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Liu J, Chen S, Zhou Y, Zheng X, Meng R, Tan N, Liu Y. Effect of cumulative radiation exposure from Coronary catheterization on lung cancer mortality. BMC Cancer 2023; 23:757. [PMID: 37582730 PMCID: PMC10426196 DOI: 10.1186/s12885-023-11231-4] [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: 04/20/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Coronary catheterization (CC) procedure inevitably exposes patients with cardiovascular disease (CVD) to radiation, while cumulative radiation exposure may lead to higher risk of cancer. METHODS This multi-center, retrospective study was based on the CC procedure in Cardiorenal ImprovemeNt II cohort (CIN-II, NCT05050877) among five regional central tertiary teaching hospitals in China between 2007 and 2020. Patients without known cancer were stratified according to the times they received CC procedure. Baseline information from their last CC procedure was analyzed. Cox regression and Fine-Gray competing risk models were used to assess the relationship between cumulative radiation exposure from CC procedures and cancer-specific, all-cause and cardiovascular mortality. RESULTS Of 136,495 hospitalized survivors without cancer at baseline (mean age: 62.3 ± 11.1 years, 30.9% female), 116,992 patients (85.7%) underwent CC procedure once, 15,184 patients (11.1%) on twice, and 4,319 patients (3.2%) underwent CC procedure more than three times. During the median follow-up of 4.7 years (IQR: 2.5 to 7.4), totally 18,656 patients (13.7%) died after discharge, of which 617 (0.5%) died of lung cancer. Compared with the patients who underwent CC procedure once, the risk of lung cancer mortality increased significantly with the increase of the number of CC procedure (CC 2 times vs. 1 time: HR 1.42, 95% CI 1.13 to 1.78, P < 0.001; CC ≥ 3 times vs. 1 time: HR 1.64, 95%CI 1.13 to 2.39, P < 0.05). Similar results were observed in all-cause mortality and cardiovascular mortality, but not in other cancer-specific mortality. CONCLUSIONS Our data suggest that substantial proportion of CVD patients are exposed to multiple high levels of low-dose ionizing radiation from CC procedure, which is associated with an increased risk of cancer mortality in this population. TRIAL REGISTRATION ClinicalTrials.gov: NCT05050877; URL: http://www. CLINICALTRIALS gov ; 21/09/2021.
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Affiliation(s)
- Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yang Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xueyan Zheng
- Institute of Control and Prevention for Chronic Non-Infective Disease, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Ruilin Meng
- Institute of Control and Prevention for Chronic Non-Infective Disease, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, China.
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, China.
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Evaluation of patients’ and occupational radiation risk dose during conventional and interventional radiology procedures. Radiat Phys Chem Oxf Engl 1993 2023. [DOI: 10.1016/j.radphyschem.2023.110818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Erdem O, Ay M, Yalcin A, Bilgic S, Sanlıdilek U, Amasyalı B, Sancak T, Olgar T. PATIENT AND STAFF DOSES FOR VARIOUS INTERVENTIONAL RADIOLOGY AND CARDIOLOGY EXAMINATIONS IN TURKEY. RADIATION PROTECTION DOSIMETRY 2022; 198:158-166. [PMID: 35165744 DOI: 10.1093/rpd/ncac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
This study aims to determine the radiation doses of patients and staff during different interventional radiology and cardiology examinations. Dose measurements for interventional radiology examinations were performed in Ibn-i Sina Hospital of Ankara University using Siemens Artis-Zee medical imaging system. Patient dose measurement was carried out for interventional cardiology examinations in Cardiology Department of TOBB-ETU University, Medical Faculty Hospital using Philips Allura Centron interventional X-ray system. Patient doses were obtained in terms of kerma area product (KAP) and cumulative air kerma (CAK) from KAP meter attached to the angiography system. Performance tests of the angiography system were performed before patient dose measurements. Staff dose measurements were carried out with thermoluminescence dosimeters (TLD-100) placed in certain areas on the staff. Patient dose measurements were performed for 15 different interventional radiology examinations on a total of 431 patients and for four different cardiology examinations on a total of 299 patients. Monte Carlo based PCXMC 2.0 program was used to calculate patient effective doses. Lower extremity arteriography was the most common examination with a mean KAP value of 30 Gy cm2 and mean effective dose value of 1.2 mSv for total number of 194 patients. Mean KAP values calculated for coronary angiography, percutaneous coronary intervention, electrophysiological procedures and radiofrequency cardiac ablation examinations were 62.8, 162.8, 16.7 and 70.6 Gy cm2, respectively. Radiologist, nurse and technician effective dose normalised to the unit KAP of patient dose were 0.15, 0.11 and 0.14 μSv Gy-1 cm-2. Similarly, cardiologist, nurse and technician effective dose normalised to the unit KAP of patient dose were 0.22, 0.15 and 0.09 μSv Gy-1 cm-2. Measured KAP and CAK values vary depending on the type and complexity of the examination. The measured staff doses during cardiac examinations were higher when compared with that measured for interventional radiology as expected.
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Affiliation(s)
- Onur Erdem
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Musa Ay
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Asena Yalcin
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Sadık Bilgic
- Ankara University, Faculty of Medicine, Department of Radiology, 06100 Ankara, Turkey
| | - Umman Sanlıdilek
- Ankara University, Faculty of Medicine, Department of Radiology, 06100 Ankara, Turkey
| | - Basri Amasyalı
- TOBB University of Economics and Technology Hospital, Department of Cardiology, 06510 Ankara, Turkey
| | - Tanzer Sancak
- TOBB University of Economics and Technology Hospital, Department of Radiology, 06510 Ankara, Turkey
| | - Turan Olgar
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
- Ankara University, Faculty of Engineering, Department of Physics Engineering, 06100 Ankara, Turkey
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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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Morota K, Moritake T, Nagamoto K, Matsuzaki S, Nakagami K, Sun L, Kunugita N. Optimization of the Maximum Skin Dose Measurement Technique Using Digital Imaging and Communication in Medicine-Radiation Dose Structured Report Data for Patients Undergoing Cerebral Angiography. Diagnostics (Basel) 2020; 11:E14. [PMID: 33374876 PMCID: PMC7824295 DOI: 10.3390/diagnostics11010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/04/2020] [Accepted: 12/18/2020] [Indexed: 11/24/2022] Open
Abstract
Understanding the maximum skin dose is important for avoiding tissue reactions in cerebral angiography. In this study, we devised a method for using digital imaging and communication in medicine-radiation dose structured report (DICOM-RDSR) data to accurately estimate the maximum skin dose from the total air kerma at the patient entrance reference point (Total Ka,r). Using a test data set (n = 50), we defined the mean ratio of the maximum skin dose obtained from measurements with radio-photoluminescence glass dosimeters (RPLGDs) to the Total Ka,r as the conversion factor, CFKa,constant, and compared the accuracy of the estimated maximum skin dose obtained from multiplying Total Ka,r by CFKa,constant (Estimation Model 1) with that of the estimated maximum skin dose obtained from multiplying Total Ka,r by the functional conversion factor CFKa,function (Estimation Model 2). Estimation Model 2, which uses the quadratic function for the ratio of the fluoroscopy Ka,r to the Total Ka,r (Ka,r ratio), provided an estimated maximum skin dose closer to that obtained from direct measurements with RPLGDs than compared with that determined using Estimation Model 1. The same results were obtained for the validation data set (n = 50). It was suggested the quadratic function for the Ka,r ratio provides a more accurate estimate of the maximum skin dose in real time.
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Affiliation(s)
- Koichi Morota
- Department of Radiology, Shinkomonji Hospital, 2-5 Dairishinmachi, Moji-ku, Kitakyushu, Fukuoka 800-0057, Japan; (K.M.); (S.M.)
- Department of Radiobiology and Hygiene Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; (K.N.); (K.N.)
| | - Takashi Moritake
- Department of Radiobiology and Hygiene Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; (K.N.); (K.N.)
| | - Keisuke Nagamoto
- Department of Radiobiology and Hygiene Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; (K.N.); (K.N.)
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556, Japan
| | - Satoru Matsuzaki
- Department of Radiology, Shinkomonji Hospital, 2-5 Dairishinmachi, Moji-ku, Kitakyushu, Fukuoka 800-0057, Japan; (K.M.); (S.M.)
