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Somasundaram E, Brady SL, Strauss KJ. Application of reference air kerma alert levels for pediatric fluoroscopic examinations. J Appl Clin Med Phys 2022; 23:e13721. [PMID: 35925012 PMCID: PMC9512353 DOI: 10.1002/acm2.13721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
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: RAK98%=em.xavg+s98.c^, where xavg is the institute's average patient thickness or age, and c^ is the intercept based on the average RAK of the patient population calculated as c^=ln(RAKavg)−m.xavg.RAKavg is the institution's average RAK (mGy). m and s98 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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Affiliation(s)
- Elanchezhian Somasundaram
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Samuel L Brady
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Keith J Strauss
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
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Papanastasiou E, Protopsaltis A, Finitsis S, Hatzidakis A, Prassopoulos P, Siountas A. Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures. Phys Med 2021; 89:63-71. [PMID: 34352677 DOI: 10.1016/j.ejmp.2021.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Institutional (local) Diagnostic Reference Levels for Cerebral Angiography (CA), Percutaneous Transhepatic Cholangiography (PTC), Transarterial Chemoembolization (TACE) and Percutaneous Transhepatic Biliary Drainage (PTBD) are reported in this study. MATERIALS AND METHODS Data for air kerma-area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT) and number of images (NI) as well as estimates of Peak Skin Dose (PSD) were collected for 142 patients. Therapeutic procedure complexity was also evaluated, in an attempt to incorporate it into the DRL analysis. RESULTS Local PKA DRL values were 70, 34, 189 and 54 Gy.cm2 for CA, PTC, TACE and PTBD respectively. The corresponding DRL values for Ka,r were 494, 194, 1186 and 400 mGy, for FT they were 9.2, 14.2, 27.5 and 22.9 min, for the NI they were 844, 32, 602 and 13 and for PSD they were 254, 256, 1598 and 540 mGy respectively. PKA for medium complexity PTBD procedures was 2.5 times higher than for simple procedures. For TACE, the corresponding ratio was 1.6. PSD was estimated to be roughly 50% of recorded Ka,r for procedures in the head/neck region and 10% higher than recorded Ka,r for procedures in the body region. In only 5 cases the 2 Gy dose alarm threshold for skin deterministic effects was exceeded. CONCLUSION Procedure complexity can differentiate DRLs in Interventional Radiology procedures. PSD could be deduced with reasonable accuracy from values of Ka,r that are reported in every angiography system.
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Affiliation(s)
- Emmanouil Papanastasiou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
| | - Athanasios Protopsaltis
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Stefanos Finitsis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Adam Hatzidakis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Panos Prassopoulos
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Anastasios Siountas
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Fum WKS, Wong JHD, Tan LK. Monte Carlo-based patient internal dosimetry in fluoroscopy-guided interventional procedures: A review. Phys Med 2021; 84:228-240. [PMID: 33849785 DOI: 10.1016/j.ejmp.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This systematic review aims to understand the dose estimation approaches and their major challenges. Specifically, we focused on state-of-the-art Monte Carlo (MC) methods in fluoroscopy-guided interventional procedures. METHODS All relevant studies were identified through keyword searches in electronic databases from inception until September 2020. The searched publications were reviewed, categorised and analysed based on their respective methodology. RESULTS Hundred and one publications were identified which utilised existing MC-based applications/programs or customised MC simulations. Two outstanding challenges were identified that contribute to uncertainties in the virtual simulation reconstruction. The first challenge involves the use of anatomical models to represent individuals. Currently, phantom libraries best balance the needs of clinical practicality with those of specificity. However, mismatches of anatomical variations including body size and organ shape can create significant discrepancies in dose estimations. The second challenge is that the exact positioning of the patient relative to the beam is generally unknown. Most dose prediction models assume the patient is located centrally on the examination couch, which can lead to significant errors. CONCLUSION The continuing rise of computing power suggests a near future where MC methods become practical for routine clinical dosimetry. Dynamic, deformable phantoms help to improve patient specificity, but at present are only limited to adjustment of gross body volume. Dynamic internal organ displacement or reshaping is likely the next logical frontier. Image-based alignment is probably the most promising solution to enable this, but it must be automated to be clinically practical.
