scholarly journals Monitoring Radiation Doses during Diagnostic and Therapeutic Neurointerventional Procedures: Multicenter Study for Establishment of Reference Levels

2021 ◽  
Author(s):  
Yon-Kwon Ihn ◽  
Bum-soo Kim ◽  
Hae Woong Jeong ◽  
Sang Hyun Suh ◽  
Yoo Dong Won ◽  
...  
Keyword(s):  
Cerebral Angiography ◽  
Interventional Neuroradiology ◽  
Reference Level ◽  
Radiation Doses ◽  
Large Variability ◽  
Dose Area Product ◽  
Stroke Thrombolysis ◽  
Neurointerventional Procedures ◽  
Aneurysm Coiling ◽  
Significant Factors

Purpose: To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL).Materials and Methods: Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution.Results: Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm<sup>2</sup>, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm<sup>2</sup>, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm<sup>2</sup>, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm<sup>2</sup>, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group.Conclusion: Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm<sup>2</sup>) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.

scholarly journals A dose audit of fluoroscopy examinations at Charlotte Maxeke Johannesburg Academic Hospital: Analysis of preliminary results

2009 ◽  
Vol 13 (2) ◽  
pp. 24
Author(s):  
T Nyathi ◽  
M L Pule ◽  
P Segone ◽  
D G Van der Merwe ◽  
S P Rapoho
Keyword(s):  
South Africa ◽  
Dose Optimization ◽  
Skin Dose ◽  
Radiation Doses ◽  
Voiding Cystourethrogram ◽  
Academic Hospital ◽  
Reference Levels ◽  
Large Variability ◽  
Dose Area Product ◽  
Area Product

Purpose: To retrospectively analyze the radiation doses delivered to patients undergoing fluoroscopy examinations in terms of the skin dose and the dose-area product (DAP). Materials and Methods: The subjects of this study were patients who underwent fluoroscopy examinations at Charlotte Maxeke Johannesburg Academic Hospital, South Africa during the period August 2007 to March 2008. The skin dose and dose-area product values were obtained from a built-in DAP-meter installed on a digital Philips Medical Systems MultiDiagnost Eleva fluoroscopy unit. The following cases were analyzed namely barium swallow, barium meal, barium enema, hexabrix swallow, gastrografin meal, voiding cystourethrogram, fistulogram, myelogram, nephrostomy and loopogram. Results: An analysis of three hundred and thirty one examinations is presented. From the recorded data the following quantities were deduced: the mean- and range of the skin doses and DAPs, mean screening time and mean fluoroscopy duration. An analysis of the screening time for the various examinations showed a weak correlation (r = 0.59) between skin dose and screening time, while a poor correlation (r = 0.42) was deduced between DAP reading and screening time. Conclusion: There is a wide spread in the radiation doses registered for any one given type of examination. The large variability in the radiation dose delivered proves that fluoroscopic examinations stand to gain from dose optimization. The usefulness and potential use of DAP meters with regards to dose optimization in radiology is shown. In line with efforts to optimize dose from diagnostic radiography examinations the authors recommend the establishment of diagnostic reference levels (DRLs) in South Africa for the most frequent examinations in general radiography, fluoroscopy, mammography and computed tomography. Keywords: patient dose, genetic risk, dose optimization, dose reference levels

scholarly journals Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site Experience

2017 ◽  
Vol 6 (3-4) ◽  
pp. 105-116 ◽  
Author(s):  
Ameer E. Hassan ◽  
Sophie Amelot
Keyword(s):  
Cerebral Angiography ◽  
Digital Subtraction ◽  
Patient Exposure ◽  
Flat Panel ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
Alara Principle ◽  
Area Product ◽  
Procedure Type ◽  
Neurointerventional Procedures

Background and Purpose: Per the ALARA principle, reducing the dose delivered to both patients and staff must be a priority for endovascular therapists, who should monitor their own practice. We evaluated patient exposure to radiation during common neurointerventions performed with a recent flat-panel detector angiographic system and compared our results with those of recently published studies. Methods: All consecutive patients who underwent a diagnostic cerebral angiography or intervention on 2 modern flat-panel detector angiographic biplane systems (Innova IGS 630, GE Healthcare, Chalfont St Giles, UK) from February to November 2015 were retrospectively analyzed. Dose-area product (DAP), cumulative air kerma (CAK) per plane, fluoroscopy time (FT), and total number of digital subtraction angiography (DSA) frames were collected, reported as median (interquartile range), and compared with the previously published literature. Results: A total of 755 consecutive cases were assessed in our institution during the study period, including 398 diagnostic cerebral angiographies and 357 interventions. The DAP (Gy × cm2), fontal and lateral CAK (Gy), FT (min), and total number of DSA frames were as follows: 43 (33-60), 0.26 (0.19-0.33), 0.09 (0.07-0.13), 5.6 (4.2-7.5), and 245 (193-314) for diagnostic cerebral angiographies, and 66 (41-110), 0.46 (0.25-0.80), 0.18 (0.10-0.30), 18.3 (9.1-30.2), and 281 (184-427) for interventions. Conclusion: Our diagnostic cerebral angiography group had a lower median and was in the 75th percentile of DAP and FT when compared with the published literature. For interventions, both DAP and number of DSA frames were significantly lower than the values reported in the literature, despite a higher FT. Subgroup analysis by procedure type also revealed a lower or comparable DAP.

