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D'Alessio A, Strocchi S, Dalmasso F, Cannillo B, Matheoud R, Ponzetti A, Aimonetto S, Cernigliaro M, Azzalin G, Giorgianni A, Natrella M, Carriero A, Guzzardi G, Brambilla M. Effective and organ doses in patient undergoing interventional neuroradiology procedures: A multicentre study. Phys Med 2024; 122:103383. [PMID: 38810393 DOI: 10.1016/j.ejmp.2024.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/22/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Radiation doses to adult patients submitted to cerebral angiography and intracranial aneurysms treatments were assessed by using DICOM Radiation Dose Structured Reports (RDSR) and Monte Carlo simulations. Conversion factors to estimate effective and organ doses from Kerma-Area Product (PKA) values were determined. METHODS 77 cerebral procedures performed with five angiographic equipment installed in three Italian centres were analyzed. Local settings and acquisition protocols were considered. The geometrical, technical and dosimetric data of 16,244 irradiation events (13305 fluoroscopy, 2811 digital subtraction angiography, 128 cone-beam CT) were extracted from RDSRs by local dose monitoring systems and were input in MonteCarlo PCXMC software to calculate effective and organ doses. Finally, conversion factors to determine effective and organ doses from PKA were determined. Differences between centres were assessed through statistical analysis and accuracy of dose calculation method based on conversion factors was assessed through Bland-Altman analysis. RESULTS Large variations in PKA (14-561 Gycm2) and effective dose (1.2-73.5 mSv) were observed due to different degrees of complexity in the procedures and angiographic system technology. The most exposed organs were brain, salivary glands, oral mucosa, thyroid and skeleton. The study highlights the importance of recent technology in reducing patient exposure (about fourfold, even more in DSA). No statistically significant difference was observed in conversion factors between centres, except for some organs. A conversion factor of 0.09 ± 0.02 mSv/Gycm2 was obtained for effective dose. CONCLUSIONS Organ and effective doses were assessed for neuro-interventional procedures. Conversion factors for calculating effective and organ doses from PKA were provided.
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Affiliation(s)
- Andrea D'Alessio
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
| | - Sabina Strocchi
- Medical Physics Department, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federico Dalmasso
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | - Barbara Cannillo
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Roberta Matheoud
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Alex Ponzetti
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy; Medical Physics Postgraduate School, University of Turin, Turin, Italy
| | - Stefania Aimonetto
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | | | - Giulia Azzalin
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Andrea Giorgianni
- Neuroradiology Department, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Massimiliano Natrella
- Radiology Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | - Alessandro Carriero
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
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González-Ruíz A, Ou-Saada I, Isidro-Ortega FJ, Sánchez-Mendoza HI. Local dose reference levels during transarterial chemoembolization procedure. Appl Radiat Isot 2021; 178:109982. [PMID: 34655924 DOI: 10.1016/j.apradiso.2021.109982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
The aim of this study was to develop local diagnostic reference levels (LDRL) during Transarterial chemoembolization (TACE). This cross-sectional study reports radiation dose indicators of 108 patients in a Mexican hospital, obtained over a period of 35 months. Kerma-area product (PKA), air-kerma at the reference point (Ka, r), and descriptive statistical analysis were examined according to sociodemographic characteristics of the sample patients. The LDRL obtained were then compared to a similar international framework. The present study contributes to the establishment of a TACE LDRL and identifies significant correlations among radiology factors and dosimetric quantities obtained.
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Affiliation(s)
- Abraham González-Ruíz
- Universidad Autónoma del Estado de México, Paseo Tollocan S/N, Toluca, Estado de México, 50180, México
| | - Imane Ou-Saada
- Laboratory of High Energy Physics, Modelling and Simulations Faculty of Sciences Rabat, Mohammed V University, 4 Avenue Ibn Battouta B.P. 1014, Rabat, Morocco
| | - Frank Jhonatan Isidro-Ortega
- División de Estudios de Posgrado e Investigación, Instituto Tecnológico de Toluca, Metepec, 52149, Estado de México, México
| | - Helen's Irais Sánchez-Mendoza
- Instituto Nacional de Salud Pública, Fray Pedro de Gante 12, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México.
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D'Alessio A, Cannillo B, Guzzardi G, Cernigliaro M, Carriero A, Brambilla M. Conversion factors for effective dose and organ doses with the air Kerma area product in hysterosalpingography. Phys Med 2020; 81:40-46. [PMID: 33373780 DOI: 10.1016/j.ejmp.2020.11.032] [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: 07/11/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022] Open
Abstract
Histerosalpingography (HSG) remains the dominant diagnostic tool for investigation of infertility in women. Conversion factors used to estimate effective (E) and organ doses (HT) from air Kerma area product (KAP) are needed to estimate patient doses in HSG, performed with state-of-the-art fluoroscopic X-ray systems with digital detectors. In this study, estimates of E and HT for six critical organs/tissues, were derived on an individual basis in 120 HSG procedures and in 1410 irradiation events, performed on two X-ray systems from information available through the radiation dose structured report using Monte Carlo methods. Mean values of E and Hovaries were1.0 ± 0.9 mSv and 5.6 ± 5.4 mGy. E/KAP conversion factors of 0.13; 0.18; 0.28 and 0.35 mSv Gy-1cm-2 were established for irradiation events with a Cu filtration of 0.0; 0.1; 0.4 and 0.9 mm. A high agreement was obtained between E estimated through Monte Carlo methods and E/KAP conversion factors accounting separately for the different modes of fluoroscopy and the radiography component of HSG, with a systematic error of 0 mSv and lower/upper limits of agreement of -0.6 and 0.5 mSv. On the contrary, the use of a single coefficient of conversion did not provide accurate estimates of E, showing a bias of -0.4 mSv and lower and upper limits of agreement of -1.9 and 1.2 mSv. An algorithm for the estimation of effective and organ doses from KAP has been established in HSG procedures depending on the Cu filtration in the X-ray irradiation events.
