Fluoroscopically-guided interventions with radiation doses exceeding 5000 mGy reference point air kerma: a dosimetric analysis of 89,549 interventional radiology, neurointerventional radiology, vascular surgery, and neurosurgery encounters

Abstract

Purpose To quantify and categorize fluoroscopically-guided procedures with radiation doses exceeding 5000 mGy reference point air kerma (Ka,r). Ka,r > 5000 mGy has been defined as a “significant radiation dose” by the Society of Interventional Radiology. Identification and analysis of interventions with high radiation doses has the potential to reduce radiation-induced injuries. Materials and methods Radiation dose data from a dose monitoring system for 19 interventional suites and 89,549 consecutive patient encounters from January 1, 2013 to August 1, 2019 at a single academic institution were reviewed. All patient encounters with Ka,r > 5000 mGy were included. All other encounters were excluded (n = 89,289). Patient demographics, medical specialty, intervention type, fluoroscopy time (minutes), dose area product (mGy·cm2), and Ka,r (mGy) were evaluated. Results There were 260 (0.3%) fluoroscopically-guided procedures with Ka,r > 5000 mGy. Of the 260 procedures which exceeded 5000 mGy, neurosurgery performed 81 (30.5%) procedures, followed by interventional radiology (n = 75; 28.2%), neurointerventional radiology (n = 55; 20.7%), and vascular surgery (n = 49; 18.4%). The procedures associated with the highest Ka,r were venous stent reconstruction performed by interventional radiology, arteriovenous malformation embolization performed by neurointerventional radiology, spinal hardware fixation by neurosurgery, and arterial interventions performed by vascular surgery. Neurointerventional radiology had the highest mean Ka,r (7,799 mGy), followed by neurosurgery (7452 mGy), vascular surgery (6849 mGy), and interventional radiology (6109 mGy). The mean Ka,r for interventional radiology performed procedures exceeding 5000 mGy was significantly lower than that for neurointerventional radiology, neurosurgery, and vascular surgery. Conclusions Fluoroscopically-guided procedures with radiation dose exceeding 5000 mGy reference point air kerma are uncommon. The results of this study demonstrate that a large proportion of cases exceeding 5000 mGy were performed by non-radiologists, who likely do not receive the same training in radiation physics, radiation biology, and dose reduction techniques as radiologists.

Characterization of patient dose distributions and probabilistic risk analysis in cardiovascular catheterization laboratories

“…It should be noted that the dose distribution associated with this data can be different from the dose distribution in each institution, using this information to predict doses above 5000 mGy may overestimate the risk in institutions where strong dose reduction measures are practiced while underestimating the risk in those institutions where weaker dose reduction measure is practiced. A subtle but important clue in this result by Bundy et al [21], that suggests that the dose distribution of that data is likely skewed to the right of our dose distribution, is that 260 cases out of 89,549 are above 5000 mGy. If we scaled our data in table 3 to 89,549 by assuming an identical dose distribution, we should expect close to 20 cases above 5000 mGy in our institution.…”

“…Bundy et al [21] reported that fluoroscopicallyguided procedures with radiation dose exceeding 5000 mGy reference point air kerma are uncommon. Based on the analysis of 89,549 patients over a six-year period from 2013 to 2019, only 260 out of 89,549 cases were above 5000 mGy.…”

“…In addition, our results can be used to predict the chance of doses between 3000 mGy and 5000 mGy. In Bundy et al's [21] analysis, high dose cases were attributed to non-radiologist who have not received training on how to reduce patient doses. It should be noted that the dose distribution associated with this data can be different from the dose distribution in each institution, using this information to predict doses above 5000 mGy may overestimate the risk in institutions where strong dose reduction measures are practiced while underestimating the risk in those institutions where weaker dose reduction measure is practiced.…”

Fluoroscopically guided vascular and cardiac transcatheter procedures: a comparison of occupational and patient dose by anatomical region

“…Staff dose is also affected by distance from the irradiated area, as found by Sailer et al and Omar et al, who reported that operator doses during neurology procedures were lower compared to thoracic and abdominal procedures [ 38 , 39 ]. Bundy et al reported that interventional neuroradiology had the highest average AK, but that procedures exceeding 5 Gy were more likely performed by vascular surgeons, suggesting this may be due to the lack of radiation training compared to radiologists [ 40 ].…”

Management of doses from medical exposures in interventional radiology: an integrative review

“…The high exposure time during the procedure makes additional care necessary. The increase in reported severe skin lesions highlights the need for education about radiation risks and the importance of strategies to optimize exposure [6,7].…”