, dose significantly correlated with complexity. CONCLUSIONS This was the first study reporting exposure practice and defining DRLs based on clinical indication for four IR procedures on a European basis. These DRLs can serve as a baseline for comparison with local practice, the study as a guideline for future surveys. KEY POINTS • The use of state-of-the-art angiographic equipment reduces dose significantly. • A significant correlation between radiation dose and complexity level is found. • Dose values vary considerably, both within and between individual hospitals, and within each complexity level of interventional radiology procedure.
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Affiliation(s)
- Alexander A Schegerer
- Department of Radiation Protection and Image Processing Systems, Hirslanden AG, Hirslanden Corporate Office, Boulevard Lilienthal 2, 8152, Opfikon-Glattpark, Switzerland. .,Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany.
| | - Guy Frija
- Paris Descartes University, Paris, France
| | - Graciano Paulo
- ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal
| | - Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - John Damilakis
- School of Medicine, University of Crete, Iraklion, Crete, Greece
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14
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Patient exposure data and operator dose in coronary interventional procedures: Impact of body-mass index and procedure complexity. Phys Med 2020; 76:38-43. [DOI: 10.1016/j.ejmp.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022] Open
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15
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Subban V. Radiation doses during cardiac catheterisation procedures in India: a multicentre study: Radiation dose study. ASIAINTERVENTION 2020; 6:25-33. [PMID: 34912981 PMCID: PMC8525728 DOI: 10.4244/aij-d-18-00044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/04/2020] [Indexed: 10/25/2023]
Abstract
AIMS Established, evidence-based measures of radiation are required to minimise its hazards, while maintaining adequate image quality. The aim of this study is to evaluate radiation data and generate reference radiation levels for commonly performed coronary catheterisation procedures in India. METHODS AND RESULTS In this prospective, observational study, all procedures were performed in accordance with the established standards using Innova IGS 520/2100-IQ catheterisation laboratories. Demographic, procedural and radiation data were collected. Dose reference limits (DRL) were established as the 75th percentile of the total distribution. There were 2,906 coronary angiograms (CAG), 750 percutaneous coronary interventions (PCI) and 715 CAG+PCI. DRLs for dose area product were: 19.6 Gy·cm2 for CAG, 49.8 Gy·cm2 for PCI and 72.0 Gy·cm2 for CAG+PCI, respectively. Median cumulative air kerma levels were: 185 mGy for CAG, 533mGy for PCI, and 891 mGy for CAG+PCI. Male gender, higher BMI, combining CAG+PCI, fluoroscopy time, number of cine frames, and image acquisition settings were significant contributors to increased radiation dose. CONCLUSIONS This study established reference radiation dose levels for diagnostic and interventional coronary procedures in India, which were comparable to and in the lower range of international standards.
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Affiliation(s)
- Vijayakumar Subban
- Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
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16
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Crowhurst JA, Whitby M, Aroney N, Dautov R, Walters D, Raffel O. Primary operator radiation dose in the cardiac catheter laboratory. Br J Radiol 2020; 93:20200018. [PMID: 32543896 DOI: 10.1259/bjr.20200018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Radiation from cardiac angiography procedures is harmful to patients and the staff performing them. This study sought to investigate operator radiation dose for a range of procedures and different operators in order to investigate trends and optimise dose. METHODS Real-time dosemeters (RTDs) were worn by operators for angiography procedures for 3 years. Dose-area product (DAP) and RTD were collected. RTD was normalised to DAP (RTD/DAP) to compare radiation dose and radiation protection measures. Comparisons were made across procedure categories and individual operators. RESULTS In 7626 procedures, median and 75th percentile levels were established for operator dose for 8 procedure categories. There was a significant difference in all operator dose measures and DAP across procedure categories (p<0.001). DAP, RTD, and RTD/DAP were significantly different across 22 individual operators (p<0.001). CONCLUSION DAP was significantly different across procedure categories and a higher RTD was seen with higher DAP. RTD/DAP can demonstrate radiation protection effectiveness and identified differences between procedures and individual operators with this measure. Procedures and individuals were identified where further optimisation of radiation protection measures may be beneficial. A reference level for operator dose can be created and audited against on a regular basis. ADVANCES IN KNOWLEDGE This study demonstrates that operator dose can be easily and routinely measured on a case by case basis to investigate dose trends for different procedures. Normalising the operator dose to DAP demonstrates radiation protection effectiveness for the individual operator which can then be optimised as part of an ongoing audit program.
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Affiliation(s)
- James A Crowhurst
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Whitby
- University of Queensland, St Lucia, Brisbane, Australia.,I-MED Radiology, Newstead, Queensland, Australia
| | - Nicholas Aroney
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
| | - Rustem Dautov
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
| | - Darren Walters
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia.,St Vincents Northside Private Hospital, Chermside, Queensland, Australia
| | - Owen Raffel
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
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17
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Zucca S, Solla I, Boi A, Loi S, Rossi A, Sanna F, Loi B. The role of a commercial radiation dose index monitoring system in establishing local dose reference levels for fluoroscopically guided invasive cardiac procedures. Phys Med 2020; 74:11-18. [PMID: 32388465 DOI: 10.1016/j.ejmp.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The primary goal was to evaluate local dose level for fluoroscopically guided invasive cardiac procedures in a high-volume activity catheterization laboratory, using automatic data registration with minimal impact on operator workload. The secondary goal was to highlight the relationship between dose indices and acquisition parameters, in order to establish an effective strategy for protocols optimization. METHODS From September 2016 to December 2018, a dosimetric survey was conducted in the 2 rooms of the catheterization laboratory of our institution. Data collection burden was minimized using a commercial Radiation Dose Index Monitoring System (RDIMs) that analyzes dicom files automatically sent by the x-ray equipment. Data were combined with clinical information extracted from the HIS records reported by the interventional cardiologist. Local dose levels were established for different invasive cardiac procedures. RESULTS A total of 3029 procedures performed for 2615 patients were analyzed. Median KAP were 21 Gycm2 for invasive coronary angiography (ICA) procedures, 61 Gycm2 for percutaneous coronary intervention (PCI) procedures, 59 Gycm2 for combined (ICA+PCI) procedures, 87 Gycm2 for structural heart intervention (TAVI) procedures. A significant dose reduction (51% for ICA procedures and 58% for PCI procedures) was observed when noise reduction acquisition techniques were applied. CONCLUSIONS RDIMs are effective tools in the establishment of local dose level in interventional cardiology, as they mitigate the burden to collect and register extensive dosimetric data and exposure parameters. Systematic review of data support the multi-disciplinary team in the definition of an effective strategy for protocol management and dose optimization.