- Department of Radiobiology and Hygiene Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; (K.N.); (K.N.)
| | - Koichi Nakagami
- Department of Radiobiology and Hygiene Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; (K.N.); (K.N.)
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556, Japan
| | - Lue Sun
- Health and Medical Research Institute, Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology (AIST), Central 6, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8566, Japan;
| | - Naoki Kunugita
- Department of Occupational and Community Health Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan;
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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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Rizk C, Fares G, Vanhavere F, Farah J. MEASUREMENT OF PATIENT SKIN DOSE DISTRIBUTIONS IN THREE LEBANESE INTERVENTIONAL CARDIOLOGY SUITES. RADIATION PROTECTION DOSIMETRY 2019; 183:375-385. [PMID: 30165531 DOI: 10.1093/rpd/ncy152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/28/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Using a mesh of 30 thermoluminescent dosemeters, adults' patient skin doses were measured for 99 coronary angiography (CA) and 89 percutaneous coronary interventions (PCI) performed in three Lebanese hospitals. Average peak skin dose (Dskin,max) were 152 mGy (range: 16-1144) for CAs and 576 mGy (range: 7-3361) for PCIs. While only four patients had a Dskin,max value exceeding the 2 Gy threshold for skin injuries, several patients had skin dose values above 1 Gy at several distinct locations proving that Dskin,max alone is not sufficient for repetitive procedures; 2D dose maps are required instead. Dskin,max correlated well with total air kerma-area product (PKA,T) for PCI in Hospitals 1 and 2 (R = 0.91 and 0.76, respectively) enabling the setup of an alert level at PKA,T = 240 and 210 Gy cm2, respectively, corresponding to a Dskin,max of 2 Gy. This was not possible for Hospital 3 due to weak correlations between Dskin,max and PKA,T.
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Affiliation(s)
- C Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research, PO Box 11-8281, Riad El Solh, Beirut, Lebanon
- Faculty of Sciences, Saint Joseph University, PO Box 11-514, Riad El Solh, Beirut, Lebanon
| | - G Fares
- Faculty of Sciences, Saint Joseph University, PO Box 11-514, Riad El Solh, Beirut, Lebanon
| | - F Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang 200, Mol, Belgium
| | - J Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France
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Habib Geryes B, Hadid-Beurrier L, Waryn MJ, Jean-Pierre A, Farah J. Benchmarking the DACS-integrated Radiation Dose Monitor® skin dose mapping software using XR-RV3 Gafchromic® films. Med Phys 2018; 45:4683-4692. [DOI: 10.1002/mp.13125] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Bouchra Habib Geryes
- Radiology Department; Necker Enfants Malades University Hospital; AP-HP; 149 Rue de Sèvres Paris 75015 France
| | - Lama Hadid-Beurrier
- Radiology Department; Lariboisière University Hospital; AP-HP; 2 Rue Ambroise Paré Paris 75010 France
| | - Marie-Joséphine Waryn
- Radiology Department; Jean Verdier Hospital; AP-HP; Avenue du 14 Juillet Bondy 93140 France
| | - Antonella Jean-Pierre
- Radiology Department; Lariboisière University Hospital; AP-HP; 2 Rue Ambroise Paré Paris 75010 France
| | - Jad Farah
- Radiology and Nuclear Medicine Division; Paris Sud University Hospitals; AP-HP; 78 Rue du Général Leclerc Le Kremlin-Bicêtre 94270 France
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Greffier J, Goupil J, Larbi A, Stefanovic X, Pereira F, Moliner G, Ovtchinnikoff S, Beregi J, Frandon J. Assessment of patient's peak skin dose during abdominopelvic embolization using radiochromic (Gafchromic) films. Diagn Interv Imaging 2018; 99:321-329. [DOI: 10.1016/j.diii.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
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Brambilla M, Cannillo B, Matheoud R, Compagnone G, Rognoni A, Bongo AS, Carriero A. Conversion factors of effective and equivalent organ doses with the air kerma area product in patients undergoing coronary angiography and percutaneous coronary interventions. Phys Med 2017; 42:189-196. [PMID: 29173914 DOI: 10.1016/j.ejmp.2017.09.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022] Open
Abstract
To derive effective dose (E), organ dose (HT) and conversion factors with the air kerma area product (KAP) in coronary angiography (CA) and percutaneous coronary intervention (PCI) by the radial route, using the ICRP 103 tissue weighting factors. The study included 34 patients referred for CA and 31 for PCI. E and HT were derived from in-the-field KAP measurements using Montecarlo methods. Median KAP of 23.2 and 56.8Gycm2 and E of 6.9 and 20.0mSv were found for CA and PCI, respectively. Mean KAP and E were significantly higher in males than in females (52.4±40.0 vs 32.3±16.6Gycm2; p=0.02) and (16.8±13.6 vs 10.7±5.8mSv; p=0.04). KAP (r=0.39; p=0.001) and E (r=0.34; p=0.005) showed a significant correlation with the patient's weight. Conversion factors between KAP and E (E/KAP) were 0.30±0.04mSvGy-1cm-2 for CA and 0.33±0.05mSvGy-1cm-2 for PCI. No significant differences in the E/KAP between males and females were found (0.31±0.05 vs 0.33±0.05; p=0.08). Again, no significant correlation was found between E/KAP and patient's weight (r=0.23; p=0.07). The correlation between E and KAP was excellent for CA (r=0.99) and PCI (r=0.96). The correlation between HT and KAP ranged from r=0.87 to r=1 and from r=0.71 to r=0.98 for CA and PCI, respectively. A single factor, the total KAP, could be used for a specific acquisition protocol to reliably estimate E and HT without the need of a patient's specific analysis. Conversion factors might be installation, X-ray beam quality or protocol dependent.
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Affiliation(s)
- M Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
| | - B Cannillo
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - R Matheoud
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - G Compagnone
- Medical Physics Department, University Hospital "S. Orsola Malpighi", Bologna, Italy
| | - A Rognoni
- Cardiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - A S Bongo
- Cardiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - A Carriero
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
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Assessment of peak skin dose in interventional cardiology: A comparison between Gafchromic film and dosimetric software em.dose. Phys Med 2017; 38:16-22. [DOI: 10.1016/j.ejmp.2017.05.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/08/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022] Open
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Greffier J, Moliner G, Pereira F, Cornillet L, Ledermann B, Schmutz L, Lomma M, Cayla G, Beregi JP. Assessment of Patient's Peak Skin Dose Using Gafchromic Films During Interventional Cardiology Procedures: Routine Experience Feedback. RADIATION PROTECTION DOSIMETRY 2017; 174:395-405. [PMID: 27522056 DOI: 10.1093/rpd/ncw191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 04/22/2016] [Indexed: 06/06/2023]
Abstract
To assess the interest of Gafchromic films in detection of patient's peak skin dose (PSD) in interventional cardiology. A prospective study of 112 patients was conducted (July-December 2015). Three diagnostic and therapeutic procedures were evaluated: coronary angiography (CA), coronary angiography and coronary angioplasty for one or two vessels disease (CA-PTCA) and coronary angioplasty of complex chronic total occlusion (CTO). Dosimetric indicators (DIs) were collected and PSD were measured with Gafchromic films. Dose distribution was evaluated within 10 'Thorax Body-zone' defined by the system. Correlations between PSD and DI or dose distribution were computed. Delivered dose increased in complex procedures. The PSD were 0.121 ± 0.063 Gy for CA, 0.256 ± 0.142 Gy for CA-PTCA and 1.116 ± 0.721 Gy for CTO. High correlations were observed for PSD and DI as well for dose distribution within the 'Thorax Body-zone'. Film dosimetry is suggested for CTO procedures since the threshold of 2 Gy for skin injuries is likely to be exceeded.
