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Vano E, Fernandez-Soto JM, Ten JI, Sanchez Casanueva RM. Occupational and patient doses for interventional radiology integrated into a dose management system. Br J Radiol 2023; 96:20220607. [PMID: 36533561 PMCID: PMC9975364 DOI: 10.1259/bjr.20220607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/30/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The International Commission on Radiological Protection recommends managing patient and occupational doses as an integrated approach, for the optimisation of interventional procedures. The conventional passive personal dosimeters only allow one to know the accumulated occupational doses during a certain period of time. This information is not enough to identify if there is a lack of occupational radiation protection during some procedures. This paper describes the use of a dose management system (DMS) allowing patient and occupational doses for individual procedures to be audited. METHODS The DMS manages patient and occupational doses measured by electronic personal dosimeters. One dosemeter located at the C-arm is used as a reference for scatter radiation. Data have been collected from five interventional rooms. Dosimetry data can be managed for the whole procedure and the different radiation events. Optimisation is done through auditing different sets of parameters for individual procedures: patient dose indicators, occupational dose values, the ratio between occupational doses, and the doses measured by the reference dosemeter at the C-arm, and the ratio between occupational and patient dose values. RESULTS The managed data correspond to the year 2021, with around 4500 procedures, and 8000 records on occupational exposures. Patient and staff dose data (for 11 cardiologists, 7 radiologists and 8 nurses) were available for 3043 procedures. The DMS allows alerts for patient dose indicators and occupational exposures to be set. CONCLUSIONS The main advantage of this integrated approach is the capacity to improve radiation safety for patients and workers together, auditing alerts for individual procedures. ADVANCES IN KNOWLEDGE The management of patient and occupational doses together (measured with electronic personal dosimeters) for individual interventional procedures, using dose management systems, allows alerting optimisation on high-dose values for patients and staff.
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Affiliation(s)
| | - José M Fernandez-Soto
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Medical Physics Service, Madrid, Spain
| | - José I Ten
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos and Medical Physics Service, Madrid, Spain
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Kellens PJ, De Hauwere A, Gossye T, Peire S, Tournicourt I, Strubbe L, De Pooter J, Bacher K. Integrity of personal radiation protective equipment (PRPE): a 4-year longitudinal follow-up study. Insights Imaging 2022; 13:183. [PMID: 36471171 PMCID: PMC9723036 DOI: 10.1186/s13244-022-01323-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Personal radiation protective equipment (PRPE) such as lead aprons minimises radiation exposure of operators using X-ray systems. However, PRPE might be prone to cracks in the attenuating layer resulting in inadequate radiation protection. This study aims to investigate the prevalence, qualification and quantification of PRPE integrity during a longitudinal follow-up study. METHODS All PRPE of a large, general hospital was evaluated yearly in the period 2018-2021. The equipment was inspected on a tele-operated X-ray table, and tears were qualified and quantified using an X-ray opaque ruler. Rejection criteria of Lambert & McKeon, with an extra rejection criterion of 15 mm2 for individual tears, were applied to accept or reject further use of the PRPE. RESULTS Over the 4-year follow-up period, a total of 1011 pieces of PRPE were evaluated. In total, 47.3% of the PRPE showed tears of which 31% exceeded the mentioned rejection criteria. Remarkably, of the 287 newly registered pieces of PRPE, 6.0% showed tears in the first year of use of which 88.2% needed to be rejected. Also, 48% of the repaired PRPE was rejected again in the consecutive year. CONCLUSIONS PRPE is prone to cracks. Up to 50% of PRPE showed tears and cracks resulting in 31% rejections. Newly purchased PRPE is not guaranteed to remain free of cracks and tears in the first year of use. Repair does not guarantee a long-term solution for prolonging the lifespan. Regular X-ray-based integrity analysis of PRPE is needed to ensure adequate radioprotection for operators using X-ray systems.