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Affiliation(s)
- Sergio Zucca
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy.
| | - Ignazio Solla
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Alberto Boi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Stefano Loi
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Angelica Rossi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Francesco Sanna
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Bruno Loi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
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18
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Ou-Saada I, Boujemaa S, Campoleoni M, Brambilla R, Bentayeb F. Local Diagnostic Reference Levels in Interventional Radiology. J Med Imaging Radiat Sci 2020; 51:307-311. [PMID: 32278664 DOI: 10.1016/j.jmir.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Interventional cardiology procedures, during which live images are acquired, involve exposure to x-rays. The use of fluoroscopy can cause high radiation doses to patients and operators because of the prolonged duration of x-ray emission. For this reason, special attention and constant vigilance represent challenges for commissions and groups of experts in the field. The purpose of this study is to establish local diagnostic reference levels (DRLs) for these procedures, to improve radiological practice, and to optimize radiation doses. METHODS This work was carried out in two university hospitals and two private medical facilities in Rabat, the capital of Morocco, during the period 2017-2018. The study concerns 657 interventional cardiology procedures (457 coronary angiography [CA] and 200 percutaneous transluminal coronary angioplasty [PTCA]), performed by 11 cardiologists on different installations in 5 catheterization rooms. The data collected for each procedure were patient age, height and weight, dosimeter indicators in terms of dose area product (PKA), total air kerma at the reference point (Kar), fluoroscopy time (FT), and the number of frames, together with the primary beam parameters as kV and total mAs. The proposed DRLs were set from the 75th percentile of the PKA and FT. RESULTS The mean of PKA for CA and PTCA procedures were 29.2 Gy∗cm2 and 70.4 Gy∗cm2, respectively, the mean of fluoroscopy time were 4.0 min and 12.17 min for 334 and 685 frames, respectively. Results for the local DRLs were 37.3 and 87.1 Gy cm2 for PKA and 4.48 and 16.15 min for FT, corresponding to CA and PTCA procedures. CONCLUSION This work focuses on proposing local DRLs in Morocco for CA and PTCA procedures. The results show that the values found conform with those of international studies.
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Affiliation(s)
- Imane Ou-Saada
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco
| | - Soumaya Boujemaa
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco
| | - Mauro Campoleoni
- Unità Operativa di Fisica Medica "Fondazione Ca 'Granda - Ospedale Maggiore Policlinico", Milano, Italy
| | - Roberto Brambilla
- Unità Operativa di Fisica Medica "Fondazione Ca 'Granda - Ospedale Maggiore Policlinico", Milano, Italy
| | - Farida Bentayeb
- Laboratory of High Energy Physics, Modelisation and Simulation, Faculty of Sciences, Rabat, Morocco.
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19
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Compagnone G, Padovani R, D'Ercole L, Orlacchio A, Bernardi G, D'Avanzo MA, Grande S, Palma A, Campanella F, Rosi A. Provision of Italian diagnostic reference levels for diagnostic and interventional radiology. Radiol Med 2020; 126:99-105. [PMID: 32239471 DOI: 10.1007/s11547-020-01165-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The diagnostic reference level (DRL) is a useful tool for the optimisation of medical exposures. Thus, a Working Party coordinated by the Italian National Institute of Health and the National Workers Compensation Authority has been formed to provide Italian DRLs, for both diagnostic and interventional procedures, to be used as appropriate for the implementation of the 2013/59 European Directive into the national regulation. MATERIALS AND METHODS The multidisciplinary Working Party was formed by professionals involved in diagnostic and interventional radiology medical exposures and started from a critical revision of both the literature and the results of previous Italian surveys. The procedures were divided into five sections for adult (projection radiography, mammography, diagnostic fluoroscopy, CT and interventional radiology) and two sections for paediatric patients (projection radiography and CT). The provided DRL values have been identified for "normal" adult patients and for age-classes of paediatric patients. RESULTS Some of the DRL values provided by the Working Party are reported in this study as an example, divided by adult/paediatric patients, radiological technique and examination: specifically, DRLs for new radiological practices and new dose quantities as DRLs metric were introduced. The median value (rather than the mean) for each procedure, derived from a sample of patients, has to be compared with the corresponding DRL value, and dosimetric data related to a minimum number of patients should be collected for each examination. CONCLUSIONS The approach to the definition and use of DRLs through guidelines of national Authorities in collaboration with scientific Associations should simplify the periodical updating and could be useful for keeping the optimisation of medical exposures faithful to the development of radiological practice.
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Affiliation(s)
- Gaetano Compagnone
- Department of Medical Physics, S.Orsola-Malpighi University Hospital, Via Massarenti, 9, 40138, Bologna, BO, Italy.
| | - Renato Padovani
- Abdus Salam International Centre for Theoretical Physics, Trieste, Italy
| | - Loredana D'Ercole
- Department of Medical Physics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Orlacchio
- Department of Radiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Maria Antonietta D'Avanzo
- Department of Medicine Epidemiology and Environmental Sanitation, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro (INAIL), Rome, Italy
| | - Sveva Grande
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Alessandra Palma
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Francesco Campanella
- Department of Medicine Epidemiology and Environmental Sanitation, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro (INAIL), Rome, Italy
| | - Antonella Rosi
- National Centre for Innovative Technologies in Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
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20
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Mettler FA, Mahesh M, Bhargavan-Chatfield M, Chambers CE, Elee JG, Frush DP, Miller DL, Royal HD, Milano MT, Spelic DC, Ansari AJ, Bolch WE, Guebert GM, Sherrier RH, Smith JM, Vetter RJ. Patient Exposure from Radiologic and Nuclear Medicine Procedures in the United States: Procedure Volume and Effective Dose for the Period 2006-2016. Radiology 2020; 295:418-427. [PMID: 32181730 DOI: 10.1148/radiol.2020192256] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Comprehensive assessments of the frequency and associated doses from radiologic and nuclear medicine procedures are rarely conducted. The use of these procedures and the population-based radiation dose increased remarkably from 1980 to 2006. Purpose To determine the change in per capita radiation exposure in the United States from 2006 to 2016. Materials and Methods The U.S. National Council on Radiation Protection and Measurements conducted a retrospective assessment for 2016 and compared the results to previously published data for the year 2006. Effective dose values for procedures were obtained from the literature, and frequency data were obtained from commercial, governmental, and professional society data. Results In the United States in 2006, an estimated 377 million diagnostic and interventional radiologic examinations were performed. This value remained essentially the same for 2016 even though the U.S. population had increased by about 24 million people. The number of CT scans performed increased from 67 million to 84 million, but the number of other procedures (eg, diagnostic fluoroscopy) and nuclear medicine procedures decreased from 17 million to 13.5 million. The number of dental radiographic and dental CT examinations performed was estimated to be about 320 million in 2016. Using the tissue-weighting factors from Publication 60 of the International Commission on Radiological Protection, the U.S. annual individual (per capita) effective dose from diagnostic and interventional medical procedures was estimated to have been 2.9 mSv in 2006 and 2.3 mSv in 2016, with the collective doses being 885 000 and 755 000 person-sievert, respectively. Conclusion The trend from 1980 to 2006 of increasing dose from medical radiation has reversed. Estimated 2016 total collective effective dose and radiation dose per capita dose are lower than in 2006. © RSNA, 2020 See also the editorial by Einstein in this issue.
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Affiliation(s)
- Fred A Mettler
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Mahadevappa Mahesh
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Mythreyi Bhargavan-Chatfield
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Charles E Chambers
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Jennifer G Elee
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Donald P Frush
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Donald L Miller
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Henry D Royal
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Michael T Milano
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - David C Spelic
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Armin J Ansari
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Wesley E Bolch
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Gary M Guebert
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Robert H Sherrier
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - James M Smith
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
| | - Richard J Vetter
- From the Department of Radiology, University of New Mexico, 3004 La Mancha Dr NW, Albuquerque, NM 87104 (F.A.M.); Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (M.M.); Department for Quality and Safety, American College of Radiology, Reston, Va (M.B.C.); Departments of Radiology and Medicine, Penn State Hershey Medical Center, Hershey, Pa (C.E.C.); Radiation Section, Louisiana Department of Environmental Quality, West Monroe, La (J.G.E.); Department of Radiology, Stanford University, Stanford, Calif (D.P.F.); Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M., D.C.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (H.D.R.); Department of Radiation Oncology, University of Rochester, Rochester, NY (M.T.M.); Radiation Studies Section, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Ga (A.J.A.); Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Fla (W.E.B.); Department of Radiology, Logan University, Maryland Heights, Mo (G.M.G.); Duke University, U.S. Department of Veterans Affairs, Durham, NC (R.H.S.); Rollins School of Public Health, Emory University, Atlanta, Ga (J.M.S.); and Mayo Clinic, Rochester, Minn (R.J.V.)