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Affiliation(s)
- J Greffier
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - G Moliner
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - F Pereira
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - L Cornillet
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - B Ledermann
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - L Schmutz
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - M Lomma
- Department of Biostatistics, Epidemiology, Public Health and Bio-informatics, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - G Cayla
- Department of Cardiology, Nîmes University Hospital, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
| | - J P Beregi
- Department of Radiology, Nîmes University Hospital, Medical Imaging Group Nîmes, EA 2415, Bd Prof Robert Debré, 30029 Nîmes Cedex, France
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Trinavarat P, Kritsaneepaiboon S, Rongviriyapanich C, Visrutaratna P, Srinakarin J. Radiation dose from CT scanning: can it be reduced? ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0501.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
CT has been used to save many patients’ lives and the demand for CT is still increasing. At the same time, there has been increasing concern of the probability of cancer induction by CT radiation. It is necessary for everyone involved in CT scanning, particularly physicians who have to communicate with patients when planning a CT scan, to have a basic knowledge of the CT radiation dose and its potential adverse effects. We have undertaken a systematic review of the literatures to document the radiation dose from CT, the lifetime cancer risk from CT exposure, CT dose parameters, the internationnal CT diagnostic reference levels, and the use and limitation of the CT effective dose. In addition, we conducted a brief survey of the use of CT scan in some university hospitals in Thailand and estimated current CT doses at these hospitals. Our review and survey suggests that CT scanning provides a great benefit in medicine but it also becomes the major source of X-ray exposure. Radiation doses from a CT scan are much higher than most conventional radiographic procedures. This raises concerns about the carcinogenic potentials. We encourage every CT unit to adhere to the International Guidelines of CT dose parameter references. Our preliminary survey from some university hospitals in Thailand revealed that CT radiation doses are within acceptable standard ranges. However, the justification for utilization of CT scans should also be required and monitored. The importance of adequate communication between attending physician and consulting radiologist is stressed.
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Affiliation(s)
- Panruethai Trinavarat
- MD, Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV, Pathumwan, Bangkok 10330, Thailand
| | - Supika Kritsaneepaiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkla 90110, Thailand
| | - Chantima Rongviriyapanich
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pannee Visrutaratna
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50000, Thailand
| | - Jiraporn Srinakarin
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Maccagni D, Godino C, Latib A, Azzalini L, Pazzanese V, Chieffo A, Margonato A, Colombo A. Analysis of a Low Dose Protocol to Reduce Patient Radiation Exposure During Percutaneous Coronary Interventions. Am J Cardiol 2017; 119:203-209. [PMID: 27863695 DOI: 10.1016/j.amjcard.2016.09.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 11/25/2022]
Abstract
The cardiac catheterization laboratory is an important source of radiation for patients and operators and it is good practice to limit exposure as much as possible. The purpose of this study was to evaluate the effectiveness and impact of a radiological low dose protocol (LDP) in terms of reduction in patient radiation exposure during percutaneous coronary interventions (PCIs). From November 2014 to October 2015, 906 consecutive patients who underwent PCI were evaluated. Of these, 571 patients (63%) were treated with the standard dose protocol (SDP) of 15 frames per second for cine acquisition and standard settings for fluoroscopy, and 335 patients (37%) with the LDP of 7.5 frames per second for cine acquisition and low-dose settings for fluoroscopy. In the LDP group, we observed a significant reduction of kerma area product (53.3 LDP vs 115 SDP Gycm2, p <0.0001) and air kerma at interventional reference point (0.79 LDP vs 1.976 SDP Gy, p <0.0001). Marked differences were observed regarding the exceeding of International Commission on Radiological Protection and National Council on Radiation Protection and Measurements' air kerma at interventional reference point trigger level (cutoff for potential skin injuries), which were significantly lower in the LDP group (1.8% vs 7.2%, p <0.0001). Such difference was more relevant in complex PCI. In conclusion, the implementation of LDP allowed a marked reduction in patient dosimetric parameters for PCI and significantly reduced the risk of exceeding the International Commission on Radiological Protection/National Council on Radiation Protection and Measurements trigger levels for potential skin injuries.
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Vilar-Palop J, Vilar J, Hernández-Aguado I, González-Álvarez I, Lumbreras B. Updated effective doses in radiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:975-990. [PMID: 27893456 DOI: 10.1088/0952-4746/36/4/975] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to review recent literature in order to provide updated values of the typical effective doses associated with the top 20 imaging tests for adults and children and for the most widely used set of weights (ICRP60) as well as for the most recent one (ICRP103). We performed a systematic research on radiation dosimetry in radiology published from 2007 onwards through the Medline, Embase and Cochrane Library Plus databases. We also included studies backed by scientific or governmental organizations. Other variables included: year and type of study (survey or descriptive), country, method and sample used for the measurement. Mean effective dose, minimum, maximum and standard deviation were calculated. We compared our results with previous evidence and with data from DDM2. We included 27 articles and 5 web references in the study. A total of 378 values from the 20 procedures included were obtained, 280 (74%) using ICRP60 and 98 (26%) using ICRP103. Effective doses for CT procedures in children were very similar to those for adults, with the exception of CT Trunk, but fluoroscopy procedures had consistently lower dose. There were differences between the current data with either ICRP60 or ICRP103, and the previous published data. In conclusion, we provided the best available evidence from literature to evaluate the effective dose received by each patient for the most typical examinations. According to the recommendations from the Report 154 and from the European Council Directive, these results could also be useful to estimate the range of average exposures to the population.
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Occupational radiation exposure in vascular interventional radiology: A complete evaluation of different body regions. Phys Med 2016; 32:1019-24. [DOI: 10.1016/j.ejmp.2016.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/10/2016] [Accepted: 06/29/2016] [Indexed: 12/29/2022] Open
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Kerma-area product is not a useful indictor of potential tissue reactions in interventional radiology. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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18
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Spira D, Kirchner S, Blumenstock G, Herz K, Ketelsen D, Wiskirchen J, Wiesinger B. Therapeutic angiographic procedures: differences in dose area product between analog image intensifier and digital flat panel detector. Acta Radiol 2016; 57:587-94. [PMID: 26231951 DOI: 10.1177/0284185115597262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiation exposure remains an unceasing concern in angiographic procedures. Modern angiography machines such as analog image intensifiers (AII) or the new flat panel detectors (FPD) aim at a further dose reduction. PURPOSE To present dose area products (DAP) in a broad spectrum of therapeutic angiographic procedures, comparing an AII to an FPD angiography system. MATERIAL AND METHODS A total of 999 peripheral therapeutic angiography procedures performed with an FPD (n = 562) and an AII system (n = 437) were evaluated. DAP, fluoroscopy time, and patients' body mass index (BMI) were recorded. Interventions were classified into five main groups: percutaneous transluminal angioplasty (PTA); PTA and stent placement; intra-arterial thrombolysis; embolization procedures; and specialized interventions. RESULTS DAP values in therapeutic angiographic procedures were significantly higher when performed with the FPD compared to the AII system. The increase of the FPD versus AII system was 100.1% for PTA, 39.9% for PTA and stent placement, 187% for intra-arterial thrombolysis, 31.3% for embolization procedures, and 361% for specialized interventions. These differences persisted after standardizing DAP values to the geometric mean fluoroscopy duration of each procedure. Fluoroscopy times were shorter in all interventions performed at the FPD as compared to the AII system. DAPs increased with higher BMI, but the DAP increase of both systems with elevated BMI was variable, depending on the individual intervention. CONCLUSION In therapeutic angiographic procedures, the FPD system required higher DAPs despite shorter fluoroscopy times as compared to an AII system. Better ergonomics and speediness of the FPD system may be advantageous in the emergency setting.
