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Hadid-Beurrier L, Geryes BH, Jean-Pierre A, Gaudin PA, Feghali JA. Clinical benchmarking of a commercial software for skin dose estimation in cardiac, abdominal, and neurology interventional procedures. Med Phys 2024; 51:3687-3697. [PMID: 38277471 DOI: 10.1002/mp.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Radiation exposure from interventional radiology (IR) could lead to potential risk of skin injury in patients. Several dose monitoring software like radiation dose monitor (RDM) were developed to estimate the patient skin dose (PSD) distribution in IR. PURPOSE This study benchmarked the accuracy of RDM software in estimating PSD as compared to GafChromic film baseline in-vivo measurements on patients during cardiac, abdominal, and neurology IR procedures. METHODS The prospective study conducted in four IR departments included 81 IR procedures (25 cardiac, 31 abdominal, and 25 neurology procedures) on three angiographic systems. PSD and field geometry were measured by placing GafChromic film under the patient's back. Statistical analyses were performed to compare the software estimation and film measurement results in terms of PSD and geometric accuracy. RESULTS Median values of measured/calculated PSD were 1140/1005, 591/655.9, and 538/409.7 mGy for neurology, cardiac, and abdominal procedures, respectively. For all angiographic systems, the median (InterQuartile Range, IQR) difference between calculated and measured PSD was -10.2% (-21.8%-5.7%) for neurology, -4.5% (-19.5%-15.5%) for cardiac, and -21.9% (-38.7%--3.6%) for abdominal IR procedures. These differences were not significant for all procedures (p > 0.05). Discrepancies increased up to -82% in lower dose regions where the measurement uncertainties are higher. Regarding the geometric accuracy, RDM correctly reproduced the skin dose map and estimated PSD area dimensions closely matched those registered on films with a median (IQR) difference of 0 cm (-1-0.8 cm). CONCLUSIONS RDM is proved to be a useful solution for the estimation of PSD and skin dose distribution during abdominal, cardiac and neurology IR procedures despite a geometry phantom which is not specific to the latter type of IR procedures.
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Affiliation(s)
- Lama Hadid-Beurrier
- Medical Physics and Radiation Protection Department, APHP Lariboisière University Hospital, Paris, France
| | - Bouchra Habib Geryes
- Radiology Department, APHP Necker-Enfants Malades University Hospital, Paris, France
| | - Antonella Jean-Pierre
- Medical Physics and Radiation Protection Department, APHP Lariboisière University Hospital, Paris, France
| | - Paul-Adrien Gaudin
- URC Lariboisière-Saint Louis, Hôpital Fernand Widal, PARIS Cedex, France
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Greffier J, Belaouni A, Dabli D, Goupil J, Perolat R, Akessoul P, Kammoun T, Hoballah A, Beregi JP, Frandon J. Comparison of peak skin dose and dose map obtained with real-time software and radiochromic films in patients undergoing abdominopelvic embolization. Diagn Interv Imaging 2022; 103:338-344. [DOI: 10.1016/j.diii.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
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Feghali JA, Delépierre J, Belac OC, Dabin J, Deleu M, De Monte F, Dobric M, Gallagher A, Hadid-Beurrier L, Henry P, Hršak H, Kiernan T, Kumar R, Knežević Ž, Maccia C, Majer M, Malchair F, Noble S, Obrad D, Sans Merce M, Sideris G, Simantirakis G, Spaulding C, Tarantini G, Van Ngoc Ty C. Patient exposure dose in interventional cardiology per clinical and technical complexity levels. Part 1: results of the VERIDIC project. Acta Radiol 2021; 64:108-118. [PMID: 34958271 DOI: 10.1177/02841851211061438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients can be exposed to high skin doses during complex interventional cardiology (IC) procedures. PURPOSE To identify which clinical and technical parameters affect patient exposure and peak skin dose (PSD) and to establish dose reference levels (DRL) per clinical complexity level in IC procedures. MATERIAL AND METHODS Validation and Estimation of Radiation skin Dose in Interventional Cardiology (VERIDIC) project analyzed prospectively collected patient data from eight European countries and 12 hospitals where percutaneous coronary intervention (PCI), chronic total occlusion PCI (CTO), and transcatheter aortic valve implantation (TAVI) procedures were performed. A total of 62 clinical complexity parameters and 31 technical parameters were collected, univariate regressions were performed to identify those parameters affecting patient exposure and define DRL accordingly. RESULTS Patient exposure as well as clinical and technical parameters were collected for a total of 534 PCI, 219 CTO, and 209 TAVI. For PCI procedures, body mass index (BMI), number of stents ≥2, and total stent length >28 mm were the most prominent clinical parameters, which increased the PSD value. For CTO, these were total stent length >57 mm, BMI, and previous anterograde or retrograde technique that failed in the same session. For TAVI, these were male sex, BMI, and number of diseased vessels. DRL values for Kerma-area product (PKA), air kerma at patient entrance reference point (Ka,r), fluoroscopy time (FT), and PSD were stratified, respectively, for 14 clinical parameters in PCI, 10 in CTO, and four in TAVI. CONCLUSION Prior knowledge of the key factors influencing the PSD will help optimize patient radiation protection in IC.