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Ngaile J, Msaki P, Nyanda P, Muhulo A, Muhogora W, Mvungi R. Estimation of equivalent organ and effective doses to patients undergoing coronary angiography and percutaneous coronary intervention procedures using Monte Carlo simulation. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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da Silva DA, Maia AF, Machado R, Freitas VLSDM, Pinheiro RDC, Franco NFA, Kremer DW, Navarro MV. Patient doses in cardiac catheterisation in Santa Catarina, Brazil. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Sánchez R, Vañó E, Fernández Soto JM, Ten JI, Escaned J, Delgado C, García B, Carrera Magariño F, Fernández JFD, Luna RJM, Moreno MAR, Catalán A, Ojeda FB, Rosales Espizua FJ, Moreno JRS, Pifarré X, Goicolea J, Ordiales JM, Nogales JM, Martinez G, García P, Benedicto A, Castillo MFR, Torres LP, Font J, Bethencourt A, Cesteros MJ, Pérez A, Pinar E, Tobarra B. Updating national diagnostic reference levels for interventional cardiology and methodological aspects. Phys Med 2020; 70:169-175. [DOI: 10.1016/j.ejmp.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/05/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022] Open
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Ishibashi T, Takei Y, Sakamoto H, Yamashita Y, Kato M, Tsukamoto A, Matsumoto K, Mizutani H, Suzuki S, Katoh Y, Chida K. [Nationwide Survey of Medical Radiation Exposure on Cardiovascular Examinations in Japan]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:64-71. [PMID: 31956188 DOI: 10.6009/jjrt.2020_jsrt_76.1.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE It is very important to manage the radiation dose of cardiovascular interventional (CVI) procedures. Overseas, the diagnostic reference levels for cardiac interventional procedures were established with the air kerma at the patient entrance reference point (Ka,r) and the air kerma-area product (PKA). Although the Japan DRLs 2015 was established by the Japan Network for Research and Information on Medical Exposure (J-RIME), the Japan DRL for CVIs were established by fluoroscopic dose rates of 20 mGy/min at the patient entrance reference point with 20 cm thickness polymethyl methacrylate (PMMA) phantom. In the present our study, we performed a questionnaire survey of indicated values of angiographic parameters in CVI procedures. METHODS A nationwide questionnaire was sent by post to 765 facilities. Question focused on angiographic technology, exposure parameters and radiation doses as the displayed dosimetric parameters on the angiographic machine. RESULTS The recovery rate was 22.8% at 175 out of 765 facilities. In total 1728 cases of the coronary angiography (CAG), 1703 cases of the percutaneous coronary intervention (PCI), 962 cases of the radiofrequency catheter ablation (RFCA) and 377 cases of pediatric CVI. The 75th percentile value of Ka,r, PKA, fluoroscopy time (FT) and number of cine images (CI) for CAG, PCI, RFCA and pediatric CVI were 702, 2042, 644, and 159 mGy, respectively, 59.3, 152, 81.3, and 14.9 Gy・cm2, respectively, 10.2, 35.6, 61.1, and 35.6 min, respectively and 1503, 2672, 722, and 2378 images, respectively. Our investigation showed that the angiographic parameters were different in several CVI procedures. CONCLUSIONS The displayed dosimetric parameters on the angiographic machine in CVI procedures showed different values. We should classify the dosimetric parameters for each procedure.
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Affiliation(s)
- Tooru Ishibashi
- Department of Radiological Technology, Tsuchiya General Hospital
| | - Yasutaka Takei
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare
| | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Yukari Yamashita
- Department of Radiological Technology, Tsuchiya General Hospital
| | - Mamoru Kato
- Department of Radiology and Nuclear Medicine, Akita Cerebrospinal and Cardiovascular Center
| | | | - Kazuma Matsumoto
- Department of Clinical Radiology, Hyogo College of Medicine College Hospital
| | - Hiroshi Mizutani
- Department of Radiological Technology, Tokushima Bunri University School of Health and Human Services
| | - Shoichi Suzuki
- Department of Radiology, Fujita Medical University School of Medical Science
| | - Yoh Katoh
- Department of Radiological Sciences, Faculty of Health Sciences, Tokyo Metropolitan University
| | - Koichi Chida
- Department of Health Science, Tohoku University Graduate School of Medicine
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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Järvinen J, Sierpowska J, Siiskonen T, Järvinen H, Kiviniemi T, Rissanen TT, Matikka H, Niskanen E, Hurme S, Larjava HRS, Mäkelä TJ, Strengell S, Eskola M, Parviainen T, Hallinen E, Pirinen M, Kivelä A, Teräs M. CONTEMPORARY RADIATION DOSES IN INTERVENTIONAL CARDIOLOGY: A NATIONWIDE STUDY OF PATIENT DOSES IN FINLAND. RADIATION PROTECTION DOSIMETRY 2019; 185:483-493. [PMID: 30989216 DOI: 10.1093/rpd/ncz041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/01/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
The amount of interventional procedures such as percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI), pacemaker implantation (PI) and ablations has increased within the previous decade. Simultaneously, novel fluoroscopy mainframes enable lower radiation doses for patients and operators. Therefore, there is a need to update the existing diagnostic reference levels (DRLs) and propose new ones for common or recently introduced procedures. We sought to assess patient radiation doses in interventional cardiology in a large sample from seven hospitals across Finland between 2014 and 2016. Data were used to set updated national DRLs for coronary angiographies (kerma-air product (KAP) 30 Gycm2) and PCIs (KAP 75 cm2), and novel levels for PIs (KAP 3.5 Gycm2), atrial fibrillation ablation procedures (KAP 25 Gycm2) and TAVI (KAP 90 Gycm2). Tentative KAP values were set for implantations of cardiac resynchronization therapy devices (CRT, KAP 22 Gycm2), electrophysiological treatment of atrioventricular nodal re-entry tachycardia (6 Gycm2) and atrial flutter procedures (KAP 16 Gycm2). The values for TAVI and CRT device implantation are published for the first time on national level. Dose from image acquisition (cine) constitutes the major part of the total dose in coronary and atrial fibrillation ablation procedures. For TAVI, patient weight is a good predictor of patient dose.
