Clinical Radiation Management for Fluoroscopically Guided Interventional Procedures

Abstract

The primary goal of radiation management in interventional radiology is to minimize the unnecessary use of radiation. Clinical radiation management minimizes radiation risk to the patient without increasing other risks, such as procedural risks. A number of factors are considered when estimating the likelihood and severity of patient radiation effects. These include demographic factors, medical history factors, and procedure factors. Important aspects of the patient's medical history include coexisting diseases and genetic factors, medication use, radiation history, and pregnancy. As appropriate, these are evaluated as part of the preprocedure patient evaluation; radiation risk to the patient is considered along with other procedural risks. Dose optimization is possible through appropriate use of the basic features of interventional fluoroscopic equipment and intelligent use of dose-reducing technology. For all fluoroscopically guided interventional procedures, it is good practice to monitor radiation dose throughout the procedure and record it in the patient's medical record. Patients who have received a clinically significant radiation dose should be followed up after the procedure for possible deterministic effects. The authors recommend including radiation management as part of the departmental quality assurance program.

Use of transabdominal ultrasound-guided transjugular portal vein puncture on radiation dose in transjugular intrahepatic portosystemic shunt formation

“…Skin dose is an approximation of the total radiation dose to the skin. As the reference point from which this value is derived is not directly on the skin, this may tend to overestimate the probability of skin effects, given that the source moves in relation to the skin (30). Notably, neither DAP nor skin dose account for backscatter from the patient, which can generate substantial variation from the actual skin dose.…”

“…We aim to follow the guidelines for dose reduction outlined by Miller et al (30,34) and use: collimation, optimized patient position in relation to the tube and detector, pulsed rather than continuous fluoroscopy with as low frame rate as possible, as few fluorographic DSA runs as possible, and image hold techniques where possible.…”

“…Notably our institution is also a tertiary referral center so assumptions in this regard are equally applicable to our results. Finally the dose data were not adjusted for body habitus, but rather a standardized weight, which may introduce inaccuracy due to the increasingly prevalence of obesity, which can increase doses substantially (30).…”

Treatment of Radiation Injury

“…Thus, some 36 million of these procedures have taken place, and the frequency of major radiation injury is estimated to be between 1:10,000 and 1:100,000 procedures, although the true risk is still unknown. 6 Thus, 360 to 3,600 cases of major radiation injuries are estimated. In a detailed clinical study of radiation, skin effects occurred from percutaneous coronary intervention (PCI) of the right coronary artery in six chronic total occlusion patients (mild erythema; occurrence rate 1.5%).…”

Radiation Exposure During Internal Fixation of Extracapsular Femoral Neck Fractures by Today's Trainees

“…Stochastic complications including carcinogenesis are proportional to the individual's lifetime radiation exposure. 7 While studies have identified yearly radiation doses to orthopaedic surgeons to be within recommended levels, increased rates of cancer has been reported. [8][9][10] Given our limited knowledge of the long-term complications of cumulative low dose radiation, exposures must be kept as low as reasonably practicable.…”