Estimation of Radiation Exposure in the Pediatric Cath Lab in Ain Shams University; Cross-Sectional Observational Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Abdelrazik ◽  
Youssef Amin ◽  
Alaa Roushdy ◽  
Maiy El Sayed
Keyword(s):  
Radiation Exposure ◽  
Radiation Dosage ◽  
University Hospital ◽  
Heart Catheterization ◽  
Radiation Doses ◽  
Device Closure ◽  
Cross Sectional ◽  
Dose Area Product ◽  
Area Product ◽  
Hospital Pediatric

Abstract Aim and objectives The aim of the study is to assess the average radiation doses recorded per procedure in Ain Shams University Hospital pediatric cath lab to set benchmarks of radiation exposure in our institute. Patients and Methods The study included 198 patients who presented to Ain Shams cardiac pediatric cath lab who undergone interventional (BPV, BAV, ASD device closure, VSD device closure, PDA coil/device closure, Coarctation Stent/balloon) and diagnostic (Hemodynamics study, Diagnostic cath) heart catheterization. Radiation doses were measured without any interference with the operator’s preferences. Results Radiation dosages were measured in total AirKerma, Dose area product (DAP), and fluoroscopy time to set the benchmarks for radiation exposure in our institute per procedure. VSD device closure showed the highest radiation exposure followed by Coarctation stenting. Lowest radiation dosage was in PDA coil closure followed by ASD device closure then BPV. Conclusion Benchmarks for radiation exposure per procedure in pediatric cath lab in our institute were set and compared to each other.

RADIATION DOSE TO PATIENTS IN CORONARY INTERVENTIONAL PROCEDURES: A SURVEY

2018 ◽  
Vol 184 (1) ◽  
pp. 1-4 ◽  
Author(s):  
A Brindhaban
Keyword(s):  
Interventional Procedures ◽  
Coronary Intervention ◽  
Skin Dose ◽  
Radiation Doses ◽  
Dose Area Product ◽  
Maximum Value ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Area Product ◽  
Peak Skin Dose

Abstract The objective of this study was to evaluate dose–area product (DAP) and peak skin dose (PSD) for coronary angiography (CA) and percutaneous coronary intervention (PCI). The DAP and PSD of 300 randomly selected patients who were referred to CA and/or PCI, over a period of 3 months were recorded and analyzed. The mean DAP of 32 Gy cm2 and mean PSD of 412 mGy for CA were lower than 118 Gy cm2 and 857 mGy, respectively, for PCI. The DAP range of 2–84 Gy cm2 for CA and 12–378 mGy for PCI were also established. The maximum value of PSD for PCI procedures reached above the 2 Gy threshold for erythema. However, these values are similar to those available in literature. Periodic surveys may be required to monitor and/or reduce radiation doses in coronary interventional procedures.

Estimating Radiation Dose to Major Organs in Dental X-Ray Examinations: A Phantom Study

2020 ◽  
Author(s):  
Yong Li ◽  
Bingsheng Huang ◽  
Jun Cao ◽  
Tianqi Fang ◽  
Guoqing Liu ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Reference Level ◽  
Radiation Doses ◽  
Diagnostic Reference Level ◽  
Effective Radiation Dose ◽  
Organ Doses ◽  
X Ray ◽  
Absorbed Doses ◽  
Males And Females ◽  
Effective Radiation

Abstract The radiation doses absorbed by major organs of males and females were studied from three types of dental X-ray devices. The absorbed doses from cone-beam computed tomography (CBCT), panoramic and intraoral X-ray machines were in the range of 0.23–1314.85 μGy, and were observed to be high in organs and tissues located in or adjacent to the irradiated area, there were discrepancies in organ doses between male and female. Thyroid, salivary gland, eye lens and brain were the organs that received higher absorbed doses. The organ absorbed doses were considerably lower than the diagnostic reference level for dental radiography in China. The calculated effective radiation doses for males and females were 56.63, 8.15, 2.56 μSv and 55.18, 8.99, 2.39 μSv, respectively, when using CBCT, the panoramic X-ray machine and intraoral X-ray machine. The effective radiation dose caused by CBCT was much higher than those of panoramic and intraoral X-ray machines.