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Affiliation(s)
- Jukka Järvinen
- Department of Cardiology, Turku Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Radiology, The Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Joanna Sierpowska
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, Finland
| | | | - Hannu Järvinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Tuomas Kiviniemi
- Department of Cardiology, Turku Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas T Rissanen
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, Finland
| | - Hanna Matikka
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Eini Niskanen
- Department of Radiology, Vaasa Central Hospital, Vaasa, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku
| | - Heli R S Larjava
- Department of Medical Imaging, Central Finland Health Care District, Jyväskylä, Finland
| | - Timo J Mäkelä
- Department of Internal Medicine, Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Satu Strengell
- Department of Cardiology, Cardiology Division, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Markku Eskola
- Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere, Finland and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | | | - Elina Hallinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Markku Pirinen
- Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Antti Kivelä
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Mika Teräs
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Department of Biomedicine, Institute of Biomedicine, University of Turku, Turku, Finland
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Brindhaban A. RADIATION DOSE TO PATIENTS IN CORONARY INTERVENTIONAL PROCEDURES: A SURVEY. RADIATION PROTECTION DOSIMETRY 2019; 184:1-4. [PMID: 30289509 DOI: 10.1093/rpd/ncy179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
The objective of this study was to evaluate dose-area product (DAP) and peak skin dose (PSD) for coronary angiography (CA) and percutaneous coronary intervention (PCI). The DAP and PSD of 300 randomly selected patients who were referred to CA and/or PCI, over a period of 3 months were recorded and analyzed. The mean DAP of 32 Gy cm2 and mean PSD of 412 mGy for CA were lower than 118 Gy cm2 and 857 mGy, respectively, for PCI. The DAP range of 2-84 Gy cm2 for CA and 12-378 mGy for PCI were also established. The maximum value of PSD for PCI procedures reached above the 2 Gy threshold for erythema. However, these values are similar to those available in literature. Periodic surveys may be required to monitor and/or reduce radiation doses in coronary interventional procedures.
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Affiliation(s)
- A Brindhaban
- Department of Radiologic Sciences, Kuwait University, Sulaibikhat, Kuwait
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Osei B, Xu L, Johnston A, Darko S, Darko J, Osei E. Retrospective study of patients radiation dose during cardiac catheterization procedures. Br J Radiol 2019; 92:20181021. [PMID: 31045448 PMCID: PMC6636266 DOI: 10.1259/bjr.20181021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory. METHODS We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient's clinical radiation dose data [kerma-area-product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital's RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software. RESULTS The overall patient median age was 67.0 (range: 26.0-97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9-61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1-203.2), 80.2 (18.9-208.5), 83.7 (48.0-246.1), 113.8 (60.9-284.5), 91.7 (6.0-426.0) and 51.1 (7.0-175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3-3794.0), 1384.7 (291.7-4021.8), 1607.0 (883.5-4448.3), 2260.2 (867.4-5311.9), 1589.3 (100.2-7237.4) and 463.8 (67.7-1695.9) mGy respectively. CONCLUSION We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories. ADVANCES IN KNOWLEDGE We have investigated local patients' radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.
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Affiliation(s)
| | | | | | - Sara Darko
- Department of Clinical Trials, Grand River Regional Cancer Centre, Kitchener, ON, Canada
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Huo W, Pi Y, Feng M, Qi Y, Gao Y, Caracappa PF, Chen Z, Xu XG. VirtualDose-IR: a cloud-based software for reporting organ doses in interventional radiology. Phys Med Biol 2019; 64:095012. [PMID: 30822765 PMCID: PMC7480071 DOI: 10.1088/1361-6560/ab0bd5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A cloud-based software, VirtualDose-IR (Virtual Phantoms Inc., Albany, New York, USA), designed to report organ doses and effective doses for a diverse patient population from interventional radiology (IR) procedures has been developed and tested. This software is based on a comprehensive database of Monte Carlo-generated organ dose built with a set of 21 anatomically realistic patient phantoms. The patient types included in this database are both male and female people with different ages reflecting reference adults, obese people with different BMIs and pregnant women at different gestational stages. Selectable parameters such as patient type, tube voltage, filtration thickness, beam direction, field size, and irradiation site are also considered in VirtualDose-IR. The software has been implemented using the 'Software as a Service (SaaS)' delivery concept permitting simultaneous multi-user, multi-platform access without requiring local installation. The patient doses resulting from different target sites and patient populations were reported using the VirtualDose-IR system. The patient doses under different source to surface distances (SSD) and beam angles calculated by VirtualDose-IR and Monte Carlo simulations were compared. For most organs, the dose differences between VirtualDose-IR results and Monte Carlo results were less than 0.3 mGy at 15 000 mGy * cm2 kerma-area product (KAP). The organ dose results were compared with measurement data previously reported in literatures. The doses to organs that were located within the irradiation field match closely with experimental measurement data. The differences in the effective dose values between calculated using VirtualDose-IR and those measured were less than 2.5%. The dose errors of most organs between VirtualDose-IR and literature results were less than 40%. These results validate the accuracy of organ doses reported by VirtualDose-IR. With the inclusion of pre-specified clinical IR examination parameters (such as beam direction, target location, field of view and beam quality) and the latest anatomically realistic patient phantoms in Monte Carlo simulations, VirtualDose-IR provides users with accurate dose information in order to systematically compare, evaluate, and optimize IR plans.
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Affiliation(s)
- Wanli Huo
- School of Physical Sciences, University of Science and Technology of China, Hefei, China
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Crowhurst JA, Whitby M, Savage M, Murdoch D, Robinson B, Shaw E, Gaikwad N, Saireddy R, Hay K, Walters DL. Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography. J Med Radiat Sci 2019; 66:20-29. [PMID: 30488575 PMCID: PMC6399189 DOI: 10.1002/jmrs.315] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/27/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Diagnostic coronary angiography (CA) uses ionising radiation with relatively high doses, which impact on both patients and staff. This study sought to identify which patient and procedural factors impact patient and operator dose the most during CA. METHODS Patient and procedure related variables impacting on Kerma area product (PKA ) and operator dose (OD) were collected for 16 months. Procedures were separated into 10 different procedure categories. PKA was used for patient dose and OD was measured with an instantly downloadable dosimeter (IDD) - downloaded at the end of each procedure. High and low radiation dose was defined by binary variables based on the 75th percentile of the continuous measures. Univariate and multivariate regression were used to identify predictors. RESULTS Of 3860 patients included, the IDD was worn for 2591 (61.7%). Obesity (BMI > 30 compared to BMI < 25) was the strongest predictor for both a PKA (odds ratio (OR) = 19.1 (95% CI 13.5-26.9) P < 0.001) and OD (OR = 3.3 (2.4-4.4) P < 0.001) above the 75th percentile. Male gender, biplane imaging, the X-ray unit used, operator experience and procedure type also predicted a high PKA . Radial access, male gender, biplane imaging and procedure type also predicted a high OD. CONCLUSION Radiation dose during CA is multifactorial and is dependent on patient and procedure related variables. Many factors impact on both PKA and OD but obesity is the strongest predictor for both patients and operators to receive a high radiation dose.
