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Vano E, Fernández-Soto JM, Sánchez-Casanueva RM, Ten Morón JI. Improving a regional project on diagnostic reference levels for interventional procedures (OPRIPALC) with the support of a dose management system for the protection of patients and staff. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021520. [PMID: 38834050 DOI: 10.1088/1361-6498/ad53d8] [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: 04/07/2024] [Accepted: 06/04/2024] [Indexed: 06/06/2024]
Abstract
Interventional radiology is a clinical practice with important benefits for patients, but which involves high radiation doses. The optimisation of radiation protection (RP) for paediatric interventional cardiology is a priority for both patients and staff. The use of diagnostic reference levels (DRLs) has been proposed by the International Commission on Radiological Protection to improve RP in imaging procedures. Dose management systems (DMSs) allow the automatic collection of dosimetric, geometric and technical data to assist the optimisation process, with a continuous audit of the procedures, generating alerts to implement corrective actions when necessary. Patient dose indicators may be analysed individually and for different radiation events (fluoroscopy and cine runs). Occupational doses per procedure may be analysed (if electronic dosimeters are available) and linked with patient doses for an integrated approach to RP. Regional optimisation programmes require data collection and processing from several countries to set and periodically update the DRLs. Patient data is anonymised, and each participating hospital has access to their data in a central computer server. Using DMSs may be one of the best ways to support these programs in the collection and analysis of data, raising alerts about high patient and occupational doses and suggesting optimisation actions.
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Affiliation(s)
- E Vano
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - J M Fernández-Soto
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - R M Sánchez-Casanueva
- Servicio de Fisica Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Radiology Department, Complutense University, 28040 Madrid, Spain
| | - J I Ten Morón
- Unidad Técnica de Imagen Médica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
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Asfora VK, Freitas MB, Medeiros RB, Schelin HR, Yagui A, Oliveira MVL, Leite LMSA, Lopez GA, Roberto MRS, Gagetti FL, Souza PHO, Vargas B, Denyak VV, Khoury HJ. An Approach to Establishing Diagnostic Reference Levels in Interventional Pediatric Cardiology from Different Regions of Brazil. CHILDREN (BASEL, SWITZERLAND) 2024; 11:200. [PMID: 38397312 PMCID: PMC10887576 DOI: 10.3390/children11020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Diagnostic reference levels (DRLs) are a pivotal strategy to be implemented since pediatric interventional cardiology procedures are increasing. This work aimed to propose an initial set of Brazilian DRLs for pediatric interventional diagnostic and therapeutic (D&T) procedures. A retrospective study was carried out in four Brazilian states, distributed across the three regions of the country. Data were collected from pediatric patients undergoing cardiac interventional procedures (CIPs), including their age and anthropometric characteristics, and at least four parameters (number of images, exposure time, air kerma-area product-PKA, and cumulative air kerma). Data from 279 patients undergoing CIPs were gathered (147 diagnostic and 132 therapeutic procedures). There were no significant differences in exposure time and the number of images between the D&T procedures. A wide range of PKA was observed when the therapeutic procedures were compared to diagnostics for all age groups. There were significant differences between the D&T procedures, whether grouping data by patient weight or age. In terms of cumulative air kerma, it was noted that no value exceeded the level to trigger a monitoring process for patients. This study shows that it is possible to adopt them as the first proposal to establish national DRLs considering pediatric patient groups.
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Affiliation(s)
- Viviane K. Asfora
- Departamento de Energia Nuclear, Universidade Federal de Pernambuco, Recife 50740-540, Brazil; (V.K.A.); (L.M.S.A.L.); (M.R.S.R.); (H.J.K.)
| | - Marcelo B. Freitas
- Departamento de Biofísica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
| | - Regina B. Medeiros
- Programa de Pós-Graduação em Medicina (Cardiologia), Universidade Federal de São Paulo, São Paulo 04024-002, Brazil;
| | - Hugo R. Schelin
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba 80250-209, Brazil; (H.R.S.); (A.Y.); (B.V.)
| | - Akemi Yagui
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba 80250-209, Brazil; (H.R.S.); (A.Y.); (B.V.)
| | - Marcus V. L. Oliveira
- Departamento de Tecnologia em Saúde e Biologia, Instituto Federal da Bahia, Salvador 40301-015, Brazil; (M.V.L.O.); (G.A.L.)
| | - Luiz M. S. A. Leite
- Departamento de Energia Nuclear, Universidade Federal de Pernambuco, Recife 50740-540, Brazil; (V.K.A.); (L.M.S.A.L.); (M.R.S.R.); (H.J.K.)
| | - Guillermo A. Lopez
- Departamento de Tecnologia em Saúde e Biologia, Instituto Federal da Bahia, Salvador 40301-015, Brazil; (M.V.L.O.); (G.A.L.)
| | - Maryanna R. S. Roberto
- Departamento de Energia Nuclear, Universidade Federal de Pernambuco, Recife 50740-540, Brazil; (V.K.A.); (L.M.S.A.L.); (M.R.S.R.); (H.J.K.)
| | - Fabio L. Gagetti
- Programa de Residência em Física Médica, Universidade Federal de São Paulo, São Paulo 04021-001, Brazil; (F.L.G.); (P.H.O.S.)