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Affiliation(s)
- Pieter-Jan Kellens
- grid.5342.00000 0001 2069 7798Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium
| | - An De Hauwere
- grid.5342.00000 0001 2069 7798Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium
| | - Tim Gossye
- grid.5342.00000 0001 2069 7798Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium
| | - Sven Peire
- grid.420036.30000 0004 0626 3792AZ Sint-Jan Brugge - Oostende AV, Brugge, Belgium
| | - Ingrid Tournicourt
- grid.420036.30000 0004 0626 3792AZ Sint-Jan Brugge - Oostende AV, Brugge, Belgium
| | - Luc Strubbe
- grid.420036.30000 0004 0626 3792AZ Sint-Jan Brugge - Oostende AV, Brugge, Belgium
| | - Jan De Pooter
- grid.410566.00000 0004 0626 3303Heart Centre, University Hospital Ghent, Ghent, Belgium
| | - Klaus Bacher
- grid.5342.00000 0001 2069 7798Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium
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3
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Vano E, Fernández JM, Ten JI, Sanchez RM. Benefits and limitations for the use of radiation dose management systems in medical imaging. Practical experience in a university hospital. Br J Radiol 2022; 95:20211340. [PMID: 35007182 PMCID: PMC10993955 DOI: 10.1259/bjr.20211340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Radiation dose management systems (DMS) are currently used to help improve radiation protection in medical imaging and interventions. This study presents our experience using a homemade DMS called DOLQA (Dose On-Line for Quality Assurance). METHODS Our DMS is connected to 14 X-ray systems in a university hospital linked to the central data repository of a large network of 16 public hospitals in the Autonomous Community of Madrid, with 6.7 million inhabitants. The system allows us to manage individual patient dose data and groups of procedures with the same clinical indications, and compare them with diagnostic reference levels (DRLs). The system can also help to prioritise optimisation actions. RESULTS This study includes results of imaging examinations from 2020, with 37,601 procedures and 286,471 radiation events included in the radiation dose structured reports (RDSR), for computed tomography (CT), interventional procedures, positron emission tomography-CT (PET-CT) and mammography. CONCLUSIONS The benefits of the system include: automatic registration and management of patient doses, creation of dose reports for patients, information on recurrent examinations, high dose alerts, and help to define optimisation actions.The system requires the support of medical physicists and implication of radiologists and radiographers. DMSs must undergo periodic quality controls and audit reports must be drawn up and submitted to the hospital's quality committee.The drawbacks of DMSs include the need for continuous external support (medical physics experts, radiologists, radiographers, technical services of imaging equipment and hospital informatics services) and the need to include data on clinical indication for the imaging procedures. ADVANCES IN KNOWLEDGE DMS perform automatic management of radiation doses, produces patient dose reports, and registers high dose alerts to suggest optimisation actions. Benefits and limitations are derived from the practical experience in a large university hospital.
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Affiliation(s)
- Eliseo Vano
- Instituto de Investigación Sanitaria del Hospital
Clínico San Carlos and Medical Physics Service,
28040, Madrid,
Spain
- Department of Radiology, Medical School. Complutense
University, 28040 Madrid,
Spain
| | - José M Fernández
- Instituto de Investigación Sanitaria del Hospital
Clínico San Carlos and Medical Physics Service,
28040, Madrid,
Spain
| | - José I. Ten
- Instituto de Investigación Sanitaria del Hospital
Clínico San Carlos and Medical Physics Service,
28040, Madrid,
Spain
| | - Roberto M. Sanchez
- Instituto de Investigación Sanitaria del Hospital
Clínico San Carlos and Medical Physics Service,
28040, Madrid,
Spain
- Department of Radiology, Medical School. Complutense
University, 28040 Madrid,
Spain
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Vano E, Loose R, Frija G, Paulo G, Efstathopoulos E, Granata C, Corridori R, Torresin A, Andersson JS, Tsapaki V, Ammon J, Hoeschen C. Notifications and alerts in patient dose values for computed tomography and fluoroscopy-guided interventional procedures. Eur Radiol 2022; 32:5525-5531. [PMID: 35294584 PMCID: PMC9279248 DOI: 10.1007/s00330-022-08675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/04/2022]
Abstract
The terms "notifications" and "alerts" for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to help in optimisation for CT and for fluoroscopy-guided interventional procedures as well as in the analysis of unintended and accidental medical exposures. The paper also includes cautions in setting the alert values and discusses the benefits of using patient dose management systems for the alerts, their registry and follow-up, and the differences between notifications, alerts, and trigger levels for individual procedures and the terms used for the collective approach, such as diagnostic reference levels. KEY POINTS: • Notifications and alerts on patient dose values for computed tomography (CT) and fluoroscopy-guided interventional procedures (FGIP) allow to improve radiation safety and contribute to the avoidance of radiation injuries and unintended and accidental exposures. • Alerts may be established before the imaging procedures (as in CT) or during and after the procedures as for FGIP. • Dose management systems should include notifications and alerts and their registry for the hospital quality programmes.