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Affiliation(s)
- James A. Crowhurst
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Mark Whitby
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Bio‐Medical Technical ServicesThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Michael Savage
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Dale Murdoch
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Brendan Robinson
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Elizabeth Shaw
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Niranjan Gaikwad
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Ramkrishna Saireddy
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Cairns Base HospitalCairnsQueenslandAustralia
| | - Karen Hay
- QIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Darren L. Walters
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
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31
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Ngaile JE, Msaki PK, Mvungi R, Schreiner LJ. PRELIMINARY INVESTIGATION OF RADIATION DOSE TO PATIENTS FROM CARDIOVASCULAR INTERVENTIONAL PROCEDURES IN TANZANIA. RADIATION PROTECTION DOSIMETRY 2018; 181:317-332. [PMID: 29474654 DOI: 10.1093/rpd/ncy030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Although contemporary cardiac X-ray exams are typically set so benefits outweighs the risk, the growing use and increasing complexity of the cardiovascular interventional radiological (CVIR) procedures does increase the risk of radiation-related tissue effects and stochastic effects to the individual patients and the population. In view of these radiological concerns there is a need to investigate factors that influence the doses received by the patients and enable optimisation needed. The air kerma area product (KAP), cumulative air kerma (CAK) and fluoroscopy time (FT) to patients from two major CVIR procedures: coronary angiography (CA) and percutaneous coronary interventions (PCI), were obtained from two major hospitals in Tanzania. The CAK and KAP were determined using ionisation chambers equipped in each angiographic unit. The median values of the KAP, CAK and FT for the CA procedures were 37.8 Gy cm2, 425.5 mGy and 7.6 min, respectively, while for the PCI were 86.5 Gy cm2, 1180.3 mGy and 19.0 min, respectively. The overall differences among individual KAP, CAK and FT values across the two hospitals investigated differed by factors of up to 33.5, 58.7 and 26.3 for the CA, while for the PCI procedures differed by factors of up to 10.9, 25.3 and 13.8, respectively. The mean values of KAP and FT for both CA and PCI were mostly higher than those reported values for Ireland, Belgium, Greece, France, China and Australia. The third quartiles of the KAP, CAK and FT for both CA and PCI were relatively above the preliminary diagnostic reference levels proposed by the IAEA, DIMOND III and SENTINEL. The observed substantial variations of mean values of technical parameters and patient doses (KAP, CAK and FT values) observed for the CA and PCI procedures inter and intra-hospitals were mainly explained by the complexity of the CVIR procedures, the nature of pathology, patient-specific characteristics, the variation in levels of skills and experiences among IC personnel, and the different procedural protocols employed among interventional cardiologists and hospitals. The observed great variations of procedural protocols and patient doses within and across the hospitals and relative higher dose than reported values from the literature call for the need to optimise radiation dose to patient from IC procedures.
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Affiliation(s)
- J E Ngaile
- Department of Physics, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - P K Msaki
- Department of Physics, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - R Mvungi
- Jakaya Kikwete Cardiac Institute, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - L J Schreiner
- Departments of Oncology and Physics, Queens University, Kingston, Onatrio, Canada
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Siiskonen T, Ciraj-Bjelac O, Dabin J, Diklic A, Domienik-Andrzejewska J, Farah J, Fernandez J, Gallagher A, Hourdakis C, Jurkovic S, Järvinen H, Järvinen J, Knežević Ž, Koukorava C, Maccia C, Majer M, Malchair F, Riccardi L, Rizk C, Sanchez R, Sandborg M, Merce MS, Segota D, Sierpowska J, Simantirakis G, Sukupova L, Thrapsanioti Z, Vano E. Establishing the European diagnostic reference levels for interventional cardiology. Phys Med 2018; 54:42-48. [DOI: 10.1016/j.ejmp.2018.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022] Open
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Balter S, Brinkman M, Kalra S, Nazif T, Parikh M, Kirtane A, Moses J, Leon M, Feri A, Green P, Ali Z, Liao M, Karmpaliotis D. Novel radiation dose reduction fluoroscopic technology facilitates chronic total occlusion percutaneous coronary interventions. EUROINTERVENTION 2017; 13:e1468-e1474. [DOI: 10.4244/eij-d-16-00216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hadjiconstanti AC, Messaris GAT, Thomopoulos KC, Panayiotakis GS. Patient Radiation Doses in Therapeutic Endoscopic Retrograde Cholangiopancreatography in Patras and the Key Role of the Operator. RADIATION PROTECTION DOSIMETRY 2017; 177:243-249. [PMID: 28419374 DOI: 10.1093/rpd/ncx037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
The patient radiation doses, in conjunction with the operator experience, in therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, performed in our hospital, were obtained. Ninety-six patients participated in the study and were divided into 3 groups, based on the operator experience. The dosemetric indices, fluoroscopy time (FT), cumulative dose (Ka,r) and air kerma-area product (PKA), were collected. For the total and weight banding group the third quartile values of the distribution of FT, Ka,r and PKA were 2.90 and 2.92 min, 6.89 and 6.93 mGy and 1.84 and 1.85 Gycm2, respectively, and were comparative or significantly lower than the corresponding values previously reported. Taking as a criterion the operator, the differences in the patient radiation doses were statistically significant, with the highest dose recorded for the operator of the lowest experience degree. The values obtained could contribute in establishing local and national diagnostic reference levels and in optimising ERCP procedure.
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Affiliation(s)
| | - Gerasimos A T Messaris
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
| | | | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
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35
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Georges JL, Karam N, Tafflet M, Livarek B, Bataille S, Loyeau A, Mapouata M, Benamer H, Caussin C, Garot P, Varenne O, Barbou F, Teiger E, Funck F, Karrillon G, Lambert Y, Spaulding C, Jouven X. Time-Course Reduction in Patient Exposure to Radiation From Coronary Interventional Procedures. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005268. [DOI: 10.1161/circinterventions.117.005268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/26/2017] [Indexed: 11/16/2022]
Abstract
Background—
The frequency of complex percutaneous coronary interventions (PCIs) has increased in the last few years, with a growing concern on the radiation dose received by the patients. Multicenter data from large unselected populations on patients’ radiation doses during coronary angiography (CA) and PCI and temporal trends are lacking. This study sought to evaluate the temporal trends in patients’ exposure to radiation from CA and PCI.
Methods and Results—
Data were taken from the CARDIO-ARSIF registry that prospectively collects data on all CAs and PCIs performed in the 36 catheterization laboratories in the Greater Paris Area, the most populated regions in France with about 12 million inhabitants. Kerma area product and Fluoroscopy time from 152 684 consecutive CAs and 103 177 PCIs performed between 2009 and 2013 were analyzed. A continuous trend for a decrease in median [interquartile range] Kerma area product was observed, from 33 [19–55] Gy cm
2
in 2009 to 27 [16–44] Gy cm
2
in 2013 for CA (
P
<0.0001), and from 73 [41–125] to 55 [31–91] Gy cm
2
for PCI (
P
<0.0001). Time-course differences in Kerma area product remained highly significant after adjustment on Fluoroscopy time, PCI procedure complexity, change of x-ray equipment, and other patient- and procedure-related covariates.
Conclusions—
In a large patient population, a steady temporal decrease in patient radiation exposure during CA and PCI was noted between 2009 and 2013. Kerma area product reduction was consistent in all types of procedure and was independent of patient-related factors and PCI procedure complexity.