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Affiliation(s)
- Wilbur K S Fum
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
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Colombo P, Felisi M, Riga S, Torresin A. On skin dose estimation software in interventional radiology. Phys Med 2021; 81:182-184. [DOI: 10.1016/j.ejmp.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/29/2022] Open
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Rizk C, Sarkis A, Bejjani A, Dabin J, Farah J. BENCHMARKING THE DOSE MAP SOFTWARE FOR CLINICAL IMPLEMENTATION AND ESTABLISHMENT OF A LOCAL FOLLOW-UP PROTOCOL FOR THE MANAGEMENT OF SKIN INJURES FOLLOWING COMPLEX INTERVENTIONAL CARDIOLOGY PROCEDURES. RADIATION PROTECTION DOSIMETRY 2020; 190:392-399. [PMID: 32909041 DOI: 10.1093/rpd/ncaa119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 08/15/2020] [Indexed: 06/11/2023]
Abstract
This paper aims to validate the accuracy of the peak skin dose (Dskin,max) computed by the Dose Map software (DMS)-general electric and establish a local follow-up protocol for the management of patient skin injuries following complex interventional cardiology procedures (ICPs). Dskin,max was computed by the DMS and was simultaneously measured by a dense mesh of 72 thermoluminescent dosemeters for 20 ICP. Measured and computed Dskin,max were compared using Lin's concordance coefficient (${\rho}_c$). The implementation of a local follow-up strategy was based on a computed Dskin,max of 2 Gy. After eliminating 2 outliers, the average deviation between the two methods was 6% (range: -36 to +40%). Concordance between the two methods was moderate with ${\rho}_c$ (confidence interval) of 0.9128 (0.8541-0.9486). DMS computes Dskin,max with an acceptable accuracy and can be used to setup an individual follow-up process for patients with high skin exposure and risks.
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Affiliation(s)
- Chadia Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research, 11-8281 Beirut, Lebanon
| | - Antoine Sarkis
- Department of Interventional Cardiology, Hotel Dieu de France Hospital, 16-6830 Beirut, Lebanon
| | - Alice Bejjani
- Lebanese Atomic Energy Commission, National Council for Scientific Research, 11-8281 Beirut, Lebanon
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK-CEN), BE-2400 Mol, Belgium
| | - Jad Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, 94270 Le Kremlin-Bicêtre, France
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Järvinen J, Sierpowska J, Siiskonen T, Husso M, Järvinen H, Kiviniemi T, Rissanen TT, Lindholm C, Matikka H, Larjava HRS, Mäkelä TJ, Strengell S, Eskola M, Parviainen T, Hallinen E, Pirinen M, Kivelä A, Teräs M. CONTEMPORARY RADIATION DOSES IN INTERVENTIONAL CARDIOLOGY: A NATIONWIDE STUDY OF PATIENT SKIN DOSES IN FINLAND. RADIATION PROTECTION DOSIMETRY 2020; 188:181-190. [PMID: 31838516 DOI: 10.1093/rpd/ncz273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/13/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
In contemporary interventional cardiology, for typical elderly patients, the most severe radiation-related harm to patients can be considered to come from skin exposures. In this paper, maximum local skin doses in cardiological procedures are explored with Gafchromic film dosimetry. Film and reader calibrations and reading were performed at the Secondary Standards Dosimetry Laboratory of the Radiation and Nuclear Safety Authority (STUK), and data were gathered from seven hospitals in Finland. As alert levels for early transient erythema, 200 Gycm2 kerma area product (KAP) and 2000 mGy air kerma levels for transcatheter aortic valve implantations (TAVI) procedures are proposed. The largest doses were measured in TAVI (4158.8 mGy) and percutaneous coronary interventions (PCI) (941.68 mGy). Accuracies of the GE DoseWatch and Siemens CareMonitor skin dose estimates were reasonable, but more results are needed to reliably assess and validate the tools' capabilities and reliabilities. Uncertainty of the Gafchromic dosimetry was estimated as 9.1% for a calibration with seven data points and 19.3% for a calibration with five data points.
