Radiation exposure during angiographic interventions in interventional radiology – risk and fate of advanced procedures

Kaatsch, Hanns Leonhard; Schneider, Julian; Brockmann, Carolin; Brockmann, Marc A.; Overhoff, Daniel; Becker, B; Waldeck, Stephan

doi:10.1080/09553002.2021.2020362

Cited by 11 publications

(10 citation statements)

References 76 publications

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“…A helpful benchmark for dose monitoring are DRLs, which indicate typical ionising radiation exposure values in a country, region or an institute [19,20]. The role of DRLs in interventional radiology has increased in recent years, and the guidelines for radiation protection have been updated to include interventional procedures that are regularly used in clinical routine for quality control and benchmarking between institutions [15,20,21]. The goal is to raise awareness of dose and, in the long term, to optimise the modification of equipment, techniques and imaging parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Although the risk of stochastic radiation damage is not clinically relevant in patients with malignant diseases due to their limited lifespan, overall dose optimisation should be sought to reduce radiation exposure for the staff members performing repeated RE [14,15]. Therefore, the aim of this study was to investigate radiation exposure associated with the angiographic procedure itself and to establish local diagnostic reference levels (DRLs).…”

Section: Introductionmentioning

confidence: 99%

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Radiation dose aspects and establishment of diagnostic reference levels for ⁹⁰Y radioembolisation during angiographic procedure

et al. 2022

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90Y radioembolization (RE) is an angiographic procedure used in patients with both primary and secondary hepatic malignancies. Local tumor control can be achieved by short range tumor irradiation by the regional intraarterial administration of glass or resin microspheres loaded with 90Yttrium that accumulate in the tumorous tissue. The aim of this study was to investigate the radiation exposure of RE and to establish a local diagnostic reference level (DRL). In this retrospective study, dose data from 397 procedures in 306 patients (mean age 67.4±10.6 years, 82 female) who underwent RE between 06/2017-01/2022 at one of two different angiography systems were analyzed. DRL was set as the 75th percentile of the dose distribution. In the overall population, dose area product (DAP) (median (IQR)) was 26 Gy·cm2 (IQR 12-50) with a median fluoroscopy time (FT) of 4.5 minutes (IQR 2.9-8.0). FT and DAP increased significantly with the number of infusion positions (median, IQR): one position 23 Gy·cm2 (12-46), two positions 33 Gy·cm2 (14-60), three positions 50 Gy·cm2 (24-82) (p<0.0001). Local DRL is 47 Gy·cm2 for RE and 111 Gy·cm2 for RE with additional embolisation. Radiation exposure and FT are significantly higher with increasing number of infusion positions as well as additional embolization. Our established DRLs for RE may serve as a benchmark for dose optimization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiation dose aspects and establishment of diagnostic reference levels for ⁹⁰Y radioembolisation during angiographic procedure

et al. 2022

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“…3 Fluoroscopy is a lower-dose acquisition used for navigation, and the higher-dose angiography run is for diagnostic tasks. Although modern dose reduction techniques have significantly reduced X-ray exposure for standard procedures, [4][5][6] they have in turn facilitated longer procedures of increasing complexity, 3,7 effectively limiting the overall savings to both patients and staff. Therefore, dose reduction remains an important goal in interventional X-ray imaging.…”

Section: Introductionmentioning

confidence: 99%

A visibility overshoot index for interventional x-ray image quality assessment

Kumcu¹,

Platiša

Goossens

et al. 2023

Medical Imaging 2023: Image Perception, Observer Performance, and Technology Assessment

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Dose reduction remains an important goal in interventional X-ray. We propose an image quality (IQ) measure called the Visibility Overshoot Index. Given a patient image and a specified clinical task, the index quantifies the maximum acceptable dose reduction. The dose control system can then use this information to deliver the minimum dose necessary for detection of clinical signals, reducing unnecessary radiation exposure. We developed an experimental visual model to estimate signal detectability as a function of image features such as noise and signal contrast. The model is used to find a feature's threshold -the maximum change in noise or signal contrast where signal detectability remains possible. An automated algorithm measures the magnitudes of these features on a frame. Visibility Overshoot is expressed in terms of the image features: the Noise Overshoot and Contrast Overshoot indices are the ratio of the threshold to measured noise/contrast. The indices demonstrate good agreement with detector dose, Channelized Hotelling Observer results, and clinicians' judgments. In our study of a cylindrical object phantom acquired at seven dose levels, we found that the Noise Overshoot index is linearly related to the square root of detector dose and the CHO detectability index, with Pearson correlation 0.995-1.0 for signals 1-4 mm diameter. For interventional cardiology and neurology sequences acquired at standard and 25-30% dose, the index and clinicians rank IQ similarly. Results on the phantom suggest at least 15% dose reduction could be achieved in fluoroscopy mode. Our patient-specific IQ approach could bring additional dose savings to clinical practice.