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Affiliation(s)
- Jean-Louis Georges
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Nicole Karam
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Muriel Tafflet
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Bernard Livarek
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Sophie Bataille
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Aurélie Loyeau
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Mireille Mapouata
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Hakim Benamer
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Christophe Caussin
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Philippe Garot
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Olivier Varenne
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Franck Barbou
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Emmanuel Teiger
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - François Funck
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Gaëtan Karrillon
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Yves Lambert
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Christian Spaulding
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
| | - Xavier Jouven
- From the Cardiology Department (J.-L.G., B.L.), Emergency Department (S.B.), and SAMU 78 (Y.L.), Versailles Hospital (André Mignot), Le Chesnay, France; Paris Cardiovascular Research Center, INSERM Unit 970, France (N.K., M.T., C.S., X.J.); Cardiology Department, European Georges Pompidou University Hospital (N.K., C.S., X.J.), Cardiology Department, University Hospital Cochin (O.V.), and Cardiology Department, University Hospital Henri Mondor (E.T.), Assistance Publique-Hôpitaux de Paris, France
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Dehairs M, Bosmans H, Desmet W, Marshall NW. Evaluation of automatic dose rate control for flat panel imaging using a spatial frequency domain figure of merit. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1361-6560/aa7a9d] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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37
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Uniyal SC, Chaturvedi V, Sharma SD, Rawat A. PATIENT DOSIMETRY DURING INTERVENTIONAL CARDIAC PROCEDURES IN A DEDICATED CATHETERIZATION LABORATORY. RADIATION PROTECTION DOSIMETRY 2017; 175:201-208. [PMID: 27744352 DOI: 10.1093/rpd/ncw286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/25/2016] [Indexed: 06/06/2023]
Abstract
Cardiac interventions often result in high radiation dose to patient's skin, so a reliable indicator in terms of a commonly used dose descriptor is required to monitor skin exposures. In the present study, Gafchromic XR-RV3 film was used to measure the peak skin dose (PSD) during 40 coronary angiography (CA) and 50 percutaneous transluminal coronary angioplasty (PTCA) procedures. Corresponding values of kerma-area product (PKA), fluoroscopy time (FT) and reference air-kerma (Ka,r) were recorded and correlated with PSD. Doses to patient's eyes and thyroid were also measured by using thermoluminescent dosimeters (TLDs) during PTCA procedures. The average dose to thyroid was about six times higher than the average dose to eyes. The mean values of PSD, PKA and FT were 1140 mGy, 97 Gy cm2 and 15.7 min for PTCA and 290 mGy, 21.1 Gy cm2 and 2.4 min for CA procedures, respectively. One in seven patients of PTCA procedure received PSD >2 Gy. With respect to FT, PKA may be used as a better predictor of skin exposures because the correlation of PSD with PKA was found better than with FT for both CA and PTCA procedures.
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Affiliation(s)
- Satish C Uniyal
- Department of Radiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun 248016, India
| | - Vineet Chaturvedi
- Department of Radiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun 248016, India
| | - Sunil D Sharma
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Anushaktinagar, Mumbai 400094, India
| | - Anurag Rawat
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun 248016, India
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38
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Georges JL, Belle L, Etard C, Azowa JB, Albert F, Pansieri M, Monsegu J, Barbou F, Trouillet C, Leddet P, Livarek B, Marcaggi X, Hanssen M, Cattan S. Radiation Doses to Patients in Interventional Coronary Procedures-Estimation of Updated National Reference Levels by Dose Audit. RADIATION PROTECTION DOSIMETRY 2017; 175:17-25. [PMID: 27624893 DOI: 10.1093/rpd/ncw261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
The objective of this study was to estimate the French national updated reference levels (RLs) for coronary angiography (CA) and percutaneous coronary intervention (PCI) by a dose audit from a large data set of unselected procedures and in standard-sized patients. Kerma-area product (PKA), air kerma at interventional point (Ka,r), fluoroscopy time (FT), and the number of registered frames (NFs) and runs (NRs) were collected from 51 229 CAs and 42 222 PCIs performed over a 12-month period at 61 French hospitals. RLs estimated by the 75th percentile in CAs and PCIs performed in unselected patients were 36 and 78 Gy.cm² for PKA, 498 and 1285 mGy for Ka,r, 6 and 15 min for FT, and 566 and 960 for NF, respectively. These values were consistent with the RLs calculated in standard-sized patients. The large difference in dose between sexes leads us to propose specific RLs in males and females. The results suggest a trend for a time-course reduction in RLs for interventional coronary procedures.
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Affiliation(s)
- Jean-Louis Georges
- Service de Cardiologie, Centre Hospitalier de Versailles, 78150 Le Chesnay, France
- Collège National des Cardiologues des Hôpitaux, Paris, France
| | - Loic Belle
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier d'Annecy-Genevois, Annecy, France
| | - Cécile Etard
- Institut de Radioprotection et de Sureté Nucléaire, PRP-HOM/SER, BP17, 92262 Fontenay-aux-Roses, France
| | - Jean-Baptiste Azowa
- Service de Cardiologie, Centre Hospitalier de Versailles, 78150 Le Chesnay, France
| | - Franck Albert
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Hôpital Louis Pasteur, Chartres, France
| | - Michel Pansieri
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier d'Avignon, Avignon, France
| | - Jacques Monsegu
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Franck Barbou
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Hôpital d'instruction des Armées du Val de Grâce, Paris, France
| | - Charlotte Trouillet
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Groupe Hospitalier de la Rochelle-Ré-Aunis, La Rochelle, France
| | - Pierre Leddet
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier de Haguenau, Haguenau, France
| | - Bernard Livarek
- Service de Cardiologie, Centre Hospitalier de Versailles, 78150 Le Chesnay, France
- Collège National des Cardiologues des Hôpitaux, Paris, France
| | - Xavier Marcaggi
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier Jacques Lacarin, Vichy, France
| | - Michel Hanssen
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Centre Hospitalier de Haguenau, Haguenau, France
| | - Simon Cattan
- Collège National des Cardiologues des Hôpitaux, Paris, France
- Service de Cardiologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
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Metaxas VI, Messaris GA, Gatzounis GD, Tzortzidis FN, Konstantinou DT, Panayiotakis GS. Institutional (local) diagnostic reference levels in fluoroscopically guided spine surgery. Eur J Radiol 2017; 90:50-59. [DOI: 10.1016/j.ejrad.2017.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
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Ozpelit ME, Ercan E, Ozpelit E, Pekel N, Tengiz I, Ozyurtlu F, Yilmaz A. OPERATOR DEPENDENCY OF THE RADIATION EXPOSURE IN CARDIAC INTERVENTIONS: FEASIBILITY OF ULTRA LOW DOSE LEVELS. RADIATION PROTECTION DOSIMETRY 2017; 173:383-388. [PMID: 26940438 DOI: 10.1093/rpd/ncw028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Mean radiation exposure in invasive cardiology varies greatly between different centres and interventionists. The International Commission on Radiological Protection and the EURATOM Council stipulate that, despite reference values, 'All medical exposure for radiodiagnostic purposes shall be kept as low as reasonably achievable' (ALARA). The purpose of this study is to establish the effects of the routine application of ALARA principles and to determine operator and procedure impact on radiation exposure in interventional cardiology. MATERIALS AND METHODS A total of 240 consecutive cardiac interventional procedures were analysed. Five operators performed the procedures, two of whom were working in accordance with ALARA principles (Group 1 operators) with the remaining three working in a standard manner (Group 2 operators). Radiation exposure levels of these two groups were compared. RESULTS Total fluoroscopy time and the number of radiographic runs were similar between groups. However, dose area product and cumulative dose were significantly lower in Group 1 when compared with Group 2. Radiation levels of Group 1 were far below even the reference levels in the literature, thus representing an ultra-low-dose radiation exposure in interventional cardiology. CONCLUSION By use of simple radiation reducing techniques, ultra-low-dose radiation exposure is feasible in interventional cardiology. Achievability of such levels depends greatly on operator awareness, desire, knowledge and experience of radiation protection.