| | - Pablo H. O. Souza
- Programa de Residência em Física Médica, Universidade Federal de São Paulo, São Paulo 04021-001, Brazil; (F.L.G.); (P.H.O.S.)
| | - Bruna Vargas
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba 80250-209, Brazil; (H.R.S.); (A.Y.); (B.V.)
| | - Valeriy V. Denyak
- Programa de Pós-Graduação em Engenharia Biomédica, Universidade Tecnológica Federal do Paraná, Curitiba 80230-901, Brazil;
| | - Helen J. Khoury
- Departamento de Energia Nuclear, Universidade Federal de Pernambuco, Recife 50740-540, Brazil; (V.K.A.); (L.M.S.A.L.); (M.R.S.R.); (H.J.K.)
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Azcurra P, Leyton F, Lucini V, Rivarola M, Trentacoste L, Marques A, Chiabrando J, Seropian I, Mundo N, Ubeda C, Agatiello C. Local Diagnostic Reference Levels for Pediatric Interventional Cardiology Procedures in Argentina. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1877. [PMID: 38136079 PMCID: PMC10741962 DOI: 10.3390/children10121877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/02/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
The aim of this work was to propose a preliminary local diagnostic reference levels (DRL) for pediatric interventional cardiology (PIC) procedures in Argentina, for different ranges of age and weight. This work has been conducted in the framework of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency to ensuring that radiation exposures of pediatric patients are the minimum necessary during fluoroscopy-guided interventional procedures. The local DRL values presented in this paper by weight group and age group were 7.1 Gy·cm2 (<5 kg), 10.7 Gy·cm2 (5-15 kg), 18.0 Gy·cm2 (15-30 kg), 15.9 Gy·cm2 (30-50 kg), and 28.2 Gy·cm2 (50-80 kg) and 5.3 Gy·cm2 (<1), 11.2 Gy·cm2 (1 to 5<), 19.6 Gy·cm2 (5 to 10<), and 21.4 Gy·cm2 (10 to 16<), respectively. Our dose results are among the values found in other international studies; however, there is great potential for dose optimization.
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Affiliation(s)
- Patricia Azcurra
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Fernando Leyton
- Personal Dosimetry Laboratory (LABODOP), School of Medical Technology, Faculty of Health Sciences, University of Tarapacá, Arica 1010072, Chile
| | - Victorio Lucini
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Marcelo Rivarola
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Luis Trentacoste
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Adela Marques
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Juan Chiabrando
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Ignacio Seropian
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Nicolas Mundo
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Carlos Ubeda
- Personal Dosimetry Laboratory (LABODOP), School of Medical Technology, Faculty of Health Sciences, University of Tarapacá, Arica 1010072, Chile
| | - Carla Agatiello
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
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Aristizabal AM, Gutiérrez JA, Ramirez E, Mejía-Quiñones V, Ubeda C, Mosquera WF, Mosquera W. Diagnostic Reference Levels in Interventional Pediatric Cardiology: Two-Year Experience in a Tertiary Referral Hospital in Latin America. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1588. [PMID: 37892251 PMCID: PMC10605529 DOI: 10.3390/children10101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 10/29/2023]
Abstract
The goal of the present study was to propose the first local diagnostic reference levels (DRLs) for interventional pediatric cardiology procedures in a large hospital in Colombia. The data collection period was from April 2020 to July 2022. The local DRLs were calculated as the 3rd quartile of patient-dose distributions for the kerma-area product (Pka) values. The sample of collected clinical procedures (255) was divided into diagnostic and therapeutic procedures and grouped into five weight and five age bands. The Pka differences found between diagnostic and therapeutic procedures were statistically significant in all weight and age bands, except for the 1-5-year age group. The local DRLs for weight bands were 3.82 Gy·cm2 (<5 kg), 7.39 Gy·cm2 (5-<15 kg), 19.72 Gy·cm2 (15-<30 kg), 28.99 Gy·cm2 (30-<50 kg), and 81.71 Gy·cm2 (50-<80 kg), respectively. For age bands, the DRLs were 3.97 Gy·cm2 (<1 y), 9.94 Gy·cm2 (1-<5 y), 20.82 Gy·cm2 (5-<10 y), 58.00 Gy·cm2 (10-<16 y), and 31.56 Gy·cm2 (<16 y), respectively. In conclusion, when comparing our results with other existing DRL values, we found that they are similar to other centers and thus there is scope to continue optimizing the radiation dose values. This will contribute to establishing national DRLs for Colombia in the near future.
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Affiliation(s)
- Ana M. Aristizabal
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
| | - Jaiber A. Gutiérrez
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
| | - Emmanuel Ramirez
- Oficina de Física Médica & Protección Radiológica, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia;
| | - Valentina Mejía-Quiñones
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia
| | - Carlos Ubeda
- Diagnóstico por Imagen, Laboratorio de Dosimetría Personal (LABODOP), Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica 1020000, Chile;
| | - Walter Fernando Mosquera
- Servicio de Hospitalización, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia;
| | - Walter Mosquera
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
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