AAPM Medical Physics Practice Guideline 12.a: Fluoroscopy dose management

Fisher, R; Applegate, Kimberly E.; Berkowitz, Lindsey K; Christianson, Olav; Dave, Jaydev K.; DeWeese, Lindsay; Harris, Nichole; Jafari, Mary Ellen; Jones, A. Kyle; Kobistek, Robert J.; Loughran, B; Marous, Loren; Miller, Donald L.; Schueler, Beth A.; Springer, A.; Wunderle, Kevin

doi:10.1002/acm2.13526

Cited by 13 publications

(3 citation statements)

References 27 publications

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“…Furthermore, a QA program that helps manage the patient dose for an institution must be adjustable to account for the site's unique patient population, especially if pediatric patients are involved. The AAPM's recently published Practice Guideline 12.a 8 is an excellent guide with respect to establishing alarm levels for adult fluoroscopy. However, its scope did not include the importance of establishing alert levels as a function of patient size, which is an important task within a QA program for fluoroscopy of both pediatric and small sized adult patients.…”

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 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%

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Somasundaram

Brady

Strauss

2022

J Applied Clin Med Phys

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“…Our data describing radiation-induced skin injury in the SKH-1 model is also useful beyond the context of therapeutic exposures. Cutaneous injuries can develop in normal human skin following a wide variety of radiation exposures, including nuclear device fallout, nuclear energy accidents, nuclear testing, medical exposures, and industrial overexposures [83][84][85][86] . Indeed, skin damage is the most common radiation injury in humans [87] .…”

Section: Discussionmentioning

confidence: 99%

Radiation dermatitis in the hairless mouse model mimics human radiation dermatitis

Lawrence,

Seelig,

Demos-Davies

et al. 2024

Preprint

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Over half of all people diagnosed with cancer receive radiation therapy. Moderate to severe radiation dermatitis occurs in most human radiation patients, causing pain, aesthetic distress, and a negative impact on tumor control. No effective prevention or treatment for radiation dermatitis exists. The lack of well-characterized, clinically relevant animal models of human radiation dermatitis contributes to the absence of strategies to mitigate radiation dermatitis. Here, we establish and characterize a hairless SKH-1 mouse model of human radiation dermatitis by correlating temporal stages of clinical and pathological skin injury. We demonstrate that a single ionizing radiation treatment of 30 Gy using 6 MeV electrons induces severe clinical grade 3 peak toxicity at 12 days, defined by marked erythema, desquamation and partial ulceration, with resolution occurring by 25 days. Histopathology reveals that radiation-induced skin injury features temporally unique inflammatory changes. Upregulation of epidermal and dermal TGF-β1 and COX-2 protein expression occurs at peak dermatitis, with sustained epidermal TGF-β1 expression beyond resolution. Specific histopathological variables that remain substantially high at peak toxicity and early clinical resolution, including epidermal thickening, hyperkeratosis and dermal fibroplasia/fibrosis, serve as specific measurable parameters for in vivo interventional preclinical studies that seek to mitigate radiation-induced skin injury.

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“…Although fluoroscopy time was reported in more than 50% of patients, it is not sufficient to estimate radiation dose from these exams. 48 In addition, we did not include nuclear imaging tests in this retrospective study, because only a few (four cases and one control) patients received them.…”

Section: Discussionmentioning

confidence: 99%

Cumulative radiation dose from medical imaging in paediatric congenital heart disease patients with epicardial cardiac implantable electronic devices

Aboyewa,

Laternser,

Popescu

et al. 2024

European Heart Journal - Imaging Methods and Practice

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Aims To determine whether pediatric congenital heart disease (CHD) patients with epicardial cardiac implantable electronic devices (CIEDs) receive high cumulative effective doses (CED) of ionizing radiation from medical imaging tests. Methods and Results We compared 28 pediatric CHD patients with epicardial CIEDs (cases) against 40 patients with no CIED matched by age at operation, sex, surgical era, and CHD diagnosis (controls). We performed a retrospective review of radiation exposure from medical imaging exams between 2006 and 2022. Radiation dose from computed tomography (CT) and X-ray radiography was calculated using the National Cancer Institute radiation dosimetry tool. We performed univariate analysis to compare the CED between the two groups. In the case subgroup, we convened experts review to adjudicate the prevalence of CT exams that should have been performed with MRI in the absence of a CIED. Children (median age 2.5 years at implant) with CIEDs received significantly higher median CED compared to matched controls (6.90 vs. 1.72 mSv, p = 0.0018). In cases, expert adjudication showed that 80% of the CT exams would have been performed with MRI in the absence of a CIED. This resulted, on average, a 5-fold increase in the ED from post-lead implant CTs. Conclusion Pediatric CHD patients with CIED received four times higher CED than matched controls. Improved access to medical imaging tests without ionizing radiation, such as MRI, could potentially reduce the ED in CIED patients by up to five times.

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AAPM Medical Physics Practice Guideline 12.a: Fluoroscopy dose management

Cited by 13 publications

References 27 publications

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Radiation dermatitis in the hairless mouse model mimics human radiation dermatitis

Cumulative radiation dose from medical imaging in paediatric congenital heart disease patients with epicardial cardiac implantable electronic devices

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