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Affiliation(s)
- Joelle Ann Feghali
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Julie Delépierre
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Olivera Ciraj Belac
- Department of Radiation and Environmental Protection, Vinca Institute of Nuclear Sciences-National Institute of the Republic of Serbia, University of Belgrade, Beograd, Serbia
| | - Jérémie Dabin
- SCK CEN Belgian Nuclear Research Center, Mol, Belgium
| | - Marine Deleu
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Milan Dobric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aoife Gallagher
- Department of Medical Physics, University Hospital Limerick, Limerick, Ireland
| | - Lama Hadid-Beurrier
- Department of Radiation Protection and Medical Physics, Lariboisière University Hospital, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Tom Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Rajesh Kumar
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | | | - Carlo Maccia
- Centre d’Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | | | - Françoise Malchair
- Centre d’Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | - Stéphane Noble
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | | | - Marta Sans Merce
- Department of Radiology, Geneva University Hospital, Geneva, Switzerland
| | - Georgios Sideris
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Christian Spaulding
- Department of Cardiology, European Georges Pompidou University Hospital, Paris, France
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Claire Van Ngoc Ty
- Department of Radiology, European Georges Pompidou Hospital, Paris, France
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Papanastasiou E, Protopsaltis A, Finitsis S, Hatzidakis A, Prassopoulos P, Siountas A. Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures. Phys Med 2021; 89:63-71. [PMID: 34352677 DOI: 10.1016/j.ejmp.2021.07.029] [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: 04/13/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Institutional (local) Diagnostic Reference Levels for Cerebral Angiography (CA), Percutaneous Transhepatic Cholangiography (PTC), Transarterial Chemoembolization (TACE) and Percutaneous Transhepatic Biliary Drainage (PTBD) are reported in this study. MATERIALS AND METHODS Data for air kerma-area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT) and number of images (NI) as well as estimates of Peak Skin Dose (PSD) were collected for 142 patients. Therapeutic procedure complexity was also evaluated, in an attempt to incorporate it into the DRL analysis. RESULTS Local PKA DRL values were 70, 34, 189 and 54 Gy.cm2 for CA, PTC, TACE and PTBD respectively. The corresponding DRL values for Ka,r were 494, 194, 1186 and 400 mGy, for FT they were 9.2, 14.2, 27.5 and 22.9 min, for the NI they were 844, 32, 602 and 13 and for PSD they were 254, 256, 1598 and 540 mGy respectively. PKA for medium complexity PTBD procedures was 2.5 times higher than for simple procedures. For TACE, the corresponding ratio was 1.6. PSD was estimated to be roughly 50% of recorded Ka,r for procedures in the head/neck region and 10% higher than recorded Ka,r for procedures in the body region. In only 5 cases the 2 Gy dose alarm threshold for skin deterministic effects was exceeded. CONCLUSION Procedure complexity can differentiate DRLs in Interventional Radiology procedures. PSD could be deduced with reasonable accuracy from values of Ka,r that are reported in every angiography system.
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Affiliation(s)
- Emmanouil Papanastasiou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
| | - Athanasios Protopsaltis
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Stefanos Finitsis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Adam Hatzidakis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Panos Prassopoulos
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Anastasios Siountas
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Calibration of Gafchromic XR-RV3 film under interventional radiology conditions. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2021. [DOI: 10.2478/pjmpe-2021-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Introduction: The purpose of the study was the calibration of Gafchromic films in clinical interventional radiology conditions and the assessment of the influence of dose range, the shape of the fitting curve, and its practical application. The aim of the work was to show how practically perform calibration in a wide range of doses.
Material and methods: Gafchromic XR–RV3 films were included in the study. The calibration was performed for A and B film series separately. Doses from the range of 0 – 8 Gy were used. Film dosimeters were read out in reflective mode with a commercial flatbed scanner.
Results: Among various degrees of a polynomial function, the best fit, which fulfilled the chosen criterion of 95% agreement between measured and reconstructed doses and simple equation criterion, was observed for third-degree polynomial. The fitting curve where the dose is the function of optical density (logMPV) was demonstrated to be more precise than the fitting curve based on MPV only. To minimize the difference between dose absorbed by the film and dose reconstructed from the fitting curve below 5% it is necessary to divide the calibration range of 0 – 8 Gy into two subranges for use in interventional radiology. This difference was set at a maximum level of 3.8% and 1.9% for the lowand high-dose range, respectively. Each series of films may have a slightly different calibration curve, especially for the low dose range. A deviation of up to 36% between two batches of Gafchromic film was observed.