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Affiliation(s)
- Andrea D'Alessio
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Barbara Cannillo
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | | | - Alessandro Carriero
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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Effective Dose Assessment for Patients Undergoing Contemporary Fluoroscopically Guided Interventional Procedures. AJR Am J Roentgenol 2020; 214:158-170. [DOI: 10.2214/ajr.19.21804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Establishing Local Diagnostic Reference Levels in IR Procedures with Dose Management Software. J Vasc Interv Radiol 2017; 28:429-441. [DOI: 10.1016/j.jvir.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/01/2016] [Accepted: 10/12/2016] [Indexed: 11/21/2022] Open
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Vilar-Palop J, Vilar J, Hernández-Aguado I, González-Álvarez I, Lumbreras B. Updated effective doses in radiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:975-990. [PMID: 27893456 DOI: 10.1088/0952-4746/36/4/975] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to review recent literature in order to provide updated values of the typical effective doses associated with the top 20 imaging tests for adults and children and for the most widely used set of weights (ICRP60) as well as for the most recent one (ICRP103). We performed a systematic research on radiation dosimetry in radiology published from 2007 onwards through the Medline, Embase and Cochrane Library Plus databases. We also included studies backed by scientific or governmental organizations. Other variables included: year and type of study (survey or descriptive), country, method and sample used for the measurement. Mean effective dose, minimum, maximum and standard deviation were calculated. We compared our results with previous evidence and with data from DDM2. We included 27 articles and 5 web references in the study. A total of 378 values from the 20 procedures included were obtained, 280 (74%) using ICRP60 and 98 (26%) using ICRP103. Effective doses for CT procedures in children were very similar to those for adults, with the exception of CT Trunk, but fluoroscopy procedures had consistently lower dose. There were differences between the current data with either ICRP60 or ICRP103, and the previous published data. In conclusion, we provided the best available evidence from literature to evaluate the effective dose received by each patient for the most typical examinations. According to the recommendations from the Report 154 and from the European Council Directive, these results could also be useful to estimate the range of average exposures to the population.
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Peruzzo Cornetto A, Aimonetto S, Pisano F, Giudice M, Sicuro M, Meloni T, Tofani S. The contribution of interventional cardiology procedures to the population radiation dose in a 'health-care level I' representative region. RADIATION PROTECTION DOSIMETRY 2016; 168:261-70. [PMID: 26012484 PMCID: PMC4884888 DOI: 10.1093/rpd/ncv307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 06/04/2023]
Abstract
This study evaluates per-procedure, collective and per capita effective dose to the population by interventional cardiology (IC) procedures performed during 2002-11 at the main hospital of Aosta Valley Region that can be considered as representative of the health-care level I countries, as defined by the UNSCEAR, based on its socio-demographic characteristics. IC procedures investigated were often multiple procedures in patients older than 60 y. The median extreme dose-area product values of 300 and 22 908 cGycm(2) were found for standard pacemaker implantation and coronary angioplasty, respectively, while the relative mean per-procedure effective dose ranged from 0.7 to 47 mSv. A 3-fold increase in frequency has been observed together with a correlated increase in the delivered per capita dose (0.05-0.27 mSv y(-1)) and the collective dose (5.8-35 man Sv y(-1)). Doses increased particularly from 2008 onwards mainly because of the introduction of coronary angioplasty procedures in the authors' institution. IC practice contributed remarkably in terms of effective dose to the population, delivering ∼10% of the total dose by medical ionising radiation examination categories.
