Updating national diagnostic reference levels for interventional cardiology and methodological aspects

Sánchez, Roberto; Vañó, Eliseo; Soto, Jose M.; Ten, J. I.; Escaned, Javier; Delgado, Clara; García, Bruno; Magariño, Francisco Carrera; Fernández, José Francisco Díaz; Luna, R.J. Martinez; Moreno, Miguel Ángel Romero; Catalán, Antonio; Ojeda, Francisco Bosa; Rosales, Francisco; Moreno, Jesús Roberto Sáez; Pifarre, X.; Goicolea, Javier; Ordiales, J M; Nogales, Juan; Martínez, G; García, Paula; Benedicto, Amparo; Castillo, Manuel Francisco Rodriguez; Torres, Luis Pastor; Font, J.; Bethencourt, Armando; Cesteros, María Jesús; Pérez, Armando; Pinar, Eduardo; Tobarra, B.

doi:10.1016/j.ejmp.2020.01.014

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…It is not clear whether this represents an expanded uncertainty or not. Sanchez et al (2020) have suggested that a ±10% error margin can be easily checked by a medical physics expert in reference conditions-this corresponds to an expanded uncertainty of ±20% if a coverage factor of k = 2 is employed. On the other hand, in cases where a KAP meter is not used, a ±7% tolerance can be realised in practice; for example, Worrall and Sutton (2015) have shown that the uncertainty budget can be less than this if an ionisation chamber is used to measure output factors.…”

Section: Methods and Resultsmentioning

confidence: 99%

The influence of patient size on the overall uncertainty in radiographic dose audit

Sutton¹,

Worrall²,

Sexton³

et al. 2021

J. Radiol. Prot.

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The aim of this work was to investigate the effect of patient and cohort size on the overall uncertainty associated with dose audit using radiography of the abdomen as the exemplar. Water equivalent diameter Dw was used as the surrogate for patient size and its distribution (σ(Dw)) was used to quantify the effect of sample size. The more precise the kerma area product calibration, the more patients are required in the cohort to have the same impact on the overall uncertainty. Patient sample sizes of 300–400 will result in expanded uncertainties approaching the theoretical limit of double the measurement uncertainty when audits are performed with instruments having measurement uncertainties equal to ±7%, ±10% or ±12.5%. By way of example, for a field instrument with a measurement uncertainty of ±10%, a minimum sample size of 350 is required to achieve a total expanded uncertainty of ±21%. In the case of instruments with associated measurement uncertainty of ±3.5%, patient sample sizes of 300–400 will result in expanded uncertainties of approximately ±10%. From review of the literature and comparison with the results obtained here, it is conjectured that for radiographic dose audits of all parts of the trunk the contribution to overall uncertainty due to patient and sample size could be predicted using an indicative value for σ(Dw) of 3.4 where local data is not available.

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Section: Methods and Resultsmentioning

confidence: 99%

The influence of patient size on the overall uncertainty in radiographic dose audit

Sutton¹,

Worrall²,

Sexton³

et al. 2021

J. Radiol. Prot.

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“…Note also a maximum value of 5.74 mSv at the C-arm, in a single complex procedure done by this operator. Patient dose values at the hospital (median values) are under the national diagnostic reference levels published for Spain: 38 and 68 Gy cm 2 for coronary angiography and PTCAs respectively [21].…”

Section: Resultsmentioning

confidence: 99%

Helping to know if you are properly protected while working in interventional cardiology

2020

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Occupational protection is still a challenge for interventional cardiology. One of the main problems is the occasional improper use of the ceiling suspended screen. We present a methodology to audit the correct use of the shielding using active electronic dosimeters. To improve the protection, we suggest the use of an alert based on the ratio between the occupational dose per procedure, measured by a personal electronic dosimeter over the lead apron, and the dose measured by an unshielded dosimeter, located at the C-arm. The new electronic dosimeters and the automatic dose management systems allow processing the dosimetric data for individual procedures and for the radiation events, sending the values (wireless) to a central database. We selected six interventional cardiologists and analysed 385 interventional procedures involving about 30 000 radiation events. Our results suggest that for individual procedures, standard values of the ratio between operator dose and the C-arm reference dose, should be between 1%–2% for a proper use of the shielding. Percentage values ≥5%–10% for individual procedures, require an analysis of the different radiation events to identify the lack of occupational protection and suggest corrective actions. In our sample, half of the operators should improve the use of the shielding in around 20% of the procedures. Using this ratio as an alert to operators allows optimising occupational radiation protection and discriminating between high occupational doses derived from complex procedures and high doses due to the improper use of the protective screen.

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“…Data from literature refer similar survey carried out at European level, in compliance to Euratom Directive, in the framework of EU ALARA network and EUCLID -European Study on Clinical DRL for x-ray Medical Imaging project, and also at International level [13][14][15][16][17][18][19][20]. In this studies, patient dose data (such as Computed tomography dose index, Dose Length Product, Scan Length, Kerma Area Product, Cumulative air kerma at the patient entrance reference point, Fluoroscopy time, for diagnostic and therapeutic procedures); patient age and weight, characteristics of each center in terms of its x-ray equipment, personnel, number of procedures performed, etc.…”

Section: Introductionmentioning

confidence: 99%

“…In this studies, patient dose data (such as Computed tomography dose index, Dose Length Product, Scan Length, Kerma Area Product, Cumulative air kerma at the patient entrance reference point, Fluoroscopy time, for diagnostic and therapeutic procedures); patient age and weight, characteristics of each center in terms of its x-ray equipment, personnel, number of procedures performed, etc. were collected from hospitals [13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

National survey to update the diagnostic reference levels in interventional radiology procedures in Italy: working methodology

D’Ercole,

Rosi,

Bernardi

et al. 2024

J. Radiol. Prot.

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Interventional Radiology (IR) deals with the diagnosis and treatment of various diseases through medically guided imaging. It provides unquestionable benefits to patients, but requires, in many cases, the use of high doses of ionizing radiation with a high impact on radiation risks to patients and to overall dose to the population. The International Commission on Radiological Protection (ICRP) introduced Diagnostic Reference Levels (DRLs) as an effective tool to facilitate dose verification and optimize protection for patients undergoing radiological procedures.In addition, EURATOM Council Directive 2013/59 and its Italian transposition (Legislative Decree 101/2020) have reiterated that DRLs must be established for many common radiological diagnostic procedures to compare the radiation dose delivered for the same diagnostic examination. Within this framework, Istituto Superiore di Sanità -Italian National Institute of Health (ISS), in collaboration with relevant Italian Scientific Societies, has provided documents on DRLs in radiological practices such as diagnostic and interventional radiology and diagnostic nuclear medicine.These reference documents enable National Hospitals to comply national regulation. The implementation of DRLs in IR is a difficult task because of the wide distribution of doses to patients even within the same procedure. Some studies have revealed that the amount of radiation in IR procedures is influenced more by the complexity of the procedure than by the weight of the patient, so complexity should be included in the definition of DRLs. For this reason, ISS promoted a survey among a sample of Italian Centers update national DRL in interventional radiology procedures with related complexity factors than can be useful for other radiological centers and to standardize the DRLs values. In the present paper the procedural methodology developed by ISS and used for the survey will be illustrated.

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Updating national diagnostic reference levels for interventional cardiology and methodological aspects

Cited by 12 publications

References 26 publications

The influence of patient size on the overall uncertainty in radiographic dose audit

The influence of patient size on the overall uncertainty in radiographic dose audit

Helping to know if you are properly protected while working in interventional cardiology

National survey to update the diagnostic reference levels in interventional radiology procedures in Italy: working methodology

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