Conclusions: For the third-degree polynomial fitting function (one of the recommended in the literature) calibration should be done into low and high dose ranges and for each batch separately. A systematic error higher than 20% could be introduced when the fitting curve from one film batch is applied to the other film batch.
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Krajinović M, Kržanović N, Ciraj‐Bjelac O. Vendor-independent skin dose mapping application for interventional radiology and cardiology. J Appl Clin Med Phys 2021; 22:145-157. [PMID: 33440056 PMCID: PMC7882120 DOI: 10.1002/acm2.13167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 10/09/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The purpose of this paper is to present and validate an originally developed application SkinCare used for skin dose mapping in interventional procedures, which are associated with relatively high radiation doses to the patient's skin and possible skin reactions. METHODS SkinCare is an application tool for generating skin dose maps following interventional radiology and cardiology procedures using the realistic 3D patient models. Skin dose is calculated using data from Digital Imaging and Communications in Medicine (DICOM) Radiation Dose Structured Reports (RDSRs). SkinCare validation was performed by using the data from the Siemens Artis Zee Biplane fluoroscopy system and conducting "Acceptance and quality control protocols for skin dose calculating software solutions in interventional cardiology" developed and tested in the frame of the VERIDIC project. XR-RV3 Gafchromic films were used as dosimeters to compare peak skin doses (PSDs) and dose maps obtained through measurements and calculations. DICOM RDSRs from four fluoroscopy systems of different vendors (Canon, GE, Philips, and Siemens) were used for the development of the SkinCare and for the comparison of skin dose maps generated using SkinCare to skin dose maps generated by different commercial software tools (Dose Tracking System (DTS) from Canon, RadimetricsTM from Bayer and RDM from MEDSQUARE). The same RDSRs generated during a cardiology clinical procedure (percutaneous coronary intervention-PCI) were used for comparison. RESULTS Validation performed using VERIDIC's protocols for skin dose calculation software showed that PSD calculated by SkinCare is within 17% and 16% accuracy compared to measurements using XR-RV3 Gafchromic films for fundamental irradiation setups and simplified clinical procedures, respectively. Good visual agreement between dose maps generated by SkinCare and DTS, RadimetricsTM and RDM was obtained. CONCLUSIONS SkinCare is proved to be very convenient solution that can be used for monitoring delivered dose following interventional procedures.
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Affiliation(s)
- Marko Krajinović
- School of Electrical EngineeringUniversity of BelgradeBelgradeSerbia
- „VINČA" Institute of Nuclear Sciences ‐ National Institute of the Republic of SerbiaUniversity of BelgradeBelgradeSerbia
| | - Nikola Kržanović
- School of Electrical EngineeringUniversity of BelgradeBelgradeSerbia
- „VINČA" Institute of Nuclear Sciences ‐ National Institute of the Republic of SerbiaUniversity of BelgradeBelgradeSerbia
| | - Olivera Ciraj‐Bjelac
- School of Electrical EngineeringUniversity of BelgradeBelgradeSerbia
- „VINČA" Institute of Nuclear Sciences ‐ National Institute of the Republic of SerbiaUniversity of BelgradeBelgradeSerbia
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7
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Skin dose assessment in interventional radiology. Phys Med 2021; 81:170-172. [DOI: 10.1016/j.ejmp.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023] Open
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Clinical evaluation of a dose management system-integrated 3D skin dose map by comparison with radiochromic films. Eur Radiol 2020; 30:5071-5081. [DOI: 10.1007/s00330-020-06877-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 01/28/2023]
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9
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Rühm W, Ainsbury E, Breustedt B, Caresana M, Gilvin P, Knežević Ž, Rabus H, Stolarczyk L, Vargas A, Bottollier-Depois J, Harrison R, Lopez M, Stadtmann H, Tanner R, Vanhavere F, Woda C, Clairand I, Fantuzzi E, Fattibene P, Hupe O, Olko P, Olšovcová V, Schuhmacher H, Alves J, Miljanic S. The European radiation dosimetry group – Review of recent scientific achievements. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108514] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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11
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Experimental evaluation of a radiation dose management system-integrated 3D skin dose map by comparison with XR-RV3 Gafchromic® films. Phys Med 2019; 66:77-87. [DOI: 10.1016/j.ejmp.2019.09.234] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/10/2019] [Accepted: 09/14/2019] [Indexed: 11/22/2022] Open
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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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Pasquino M, Cutaia C, Poli M, Valero C, Peroni G, De Benedictis M, Petrucci E, Stasi M. Patient’s Peak Skin Dose evaluation using Gafchromic films in interventional cardiology procedures and its correlation with other dose indicators. Phys Med 2018; 53:103-107. [DOI: 10.1016/j.ejmp.2018.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022] Open
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14