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Affiliation(s)
- Daniel Spira
- Department of Diagnostic and Interventional Radiology, Universitätsklinik Heidelberg, Heidelberg, Germany
| | - Sebastian Kirchner
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - Gunnar Blumenstock
- Institute of Clinical Epidemiology and Applied Biometry, Eberhard-Karls-University, Tübingen, Germany
| | - Klaus Herz
- Institute for Radiation Protection and Radionuclide Laboratory, Eberhard-Karls-University, Tübingen, Germany
| | - Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
| | - Jakub Wiskirchen
- Department of Radiology and Nuclear Medicine, Franziskus Hospital, Bielefeld, Germany
| | - Benjamin Wiesinger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany
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19
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Occupational doses of medical staff and their relation to patient exposure incurred in coronary angiography and intervention. RADIAT MEAS 2016. [DOI: 10.1016/j.radmeas.2015.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Song S, Liu C, Zhang M. Radiation dose and mortality risk to children undergoing therapeutic interventional cardiology. Acta Radiol 2015; 56:867-72. [PMID: 25024440 DOI: 10.1177/0284185114542459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 06/12/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children undergoing interventional cardiology procedures deserve special concern due to the greater radiation sensitivity of their tissues and more remaining years of life during which a radiation-induced cancer may develop. PURPOSE To determine the patient radiation dose for pediatric therapeutic interventional cardiology and to estimate the patient effective dose and lifetime mortality risk to children associated with five common procedures. MATERIAL AND METHODS Ninety children with congenital heart defects undergoing interventional therapy were enrolled in this study. Data regarding fluoroscopy and radiography time, dose-area product (DAP) and peak skin dose (PSD) for each case were measured. Patients were divided into five groups. The patient effective dose (E) was calculated using a multiplicative model of ICRP 60. The overall lifetime mortality risk was evaluated using appropriate risk coefficients. RESULTS The mean, median, standard deviation, and range of time, PSD, DAP, and E were presented for the five study groups. When these metrics were considered, there were wide variations for different cases within the same group and statistically significant differences between the five groups. The PSD correlated significantly with DAP (Pearson r = 0.70; P < 0.01), but the correlation in individual cases was poor. For all cases, the range of E was found to be between 0.44 and 66.7 mSv. The corresponding risk of lifetime mortality was 1.16 per thousand. CONCLUSION The current study provides overall data on the time, PSD, E, and lifetime mortality risk for pediatric therapeutic interventional cardiology. Radio frequency ablation showed the highest radiation risk.
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Affiliation(s)
- Shanjun Song
- Interventional Department, Liaocheng People’s Hospital, Liaocheng, Shandong, PR China
| | - Chenzhi Liu
- Interventional Department, Liaocheng People’s Hospital, Liaocheng, Shandong, PR China
| | - Menglong Zhang
- Shandong Medical Imaging Research Institute, Jinan, PR China
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Teixeira NG, Coutinho GM, Trindade HR, Cunha GR, Carvoeiras PP. A survey in Portuguese X-ray fluoroscopy equipment: dose rates and image quality. RADIATION PROTECTION DOSIMETRY 2015; 164:354-360. [PMID: 25157197 DOI: 10.1093/rpd/ncu271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/03/2014] [Indexed: 06/03/2023]
Abstract
X-ray fluoroscopy is essential in both diagnosis and medical intervention, although it may contribute to significant radiation doses to patients that have to be optimised and justified. Therefore, it is crucial to the patient to be exposed to the lowest achievable dose without compromising the image quality. The purpose of this study was to perform an analysis of the quality control measurements, particularly dose rates, contrast and spatial resolution of Portuguese fluoroscopy equipment and also to provide a contribution to the establishment of reference levels for the equipment performance parameters. Measurements carried out between 2007 and 2013 on 143 fluoroscopy equipment distributed by 34 nationwide health units were analysed. The measurements suggest that image quality and dose rates of Portuguese equipment are congruent with other studies, and in general, they are as per the Portuguese law. However, there is still a possibility of improvements intending optimisation at a national level.
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Affiliation(s)
- Nuno G Teixeira
- Department of Exact and Natural Sciences, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - Guilherme M Coutinho
- Department of Physics, Biomedical Engineering, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Campus da Caparica, Portugal
| | | | - Gilda R Cunha
- Department of Exact and Natural Sciences, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
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Jones AK, Ensor JE, Pasciak AS. How accurately can the peak skin dose in fluoroscopy be determined using indirect dose metrics? Med Phys 2015; 41:071913. [PMID: 24989391 DOI: 10.1118/1.4884020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Skin dosimetry is important for fluoroscopically-guided interventions, as peak skin doses (PSD) that result in skin reactions can be reached during these procedures. There is no consensus as to whether or not indirect skin dosimetry is sufficiently accurate for fluoroscopically-guided interventions. However, measuring PSD with film is difficult and the decision to do so must be madea priori. The purpose of this study was to assess the accuracy of different types of indirect dose estimates and to determine if PSD can be calculated within ± 50% using indirect dose metrics for embolization procedures. METHODS PSD were measured directly using radiochromic film for 41 consecutive embolization procedures at two sites. Indirect dose metrics from the procedures were collected, including reference air kerma. Four different estimates of PSD were calculated from the indirect dose metrics and compared along with reference air kerma to the measured PSD for each case. The four indirect estimates included a standard calculation method, the use of detailed information from the radiation dose structured report, and two simplified calculation methods based on the standard method. Indirect dosimetry results were compared with direct measurements, including an analysis of uncertainty associated with film dosimetry. Factors affecting the accuracy of the different indirect estimates were examined. RESULTS When using the standard calculation method, calculated PSD were within ± 35% for all 41 procedures studied. Calculated PSD were within ± 50% for a simplified method using a single source-to-patient distance for all calculations. Reference air kerma was within ± 50% for all but one procedure. Cases for which reference air kerma or calculated PSD exhibited large (± 35%) differences from the measured PSD were analyzed, and two main causative factors were identified: unusually small or large source-to-patient distances and large contributions to reference air kerma from cone beam computed tomography or acquisition runs acquired at large primary gantry angles. When calculated uncertainty limits [-12.8%, 10%] were applied to directly measured PSD, most indirect PSD estimates remained within ± 50% of the measured PSD. CONCLUSIONS Using indirect dose metrics, PSD can be determined within ± 35% for embolization procedures. Reference air kerma can be used without modification to set notification limits and substantial radiation dose levels, provided the displayed reference air kerma is accurate. These results can reasonably be extended to similar procedures, including vascular and interventional oncology. Considering these results, film dosimetry is likely an unnecessary effort for these types of procedures when indirect dose metrics are available.
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Affiliation(s)
- A Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Joe E Ensor
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Alexander S Pasciak
- Department of Radiology, The University of Tennessee Medical Center, Knoxville, Tennessee 37920
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Okuno Y, Oguro S, Iwamoto W, Miyamoto T, Ikegami H, Matsumura N. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elbow Surg 2014; 23:e199-206. [PMID: 24618195 DOI: 10.1016/j.jse.2013.12.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/26/2013] [Accepted: 12/03/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neovessels and accompanying nerves are possible sources of pain. We postulated that transcatheter arterial embolization of abnormal neovessels would relieve pain and symptoms in patients with adhesive capsulitis. METHODS Adhesive capsulitis was treated by transcatheter arterial embolization in 7 patients. Adverse events, changes in visual analog scale scores for night pain and overall shoulder pain, and changes in range of motion and American Shoulder and Elbow Surgeons scores were assessed at 1 week and at 1, 3, and 6 months after the procedure. RESULTS Abnormal neovessels were identified at the rotator interval in all patients. No major or minor adverse events were associated with the procedures. Transcatheter arterial embolization rapidly decreased nighttime pain scores from 67 ± 14 mm to 27 ± 14 mm at 1 week after the procedure, with further improvement at 1 and 6 months (6 ± 8 mm and 2 ± 5 mm, respectively). The American Shoulder and Elbow Surgeons score significantly improved from 17.8 ± 4.5 to 39.8 ± 12.0, 64.3 ± 13.9, and 76.2 ± 4.4 at 1, 3, and 6 months, respectively. CONCLUSION All patients with adhesive capsulitis had abnormal neovessels at the rotator interval. Transcatheter arterial embolization was feasible, relieved unrelenting pain, and restored shoulder function.
