Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures

Papanastasiou, Emmanouil; Protopsaltis, Athanasios; Finitsis, Stephanos; Hatzidakis, Adam; Prassopoulos, Panos; Σιούντας, Αναστάσιος

doi:10.1016/j.ejmp.2021.07.029

Cited by 10 publications

(10 citation statements)

References 41 publications

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“…The relationship between KAP and FT is not as strong. This is consistent with findings from local 13 and international 17 , 18 studies and emphasises that no dose parameters can be extrapolated to infer radiation exposure; instead, as many parameters as possible should be evaluated when optimising radiation exposure. This is echoed in the recommendations by the ICRP.…”

Section: Discussionsupporting

confidence: 87%

An audit of patient radiation doses in interventional radiology at a South African hospital

Slave

Mahomed

2023

South African Journal of Radiology

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Background: Interventional radiology (IR) is becoming more relevant in patient care and is associated with increased patient radiation exposure and radiation-induced adverse effects. Diagnostic reference levels (DRLs) are crucial for radiation control. There is a paucity of published DRLs for IR in South Africa and sub-Saharan Africa.Objectives: This study aimed to determine local DRLs for fluoroscopically-guided IR procedures and compare the achieved DRLs with published local and international DRLs.Method: Retrospective, descriptive, single-centre study. Kerma air product (KAP), reference point air kerma (Ka,r) and fluoroscopy time (FT) were collected for patients (12 years and older) who underwent IR procedures at a university hospital from 01 January 2019 to 31 December 2019. The 75th percentile of the distribution of each dose parameter (KAP, Ka,r and FT) per procedure was calculated and taken as the local diagnostic reference levels (LDRL). The established LDRLs were compared to published DRLs.Results: A total of 564 cases were evaluated. The 13 most frequent procedures (with 15 or more cases) represented 86.1% (487/564). Percutaneous transhepatic biliary drainage was the most common procedure (n = 146, 25.9%). Diagnostic cerebral angiogram DRLs exceeded the published DRL data ranges for all parameters (DRL 209.3), and interventional cerebral angiogram exceeded published ranges (DRL 275). Uterine artery embolisation (UAE) exceeded these ranges for KAP and Ka,r. (KAP-954.9 Gy/cm2, Ka,r-2640.8 mGy).Conclusion: The LDRLs for diagnostic cerebral angiogram, interventional cerebral angiogram and UAE exceeded published international DRL ranges. These procedures require radiation optimisation as recommended by the International Commission on Radiological Protection (ICRP).Contribution: In addition to informing radiation protection practices at the level of the institution, the established LDRLs contribute towards Regional and National DRLs.

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Section: Discussionsupporting

confidence: 87%

An audit of patient radiation doses in interventional radiology at a South African hospital

Slave

Mahomed

2023

South African Journal of Radiology

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“…The range of measured RAK values for a single patient thickness in our study is larger, as expected, 9 than previous published DRLs, which typically report a single average RAK for a group of patients comprised of a small range of ages. The difference between this study's RAK values converted to KAP DRLs for adult sized FGI DRL data published in 2021 in Europe for percutaneous transhepatic biliary drainage, cerebral angiography, 26 or vertebroplasty 27 examinations was 112%, 64%, or 34%, respectively. Finally, this study's KAP DRL estimates for adult foot/ankle, elbow, and hip orthopedic MC fluoroscopies in the operating room compared to European published DRLs published in 2019 were 99%, 75%, and 66%, 28 respectively.…”

Section: Discussionmentioning

confidence: 64%

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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“…Millimetric precision is also required for stent placement, the uncovered part of which must be placed inside the biliary tree, while the covered part is deployed transhepatically and transgastrically; all these steps must be performed under real-time radioscopic guidance. However, the alternative to this procedure would be percutaneous transhepatic biliary drainage, for which comparable RE has been reported 17 .…”

Section: Discussionmentioning

confidence: 94%

“…However, the alternative to this procedure would be percutaneous transhepatic biliary drainage, for whom comparable RE has been reported [17].…”

Section: Accepted Manuscriptmentioning

confidence: 93%

“…Fluid collection drainage (EUS-FCD) with lumen apposing metal stents (LAMS, N = 26) were performed fluoroless, while EUS-FCD with double-pigtail plastic stents (DPPS, N = 28) required higher RE (KAP = 23 ). EUS-guided gallbladder drainage (EUS-GBD, N = 6) required scarce RE (KAP = 9 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]) for coaxial DPPS placement. EUS-GE (N = 27) required higher RE than duodenal stenting (KAP = 44 versus 29 , P = 0.03).…”

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confidence: 99%

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Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

et al. 2022

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Background. Therapeutic EUS (t-EUS) is increasingly adopted in clinical practice of tertiary referral centres; however, little is known about Radiation Exposure (RE) metrics and Diagnostic Reference Limits. Methods. Kerma-Area Product (KAP [Gy·cm2]), Air Kerma and Fluoroscopy Time were retrospectively evaluated for all consecutive t-EUS procedures performed in San Raffaele Institute between 2019-2021. For EUS-guided Choledochoduoenostomies (EUS-CDS) and Gastroenterostomies (EUS-GE) an equal number of ERCPs + metal stenting and Duodenal Stentings were included for comparison. Results. 141 t-EUS procedures were retrieved (49% pancreatic cancer, 38% peripancreatic fluid collections). EUS-CDS (N=44) were mainly performed fluoroless, while ERCPs required a significantly higher RE (KAP=25 [17-55], p<0.0001). Fluid collection drainage (EUS-FCD) with Lumen Apposing stents (LAMS, N=26) were performed fluoroless, while EUS-FCD with double-pigtail plastic stents (DPPS, N=28) required higher RE (KAP=23 [13-45]). EUS-guided gallbladder drainage (EUS-GBD, N=6) required scarce RE (KAP=9 [3-21]) for coaxial DPPS placement. EUS-GE (N=27) required higher RE than Duodenal Stenting (KAP=44 [28-88] versus 29 [19-46], p=0.03). EUS-guided Hepatico-Gastrostomies (EUS-HGS, N=10) had the highest RE amongst t-EUS procedures (KAP=81 [49-123]). Procedure complexity or intervening complications were evaluated and resulted in higher RE within each procedure. Conclusions. t-EUS procedures have different RE (p<0.000001). EUS-Choledochoduodenostomy, Gallbladder Drainage and Fluid Collection Drainage with LAMS can be performed with no-to-mild radioscopy, unlike standard alternatives. However, radioscopy remains essential in case of technical difficulties or complications. EUS-Gastroenterostomy and EUS-Hepaticogastrostomy involve a high RE. Endoscopists involved in t-EUS might experience a RE superior to category standards, claiming for increased awareness and personalized preventive measures.

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Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures

Cited by 10 publications

References 41 publications

An audit of patient radiation doses in interventional radiology at a South African hospital

An audit of patient radiation doses in interventional radiology at a South African hospital

Application of reference air kerma alert levels for pediatric fluoroscopic examinations

Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

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