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Affiliation(s)
- Eliseo Vano
- Radiology Department, Complutense University, 28040, Madrid, Spain.
| | - Reinhard Loose
- Institute of Medical Physics, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Guy Frija
- Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal
| | - Efstathios Efstathopoulos
- Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Claudio Granata
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Virginia Tsapaki
- Medical Physics, Konstantopoulio General Hospital, Nea Ionia, Greece
| | - Josefin Ammon
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Christoph Hoeschen
- Institut Für Medizintechnik, Otto-Von-Guericke Universität, Magdeburg, Germany
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Zanardo M, Gerasia R, Giovannelli L, Scurto G, Cornacchione P, Cozzi A, Durante S, Schiaffino S, Monfardini L, Sardanelli F. A critical appraisal of the quality of guidelines for radiation protection in interventional radiology using the AGREE II tool: A EuroAIM initiative. Eur J Radiol 2021; 143:109906. [PMID: 34479125 DOI: 10.1016/j.ejrad.2021.109906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To systematically review and assess the methodological quality of guidelines for radiation protection in interventional radiology. MATERIALS AND METHODS On April 15th, 2021, a systematic search for guidelines on radiation protection in interventional radiology was performed using MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence databases. Among retrieved guidelines, we then excluded those not primarily focused on radiation protection or on interventional radiology. Authors' professional role and year of publication were recorded for each included guideline. Guideline quality evaluation was performed independently by three authors using the six-domain tool "AGREE II", with an overall guideline quality score divided into three classes: low (<60%), acceptable (60-80%), and good quality (>80%). RESULTS Our literature search identified 106 citations: after applying exclusion criteria, 11 guidelines published between 2009 and 2018 were included, most of their authors being interventional radiologists (168/224, 75%). Overall quality of included guidelines was acceptable (median 72%, interquartile range 64-83%), with only one guideline (9%) with overall low quality and four guidelines (36%) with overall good quality. Among AGREE II domains, "Scope and Purpose", "Clarity of Presentations", and "Editorial Independence" had the best results (87%, 76%, and 75% respectively), while "Applicability", "Rigor of Development", and "Stakeholder Involvement" the worst (46%, 49%, and 52% respectively). CONCLUSION Considering all guidelines, the overall methodological quality was acceptable with one third of them reaching the highest score class. The "Applicability" domain had the lowest median score, highlighting a practical implementation gap to be addressed by future guidelines.
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Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Roberta Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; AITRI, Italian Association of Interventional Radiographers, Milan, Italy.
| | - Lorenzo Giovannelli
- Radiology Department, Ospedale Santa Maria del Carmine, Azienda Provinciale per i Servizi Sanitari di Trento, Viale Verona 4, 38068 Rovereto (TN), Italy; HTA team, FNO TSRM e PSTRP, Via Magna Grecia 30/A, 00183 Rome, Italy.
| | - Giuseppe Scurto
- HTA team, FNO TSRM e PSTRP, Via Magna Grecia 30/A, 00183 Rome, Italy; Radiology Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Viale Strasburgo 233, 90146 Palermo, Italy.
| | - Patrizia Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy.
| | - Lorenzo Monfardini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy.
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy.
