Radiation Dose to the Radiologist’s Hand During Continuous CT Fluoroscopy-Guided Interventions

Stoeckelhuber, Beate M.; Leibecke, Thorsten; Schulz, Edda; Melchert, Uwe H.; Bergmann-Koester, Claudia U.; Helmberger, Thomas; Gellißen, J.

doi:10.1007/s00270-005-0104-2

Cited by 81 publications

(47 citation statements)

References 13 publications

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“…The inherent drawback of CT fluoroscopy is rather high radiation exposure to the patient and operator, which may explain why CT fluoroscopy has not been more broadly accepted (7).…”

mentioning

confidence: 99%

CT Fluoroscopy Shielding: Decreases in Scattered Radiation for the Patient and Operator

Neeman

Dromi

Sarin

et al. 2006

Journal of Vascular and Interventional Radiology

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PURPOSE-High-radiation exposure occurs during computed tomographic (CT) fluoroscopy. Patient and operator doses during thoracic and abdominal interventional procedures were studied in the present experiment, and a novel shielding device to reduce exposure to the patient and operator was evaluated. MATERIALS AND METHODS-With a 16-slice CT scanner in CT fluoroscopy mode (120 kVp, 30 mA), surface dosimetry was performed on adult and pediatric phantoms. The shielding was composed of tungsten antimony in the form of a lightweight polymer sheet. Doses to the patient were measured with and without shielding for thoracic and abdominal procedures. Doses to the operator were recorded with and without phantom, gantry, and table shielding in place. Double-layer leadfree gloves were used by the operator during the procedures.RESULTS-Tungsten antimony shielding adjacent to the scan plane resulted in a maximum dose reduction of 92.3% to the patient. Maximum 85.6%, 93.3%, and 85.1% dose reductions were observed for the operator's torso, gonads, and hands, respectively. The use of double-layer lead-free gloves resulted in a maximum radiation dose reduction of 97%.CONCLUSIONS-Methods to reduce exposure during CT fluoroscopy are effective and should be searched for. Significant reduction in radiation doses to the patient and operator can be accomplished with tungsten antimony shielding.Computed tomography (CT) has been used to guide interventional procedures of the chest and abdomen for nearly two decades (1,2). CT-guided procedures have continued to increase in number (3) and are less invasive than many surgical options. Despite advances in other areas of imaging, CT has remained the imaging study of choice for many procedures because of its inherently superior contrast and spatial resolution in comparison with conventional fluoroscopy and ultra-sonography (US). However, unlike other imaging modalities, conventional CT lacks real-time imaging capabilities. Therefore, CT-guided procedures generally take longer because the region of interest must be intermittently scanned to confirm safe adjustment and placement of the needle or catheter.CT fluoroscopy is a technique that has been developed in the past decade (4). In this acquisition mode, CT images are reconstructed and displayed nearly in real time. This provides the interventionalist with immediate feedback during the procedure. CT fluoroscopy has been shown to reduce procedure time (5) and increase efficacy compared with standard CT guidance (6).The inherent drawback of CT fluoroscopy is rather high radiation exposure to the patient and operator, which may explain why CT fluoroscopy has not been more broadly accepted (7). Radiation exposure for the patient is primarily along the scan plane. Because the exposure along the scan plane is cumulative, deterministic effects can be significant (8,9). Scattered radiation from the direct beam and collimator leakage also contribute to the patient dose (10).For the operator, exposure is primarily a function of scattered radiation ...

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“…The inherent drawback of CT fluoroscopy is rather high radiation exposure to the patient and operator, which may explain why CT fluoroscopy has not been more broadly accepted (7).…”

mentioning

confidence: 99%

CT Fluoroscopy Shielding: Decreases in Scattered Radiation for the Patient and Operator

Neeman

Dromi

Sarin

et al. 2006

Journal of Vascular and Interventional Radiology

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“…(0.0295 mSv per case) [20]. An explanation for these lower hand dose values is the use of radiation protection gloves and long needle holders.…”

Section: Hand Dose Valuesmentioning

confidence: 99%

“…In the statement of the German Commission on Radiological Protection regarding the topic of "dose limits for occupational skin exposure to ionizing radiation", the above calculations are dismissed and surface personal dose measurement is greatly overestimated [31,32]. With the following additional radiation protection tools/ measures, the hand dose can be greatly minimized: Use of a needle holder, fluoroscopy with low tube current intensity (possibly with incremental adjustment, start thorax: 10 mA; abdomen: 30 mA) or lower tube voltage (≤ 120 kV), low collimation (≤ 4 mm to lower the scattered radiation), restrictive use of continuous fluoroscopy, "angular beam modulation", and, if possible, use of radiation protection gloves [17,20,33,35]. However, radiation protection gloves can give a false sense of security thus resulting in higher hand dose values [35].…”