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Affiliation(s)
- Andrea Peruzzo Cornetto
- Department of Medical Physics, AUSL Valle d'Aosta, 'U. Parini' Regional Hospital, Viale Ginevra no. 3, Aosta 11100, Italy
| | - Stefania Aimonetto
- Department of Medical Physics, AUSL Valle d'Aosta, 'U. Parini' Regional Hospital, Viale Ginevra no. 3, Aosta 11100, Italy
| | - Francesco Pisano
- Department of Diagnostic and Interventional Cardiology, AUSL Valle d'Aosta, 'U. Parini' Regional Hospital, Viale Ginevra no. 3, Aosta 11100, Italy
| | - Marcello Giudice
- Department of Diagnostic and Interventional Cardiology, AUSL Valle d'Aosta, 'U. Parini' Regional Hospital, Viale Ginevra no. 3, Aosta 11100, Italy
| | - Marco Sicuro
- Department of Diagnostic and Interventional Cardiology, AUSL Valle d'Aosta, 'U. Parini' Regional Hospital, Viale Ginevra no. 3, Aosta 11100, Italy
| | - Teodoro Meloni
- Department of Diagnostic and Interventional Radiology, AUSL Valle d'Aosta, 'U. Parini' Regional Hospital, Viale Ginevra no. 3, Aosta 11100, Italy
| | - Santi Tofani
- Department of Medical Physics, AUSL Valle d'Aosta, 'U. Parini' Regional Hospital, Viale Ginevra no. 3, Aosta 11100, Italy
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Garzón WJ, Kramer R, Khoury HJ, de Barros VSM, Andrade G. Estimation of organ doses to patients undergoing hepatic chemoembolization procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2015; 35:629-647. [PMID: 26270613 DOI: 10.1088/0952-4746/35/3/629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study is to evaluate organ and tissue absorbed doses to patients undergoing hepatic chemoembolization procedures performed in two hospitals in the city of Recife, Brazil. Forty eight patients undergoing fifty hepatic chemoembolization procedures were investigated. For the 20 cases with PA projection only, organs and tissues dose to KAP conversion coefficients were calculated using the mesh-based anthropometric phantom series FASH and MASH coupled to the EGSnrc Monte Carlo code. Clinical, dosimetric and irradiations parameters were registered for all patients. The maximum organ absorbed doses found were 2.4 Gy, 0.85 Gy, 0.76 Gy and 0.44 Gy for skin, kidneys, adrenals and liver, respectively.
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Affiliation(s)
- W J Garzón
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
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Khoury HJ, Garzon WJ, Andrade G, Lunelli N, Kramer R, de Barros VSM, Huda A. Radiation exposure to patients and medical staff in hepatic chemoembolisation interventional procedures in Recife, Brazil. RADIATION PROTECTION DOSIMETRY 2015; 165:263-267. [PMID: 25870436 DOI: 10.1093/rpd/ncv075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to evaluate patient and medical staff absorbed doses received from transarterial chemoembolisation of hepatocellular carcinoma, which is the most common primary liver tumour worldwide. The study was performed in three hospitals in Recife, capital of the state of Pernambuco, located in the Brazilian Northeastern region. Two are public hospitals (A and B), and one is private (C). For each procedure, the number of images, irradiation parameters (kV, mA and fluoroscopy time), the air kerma-area product (PKA) and the cumulative air kerma (Ka,r) at the reference point were registered. The maximum skin dose (MSD) of the patient was estimated using radiochromic film. For the medical staff dosimetry, thermoluminescence dosemeters (TLD-100) were attached next to the eyes, close to the thyroid (above the shielding), on the thorax under the apron, on the wrist and on the feet. The effective dose to the staff was estimated using the algorithm of von Boetticher. The results showed that the mean value of the total PKA was 267.49, 403.83 and 479.74 Gy cm(2) for Hospitals A, B and C, respectively. With regard to the physicians, the average effective dose per procedure was 17 µSv, and the minimum and maximum values recorded were 1 and 41 µSy, respectively. The results showed that the feet received the highest doses followed by the hands and lens of the eye, since the physicians did not use leaded glasses and the equipment had no lead curtain.
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Affiliation(s)
- H J Khoury
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - W J Garzon
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - G Andrade
- IMIP-Institute of Medicine Dr. Fernando Figueira, Recife, PE, Brazil
| | - N Lunelli
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - R Kramer
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - V S M de Barros
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - A Huda
- California State University, Fresno, CA, USA
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Aimonetto S, Arrichiello C, Peruzzo Cornetto A, Catuzzo P, Zeverino M, Poti C, Meloni T, Pasquino M, Tofani S. Exposures from nuclear medicine diagnostic procedures: the dose impact on the Aosta Valley population. RADIATION PROTECTION DOSIMETRY 2013; 157:339-347. [PMID: 23816980 DOI: 10.1093/rpd/nct158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present work evaluates the per-procedure, annual collective and per-capita effective doses to the Aosta Valley region population from nuclear medicine (NM) examinations performed from 2005 to 2011 at the regional NM department. Based on its demographical and socioeconomics characteristics, this area can be considered as representative of the level I countries, as defined by the United Nations Scientific Committee on the Effects of Atomic Radiation. The NM per-procedures effective doses were within the range of 0.018-35 mSv. A steady frequency per 10 000 inhabitants has been observed, together with a decrease for thyroid and whole-body bone scintigraphy. Myocardial and bone scintigraphy studies were the major contributors to the total collective effective dose. The mean annual collective and per-capita effective doses to the population were 15 man Sv y(-1) and 120 µSv y(-1), respectively. The NM contribution to the total per-capita effective dose accounts for 5.9 % of that due to the medical ionising radiation examinations overall.
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Affiliation(s)
- S Aimonetto
- Department of Medical Physics, Valle d'Aosta Regional Hospital, Viale Ginevra 3, Aosta 11100, Italy
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