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Affiliation(s)
| | - Ertugrul Ercan
- Department of Cardiology, Izmir University, Izmir, Turkey
| | - Ebru Ozpelit
- Department of Cardiology, Dokuz Eylul University, Izmir, Turkey
| | - Nihat Pekel
- Department of Cardiology, Izmir University, Izmir, Turkey
| | | | - Ferhat Ozyurtlu
- Department of Cardiology, Grand Medical Hospital, Manisa, Turkey
| | - Akar Yilmaz
- Department of Cardiology, Izmir University, Izmir, Turkey
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Saukko E, Henner A, Nieminen MT, Ahonen SM. THE ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVELS IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A PRACTICAL TOOL FOR THE OPTIMISATION AND FOR QUALITY ASSURANCE MANAGEMENT. RADIATION PROTECTION DOSIMETRY 2017; 173:338-344. [PMID: 26932805 DOI: 10.1093/rpd/ncw018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
Fluoroscopic procedures are an area of special concern in relation to radiation protection. The aim of this study was to describe the current level of patient radiation doses in endoscopic retrograde cholangiopancreatography (ERCP) collected from a single centre, as well as to establish and review local diagnostic reference levels (DRLs) in ERCP. A total of 100 patients' radiation doses in ERCP were recorded, and the third-quartile method was adopted to establish local DRLs for ERCP. The mean dose area product (DAP) was 2.05 Gy cm2, fluoroscopy time (FT) 1.7 min and the number of images was 3. The proposed local DRLs for ERCP were 3.00 Gy cm2 and 3.0 min. Local DRLs were reviewed in a sample of 25 patients 5 y after they had been established. In reviewing data, the averages of DAP and FT were below the local DRLs. Local DRLs help in the optimisation process of fluoroscopic procedures and guides to a good clinical practice.
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Affiliation(s)
- E Saukko
- Turku University Hospital, The Medical Imaging Centre of Southwest Finland, Kiinamyllynkatu 4-8, PO Box 52, 20521 Turku, Finland
| | - A Henner
- Oulu University of Applied Sciences, School of Health and Social Care, Kiviharjuntie 8, 90220 Oulu, Finland
| | - M T Nieminen
- University of Oulu, Research Unit of Medical Imaging, Physics and Technology, PO Box 5000, 90014 Oulu, Finland
- Oulu University Hospital, Department of Diagnostic Radiology, PO Box 50, 90029 Oulu, Finland
| | - S-M Ahonen
- University of Oulu, Research Unit of Nursing Science and Health Management, PO Box 5000, 90014 Oulu, Finland
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Balter S, Chambers CE. Radiation Management in Interventional Cardiology. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Didier R, Magalhaes MA, Koifman E, Leven F, Castellant P, Boschat J, Jobic Y, Kiramijyan S, Nicol PP, Gilard M. The utilisation of the cardiovascular automated radiation reduction X-ray system (CARS) in the cardiac catheterisation laboratory aids in the reduction of the patient radiation dose. EUROINTERVENTION 2016; 12:e948-e956. [DOI: 10.4244/eijv12i8a157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kastrati M, Langenbrink L, Piatkowski M, Michaelsen J, Reimann D, Hoffmann R. Reducing Radiation Dose in Coronary Angiography and Angioplasty Using Image Noise Reduction Technology. Am J Cardiol 2016; 118:353-6. [PMID: 27344273 DOI: 10.1016/j.amjcard.2016.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
This study sought to quantitatively evaluate the reduction of radiation dose in coronary angiography and angioplasty with the use of image noise reduction technology in a routine clinical setting. Radiation dose data from consecutive 605 coronary procedures (397 consecutive coronary angiograms and 208 consecutive coronary interventions) performed from October 2014 to April 2015 on a coronary angiography system with noise reduction technology (Allura Clarity IQ) were collected. For comparison, radiation dose data from consecutive 695 coronary procedures (435 coronary angiograms and 260 coronary interventions) performed on a conventional coronary angiography system from October 2013 to April 2014 were evaluated. Patient radiation dosage was evaluated based on the cumulative dose area product. Operators and operator practice did not change between the 2 evaluated periods. Patient characteristics were collected to evaluate similarity of patient groups. Image quality was evaluated on a 5-grade scale in 30 patients of each group. There were no significant differences between the 2 evaluated groups in gender, age, weight, and fluoroscopy time (6.8 ± 6.1 vs 6.9 ± 6.3 minutes, not significant). The dose area product was reduced from 3195 ± 2359 to 983 ± 972 cGycm(2) (65%, p <0.001) in coronary angiograms and from 7123 ± 4551 to 2431 ± 1788 cGycm(2) (69%, p <0.001) in coronary interventions using the new noise reduction technology. Image quality was graded as similar between the evaluated systems (4.0 ± 0.7 vs 4.2 ± 0.6, not significant). In conclusion, a new x-ray technology with image noise reduction algorithm provides a substantial reduction in radiation exposure without the need to prolong the procedure or fluoroscopy time.
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Jurado-Román A, Sánchez-Pérez I, Lozano Ruíz-Poveda F, López-Lluva MT, Pinilla-Echeverri N, Moreno Arciniegas A, Agudo-Quilez P, Gil Agudo A. Effectiveness of the implementation of a simple radiation reduction protocol in the catheterization laboratory. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:328-32. [PMID: 27085219 DOI: 10.1016/j.carrev.2016.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/03/2016] [Accepted: 03/11/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A reduction in radiation doses at the catheterization laboratory, maintaining the quality of procedures is essential. Our objective was to analyze the results of a simple radiation reduction protocol at a high-volume interventional cardiology unit. METHODS We analyzed 1160 consecutive procedures: 580 performed before the implementation of the protocol and 580 after it. The protocol consisted in: the reduction of the number of ventriculographies and aortographies, the optimization of the collimation and the geometry of the X ray tube-patient-receptor, the use of low dose-rate fluoroscopy and the reduction of the number of cine sequences using the software "last fluoroscopy hold". RESULTS There were no significant differences in clinical baseline features or in the procedural characteristics with the exception of a higher percentage of radial approach (30.7% vs 69.6%; p<0.001) and of percutaneous coronary interventions of chronic total occlusions after the implementation of the protocol (2.1% vs 6.7%; p=0,001). Angiographic success was similar during both periods (98.3% vs 99.2%; p=0.2). There were no significant differences between both periods regarding the overall duration of the procedures (26.9 vs 29.6min; p=0.14), or the fluoroscopy time (13.3 vs 13.2min; p=0.8). We observed a reduction in the percentage of procedures with ventriculography (80.9% vs 7.1%; p<0.0001) or aortography (15.4% vs 4.4%; p<0.0001), the cine runs (21.8 vs 6.9; p<0.0001) and the dose-area product (165 vs 71 Gyxcm(2); p<0.0001). CONCLUSIONS With the implementation of a simple radiation reduction protocol, a 57% reduction of dose-area product was observed without a reduction in the quality or the complexity of procedures.
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Affiliation(s)
- Alfonso Jurado-Román
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real.
| | - Ignacio Sánchez-Pérez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real
| | | | - María T López-Lluva
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real
| | | | | | | | - Antonio Gil Agudo
- Servicio de Radiofísica y Protección Radiológica, Hospital General Universitario de Ciudad Real
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Ten Cate T, van Wely M, Gehlmann H, Mauti M, Camaro C, Reifart N, Suryapranata H, de Boer MJ. Novel X-ray image noise reduction technology reduces patient radiation dose while maintaining image quality in coronary angiography. Neth Heart J 2015; 23:525-30. [PMID: 26369914 PMCID: PMC4608924 DOI: 10.1007/s12471-015-0742-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AIMS The consequences of high radiation dose for patient and staff demand constant improvements in X-ray dose reduction technology. This study assessed non-inferiority of image quality and quantified patient dose reduction in interventional cardiology for an anatomy-specific optimised cine acquisition chain combined with advanced real-time image noise reduction algorithms referred to as 'study cine', compared with conventional angiography. METHODS Fifty patients underwent two coronary angiographic acquisitions: one with advanced image processing and optimised exposure system settings to enable dose reduction (study cine) and one with standard image processing and exposure settings (reference cine). The image sets of 39 patients (18 females, 21 males) were rated by six experienced independent reviewers, blinded to the patient and image characteristics. The image pairs were randomly presented. Overall 85 % of the study cine images were rated as better or equal quality compared with the reference cine (95 % CI 0.81-0.90). The median dose area product per frame decreased from 55 to 26 mGy.cm(2)/frame (53 % reduction, p < 0.001). CONCLUSION This study demonstrates that the novel X-ray imaging technology provides non-inferior image quality compared with conventional angiographic systems for interventional cardiology with a 53 % patient dose reduction.