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Affiliation(s)
- Jukka Järvinen
- Department of Cardiology, Turku Heart Centre, Turku University Hospital, Turku, 20521 Finland
- Department of Radiology, Turku University Hospital, Turku, 20521 Finland
- Department of Medical Physics, Turku University Hospital, Turku, 20521 Finland
| | - Joanna Sierpowska
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, 80210 Finland
| | - Teemu Siiskonen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Minna Husso
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, 70210 Finland
| | - Hannu Järvinen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Tuomas Kiviniemi
- Department of Cardiology, Turku Heart Centre, Turku University Hospital, Turku, 20521 Finland
| | - Tuomas T Rissanen
- Department of Radiology, Central Hospital of Northern Karelia, Joensuu, 80210 Finland
| | - Carita Lindholm
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Hanna Matikka
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, 70210 Finland
| | - Heli R S Larjava
- Department of Medical Imaging, Central Finland Health Care District, Jyväskylä, 40620 Finland
| | - Timo J Mäkelä
- Division of Cardiology, Department of Internal Medicine, Oulu University Hospital, Oulu, 90220 Finland
| | - Satu Strengell
- Cardiology division, Heart and lung center, Helsinki University Hospital, Helsinki, 00029 Finland
| | - Markku Eskola
- Department of Cardiology, Heart Hospital, Tampere University Hospital, Tampere, Finland and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, 33520 Finland
| | - Teuvo Parviainen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Elina Hallinen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Markku Pirinen
- STUK - Radiation and Nuclear Safety Authority, Helsinki, 00880 Finland
| | - Antti Kivelä
- Department of Radiology, Imaging Centre, Kuopio University Hospital, Kuopio, 70210 Finland
| | - Mika Teräs
- Department of Medical Physics, Turku University Hospital, Turku, 20521 Finland
- Institute of Biomedicine, University of Turku, Turku, 20521 Finland
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7
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Full feature selection for estimating KAP radiation dose in coronary angiographies and percutaneous coronary interventions. Comput Biol Med 2020; 120:103725. [DOI: 10.1016/j.compbiomed.2020.103725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/15/2020] [Accepted: 03/21/2020] [Indexed: 12/30/2022]
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Rühm W, Ainsbury E, Breustedt B, Caresana M, Gilvin P, Knežević Ž, Rabus H, Stolarczyk L, Vargas A, Bottollier-Depois J, Harrison R, Lopez M, Stadtmann H, Tanner R, Vanhavere F, Woda C, Clairand I, Fantuzzi E, Fattibene P, Hupe O, Olko P, Olšovcová V, Schuhmacher H, Alves J, Miljanic S. The European radiation dosimetry group – Review of recent scientific achievements. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108514] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rizk C, Farah J, Vanhavere F, Fares G. NATIONAL DIAGNOSTIC REFERENCE LEVELS IN INTERVENTIONAL RADIOLOGY SUITES IN LEBANON: A MULTICENTER SURVEY. RADIATION PROTECTION DOSIMETRY 2019; 187:50-60. [PMID: 31111937 DOI: 10.1093/rpd/ncz137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Abstract
Air kerma-area product (PKA), cumulative air kerma at patient entrance reference point, fluoroscopy time and number of images were retrospectively collected from 15 hospitals in Lebanon for 11282 fluoroscopically-guided interventional (FGI) procedures between March 2016 and November 2018. National diagnostic reference levels (NDRLs) were established based on the third quartile of the distribution of median values of exposure parameters per department for 27 types of FGI procedures. NDRLs were in line with international DRLs except for coronary angiography (CA), percutaneous coronary interventions (PCI) and transcatheter aortic valve implantation (TAVI) which require optimisation. Additionally, following the National Council on Radiation Protection and Measurements report 168, PCI, TAVI, triple chamber pacemaker implantation, endovascular aortic repair, nephrostomy, kyphoplasty and percutaneous transhepatic biliary drainage were classified as potentially high-dose procedures with >5% of the patients with PKA exceeding 300 Gycm2. The established NDRLs will promote dose optimisation and patient radiation protection.
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Affiliation(s)
- C Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research, PO Box, Riad El Solh, Beirut, Lebanon
- Faculty of Sciences, Saint-Joseph University, PO Box, Riad El Solh, Beirut, Lebanon
| | - J Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France
| | - F Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang, BE-2400 Mol, Belgium
| | - G Fares
- Faculty of Sciences, Saint-Joseph University, PO Box, Riad El Solh, Beirut, Lebanon
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Rizk C, Fares G, Vanhavere F, Farah J. MEASUREMENT OF PATIENT SKIN DOSE DISTRIBUTIONS IN THREE LEBANESE INTERVENTIONAL CARDIOLOGY SUITES. RADIATION PROTECTION DOSIMETRY 2019; 183:375-385. [PMID: 30165531 DOI: 10.1093/rpd/ncy152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/28/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Using a mesh of 30 thermoluminescent dosemeters, adults' patient skin doses were measured for 99 coronary angiography (CA) and 89 percutaneous coronary interventions (PCI) performed in three Lebanese hospitals. Average peak skin dose (Dskin,max) were 152 mGy (range: 16-1144) for CAs and 576 mGy (range: 7-3361) for PCIs. While only four patients had a Dskin,max value exceeding the 2 Gy threshold for skin injuries, several patients had skin dose values above 1 Gy at several distinct locations proving that Dskin,max alone is not sufficient for repetitive procedures; 2D dose maps are required instead. Dskin,max correlated well with total air kerma-area product (PKA,T) for PCI in Hospitals 1 and 2 (R = 0.91 and 0.76, respectively) enabling the setup of an alert level at PKA,T = 240 and 210 Gy cm2, respectively, corresponding to a Dskin,max of 2 Gy. This was not possible for Hospital 3 due to weak correlations between Dskin,max and PKA,T.