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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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Jarvinen H, Farah J, Siiskonen T, Ciraj-Bjelac O, Dabin J, Carinou E, Domienik-Andrzejewska J, Kluszczynski D, Knežević Ž, Kopec R, Majer M, Malchair F, Negri A, Pankowski P, Sarmento S, Trianni A. Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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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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Jaschke W, Schmuth M, Trianni A, Bartal G. Radiation-Induced Skin Injuries to Patients: What the Interventional Radiologist Needs to Know. Cardiovasc Intervent Radiol 2017; 40:1131-1140. [PMID: 28497187 PMCID: PMC5489635 DOI: 10.1007/s00270-017-1674-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
For a long time, radiation-induced skin injuries were only encountered in patients undergoing radiation therapy. In diagnostic radiology, radiation exposures of patients causing skin injuries were extremely rare. The introduction of fast multislice CT scanners and fluoroscopically guided interventions (FGI) changed the situation. Both methods carry the risk of excessive high doses to the skin of patients resulting in skin injuries. In the early nineties, several reports of epilation and skin injuries following CT brain perfusion studies were published. During the same time, several papers reported skin injuries following FGI, especially after percutaneous coronary interventions and neuroembolisations. Thus, CT and FGI are of major concern regarding radiation safety since both methods can apply doses to patients exceeding 5 Gy (National Council on Radiation Protection and Measurements threshold for substantial radiation dose level). This paper reviews the problem of skin injuries observed after FGI. Also, some practical advices are given how to effectively avoid skin injuries. In addition, guidelines are discussed how to deal with patients who were exposed to a potentially dangerous radiation skin dose during medically justified interventional procedures.
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Affiliation(s)
- Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Matthias Schmuth
- Department of Dermatology, Venereology and Allergology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Annalisa Trianni
- Department of Physics, Udine University Hospital, Piazzale S. Maria Della Misericordia, n. 15, 33100, Udine, Italy
| | - Gabriel Bartal
- Department of Radiology, Meir Medical Center, Street Tchernichovsky 59, 44281, Kfar Saba, Israel
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Habib Geryes B, Bak A, Lachaux J, Ozanne A, Boddaert N, Brunelle F, Naggara O, Saliou G. Patient radiation doses and reference levels in pediatric interventional radiology. Eur Radiol 2017; 27:3983-3990. [PMID: 28210801 DOI: 10.1007/s00330-017-4769-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/20/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe, in a multicentric paediatric population, reference levels (RLs) for three interventional radiological procedures. METHODS From January 2012 to March 2015, children scheduled for an interventional radiological procedure in two French tertiary centres were retrospectively included and divided into four groups according to age: children younger than 2 years (A1), aged 2-7 years (A5), 8-12 years (A10) and 13-18 years (A15). Three procedures were identified: cerebral digital subtraction angiography (DSA), brain arteriovenous malformation (bAVM) embolization, and head and neck superficial vascular malformation (SVM) percutaneous sclerotherapy. Demographic and dosimetric data, including dose area product (DAP), were collected. RESULTS 550 procedures were included. For DSA (162 procedures), the proposed RL values in DAP were 4, 18, 12 and 32 Gy∙cm2 in groups A1, A5, A10 and A15, respectively. For bAVM embolization (258 procedures), values were 33, 70, 105 and 88 Gy∙cm2 in groups A1, A5, A10 and A15, respectively. For SVM sclerotherapy (130 procedures), values were 350, 790, 490 and 248 mGy∙cm2 in groups A1, A5, A10 and A15, respectively. CONCLUSION Consecutive data were available to permit a proposal of reference levels for three major paediatric interventional radiology procedures. KEY POINTS • We determined reference levels (RLs) for bAVM embolization, DSA and SVM sclerotherapy. • The proposed RLs will permit benchmarking practice with an external standard. • The proposed RLs by age may help to develop paediatric dose guidelines.
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Affiliation(s)
- Bouchra Habib Geryes
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Adeline Bak
- Department of Neuroradiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - Julie Lachaux
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Augustin Ozanne
- Department of Neuroradiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - Nathalie Boddaert
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Francis Brunelle
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Olivier Naggara
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France. .,Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasculaire, Centre Hospitalier Sainte-Anne, Paris, France. .,Department of Neuroradiology, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR894, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75014, Paris, France.
| | - Guillaume Saliou
- Department of Neuroradiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
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Wilson SM, Prasan AM, Virdi A, Lassere M, Ison G, Ramsay DR, Weaver JC. Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography. EUROINTERVENTION 2016; 12:e939-e947. [DOI: 10.4244/eijv12i8a156] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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