MEASURES OF PATIENT EXPOSURE TO IONIZING RADIATION DURING INTERVENTIONAL RADIOLOGY PROCEDURES
Keywords:
radiation exposure, interventional radiology, radiation dose, radiation measure, patients, review
Abstract
Procedures used in interventional radiology brought considerable prosperity to patients when compared to traditional surgery. The negative aspect of interventional radiology procedures are effects of ionizing radiation on patients and the medical team that performs these procedures. The amount of ionizing radiation is defined as exposure, which is expressed in different measures. In order to present the effects of radiation, different types of units are used, since it is not achievable to quantify the stochastic and deterministic effects directly. Dose-area product, air kerma and fluoroscopy time are units that are used in interventional radiology, all of them are granted by the angiography machine. These units are used for the estimation of the entrance-skin dose and effective dose, which are associated with deterministic and stochastic effects, respectively. Finally, the main purpose is to obtain the absorption dose, which helps us to observe the patient exposure during interventional radiology procedures. The aim of this paper is to describe measures of patient exposure to ionizing radiation during interventional radiology procedures, using a thorough literature search.
References
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30- Fletcher DW, Miller DL, Balter S, Taylor MA. Comparison of four techniques to estimate radiation dose to skin during angio graphic and interventional radiology procedures. J Vasc Interv Radiol 2002; 13:391–397.
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34- Miller DL. Make Radiation Protection a Habit. Tech Vasc Interv Radiol 2018; 21(1):37-42.
35- Ludlow JB, Timothy R, Walker C et al. Effective dose of dental CBCT-a meta analysis of published data and additional data for nine CBCT units. Dentomaxillofac Radiol 2015; 44(1):20140197.
36- Masjedi H, Zare MH, Keshavarz Siahpoush N, Razavi-Ratki SK, Alavi F, Shabani M. European trends in radiology: investigating factors affecting the number of examinations and the effective dose. Radiol Med 2019. doi:10.1007/s11547-019-01109-6.
37- Stadnyk L, Shalopa O, Nosyk O. Collective effective dose from diagnostic radiology in Ukraine. Radiat Prot Dosimetry 2015; 165(1-4):146-9.
38- Nekolla EA, Schegerer AA, Griebel J, Brix G. Frequency and doses of diagnostic and interventional X‑ray applications: Trends between 2007 and 2014. Radiologe 2017; 57(7):555-562.
39- Thierry-Chef I, Simon SL, Land CE, Miller DL. Radiation dose to the brain and subsequent risk of developing brain tumors in pediatric patients undergoing interventional neuroradiology procedures. Radiat Res 2008; 170(5):553-65.
40- Schmitz D, Vogl T, Nour-Eldin NA et al. Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study. Eur Radiol 2019; 29(7):3390-3400.
41- Hankin RA, Jones SP. The impact of educational interventions on clinicians' knowledge of radiation protection: An integrative review. Radiography (Lond) 2020. pii: S1078-8174(20)30009-2.
2- Tsapaki V, Ahmed NA, AlSuwaidi JS et al. Radiation exposure to patients during interventional procedures in 20 countries: initial IAEA project results. AJR Am J Roentgenol 2009; 193(2):559-69.
3- Walsh C, O'Callaghan A, Moore D et al. Measurement and optimization of patient radiation doses in endovascular aneurysm repair. Eur J Vasc Endovasc Surg 2012; 43(5):534-9.
4- Joiner M, van der Kogel A, eds. Basic Clinical Radiobiology, 4th ed. London: CRC Press; 2009:11–14.
5- Stecker MS, Balter S, Towbin RB et al. SIR Safety and Health Committee; CIRSE Standards of Practice Committee. Guidelines for patient radiation dose management. J Vasc Interv Radiol 2009; 20(7):S263-73.
6- Boos J, Meineke A, Bethge OT, Antoch G, Kröpil P. Dose Monitoring in Radiology Departments: Status Quo and Future Perspectives. Rofo 2016; 188(5):443-50.
7- Heidbuchel H, Wittkampf FH, Vano E et al. Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace 2014; 16(7):946-64.
8- Hall EJ, Giaccia AJ. Radiobiology for the Radiologist, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:135–136.
9- International Commission on Radiation Units and Measurements. Patient dosimetry for x rays used in medical imaging. J ICRU 2005; 5(2):iv-vi.
10- Vano E, Järvinen H, Kosunen A, Bly R, Malone J, Dowling A et al. Patient dose in interventional radiology: a European survey. Radiat Prot Dosimetry 2008; 129(1-3):39-45.
11- Miller DL, Balter S, Cole P, Lu HT, Berenstein A, Albert R et al. Radiation Doses In Interventional Radiology procedures: the RAD-IR Study: part II: skin dose. J Vasc Interv Radiol 2003; 14:977–90.
12- Struelens L, Vanhavere F, Bosmans H, Van Loon R, Mol H. Skin dose measurement on patients for diagnostic and interventional neuroradiology: a multicentre study. Radiat Prot Dosimetry 2005; 114:143–46.
13- Hirshfeld JW Jr, Balter S, Brinker JA et al. ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Circulation 2005; 111(4):511-32.
14- Moon EK, Wang W, Newman JS, Bayona-Molano Mdel P. Challenges in interventional radiology: the pregnant patient. Semin Intervent Radiol 2013; 30(4):394-402.
