Establishment of trigger levels to steer the follow-up of radiation effects in patients undergoing fluoroscopically-guided interventional procedures in Belgium

Struelens, Lara; Bacher, Klaus; Bosmans, Hilde; Bleeser, F; Hoornaert, M.T.; Malchair, F; Balter, Stephen

doi:10.1016/j.ejmp.2014.09.006

Cited by 18 publications

(6 citation statements)

References 16 publications

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“…2,3 Radiation exposure alarm levels for adults, based on peak skin dose, reference point air Kerma, Kerma-area product, or fluoroscopy time during FGI were developed for adults. 4,5 In addition, post procedure thresholds 6 were established to identify patients that would require follow-up to properly manage potential skin effects. 4 With respect to alert levels, radiation dose from all types of fluoroscopic procedures, that is, general fluoroscopy, mobile C-arm fluoroscopy (typically employed in a surgery setting), and most FGIs, do not exceed alarm levels that would cause a skin effect, but may be inappropriately high with respect to other similarly performed procedures within a specific patient demographic (i.e., based on patient body thickness or patient age).…”

Section: Introductionmentioning

confidence: 99%

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Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Somasundaram

Brady

Strauss

2022

J Applied Clin Med Phys

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The purpose of this study was to provide an empirical model to develop reference air kerma (RAK) alert levels as a function of patient thickness or age for pediatric fluoroscopy for any institution to use in a Quality Assurance program. RAK and patient thickness were collected for 10&663 general fluoroscopic examinations and 1500 fluoroscopically guided interventions (FGIs). RAK and patient age were collected for 6137 fluoroscopic examinations with mobile-C-arms (MC). Coefficients of linear regression fits of logarithmic RAK as a function of patient thickness or age were generated for each fluoroscopy group. Regression fits of RAK for 50%, 90%, and 98% upper prediction levels were used as inputs to derive an empirical formula to estimate alert levels as a function of patient thickness. A methodology is presented to scale results from this study for any patient thickness or age for any institution, for example, the patient thickness dependent RAK alert level at the top 1% of expected RAK can be set using the 98% upper prediction interval boundary given by: RAK 98% = e m.x avg +s 98 . ĉ , where x avg is the institute's average patient thickness or age, and ĉ is the intercept based on the average RAK of the patient population calculated as ĉ = ln(RAK avg ) − m.x avg .RAK avg is the institution's average RAK (mGy). m and s 98 are constants presented for each type of fluoroscope and RAK group and represent slope of the fit and scale factor, respectively. An empirical equation, which estimates alert levels expressed as air Kerma without backscatter at the interventional reference point as a function of patient thickness or age is provided for each fluoroscopic examination type. The empirical equations allow any facility with limited data to scale the results of this study's single facility data to model their practice's unique RAK alert levels and patient population demographics to establish pediatric alert levels for fluoroscopic procedures.

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Section: Introductionmentioning

confidence: 99%

“…Radiation exposure alarm levels for adults, based on peak skin dose, reference point air Kerma, Kerma‐area product, or fluoroscopy time during FGI were developed for adults 4,5 . In addition, post procedure thresholds 6 were established to identify patients that would require follow‐up to properly manage potential skin effects. 4…”

Section: Introductionmentioning

confidence: 99%

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Somasundaram

Brady

Strauss

2022

J Applied Clin Med Phys

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“…The deleterious effects of radiation are differentiated in tissue effects, which result from radiation‐induced cell injury occurring above a threshold dose . Associated with deterministic impact of radiation is the entrance dose, expressed in terms of reference air kerma, whereas KAP is multiplied by the cross‐sectional area and reflects stochastic effects of radiation .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of radiation dose reduction due to real‐time monitoring and visualization of peak skin dose during coronary angiography and percutaneous coronary intervention

Ichimoto

Kadohira

Nakayama

et al. 2017

Cathet Cardio Intervent

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“…Trigger levels for dose area product (DAP) can be multiplied with the ratio of effective FOV to 100 cm 2 . Earlier Belgian research has pointed to similar trigger levels for action [3].…”

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confidence: 82%

Image Guided Interventional Procedures: What Should We Tell Our Patients?

Bosmans

Maleux

2019

Journal of the Belgian Society of Radiology

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Establishment of trigger levels to steer the follow-up of radiation effects in patients undergoing fluoroscopically-guided interventional procedures in Belgium

Cited by 18 publications

References 16 publications

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Efficacy of radiation dose reduction due to real‐time monitoring and visualization of peak skin dose during coronary angiography and percutaneous coronary intervention

Image Guided Interventional Procedures: What Should We Tell Our Patients?

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