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Affiliation(s)
- Yuji Okuno
- Department of Orthopedic Surgery, Edogawa Hospital, Tokyo, Japan.
| | - Sota Oguro
- Department of Radiology, School of Medicine, Keio University, Tokyo, Japan
| | - Wataru Iwamoto
- Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroyasu Ikegami
- Department of Orthopaedic Surgery, Toho University (Ohashi), Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Yuan MK, Chang SC, Hsu LC, Pan PJ, Huang CC, Leu HB. Mammography and the Risk of Thyroid and Hematological Cancers: A Nationwide Population-based Study. Breast J 2014; 20:496-501. [DOI: 10.1111/tbj.12311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Mei-Kang Yuan
- Department of Radiology; National Yang-Ming University Hospital; Yi-Lan Taiwan
- Faculty of Medicine; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Shih-Chieh Chang
- Faculty of Medicine; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Chest Medicine; Department of Internal Medicine; National Yang-Ming University Hospital; Yi-Lan Taiwan
| | - Li-Cho Hsu
- Division of Chest Medicine; Department of Internal Medicine; National Yang-Ming University Hospital; Yi-Lan Taiwan
| | - Po-Jung Pan
- Faculty of Medicine; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Physical Medicine & Rehabilitation; National Yang-Ming University Hospital; Yi-Lan Taiwan
| | - Chin-Chou Huang
- Faculty of Medicine; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Hsin-Bang Leu
- Faculty of Medicine; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Cardiology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Healthcare and Management Center; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Research Center; School of Medicine; National Yang-Ming University; Taipei Taiwan
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Crowhurst JA, Whitby M, Thiele D, Halligan T, Westerink A, Crown S, Milne J. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals. J Med Radiat Sci 2014; 61:135-41. [PMID: 26229649 PMCID: PMC4175852 DOI: 10.1002/jmrs.67] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/05/2014] [Accepted: 07/16/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Methods Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (PKA), skin surface entrance dose (KAR), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the PKA. Results 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median KAR = 581 mGy (374–876). Median PKA = 3908 uGym2 (2489–5865) DRL = 5865 uGym2. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median KAR = 1501 mGy (928–2224). Median PKA = 8736 uGym2 (5449–12,900) DRL = 12,900 uGym2. Conclusion This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.
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Affiliation(s)
- James A Crowhurst
- The Prince Charles Hospital Chermside, Queensland, Australia ; School of Medicine, University of Queensland St. Lucia, Brisbane, Queensland, Australia
| | - Mark Whitby
- The Prince Charles Hospital Chermside, Queensland, Australia ; Biomedical Technology Services, Health Services Support Agency, Queensland Health Herston, Queensland, Australia
| | - David Thiele
- Biomedical Technology Services, Health Services Support Agency, Queensland Health Herston, Queensland, Australia
| | - Toni Halligan
- Allied Health Professions' Office of Queensland Brisbane, Queensland, Australia
| | - Adam Westerink
- Royal Brisbane and Women's Hospital Herston, Queensland, Australia
| | - Suzanne Crown
- Princess Alexandra Hospital Woolloongabba, Queensland, Australia
| | - Jillian Milne
- Cardiac Clinical Informatics Unit - Queensland Health Herston, Queensland, Australia
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26
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Karavasilis E, Dimitriadis A, Gonis H, Pappas P, Georgiou E, Yakoumakis E. Effective dose in percutaneous transhepatic biliary drainage examination using PCXMC2.0 and MCNP5 Monte Carlo codes. Phys Med 2014; 30:432-6. [PMID: 24374260 DOI: 10.1016/j.ejmp.2013.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To estimate the organ equivalent doses and the effective doses (E) in patient undergoing percutaneous transhepatic biliary drainage (PTBD) examinations, using the MCNP5 and PCXMC2 Monte Carlo-based codes. METHODS The purpose of this study is to estimate the organ doses to patients undergoing PTBD examinations by clinical measurements and Monte Carlo simulation. Dose area products (DAP) values were assessed during examination of 43 patients undergoing PTBD examination separated into groups based on the gender and the dimensions and location of the beam. RESULTS Monte Carlo simulation of photon transport in male and female mathematical phantoms was applied using the MCNP5 and PCXMC2 codes in order to estimate equivalent organ doses. Regarding the PTBD examination the organ receiving the maximum radiation dose was the lumbar spine. The mean calculated HT for the lumbar spine using the MCNP5 and PCXMC2 methods respectively, was 117.25 mSv and 131.7 mSv, in males. The corresponding doses were 139.45 mSv and 157.1 mSv respectively in females. The HT values for organs receiving considerable amounts of radiation during PTBD examinations were varied between 0.16% and 73.2% for the male group and between 1.10% and 77.6% for the female group. E in females and males using MCNP5 and PCXMC2.0 was 5.88 mSv and 6.77 mSv, and 4.93 mSv and 5.60 mSv. CONCLUSION The doses remain high compared to other invasive operations in interventional radiology. There is a reasonable good coincidence between the MCNP5 and PCXMC2.0 calculation for most of the organs.
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Affiliation(s)
- E Karavasilis
- Medical Physics Department, Medical School, University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece.
| | - A Dimitriadis
- Medical Physics Department, Medical School, University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - H Gonis
- Medical Physics Department, Laiko Hospital of Athens, 17 Ag. Thoma Str., Goudi, 11527 Athens, Greece
| | - P Pappas
- Radiology Department, Laiko Hospital of Athens, 17 Ag. Thoma Str., Goudi, 11527 Athens, Greece
| | - E Georgiou
- Medical Physics Department, Medical School, University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - E Yakoumakis
- Medical Physics Department, Medical School, University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
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Wang W, Zhang M, Zhang Y. Overall measurements of dose to patients in common interventional cardiology procedures. RADIATION PROTECTION DOSIMETRY 2013; 157:348-354. [PMID: 23770572 DOI: 10.1093/rpd/nct147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study was designed to measure peak skin dose (PSD), dose-area product (DAP), cumulative dose (CD) and fluoroscopy time (FT) for interventional cardiology procedures and to evaluate whether patient doses were higher than that in other published data. Three cardiac procedure types, including coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA) and radio frequency (RF) ablation, were entered into the study. Data of four special metrics (PSD, DAP, CD and FT) for these procedures were collected and measured. A total of 238 patients who underwent interventional radiology procedures participated in this study. For every procedure, data about PSD were resulted from six TLD arrays and DAP, CD and FT were collected from the displayed monitor. The mean, standard deviation (SD), range and third quartile of the distribution of PSD, DAP, CD and FT recorded and measured on spot were calculated for all procedures. High-dose cases were specifically recorded. There was wide variation in the doses observed for different instances of the same procedure. PSD for PTCA and RF ablation ranged from 0.1 Gy to more than 3 Gy. Of 238 instances, there were 22 (9.2 %) with PSDs greater than 2 Gy and 4 (1.7 %) than 3 Gy. The third quartile of the distribution for PTCA had exceeded the DIMOND preliminary reference levels by 41.1 % in DAP and 25.0 % in FT. Mean DAP was in the range of reported values for CAG procedure, but higher than all data obtained in literatures for PTCA. Data from this study are in the range of most reported values for CAG and RF ablation procedure, while higher than that obtained in some literatures for PTCA. In case of a constant delivering of high doses to patient and physician himself, thorough training of interventionalists and staff is necessary, and the legislation has to be revised and set dose constrains especially for the interventional high-dose procedures.
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Affiliation(s)
- Weipeng Wang
- Shandong Medical Imaging Research Institute, Jingwu road No.324, Jinan 250021, P. R. China
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D’Alessio D, Giliberti C, Soriani A, Carpanese L, Pizzi G, Vallati GE, Strigari L. Dose evaluation for skin and organ in hepatocellular carcinoma during angiographic procedure. J Exp Clin Cancer Res 2013; 32:81. [PMID: 24423052 PMCID: PMC3832252 DOI: 10.1186/1756-9966-32-81] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/18/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the radiation dose in patients undergoing liver angiographic procedure and verify the usefulness of different dose measurements to prevent deterministic effects. Gafchromic film, MicroMOSFET data and DIAMENTOR device of the X-ray system were used to characterize the examined interventional radiology (IR) procedure. MATERIALS AND METHODS A liver embolization procedure, the SIRT (Selective Internal Radiation Therapy), was investigated. The exposure parameters from the DIAMENTOR as well as patient and geometrical data were registered. Entrance skin dose map obtained using Gafchromic film (ESDGAF) in a standard phantom as well as in 12 patients were used to calculate the maximum skin dose (MSDGAF). MicroMOSFETs were used to assess ESD in relevant points/areas. Moreover, the maximum value of five MicroMOSFETs array, due to the extension of treated area and to the relative distance of 2-3 cm of two adjacent MicroMOSFETs, was useful to predict the MSD without interfering with the clinical practice. PCXMC vers.1.5 was used to calculate effective dose (E) and equivalent dose (H). RESULTS The mean dose-area product (DAPDIAMENTOR) for SIRT procedures was 166 Gycm2, although a wide range was observed. The mean MSDGAF for SIRT procedures was 1090 mGy, although a wide range was experienced. A correlation was found between the MSDGAF measured on a patient and the DAPDIAMENTOR value for liver embolizations. MOSFET and Gafchromic data were in agreement within 5% in homogeneous area and within 20% in high dose gradient regions. The mean equivalent dose in critical organs was 89.8 mSv for kidneys, 22.9 mSv for pancreas, 20.2 mSv for small intestine and 21.0 mSv for spleen. Whereas the mean E was 3.7 mSv (range: 0.5-13.7). CONCLUSIONS Gafchromic films result useful to study patient exposure and determine localization and amplitude of high dose skin areas to better predict the skin injuries. Then, DAPDIAMENTOR or MOSFET data could offer real-time methods, as on-line dose alert, to avoid any side effects during liver embolization with prolonged duration.