15- Hidajat N, Wust P, Felix R, Schröder RJ. Radiation exposure to patient and staff in hepatic chemoembolization: risk estimation of cancer and deterministic effects. Cardiovasc Intervent Radiol 2006; 29(5):791-6.
16- SI 478. European communities (Medical Ionising radiation Protection) regulations 2002. 2002.
17- Chida K, Kagaya Y, Saito H, Ishibashi T, Takahashi S, Zuguchi M. Evaluation of patient radiation dose during cardiac interventional procedures: what is the most effective method? Acta Radiol 2009; 50(5):474-81.
18- Chida K, Inaba Y, Masuyama H et al. Evaluating the performance of a MOSFET dosimeter at diagnostic X-ray energies for interventional radiology. Radiol Phys Technol 2009; 2(1):58-61.
19- McParland BJ. Entrance skin dose estimates derived from dose-area product measurements in interventional radiological procedures. Br J Radiol 1998; 71(852):1288-95.
20- Balter S, Fletcher D, Kuan H, Miller D, Richter D, Seissl H. Techniques to estimate radiation dose to skin during fluoroscopically guided procedures α. Skin Dose Measurements AAPM; 2002: 1-10.
21- Balter S. Methods for measuring fluoroscopic skin dose. Pediatr Radiol 2006;36(2):136-40.
22- Stratis AI, Anthopoulos PL, Gavaliatsis IP et al. Patient dose in cardiac radiology. Hellenic J Cardiol 2009; 50(1):17-25.
23- Miller DL, Kwon D, Bonavia GH. Reference levels for patient radiation doses in interventional radiology: proposed initial values for U.S. practice. Radiology 2009; 253(3):753-64.
24- Neil S, Padgham C, Martin CJ. A study of the relationship between peak skin dose and cumulative air kerma in interventional neuroradiology and cardiology. J Radiol Prot 2010; 30:659e72.
25- Walsh SR, Cousins C, Tang TY, Gaunt ME, Boyle JR. Ionizing radiation in endovascular interventions. J Endovasc Ther 2008; 15:680e7.
26- Vano E, Gonzalez L, Ten J, Fernandez JM, Guibelalde E, Macaya C. Skin dose and dose-area product values for interventional cardiology procedures. Br J Radiol 2001; 74: 48-55.
27- Chida K, Saito H, Kagaya Y et al. Indicators of the maximum radiation dose to the skin during percutaneous coronary intervention in different target vessels. Catheter Cardiovasc Interv 2006; 68(2):236-41.
28- European Commission Radiation Protection N° 154. European Guidance on Estimating Population Doses from Medical X-Ray Procedures. Directorate-General for Energy and Transport Directorate H — Nuclear Energy Unit H.4 — Radiation Protection. 2008.
29- International Electrotechnical Commission. Medical electrical equipment: part 2-43—particular requirements for the safety of x-ray equipment for interventional procedures. Report 60601-2-43. Geneva, Switzerland: International Electrotechnical Commission, 2000.
30- Fletcher DW, Miller DL, Balter S, Taylor MA. Comparison of four techniques to estimate radiation dose to skin during angio graphic and interventional radiology procedures. J Vasc Interv Radiol 2002; 13:391–397.
31- Kuhelj D, Zdesar U, Jevtic V, Skrk D, Omahen G, Zontar D, Surlan M, Glusic M, Popovic P, Kocijancic IJ, Salapura V. Risk of deterministic effects during endovascular aortic stent graft implantation. Br J Radiol 2010; 83(995):958-63.
32- The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007; 37(2-4):1-332.
33- Ploussi A, Efstathopoulos EP. Importance of establishing radiation protection culture in Radiology Department. World J Radiol 2016; 8(2):142-7.
34- Miller DL. Make Radiation Protection a Habit. Tech Vasc Interv Radiol 2018; 21(1):37-42.
35- Ludlow JB, Timothy R, Walker C et al. Effective dose of dental CBCT-a meta analysis of published data and additional data for nine CBCT units. Dentomaxillofac Radiol 2015; 44(1):20140197.
36- Masjedi H, Zare MH, Keshavarz Siahpoush N, Razavi-Ratki SK, Alavi F, Shabani M. European trends in radiology: investigating factors affecting the number of examinations and the effective dose. Radiol Med 2019. doi:10.1007/s11547-019-01109-6.
37- Stadnyk L, Shalopa O, Nosyk O. Collective effective dose from diagnostic radiology in Ukraine. Radiat Prot Dosimetry 2015; 165(1-4):146-9.
38- Nekolla EA, Schegerer AA, Griebel J, Brix G. Frequency and doses of diagnostic and interventional X‑ray applications: Trends between 2007 and 2014. Radiologe 2017; 57(7):555-562.
39- Thierry-Chef I, Simon SL, Land CE, Miller DL. Radiation dose to the brain and subsequent risk of developing brain tumors in pediatric patients undergoing interventional neuroradiology procedures. Radiat Res 2008; 170(5):553-65.
40- Schmitz D, Vogl T, Nour-Eldin NA et al. Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study. Eur Radiol 2019; 29(7):3390-3400.
41- Hankin RA, Jones SP. The impact of educational interventions on clinicians' knowledge of radiation protection: An integrative review. Radiography (Lond) 2020. pii: S1078-8174(20)30009-2.