Radiation dose to patients and staff during angiography of the lower limbs. Derivation of local dose reference levels

Topaltzikis, T.; Rountas, Chris; Moisidou, R.; Fezoulidis, Ioannis; Kappas, Constantin; Theodorou, K.

doi:10.1016/j.ejmp.2008.02.005

Cited by 13 publications

(6 citation statements)

References 19 publications

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“…However, radiation dose in purely diagnostic procedures is lower than when an intervention is performed. 12,14,15,17,[19][20][21][22][23][27][28][29] Our results can be viewed in the context of radiation doses associated with other imaging studies patients commonly undergo. The mean DAP value obtained in this study for interventional pelvic procedures (179.6 Gy*cm 2 ) was higher than the patient mean DAP reported Percentages for patient and procedure characteristics were calculated from the total number of available data for any respective dataset.…”

Section: Discussionmentioning

confidence: 81%

“…In another study, an analysis of AK in lower extremity diagnostic procedures was performed with consideration given to anatomic disease location. 27 This study was limited in size and scope with only 30 procedures being examined, all of which were purely diagnostic. Nonetheless, similar to our findings, the AK decreased as the procedure was performed peripheral to the pelvis.…”

Section: Discussionmentioning

confidence: 99%

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Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity

Segal

Weinberg

Leichter

et al. 2013

Journal of Vascular Surgery

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Percutaneous endovascular revascularization for lower extremity peripheral artery disease involves a substantial radiation dose, comparable, on average, to a computed tomography scan of the abdomen and pelvis. Procedures performed in the pelvis for intermittent claudication involve more radiation than thigh or below-knee procedures for chronic critical limb ischemia. Radiation dose should be considered when planning these procedures.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity

Segal

Weinberg

Leichter

et al. 2013

Journal of Vascular Surgery

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“…However, although several international commissions (4,6‐7) seriously recommend the radiation protection of the patient in terms of DRL, at present the DRL values proposed by international protocols refer principally to standard radiology or CT scan. Regarding interventional procedures, only few references in the scientific literature suggest reference levels (RL) for some FGIs (8‐10) . In literature, the RLs are stated in terms of maximum skin dose (MSD) and dose‐area product (DAP), but also other parameters, such as fluoroscopy time, number of frames or effective dose, are typically used (2,11‐12) …”

Section: Introductionmentioning

confidence: 99%

Patient skin dose measurements using a cable free system MOSFETs based in fluoroscopically guided percutaneous vertebroplasty, percutaneous disc decompression, radiofrequency medial branch neurolysis, and endovascular critical limb ischemia

Falco

Masala

Stefanini

et al. 2015

J Applied Clin Med Phys

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The purpose of this work has been to dosimetrically investigate four fluoroscopically guided interventions: the percutaneous vertebroplasty (PVP), the percutaneous disc decompression (PDD), the radiofrequency medial branch neurolysis (RF) (hereafter named spine procedures), and the endovascular treatment for the critical limb ischemia (CLI). The X‐ray equipment used was a Philips Integris Allura Xper FD20 imaging system provided with a dose‐area product (DAP) meter. The parameters investigated were: maximum skin dose (MSD), air kerma (Ka,r), DAP, and fluoroscopy time (FT). In order to measure the maximum skin dose, we employed a system based on MOSFET detectors. Before using the system on patients, a calibration factor Fc and correction factors for energy (CkV) and field size (CFD) dependence were determined. Ka,r, DAP, and FT were extrapolated from the X‐ray equipment. The analysis was carried out on 40 patients, 10 for each procedure. The average fluoroscopy time and DAP values were compared with the reference levels (RLs) proposed in literature. Finally, the correlations between MSD, FT, Ka,r, and DAP values, as well as between DAP and FT values, were studied in terms of Pearson's product‐moment coefficients for spine procedures only. An Fc value of 0.20 and a very low dependence of CFD on field size were found. A third‐order polynomial function was chosen for CkV. The mean values of MSD ranged from 2.3 to 10.8 cGy for CLI and PVP, respectively. For these procedures, the DAP and FT values were within the proposed RL values. The statistical analysis showed little correlation between the investigated parameters. The interventional procedures investigated were found to be both safe with regard to deterministic effects and optimized for stochastic ones. In the spine procedures, the observed correlations indicated that the estimation of MSD from Ka,r or DAP was not accurate and a direct measure of MSD is therefore recommended.PACS number: 87

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“…This is a considerable reduction in patient radiation burden given that multiple angiographic studies may be performed in the same patient during follow-up of a stented lower limb artery. The patient effective dose value from the standard protocol of MDCT angiography of the lower limb arteries was estimated in the current study to be 2.7 mSv, whereas the typical patient effective dose values from DSA has been reported to be approximately 10 mSv [2,23]. The latter value may be considered as representative for diagnostic DSA performed in our institution given that the use of dose area product (DAP) to effective dose conversion coefficients previously published [24] for the technique and range of DAP values recorded in our institution yield a patient effective dose range of 4-15 mSv.…”

Section: Accuracy Of Low-dose Ct Angiographymentioning

confidence: 99%

Accuracy of multislice CT angiography for the assessment of in-stent restenoses in the iliac arteries at reduced dose: a phantom study

Perisinakis

Manousaki²,

Zourari³

et al. 2011

BJR

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Objective: We investigated the potential of low-dose CT angiography for accurate assessment of in-stent restenoses (ISRs) of the iliac artery. Method: A Rando anthropomorphic phantom (Alderson Research Labs, Stanford, CA), custom-made wax simulating hyperplastic tissue and a nitinol stent were used to simulate a patient with clinically relevant iliac artery ISRs. The cylindrical lumen was filled with a solution of iodine contrast medium diluted in saline, representing a patient's blood during CT angiography. The phantom was subjected to standard-and low-dose angiographic exposures using a modern multidetector (MD) CT scanner. The percentage of ISR was determined using the profile along a line normal to the lumen axis on reconstructed images of 2 and 5 mm slice thickness. Percentage ISRs derived using the standard-and low-dose protocols were compared. In a preliminary study, seven patients with stents were subjected to standard-and low-dose MDCT angiography during followup. The resulting images were assessed and compared by two experienced radiologists. Results: The accuracy in measuring the percentage ISR was found to be better than 12% for all simulated stenoses. The differences between percentage ISRs measured on images obtained at 120 kVp/160 mAs and 80 kVp/80 mAs were below 6%. Patient image sets acquired using low-exposure factors were judged to be of satisfactory diagnostic quality. The assessment of ISR did not differ significantly between image sets acquired using the standard factors and those acquired using the low-exposure factors, although the mean reduction in patient effective dose was 48%. Conclusion: A reduction in exposure factors during MDCT angiography of the iliac artery is possible without affecting the accuracy in the determination of ISRs.

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Radiation dose to patients and staff during angiography of the lower limbs. Derivation of local dose reference levels

Cited by 13 publications

References 19 publications

Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity

Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity

Patient skin dose measurements using a cable free system MOSFETs based in fluoroscopically guided percutaneous vertebroplasty, percutaneous disc decompression, radiofrequency medial branch neurolysis, and endovascular critical limb ischemia

Accuracy of multislice CT angiography for the assessment of in-stent restenoses in the iliac arteries at reduced dose: a phantom study

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