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Affiliation(s)
- Daniela D’Alessio
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Via E. Chianesi 53, Rome, 00144, Italy
| | - Claudia Giliberti
- Dipartimento Installazioni di Produzione e Insediamenti Antropici, INAIL, Via Alessandria 220/E, Rome, 00198, Italy
| | - Antonella Soriani
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Via E. Chianesi 53, Rome, 00144, Italy
| | - Livio Carpanese
- Department of Radiology and Diagnostic Imaging, Regina Elena National Cancer Institute, Via E. Chianesi 53, Rome, 00144, Italy
| | - Giuseppe Pizzi
- Department of Radiology and Diagnostic Imaging, Regina Elena National Cancer Institute, Via E. Chianesi 53, Rome, 00144, Italy
| | - Giulio Eugenio Vallati
- Department of Radiology and Diagnostic Imaging, Regina Elena National Cancer Institute, Via E. Chianesi 53, Rome, 00144, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Via E. Chianesi 53, Rome, 00144, Italy
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Cui Y, Zhang H, Zheng J, Yang X, Liang C. An investigation of patient doses during coronary interventional procedures in China. RADIATION PROTECTION DOSIMETRY 2013; 156:296-302. [PMID: 23528327 DOI: 10.1093/rpd/nct065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to estimate patient doses during coronary angiography (CA) and different complex percutaneous transluminal coronary angioplasty (PTCA) procedures in China. Consecutive 290 patients (90 CA, 200 PTCA) with known or suspected coronary artery disease were enrolled prospectively into six groups. Differences in patient doses among the six groups were analysed, and the patient doses observed in this study were compared with the recent literature. The median dose area product values were 27.0 and 195.0 Gy cm(2) for CA and PTCA, respectively. The patient doses during CA were similar to those reported by other authors, while those during PTCA were higher. The differences in radiation doses depended on the complexity of the procedures. Enhanced knowledge of radiation doses may help cardiologists implement radiation-sparing procedures to minimise patient exposure.
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Affiliation(s)
- Yanhai Cui
- Department of Radiology, Guangdong Academy of Medical Sciences and Guangdong General Hospital, Guangzhou, China
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Pancholy SB, Bertrand OF. Radiation exposure with transradial and transfemoral procedures. Am Heart J 2013; 165:254-255. [PMID: 23453088 DOI: 10.1016/j.ahj.2013.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/15/2013] [Indexed: 06/01/2023]
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Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, Einstein AJ, Geiger B, Heintz P, Padovani R, Sim KH. ICRP PUBLICATION 120: Radiological protection in cardiology. Ann ICRP 2013; 42:1-125. [PMID: 23141687 DOI: 10.1016/j.icrp.2012.09.001] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff(1) in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission's published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy.
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Fetterly KA, Mathew V, Lennon R, Bell MR, Holmes DR, Rihal CS. Radiation dose reduction in the invasive cardiovascular laboratory: implementing a culture and philosophy of radiation safety. JACC Cardiovasc Interv 2013; 5:866-73. [PMID: 22917459 DOI: 10.1016/j.jcin.2012.05.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/20/2012] [Accepted: 05/07/2012] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This paper investigates the effects of sustained practice and x-ray system technical changes on the radiation dose administered to adult patients during invasive cardiovascular procedures. BACKGROUND It is desirable to reduce radiation dose associated with medical imaging to minimize the risk of adverse radiation effects to both patients and staff. Several clinical practice and technical changes to elevate radiation awareness and reduce patient radiation dose were implemented under the guidance of a cardiovascular invasive labs radiation safety committee. Practice changes included: intraprocedure radiation dose announcements; reporting of procedures for which the air-kerma exceeded 6,000 mGy, including procedure air-kerma in the clinical report; and establishing compulsory radiation safety training for fellows. Technical changes included establishing standard x-ray imaging protocols, increased use of x-ray beam spectral filters, reducing the detector target dose for fluoroscopy and acquisition imaging, and reducing the fluoroscopy frame rate to 7.5 s(-1). METHODS Patient- and procedure-specific cumulative skin dose was calculated from air-kerma values and evaluated retrospectively over a period of 3 years. Data were categorized to include all procedures, percutaneous coronary interventions, coronary angiography, noncardiac vascular angiography and interventions, and interventions to treat structural heart disease. Statistical analysis was based on a comparison of the cumulative skin dose for procedures performed during the first and last quarters of the 3-year study period. RESULTS A total of 18,115 procedures were performed by 27 staff cardiologists and 65 fellows-in-training. Considering all procedures, the mean cumulative skin dose decreased from 969 to 568 mGy (40% reduction) over 3 years. CONCLUSIONS This work demonstrates that a philosophy of radiation safety, implemented through a collection of sustained practice and x-ray system changes, can result in a significant decrease in the radiation dose administered to patients during invasive cardiovascular procedures.
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Affiliation(s)
- Kenneth A Fetterly
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Miller DL, Hilohi CM, Spelic DC. Patient radiation doses in interventional cardiology in the U.S.: advisory data sets and possible initial values for U.S. reference levels. Med Phys 2012; 39:6276-86. [PMID: 23039663 DOI: 10.1118/1.4754300] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To determine patient radiation doses from interventional cardiology procedures in the U.S and to suggest possible initial values for U.S. benchmarks for patient radiation dose from selected interventional cardiology procedures [fluoroscopically guided diagnostic cardiac catheterization and percutaneous coronary intervention (PCI)]. METHODS Patient radiation dose metrics were derived from analysis of data from the 2008 to 2009 Nationwide Evaluation of X-ray Trends (NEXT) survey of cardiac catheterization. This analysis used identified data and did not require review by an IRB. Data from 171 facilities in 30 states were analyzed. The distributions (percentiles) of radiation dose metrics were determined for diagnostic cardiac catheterizations, PCI, and combined diagnostic and PCI procedures. Confidence intervals for these dose distributions were determined using bootstrap resampling. RESULTS Percentile distributions (advisory data sets) and possible preliminary U.S. reference levels (based on the 75th percentile of the dose distributions) are provided for cumulative air kerma at the reference point (K(a,r)), cumulative air kerma-area product (P(KA)), fluoroscopy time, and number of cine runs. Dose distributions are sufficiently detailed to permit dose audits as described in National Council on Radiation Protection and Measurements Report No. 168. Fluoroscopy times are consistent with those observed in European studies, but P(KA) is higher in the U.S. CONCLUSIONS Sufficient data exist to suggest possible initial benchmarks for patient radiation dose for certain interventional cardiology procedures in the U.S. Our data suggest that patient radiation dose in these procedures is not optimized in U.S. practice.
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Affiliation(s)
- Donald L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA.
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Journy N, Sinno-Tellier S, Maccia C, Le Tertre A, Pirard P, Pagès P, Eilstein D, Donadieu J, Bar O. Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures. Br J Radiol 2012; 85:433-42. [PMID: 22457404 PMCID: PMC3486680 DOI: 10.1259/bjr/30010948] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 01/20/2011] [Accepted: 01/31/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. METHODS We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. RESULTS The mean MSD and DAP were respectively 389 mGy and 65 Gy cm(-2) for CAs, and 916 mGy and 69 Gy cm(-2) for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r=0.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. CONCLUSION Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions.
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Affiliation(s)
- N Journy
- Institut de Veille Sanitaire, Saint-Maurice, France.