Section: Biological Effect Of Radiation Exposure On the Handmentioning

confidence: 99%

Prospective Evaluation of the Radiologist's Hand Dose in CT-Guided Interventions

Rogits

Jungnickel

Löwenthal

et al. 2013

Fortschr Röntgenstr

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!Purpose: Assessment of radiologist's hand dose in CT-guided interventions and determination of influencing factors. Materials and Methods:The following CTguided interventions were included: Core biopsy, drainage, periradicular therapy, and celiac plexus neurolysis. The hand dose was measured with an immediately readable dosimeter, the EDD-30 (Unfors, Sweden). The default parameters for CT fluoroscopy were 120 kV, 90 mA and a 4 mm slice thickness. All interventions were performed on a 16-slice CT unit (Aquilion 16 Toshiba, Japan). The tumor size, degree of difficulty (1 -3), level of experience and device parameters (mAs, dose-length product, scan time) were documented. Results: 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 -240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 -140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 -3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other. Besides physical influencing factors, the degree of difficulty (p = 0.001) and summed puncture depth (p = 0.004) correlated significantly with the hand dose. Conclusion: The median hand dose for different CT-guided interventions was 0.22 mSv. Therefore, the annual hand dose limit would normally only be reached with about 2000 interventions. Key Points:▶ The hand dose exposure during CT fluoroscopically guided interventions was situated on a low level.▶ Due to the ambigious radiation risk estimates, additional radiation protection measures/tools should be provided.

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“…For the CT operator, exposure is primarily a function of scattered radiation and collimator or gantry leakage [3]. In past several years, some study has been done on this subject [3][4][5]. In recent years, such dosimetry processes become possible to perform by using Monte Carlo (MC) method.…”

Section: Introduction mentioning

confidence: 99%

“…This high rate of radiation can be accepted to the patient by the reason of the imagine procedure but we have to consider in the case that radiation dose around CT device that can be effect the CT operator or other staff. For the CT operator, exposure is primarily a function of scattered radiation and collimator or gantry leakage [3]. In past several years, some study has been done on this subject [3][4][5].…”

Section: Introduction mentioning

confidence: 99%

Investigation of Backscattered Dose in a Computerized Tomography (CT) Facility during Abdominal CT Scan by Considering Clinical Measurements and Application of Monte Carlo Method

Tekın¹,

Öztürk²,

Manıcı³

et al. 2016

JHS

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X-ray computed tomography (CT) related to computer-processed combination or X-ray images obtained from different angles to create patient's cross-sectional body parts images. CT ensures to have imaging various organs, bones, blood vessel etc. and more advantageous than normal plain X-ray devices in consequence of 360 degree image of internal organs, the spine and vertebrae. For decades, Radiation protection became a main topic in research areas since CT uses various dose of X-ray for imaging body. Distance factor is the one of fundamental principle of radiation protection. Maximum dose occurs around gantry and dose rate is decreases by distance in CT facilities. To know the rate of reduction of the amount of dose by distance is very significant for radiation protection procedure especially for apply criteria of International Commission on Radiological Protection (ICRP) on radiation protection. Our study aimed to measure scattered dose rates during abdominal CT scan by considering small distance ranges from gantry until exit door and comparing the empirical result with Monte Carlo (MC) calculations. As a next step of study, we modeled a simulation input for CT facility by using MCNP-X (version 2.4.0). We obtained the changes of dose rate on distance factor by using Monte Carlo method. We achieved that MCNP-X calculations were in concordance with clinical experimental measurements. It can be concluded that Monte Carlo (MC) is an effective tool for obtain dose rate variations around CT gantry and especially radiation protection calculations in CT facilities.

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Radiation Dose to the Radiologist’s Hand During Continuous CT Fluoroscopy-Guided Interventions

Cited by 81 publications

References 13 publications

CT Fluoroscopy Shielding: Decreases in Scattered Radiation for the Patient and Operator

CT Fluoroscopy Shielding: Decreases in Scattered Radiation for the Patient and Operator

Prospective Evaluation of the Radiologist's Hand Dose in CT-Guided Interventions

Investigation of Backscattered Dose in a Computerized Tomography (CT) Facility during Abdominal CT Scan by Considering Clinical Measurements and Application of Monte Carlo Method

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