How to set up and apply reference levels in fluoroscopy at a national level

Abstract

A nationwide survey was launched to investigate the use of fluoroscopy and establish national reference levels (RL) for dose-intensive procedures. The 2-year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on 12 examination types: 6 diagnostic and 6 interventional. A total of 1,000 examinations was registered. Information including the fluoroscopy time (T), the number of frames (N) and the dose-area product (DAP) was provided. The data set was used to establish the distributions of T, N and the DAP and the associated RL values. The examinations were pooled to improve the statistics. A wide variation in dose and image quality in fixed geometry was observed. As an example, the skin dose rate for abdominal examinations varied in the range of 10 to 45 mGy/min for comparable image quality. A wide variability was found for several types of examinations, mainly complex ones. DAP RLs of 210, 125, 80, 240, 440 and 110 Gy cm 2 were established for lower limb and iliac angiography, cerebral angiography, coronary angiography, biliary drainage and stenting, cerebral embolization and PTCA, respectively. The RL values established are compared to the data published in the literature.

A national patient dose survey and setting of reference levels for interventional radiology in Bulgaria

“…Reference levels reported for lower limb arteriography exhibit greater variance, the maximum difference reaching as high as a factor of 6 [13,17,18]. The reference level proposed here is comparable to only a few of the published results [13,18].…”

Radiation Exposure in Nonvascular Fluoroscopy-Guided Interventional Procedures

“…A comparison of our DAPs with the few existing data in the literature is barely possible. First, sufficient data are only available on liver TACE, PTCD placement, and PTCD control [10][11][12][13][14][15]. Second, the differing grouping of interventions, e.g., no side specified for PTCD, has the potential to completely alter the values.…”

“…Transarterial chemoembolization (TACE) of tumors or bleeds, percutaneous transhepatic bile duct interventions (PTCD), fluoroscopy-guided percutaneous gastrostomies (PRG), and percutaneous abscess drainages (PAD) are frequently performed procedures. However, especially in these nonvascular procedures, only a few DRLs have been published thus far [10][11][12][13][14][15]. Some of these procedures are performed repeatedly (e.g., TACE) in the same patient.…”

Patient radiation exposure during general fluoroscopy examinations

“…The ${\mathrm{normalK}}_{\mathrm{a},\mathrm{r}}$ in children were smaller than those for adults due to the automatic selection of fluoroscopy technique triggered by the smaller patient size. The fluoroscopy examinations were performed with longer time and higher KAP, resulting in large effective doses (Table 3) that were also broad with respect to the measured values as compared to the available values in the literature 2 , 9 , 10 , 11 , 12 , 13 , 14 , 15 . The IDRLs for the ${\mathrm{normalK}}_{\mathrm{a},\mathrm{r}}$, KAP, and fluoroscopy time, especially in children, were not available in the cited literature for comparison.…”

“…These quality assurance challenges are exacerbated by emerging health needs and lack of adequate resources coupled with the ballooning population. This study aimed to determine the radiation dose to patients, establish the necessary optimization strategies for fluoroscopy procedures, and compare the findings with the international DRLs 2 , 9 , 11 , 12 , 13 , 14 , 15 …”