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Vano E. Why is radiological protection different in medicine? Sievert Memorial Lecture. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:S128-S138. [PMID: 33971634 DOI: 10.1088/1361-6498/abffc5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
There are many aspects of radiological protection in medicine that are different from other areas of activity using ionising radiation. In this paper, the author presents and justify some of these differences and highlight the reasons for and benefits of this consideration for the medical field. It is important to understand the differences as we are all likely to be patients at some point in our lives and be exposed to ionising radiation for imaging procedures several times and, in some cases, for therapeutic indications. The work done by the International Commission on Radiological Protection and other international organisations to produce and recommend a consistent system of radiological protection in medicine for the safe use of ionising radiation in medical practices must be highlighted. We should understand why we do not apply dose limits and dose constraints to patients, as well as why we have three levels of justification when considering the use of ionising radiation for patients. We highlight the relevance of personalised radiation protection in parallel to personalised medical practice, and the importance of an integrated approach for occupational and patient protection, especially for interventional procedures. We also cover the differences between patients and volunteers in biomedical research, the importance of radiation safety in quality assurance programmes (including the consideration of unintended and accidental exposures) for some clinical practices, and the relevance of education and training in radiological protection for medical and health professionals and information on radiation risks for patients. Finally, the ethical issues with regard to the safe use of ionising radiation in medicine and the impact of new technology will be addressed.
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Affiliation(s)
- Eliseo Vano
- Radiology Department, Complutense University Madrid and Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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7
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Sánchez RM, Fernández D, Vañó E, Fernández JM. Managing occupational doses with smartphones in interventional radiology. Med Phys 2021; 48:5830-5836. [PMID: 34342016 PMCID: PMC9292171 DOI: 10.1002/mp.15148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose This study presents a prototype smartphone application for occupational dosimetry in interventional practices based on electronic personal dosimeters to assist in dose monitoring. Methods The prototype receives and records information from the occupational dose report containing the cumulative dose of electronic personal dosimeters worn over the apron at chest level and electronic area dosimeters located on C‐arms (reference dosimeters), for each fluoroscopy‐guided procedure. Using their smartphones, personnel involved in interventional practices can review and compare their occupational records with an investigation level, the dose limits, and their department colleagues (anonymously). The ratio between Hp(10) measured by the personal and the reference dosimeters at the C‐arm is presented as an indicator of consistent use of suspended operator shield. Some general results extracted from the first months of use are presented. Results The reference dosimeter located at the C‐arm (without lead protection and acting as an ambient dosimeter) recorded in one of the laboratories 217 mSv during 308 procedures over 5 months, showing an indication of the radiation risk present in an interventional laboratory. The ratio between the personal cumulative dose and the dose at a reference C‐arm dosimeter ranged from 0.2% to 1.67% (a factor of 8.5) for different interventionalists. These differences suggest different protection habits among interventional operators, as well as a target for dose reduction. Conclusions With this system, professionals have easy access to their occupational dosimetry records (including information on the workload) in the setting of their interventional departments, to thereby actively engage in the protection process.
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Affiliation(s)
- Roberto M Sánchez
- Medical Physics, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Medicine Faculty, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Fernández
- Software Engineering, Universidad Francisco de Vitoria, Madrid, Spain
| | - Eliseo Vañó
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.,Medicine Faculty, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Fernández
- Medical Physics, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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Vano E, Sanchez Casanueva R, Fernandez Soto JM, Bartal G. Challenges in Occupational Dosimetry for Interventional Radiologists. Cardiovasc Intervent Radiol 2021; 44:866-870. [PMID: 33388873 DOI: 10.1007/s00270-020-02725-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
This review presents the challenges met by interventional radiologists in occupational dosimetry. The issues mentioned are derived from the recommendations of the International Commission on Radiological Protection, the CIRSE guidelines on "Occupational radiation protection in interventional radiology" and the requirements of the European directive on Basic Safety Standards. The criteria for a proper use of personal dosimeters and the need to introduce optimization actions in some cases are set out in this review. The pros and cons of the electronic real-time dosimeters are outlined and the potential pitfalls associated with the use of personal dosimeters summarized. The electronic dosimeters, together with the appropriate software, allow an active optimization of the interventional procedures.
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Affiliation(s)
- E Vano
- Radiology Department, Faculty of Medicine, Complutense University, E-28040, Madrid, Spain. .,IdISSC and Medical Physics Service, Hospital Clínico San Carlos, Martin Lagos s.n., E-28040, Madrid, Spain.
| | - R Sanchez Casanueva
- Radiology Department, Faculty of Medicine, Complutense University, E-28040, Madrid, Spain.,IdISSC and Medical Physics Service, Hospital Clínico San Carlos, Martin Lagos s.n., E-28040, Madrid, Spain
| | - J M Fernandez Soto
- Radiology Department, Faculty of Medicine, Complutense University, E-28040, Madrid, Spain
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