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Evaluation of radiation dose to patients undergoing interventional radiology procedures at Ramathibodi Hospital, Thailand. Biomed Imaging Interv J 2012; 7:e22. [PMID: 22279499 PMCID: PMC3265194 DOI: 10.2349/biij.7.3.e22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 06/01/2011] [Accepted: 06/05/2011] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study was carried out to assess the radiation dose to patients undergoing interventional radiology procedures at Ramathibodi Hospital, Bangkok, Thailand. METHODS Data were collected from 60 patients under transarterial oily-chemoembolisation (TOCE) and femoral angiography performed with the Toshiba Infinix model VC-i FPD single plane system. Data were also collected from 60 patients who underwent brain arteriovenous malformations (AVM) and dural-arteriovenous fistula (DAVF) embolisation, performed with the Toshiba Infinix model VF-i bi-plane systems. A built-in air kerma area product (KAP) meter calibrated in situ was used for the skin dose calculation. RESULTS The calibration coefficient of air kerma area product meter at tube voltage between 50 kV and 100 kV was found to vary within ± 5.07%, ± 7.2%, ± 4.86 % from calibration coefficient of 80 kV for a single-plane, tube 1 and tube 2 of bi-plane x-ray system, respectively. Mean air kerma area product values were 90.99 ± 52.89, 31.02 ± 17.92, 33.11 ± 23.99 (Frontal), 35.01 ± 19.10 (Lateral), 50.15 ± 44.76 (Frontal), 97.31 ± 44.12 (Lateral) Gy-cm(2) for transarterial oily-chemoembolisation, femoral angiography, diagnostic cerebral angiography, therapeutic cerebral angiography, respectively. The therapeutic cerebral angiography procedure was found to give the highest entrance dose, number of images and fluoroscopy time: 362.63 cGy (Lateral), 1015 images (Lateral) and 126 minutes, respectively. However, the highest air kerma area product value was from transarterial oily-chemoembolisation with 264.37 Gy-cm(2). There were 2 cases of therapeutic cerebral angiography, where the patient entrance dose was higher than 3 Gy in the frontal view, which reached the deterministic threshold for temporary epilation. CONCLUSION Very wide variationswere found in patient dose from different interventional procedures. There is a need for a dose record system to provide feedback to radiologists who perform the procedures; especially in cases where the dose exceeds the deterministic threshold.
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Medical staff radiation exposure in electrophysiology procedures: First results during biventricular ICD implantation. RADIAT MEAS 2011. [DOI: 10.1016/j.radmeas.2011.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kwon D, Little MP, Miller DL. Reference air kerma and kerma-area product as estimators of peak skin dose for fluoroscopically guided interventions. Med Phys 2011; 38:4196-204. [PMID: 21859021 DOI: 10.1118/1.3590358] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To determine more accurate regression formulas for estimating peak skin dose (PSD) from reference air kerma (RAK) or kerma-area product (KAP). METHODS After grouping of the data from 21 procedures into 13 clinically similar groups, assessments were made of optimal clustering using the Bayesian information criterion to obtain the optimal linear regressions of (log-transformed) PSD vs RAK, PSD vs KAP, and PSD vs RAK and KAP. RESULTS Three clusters of clinical groups were optimal in regression of PSD vs RAK, seven clusters of clinical groups were optimal in regression of PSD vs KAP, and six clusters of clinical groups were optimal in regression of PSD vs RAK and K AP. Prediction of PSD using both RAK andKAP is significantly better than prediction of PSD with either RAK or KAP alone. The regression of PSD vs RAK provided better predictions of PSD than the regression of PSD vs KAP. The partial-pooling (clustered) method yields smaller mean squared errors compared with the complete-pooling method. CONCLUSION PSD distributions for interventional radiology procedures are log-normal. Estimates of PSD derived from RAK and KAP jointly are mos t accurate, followed closely byestimates derived from RAK alone. Estimates of PSD derived from KAP alone are the least accurate. Using a stochastic search approach, it is possible to cluster together certain dissimilar types of procedures to minimize the total error sum of squares.
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Affiliation(s)
- Deukwoo Kwon
- Radiation Epidemiology Branch, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20852-7238, USA
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Sukupova L, Novak L, Kala P, Cervinka P, Stasek J. Patient skin dosimetry in interventional cardiology in the Czech Republic. RADIATION PROTECTION DOSIMETRY 2011; 147:106-110. [PMID: 21757443 DOI: 10.1093/rpd/ncr284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this study, skin dosimetry of patients undergoing interventional cardiology procedures is presented. Three hospitals were included. Two methods were used for skin dosimetry--radiochromic dosimetry films and reconstruction of skin dose distribution based on examination protocol. Maximum skin doses (MSD) obtained from both methods were compared for 175 patients. For patients for whom the film MSD was >1 Gy, the reconstruction MSD differed from the film MSD in the range of ± 50 % for 83 % of patients. For remaining patients, the difference was higher and it was caused by longer fluoroscopy time. For 59 patients for whom the cumulative dose was known, the cumulative dose was compared with the film MSD. Skin dosimetry with radiochromic films is more accurate than the reconstruction method, but films do not include X-ray fields from lateral projections whilest reconstructions do.
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Affiliation(s)
- L Sukupova
- National Radiation Protection Institute, Bartoskova 28, 140 00 Prague 4, Czech Republic.
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Neocleous A, Yakoumakis E, Gialousis G, Dimitriadis A, Yakoumakis N, Georgiou E. Dosimetry using Gafchromic XR-RV2 radiochromic films in interventional radiology. RADIATION PROTECTION DOSIMETRY 2011; 147:78-82. [PMID: 21733864 DOI: 10.1093/rpd/ncr272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Patient dose measurements of local entrance dose to the skin have been carried out using radiochromic film (Gafchromic XR-RV2) in a sample of interventional procedures. The major aim of the work was to measure patient entrance dose from such examinations using Gafchromic XR-RV2. Forty-five various interventional procedures (including nefrostomies and urinary stenting, biliary stenting and percutaneous transhepatic biliary drainage (PTBD) and aorta stent grafting) were evaluated. Maximum entrance doses were 537 ± 119 mGy in nephrostomies, 943 ± 631 mGy in biliary stenting and PTBD and 2425 ± 569 mGy in aorta stent grafting. Results indicate that all patients undergoing aorta stent grafting received skin dose above 1500 mGy, which means that there is an increasing potential to suffer radiation-induced skin injuries. The film provides dose mapping, the position of the skin area with highest dose and can be used for immediate qualitative and as well as for quantitative assessment of patient skin dose.
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Affiliation(s)
- A Neocleous
- Medical Physics Department, Medical School, University of Athens, 75 Mikras Asias Str, Goudi, 115 27 Athens, Greece.
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Ubeda C, Vano E, Miranda P, Leyton F, Valenzuela E, Oyarzun C. Radiation dose and image quality for adult interventional cardiology in Chile: a national survey. RADIATION PROTECTION DOSIMETRY 2011; 147:90-93. [PMID: 21743071 DOI: 10.1093/rpd/ncr276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this work was to investigate the differences in dose settings and image quality among 10 X-ray systems used for interventional cardiology in Chile. Entrance surface air kerma (ESAK) was measured on a phantom of 20 cm thickness of polymethyl methacrylate slabs. Image quality was evaluated using DICOM images of a test object Leeds TOR 18-FG for cine mode acquisition, through the numerical parameters signal-to-noise ratio (SNR), high-contrast spatial resolution (HCSR) and figure of merit. ESAK rate values for fluoroscopy modes ranged between 7.1 and 121.7 mGy min(-1). For cine mode, ESAK values per frame ranged from 63 to 400 µGy fr(-1). SNR and HCSR parameters for cine mode varied from 4.8 to 8.6 and 0.4 to 10, respectively. FOM values resulted from 6.9 to 64.5 among the different X-ray systems. Results show important differences between systems and point out the need to launch an optimisation programme.
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Affiliation(s)
- C Ubeda
- Clinical Sciences Department, Health Sciences Faculty and CIHDE, Tarapaca University, Arica, Chile.