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“…Especially, during complex interventional procedures, which require the radiologists to be near the patient, medical staff is frequently subject to high levels of radiation exposure. 1 According to the new guidelines of the European Atomic Energy Community (EURATOM, directive 2013/59/Euratom), 2 the dose limit for occupational exposure of eye lenses has been reduced from 150 mSv/year to 20 mSv/year. Considering the increased risk of medical staff to develop cancer or even deterministic skin injuries, effective strategies are needed to monitor and reduce radiation dose.…”

Section: Introductionmentioning

confidence: 99%

“…However, occupational exposure to radiation in fluoroscopy‐guided interventions remains a major concern. Especially, during complex interventional procedures, which require the radiologists to be near the patient, medical staff is frequently subject to high levels of radiation exposure 1 . According to the new guidelines of the European Atomic Energy Community (EURATOM, directive 2013/59/Euratom), 2 the dose limit for occupational exposure of eye lenses has been reduced from 150 mSv/year to 20 mSv/year.…”

Section: Introductionmentioning

confidence: 99%

Reduction of radiation dose using real‐time visual feedback dosimetry during angiographic interventions

Koch

Conrades

Gruenewald

et al. 2022

J Applied Clin Med Phys

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This prospective study sought to evaluate potential savings of radiation dose to medical staff using real‐time dosimetry coupled with visual radiation dose feedback during angiographic interventions. For this purpose, we analyzed a total of 214 angiographic examinations that consisted of chemoembolizations and several other types of therapeutic interventions. The Unfors RaySafe i2 dosimeter was worn by the interventionalist at chest height over the lead protection. A total of 110 interventions were performed with real‐time radiation dosimetry allowing the interventionalist to react upon higher x‐ray exposure and 104 examinations served as the comparative group without real‐time radiation monitoring. By using the real‐time display during interventions, the overall mean operator radiation dose decreased from 3.67 (IQR, 0.95–23.01) to 2.36 μSv (IQR, 0.52–12.66) (−36%; p = 0.032) at simultaneously reduced operator exposure time by 4.5 min ( p = 0.071). Dividing interventions into chemoembolizations and other types of therapeutic interventions, radiation dose decreased from 1.31 (IQR, 0.46‐3.62) to 0.95 μSv (IQR, 0.53‐3.11) and from 24.39 (IQR, 12.14‐63.0) to 10.37 μSv (IQR, 0.85‐36.84), respectively, using live‐screen dosimetry ( p ≤ 0.005). Radiation dose reductions were also observed for the participating assistants, indicating that they could also benefit from real‐time visual feedback dosimetry during interventions (−30%; p = 0.039). Integration of real‐time dosimetry into clinical processes might be useful in reducing occupational radiation exposure time during angiographic interventions. The real‐time visual feedback raised the awareness of interventionalists and their assistants to the potential danger of prolonged radiation exposure leading to the adoption of radiation‐sparing practices. Therefore, it might create a safer environment for the medical staff by keeping the applied radiation exposure as low as possible.

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Radiation exposure during angiographic interventions in interventional radiology – risk and fate of advanced procedures

Cited by 11 publications

References 76 publications

Radiation dose aspects and establishment of diagnostic reference levels for ⁹⁰Y radioembolisation during angiographic procedure

Radiation dose aspects and establishment of diagnostic reference levels for ⁹⁰Y radioembolisation during angiographic procedure

A visibility overshoot index for interventional x-ray image quality assessment

Reduction of radiation dose using real‐time visual feedback dosimetry during angiographic interventions

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Radiation exposure during angiographic interventions in interventional radiology – risk and fate of advanced procedures

Cited by 11 publications

References 76 publications

Radiation dose aspects and establishment of diagnostic reference levels for 90Y radioembolisation during angiographic procedure

Radiation dose aspects and establishment of diagnostic reference levels for 90Y radioembolisation during angiographic procedure

A visibility overshoot index for interventional x-ray image quality assessment

Reduction of radiation dose using real‐time visual feedback dosimetry during angiographic interventions

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Radiation dose aspects and establishment of diagnostic reference levels for ⁹⁰Y radioembolisation during angiographic procedure

Radiation dose aspects and establishment of diagnostic reference levels for ⁹⁰Y radioembolisation during angiographic procedure