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Affiliation(s)
- T Ten Cate
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands.
| | - M van Wely
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - H Gehlmann
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - M Mauti
- Philips Healthcare, Best, The Netherlands
| | - C Camaro
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - N Reifart
- Main-Taunus-Privatklinik, Bad Soden, Germany
| | - H Suryapranata
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
| | - M J de Boer
- Department of Interventional Cardiology, RadboudUMC, Geert Grooteplein-Zuid 22, 6525, Nijmegen, GA, The Netherlands
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Bracken JA, Mauti M, Kim MS, Messenger JC, Carroll JD. A Radiation Dose Reduction Technology to Improve Patient Safety During Cardiac Catheterization Interventions. J Interv Cardiol 2015; 28:493-7. [DOI: 10.1111/joic.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- John A. Bracken
- University of Colorado Denver; Aurora Colorado
- Philips Healthcare; Markham, Ontario Canada
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Roth C, Berger R, Scherzer S, Krenn L, Gangl C, Dalos D, Delle-Karth G, Neunteufl T. Comparison of magnetic wire navigation with the conventional wire technique for percutaneous coronary intervention of chronic total occlusions: a randomised, controlled study. Heart Vessels 2015; 31:1266-76. [PMID: 26369660 DOI: 10.1007/s00380-015-0739-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/28/2015] [Indexed: 12/21/2022]
Abstract
Wire crossing of a chronic total coronary occlusion (CTO) is time consuming and limited by the amount of contrast agent and time of radiation exposure. Magnetic wire navigation (MWN) might accelerate wire crossing by maintaining a coaxial vessel orientation. This study compares MWN with the conventional approach for recanalization of CTOs. Forty symptomatic patients with CTO were randomised to MWN (n = 20) or conventional approach (n = 20) for antegrade crossing of the occlusion. In the intention-to-treat analysis, MWN showed a shorter crossing time (412 versus 1131 s; p = 0.001), and, consequently, lower usage of contrast agent (primary endpoint 42 versus 116 ml; p = 0.01), and lower radiation exposure (dose-area product: 29 versus 80 Gy*cm(2); p = 0.002) during wire crossing compared to the conventional approach. Accordingly, in the per-protocol analysis, the wire-crossing rate was, in trend, higher using the conventional approach (17 of 31) compared to MWN (9 of 28; p = 0.08). The use of MWN for revascularisation of CTOs is feasible and reduces crossing time, use of contrast agent, and radiation exposure. However, due to a broader selection of wires, the conventional approach enables wire crossing in cases failed by MWN and seems to be the more successful choice.
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Affiliation(s)
- Christian Roth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Berger
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
- Department of Internal Medicine I, Cardiology and Nephrology, Hospital of St. John of God, Eisenstadt, Austria.
| | - Sabine Scherzer
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Lisa Krenn
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Clemens Gangl
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Daniel Dalos
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Delle-Karth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Cardiology, Hospital of Hietzing, Vienna, Austria
| | - Thomas Neunteufl
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine I, Cardiology, University Hospital of Krems, Krems an der Donau, Austria
- Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria
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Vañó E, Miller DL, Dauer L. Implications in medical imaging of the new ICRP thresholds for tissue reactions. Ann ICRP 2015; 44:118-128. [PMID: 25816265 DOI: 10.1177/0146645314562322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The International Commission on Radiological Protection (ICRP) statement on tissue reactions, issued by the Commission in April 2011, reviewed epidemiological evidence and suggested that there are some tissue reactions where threshold doses are or may be lower than those previously considered. For the lens of the eye, the threshold is now considered to be 0.5 Gy. The absorbed dose threshold for circulatory disease in the heart and brain may be as low as 0.5 Gy. These values can be reached in some patients during interventional cardiology or neuroradiology procedures. They may also be of concern for repeated computed tomography examinations of the head. The new thresholds should be considered in optimisation strategies for clinical procedures, especially in patients likely to require repeated interventions. The new dose thresholds also affect occupational protection for operators and staff. Some operators do not protect their eyes or their brain adequately. After several years of work without proper protection, the absorbed doses to the lens of the eye and the brain of staff can exceed 0.5 Gy. More research is needed to understand the biological effects of cumulative incident air kerma and the instantaneous air kerma rates currently used in medical imaging. The new thresholds, and the need for specific occupational dosimetry related to lens doses, should be considered in radiation protection programmes, and should be included in the education and training of professionals involved in fluoroscopy guided procedures and computed tomography.
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Affiliation(s)
- E Vañó
- Radiology Department, Medicine School and San Carlos Hospital, Complutense University, Madrid, 28040 Spain
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, USA
| | - L Dauer
- Department of Medical Physics, Department of Radiology. Memorial Sloan-Kettering Cancer Center, USA
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Ghelani SJ, Glatz AC, David S, Leahy R, Hirsch R, Armsby LB, Trucco SM, Holzer RJ, Bergersen L. Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States. JACC Cardiovasc Interv 2015; 7:1060-9. [PMID: 25234681 DOI: 10.1016/j.jcin.2014.04.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/28/2014] [Accepted: 04/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to define age-stratified, procedure-specific benchmark radiation dose levels during interventional catheterization for congenital heart disease. BACKGROUND There is a paucity of published literature with regard to radiation dose levels during catheterization for congenital heart disease. Obtaining benchmark radiation data is essential for assessing the impact of quality improvement initiatives for radiation safety. METHODS Data were obtained retrospectively from 7 laboratories participating in the Congenital Cardiac Catheterization Project on Outcomes collaborative. Total air kerma, dose area product, and total fluoroscopy time were obtained for the following procedures: 1) patent ductus arteriosus closure; 2) atrial septal defect closure; 3) pulmonary valvuloplasty; 4) aortic valvuloplasty; 5) treatment of coarctation of aorta; and 6) transcatheter pulmonary valve placement. RESULTS Between January 2009 and July 2013, 2,713 cases were identified. Radiation dose benchmarks are presented including median, 75th percentile, and 95th percentile. Radiation doses varied widely between age groups and procedure types. Radiation exposure was lowest in patent ductus arteriosus closure and highest in transcatheter pulmonary valve placement. Total fluoroscopy time was a poor marker of radiation exposure and did not correlate well with total air kerma and dose area product. CONCLUSIONS This study presents age-stratified radiation dose values for 6 common congenital heart interventional catheterization procedures. Fluoroscopy time alone is not an adequate measure for monitoring radiation exposure. These values will be used as baseline for measuring the effectiveness of future quality improvement activities by the Congenital Cardiac Catheterization Project on Outcomes collaborative.
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Affiliation(s)
- Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Andrew C Glatz
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sthuthi David
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Ryan Leahy
- Division of Cardiology, University of Louisville, Louisville, Kentucky
| | - Russel Hirsch
- Cincinnati Children's Medical Center, Cincinnati, Ohio
| | | | - Sara M Trucco
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ralf J Holzer
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
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