Impact of digital imaging on radiation doses to the patient during X-ray examination of the urinary tract

2005 ◽  
Vol 46 (6) ◽  
pp. 657-661 ◽  
Author(s):  
B. Sjöholm ◽  
H. Geijer ◽  
J. Persliden
Keyword(s):  
Dose Reduction ◽  
Intravenous Urography ◽  
Radiation Doses ◽  
Flat Panel ◽  
Storage Phosphor ◽  
X Ray ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
Before And After ◽  
Phosphor Plates

Purpose: To compare radiation doses given to patients undergoing IVU (intravenous urography) before and after digitalization of our X-ray department. Material and Methods: IVU examinations were monitored with dose area product meters before and after the X-ray department changed to digital techniques. The first step was a change from film-screen to storage phosphor plates, while the second step involved changing to a flat panel detector. Forty-two patients were included for the film-screen situation, 69 when using the storage phosphor plates, and 70 using the flat panel detector. Results: A dose reduction from 41.8 Gycm2 to 31.5 Gycm2 was achieved with the first step when the film-screen system was replaced with storage phosphor plates. A further reduction to 12.1 Gycm2 was achieved using the flat panel detector. Conclusion: The introduction of the flat panel detectors made a considerable dose reduction possible.

P6551Evaluation of a new ultra low-dose radiation protocol during electrophysiological device implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Eichenlaub ◽  
K Astheimer ◽  
C Restle ◽  
C Maring ◽  
T Blum ◽  
...  
Keyword(s):  
Low Dose ◽  
De Novo ◽  
Cardiac Resynchronisation Therapy ◽  
Radiation Doses ◽  
Procedure Time ◽  
Low Dose Radiation ◽  
Dose Area Product ◽  
Device Implantation ◽  
The Impact ◽  
Dose Radiation

Abstract Objectives The aim of this study was to evaluate the impact of a new ultra low-dose radiation protocol on radiation doses, feasibility and safety during electrophysiological device implantation. Background Radiation is one of the main hazards during electrophysiological procedures. Shielding is especially difficult during device implantation and particularly implantation of cardiac resynchronisation therapy devices (CRT) is associated with high radiation doses. Methods From January 2005 to January 2019, 8612 patients underwent de novo device implantation at our University Heart Center. During 2018, we established a new ultra low-dose radiation protocol and compared 661 patients who were treated during 2017 utilizing the conventional low-dose protocol with 512 patients after the application of the new program (11.5% one-chamber devices, 68.5% two-chamber devices and 19.9% CRT). Results After establishment of the radiation reduction protocol, dose area products could be reduced by 62% and the effective doses by 59% (113 (47–292) vs. 43 (14–130) cGycm2, p<0.0001 and 0.25 (0.11–0.63) vs. 0.10 (0.03–0.28) mSv, p<0.0001). These results could be achieved without prolonging procedure time, increasing complication and decreasing success rate. Male gender, higher BMI, longer procedure and fluoroscopy duration and the use of the conventional radiation protocol were statistically significant factors for the need of higher radiation doses in multivariate regression analysis. Clinical and procedural characteristics All (n=1173) Group pre (n=661) Group post (n=512) P Age, years 77 (69–82) 77 (69–82) 77 (69–83) 0.6 Male, n (%) 726 (62) 403 (61) 323 (63) 0.5 Body mass index, kg/m2 26.6 (24–29.8) 26.6 (24–29.8) 26.4 (24–29.4) 0.5 Procedure time, minutes 35 (25–50) 37 (26–50) 35 (25–54.5) 0.5 Fluoroscopy time, minutes 3.7 (2–7.8) 4 (2–7.8) 3.4 (1.9–7.7) 0.07 Dose area product, cGy cm2 80 (28–228) 113 (47–292) 43 (14–130) <0.0001 Effective dose, mSv 0.18 (0.06–0.51) 0.25 (0.11–0.63) 0.1 (0.03–0.28) <0.0001 Complications, n (%) 11 (0.9) 7 (1.1) 4 (0.8) 0.8 Conclusions Radiation exposure during electrophysiological device implantation has been continuously reduced over the last years. By establishing a new ultra low-dose radiation protocol, we could further decrease the radiation dose significantly and reach the lowest radiation values published so far. This protocol can easily be implemented in the workflow of other hospitals and should become standard during implantation procedures.

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