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Thakor AS, Winterbottom A, Mercuri M, Cousins C, Gaunt ME. The radiation burden from increasingly complex endovascular aortic aneurysm repair. Insights Imaging 2011; 2:699-704. [PMID: 22347987 PMCID: PMC3259354 DOI: 10.1007/s13244-011-0120-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 05/27/2011] [Accepted: 07/12/2011] [Indexed: 12/31/2022] Open
Abstract
Objectives With increasing experience, endovascular aortic aneurysm repair (EVAR) has been extended to patients with less suitable aorto-iliac anatomy in an attempt to reduce peri-operative mortality. However, more complex EVAR procedures may take longer and can result in higher rates of complications, additional interventional procedures and more frequent radiological imaging, which may offset some of the benefit. This study determined the radiation burden for standard EVAR, as determined by the EVAR-1 trial criteria, and more complex EVAR. Methods A total of 123 elective patients aged >60, with aneurysms >5.5 cm who received a bifurcated stent-graft were allocated into a group based on whether or not they fulfilled strict EVAR-1 trial criteria. The mean radiation dose was calculated for each group, together with the additional radiation burden from routine pre- and post-EVAR CT examinations and pre-EVAR iliac artery embolisation. Results Patients not meeting the EVAR-1 trial criteria had significantly longer fluoroscopic screening times and higher radiation doses. The radiation burden in all patients was higher following exposure from routine CT examinations and following pre-EVAR iliac artery embolisation. Conclusion Whilst the radiation from standard EVAR is acceptable, more complicated and challenging EVARs, accompanied with additional radiological investigations and procedures, can significantly increase the radiation burden.
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Affiliation(s)
- Avnesh S. Thakor
- Department of Radiology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Andrew Winterbottom
- Department of Radiology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Mathew Mercuri
- Health Research Methodology, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Claire Cousins
- Department of Radiology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Michael E. Gaunt
- Department of Vascular Surgery, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 2QQ UK
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Fetterly KA, Lennon RJ, Bell MR, Holmes DR, Rihal CS. Clinical determinants of radiation dose in percutaneous coronary interventional procedures: influence of patient size, procedure complexity, and performing physician. JACC Cardiovasc Interv 2011; 4:336-43. [PMID: 21435613 DOI: 10.1016/j.jcin.2010.10.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/28/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objectives of this work were to establish the primary clinical determinants of patient radiation dose associated with percutaneous coronary interventional (PCI) and to identify opportunities for dose reduction. BACKGROUND Use of X-ray imaging and associated radiation dose is a necessary part of PCI. Potential adverse consequences of radiation dose include skin radiation injury and predicted increase in lifetime cancer risk. METHODS Cumulative skin dose (CSD) (measured in gray [Gy] units) was selected as a measurement of patient radiation burden. Several patient-, disease-, and treatment-related variables, including 15 performing physicians, were analyzed in a multiple linear regression statistical model with cumulative skin dose CSD as the primary end point. The model results provide an estimate of the relative CSD increase (decrease) attributable to each variable. RESULTS Percutaneous coronary interventions performed on 1,287 male and 540 female patients were included. Median patient age was 68.6 years, median body mass index was 29.7 kg/m(2), and median weight was 88 kg. Median CSD was 1.64 Gy per procedure for male and 1.15 Gy for female patients. Increasing body mass index, patient sex, lesion complexity, lesion location, and performing physician were significantly associated with CSD. Physicians who performed more procedures were associated with lower CSD. CONCLUSIONS Several primary determinants of patient radiation dose during PCI were identified. Along with physician development of radiation-sparing methods and skills, pre-procedure dose planning is proposed to help minimize radiation dose for PCI.
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Affiliation(s)
- Kenneth A Fetterly
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
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E. Chambers C, A. Fetterly K, Holzer R, Paul Lin PJ, C. Blankenship J, Balter S, K. Laskey W. Radiation safety program for the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2011; 77:546-56. [DOI: 10.1002/ccd.22867] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 09/28/2010] [Accepted: 10/06/2010] [Indexed: 11/11/2022]
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Ying CK, Kandaiya S. Patient skin dose measurements during coronary interventional procedures using Gafchromic film. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2010; 30:585-596. [PMID: 20826892 DOI: 10.1088/0952-4746/30/3/012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Interventional cardiology (IC) procedures are known to give high radiation doses to patients and cardiologists as they involve long fluoroscopy times and several cine runs. Patients' dose measurements were carried out at the cardiology department in a local hospital in Penang, Malaysia, using Gafchromic XR-RV2 films. The dosimetric properties of the Gafchromic film were first characterised. The film was energy and dose rate independent but dose dependent for the clinically used values. The film had reproducibility within ± 3% when irradiated on three different days and hence the same XR-RV2 dose-response calibration curve can be used to obtain patient entrance skin dose on different days. The increase in the response of the film post-irradiation was less than 4% over a period of 35 days. For patient dose measurements, the films were placed on the table underneath the patient for an under-couch tube position. This study included a total of 44 patients. Values of 35-2442 mGy for peak skin dose (PSD) and 10.9-344.4 Gy cm(2) for dose-area product (DAP) were obtained. DAP was found to be a poor indicator of PSD for PTCA procedures but there was a better correlation (R(2) = 0.7344) for CA + PTCA procedures. The highest PSD value in this study exceeded the threshold dose value of 2 Gy for early transient skin injury recommended by the Food and Drug Administration.
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Affiliation(s)
- C K Ying
- School of Physics, Universiti Sains Malaysia (USM), Penang, Malaysia
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Zontar D, Kuhelj D, Skrk D, Zdesar U. Patient peak skin doses from cardiac interventional procedures. RADIATION PROTECTION DOSIMETRY 2010; 139:262-265. [PMID: 20139269 DOI: 10.1093/rpd/ncq013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Interventional cardiac procedures not only lead to significant effective doses for the patient but also can potentially cause deterministic effects on the patient's skin. Information about the peak (maximal) skin doses (PSD) received by patients during percutaneous transluminal coronary angioplasty procedures were collected from three cardiac catheter rooms. Cumulative dose at the interventional reference point (CD(IRP)) was collected for 161 patients and for 16 patients PSD was determined using Gafchromic dosimetry films. The comparison showed that CD(IRP) readings give a useful but conservative estimation of patient peak skin dose as it can lead to a significant overestimation. The median and third quartile values of CD(IRP) were 0.64 and 0.92 Gy, respectively. The 2 Gy threshold for deterministic effects was exceeded in nine patients. A good correlation was found between CD(IRP) and kerma area product measurements while the correlation with fluorography time was very weak.
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Affiliation(s)
- D Zontar
- Slovenian Radiation Protection Administration, Ljubljana, Slovenia.
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Olgar T, Bor D, Berkmen G, Yazar T. Patient and staff doses for some complex x-ray examinations. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2009; 29:393-407. [PMID: 19690354 DOI: 10.1088/0952-4746/29/3/004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aim of this study was to measure patient and staff doses simultaneously for some complex x-ray examinations. Measurements of dose-area product (DAP) and entrance skin dose (ESD) were carried out in a sample of 107 adult patients who underwent different x-ray examinations such as double contrast barium enema (DCBE), single contrast barium enema (SCBE), barium swallow, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), and various orthopaedic surgical procedures. Dose measurements were made separately for each projection, and DAP, thermoluminescent dosimetry (TLD), film dosimetry and tube output measurement techniques were used. Staff doses were measured simultaneously with patient doses for these examinations, with the exception of barium procedures. The measured mean DAP values were found to be 8.33, 90.24, 79.96 Gy cm(2) for barium swallow, SCBE and DCBE procedures with the fluoroscopy times of 3.1, 4.43 and 5.86 min, respectively. The calculated mean DAP was 26.33 Gy cm(2) for diagnostic and 89.76 Gy cm(2) therapeutic ERCP examinations with the average fluoroscopy times of 1.9 and 5.06 min respectively. Similarly, the calculated mean DAP was 97.53 Gy cm(2) with a corresponding fluoroscopy time of 6.1 min for PTC studies. The calculated mean entrance skin dose (ESD) was 172 mGy for the orthopaedic surgical studies. Maximum skin doses were measured as 324, 891, 1218, 750, 819 and 1397 mGy for barium swallow, SCBE, DCBE, ERCP, PTC and orthopaedic surgical procedures, respectively. The high number of radiographs taken during barium enema examinations, and the high x-ray outputs of the fluoroscopic units used in ERCP, were the main reasons for high doses, and some corrective actions were immediately taken.
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Affiliation(s)
- T Olgar
- Faculty of Engineering, Department of Engineering Physics, Ankara University, Tandoğan, Ankara, Turkey.
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Bor D, Olgar T, Onal E, Caglan A, Toklu T. Assessment of radiation doses to cardiologists during interventional examinations. Med Phys 2009; 36:3730-6. [DOI: 10.1118/1.3168971] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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