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Affiliation(s)
- C Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research, PO Box 11-8281, Riad El Solh, Beirut, Lebanon
- Faculty of Sciences, Saint Joseph University, PO Box 11-514, Riad El Solh, Beirut, Lebanon
| | - G Fares
- Faculty of Sciences, Saint Joseph University, PO Box 11-514, Riad El Solh, Beirut, Lebanon
| | - F Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang 200, Mol, Belgium
| | - J Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France
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Betti M, Mazzoni LN, Belli G, Bernardi L, Bicchi S, Busoni S, Fedele D, Fedeli L, Gasperi C, Gori C, Quattrocchi M, Taddeucci A, Vigliotti M, Vaiano A, Rossi F. Surgeon eye lens dose monitoring in catheterization lab: A multi-center survey: Invited for ECMP 2018 Focus Issue. Phys Med 2019; 60:127-131. [PMID: 31000072 DOI: 10.1016/j.ejmp.2019.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To perform a multi-centre survey on the eye lens equivalent dose absorbed by primary interventionalist during catheterization procedures, using a personal dosimeter placed close to the eye lens. METHODS 15 different cardiologists working in 3 different centers, for a total of 5 operating rooms were enrolled. All of them were provided with a single thermoluminescent dosimeter positioned on the inner side of the temples of eyeglasses. The dose monitoring, performed on a two-months basis, started in 2016 and is still running. All dose measurements were performed by a ISO 17025 standard accredited dosimetry service thus providing certified uncertainties as well. Correlation of eye lens and wrist dose with KAP was also investigated. RESULTS A total number of 101 eye lens measurements were performed. Annual eye lens dose estimation was obtained for all 15 surgeons (mean, mode, range, standard deviation: 10.8, 8, 4.9-27.3, 5.6 mSv, respectively). Uncertainties on annual eye lens dose estimations ranged between 10% and 20%. No significant correlation was found between eye lens dose and KAP. CONCLUSIONS Cardiologists involved in catheterization procedures may receive annual eye lens doses close to the ICRP 118 dose limit and thus individual monitoring with a dedicated dosimeter should be carried out. Uncertainty assessment play a relevant role in eye lens equivalent dose estimation to ensure not to exceed dose limit.
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Affiliation(s)
- Margherita Betti
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | | | - Giacomo Belli
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | - Luca Bernardi
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Sara Bicchi
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Simone Busoni
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | - David Fedele
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Luca Fedeli
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Sesto Fiorentino, Firenze, Italy
| | - Chiara Gasperi
- Azienda Usl Toscana Sud-Est, Medical Physics Unit, Arezzo, Italy
| | - Cesare Gori
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Sesto Fiorentino, Firenze, Italy; INFN, Sezione di Firenze, Sesto Fiorentino, Italy
| | | | - Adriana Taddeucci
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | | | - Angela Vaiano
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Francesco Rossi
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
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Brix G, Griebel J, Czarwinski R. [Reporting and information system for significant events related to radiation exposures in medicine: Structure, responsibilities and reporting criteria]. Z Med Phys 2018; 29:66-76. [PMID: 30563737 DOI: 10.1016/j.zemedi.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/25/2022]
Abstract
The increasing frequency and complexity of medical radiation exposures to humans inevitably result in higher risks of harmful unintended or accidental radiation exposures. To ensure a high level of protection and its continuous improvement, the Directive 2013/59/Euratom thus requires to systematically record and analyze both events and near-miss events as well as, in the case of their significance, to disseminate information regarding lessons learned from these events promptly and nationwide to improve radiation protection in medicine. These requirements have been transposed into German legislation by the new radiation protection law and radiation protection ordinance that entered into force simultaneously on December 31th, 2018. The reporting and information system as provided by these regulations as well as the tasks, duties and powers of the parties involved are presented in the first part of this review article. In the second part, the established application-specified criteria for the significance - and thus the notification requirement - of (near-miss) events are itemized and explicated.
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Affiliation(s)
- Gunnar Brix
- Abteilung für medizinischen und beruflichen Strahlenschutz, Bundesamt für Strahlenschutz, Deutschland.
| | - Jürgen Griebel
- Abteilung für medizinischen und beruflichen Strahlenschutz, Bundesamt für Strahlenschutz, Deutschland
| | - Renate Czarwinski
- Abteilung für medizinischen und beruflichen Strahlenschutz, Bundesamt für Strahlenschutz, Deutschland
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Siiskonen T, Ciraj-Bjelac O, Dabin J, Diklic A, Domienik-Andrzejewska J, Farah J, Fernandez J, Gallagher A, Hourdakis C, Jurkovic S, Järvinen H, Järvinen J, Knežević Ž, Koukorava C, Maccia C, Majer M, Malchair F, Riccardi L, Rizk C, Sanchez R, Sandborg M, Merce MS, Segota D, Sierpowska J, Simantirakis G, Sukupova L, Thrapsanioti Z, Vano E. Establishing the European diagnostic reference levels for interventional cardiology. Phys Med 2018; 54:42-48. [DOI: 10.1016/j.ejmp.2018.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022] Open
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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