Real-Time Patient and Staff Radiation Dose Monitoring in IR Practice

Knowledge of medical radiation exposure permits application of radiation protection principles. In our center, the first dedicated real-time, automated patient and staff dose monitoring system (DoseWise Portal, Philips Healthcare) was installed. Aim of this study was to obtain insight in the procedural and occupational doses. All interventional radiologists, vascular surgeons, and technicians wore personal dose meters (PDMs, DoseAware, Philips Healthcare). The dose monitoring system simultaneously registered for each procedure dose-related data as the dose area product (DAP) and effective staff dose (E) from PDMs. Use and type of shielding were recorded separately. All procedures were analyzed according to procedure type; these included among others cerebral interventions (n = 112), iliac and/or caval venous recanalization procedures (n = 68), endovascular aortic repair procedures (n = 63), biliary duct interventions (n = 58), and percutaneous gastrostomy procedure (n = 28). Median (±IQR) DAP doses ranged from 2.0 (0.8–3.1) (percutaneous gastrostomy) to 84 (53–147) Gy cm2 (aortic repair procedures). Median (±IQR) first operator doses ranged from 1.6 (1.1–5.0) μSv to 33.4 (12.1–125.0) for these procedures, respectively. The relative exposure, determined as first operator dose normalized to procedural DAP, ranged from 1.9 in biliary interventions to 0.1 μSv/Gy cm2 in cerebral interventions, indicating large variation in staff dose per unit DAP among the procedure types. Real-time dose monitoring was able to identify the types of interventions with either an absolute or relatively high staff dose, and may allow for specific optimization of radiation protection.     

Dosis de radiación durante la inserción guiada por fluoroscopia de un dispositivo de acceso venoso central: un estudio observacional retrospectivo

IntroductionCentral venous access devices (CVAD) are used to deliver intravenous therapy to the bloodstream. CVAD insertion is sometimes fluoroscopically guided and thus associated with radiation dose to both the patient and the staff members within the room. The objective of this study is to assess the radiation dose to the patient through a retrospective audit and directly measure the exposure to staff members in simulated procedures. A secondary objective is to evaluate the radiation exposure to the staff and patients when utilising fluoroscopic pulse rate of 7.5 pps and 4 pps.Material and MethodsA retrospective audit of patients undergoing Permcath and Hickman line insertions was conducted. The patients were grouped by the pulse rate used for the duration of the study; 4 pulses per second (pps) (n = 24) and 7.5 pps (n = 33). A STEP OD-2 monitor and PMMA was used in a simulated environment to estimate the radiation exposure to locations that a Radiologist, Nurse and Radiographer would be standing during the procedures using the average procedure details collected in the retrospective audit. Measurements were conducted at heights to reflect a whole body estimate and an estimate to the lens of the eye.ResultsThe results show that the median dose area product (DAP) for CVAD insertion is 0.7 Gy.cm² and 0.3 Gy.cm² for procedures done at 7.5 pps and 4 pps, respectively. This corresponded to an effective dose of 0.22 mSv and 0.1 mSv. The radiologist, nurse and radiographer were exposed to a whole-body shielded dose of 0.36 μSv, 0.1 μSv and 0.05 μSv when 7.5 pps was utilised and 0.13 μSv, 0.03 μSv and 0.02 μSv when 4 pps was used. The exposure to the head of radiologist, nurse and radiographer was 2.1 μSv, 1.4 μSv, and 0.6 μSv in the 7.5 pps studies and 0.7 μSv, 0.5 μSv, and 0.2 μSv when 4 pps was used.ConclusionThe patient effective dose was estimated to be 0.1-0.22 mSv depending on the fluoroscopic pulse rate utilised during CVAD insertions. Additionally, The radiologist, nurse and radiographer whole body and lens exposure was estimated in a simulated setting. In all cases, there was a statistically significant dose reduction when the lower fluoroscopic pulse rate was used. Thus, where possible, consideration should be given to utilising a lower pulse rate during CVAD insertions to reduce the exposure to both staff and patients.     

A study on radiation doses and irradiated areas in cerebral embolisation

Patient radiation doses during interventional radiology procedures may reach the thresholds for radiation-induced skin and eye lens injuries. This study investigates the irradiated areas and doses received by patients undergoing cerebral embolisation, which is regarded as a high dose interventional radiology procedure. For each procedure the fluoroscopic and digital dose-area product (DAP), the fluoroscopic time, the total number of acquired images and entrance-skin dose (ESD) calculated by the angiographic unit were recorded. The ESD was measured by means of thermoluminescent dosimeters. In this study, the skin, eye and thyroid gland doses and the irradiated area for 30 patients were recorded. The average ESD was found to be 0.77 Gy for the posteroanterior plane and 0.78 Gy for the lateral plane. The average DAP was 48 Gy cm(2) for the posteroanterior plane and 58 Gy cm(2) for the lateral plane. The patient's average right eye dose was 60 mGy and the dose to the thyroid gland was 24 mGy. Seven patients received a dose above 1 Gy, one patient exceeded the threshold for transient erythema and one exceeded the threshold for temporary epilation. A good correlation between the DAP and the ESD for both planes has been found. The doctor's eye dose has also been measured for 17 procedures and the average dose per procedure was 0.13 mGy.     

Effect of Real-Time Radiation Dose Feedback on Pediatric Interventional Radiology Staff Radiation Exposure

PurposeTo measure and compare individual staff radiation dose levels during interventional radiologic (IR) procedures with and without real-time feedback to evaluate whether it has any impact on staff radiation dose.Materials and MethodsA prospective trial was performed in which individuals filling five different staff roles wore radiation dosimeters during all IR procedures during two phases: a 12-week “closed” phase (measurements recorded but display was off, so no feedback was provided) and a 17-week “open” phase (display was on and provided real-time feedback). Radiation dose rates were recorded and compared by Mann–Whitney U test.ResultsThere was no significant difference in median procedure time, fluoroscopy time, or patient dose (dose–area product normalized to fluoroscopy time) between the two phases. Overall, the median staff dose was lower in the open phase (0.56 µSv/min of fluoroscopy time) than in the closed phase (3.01 µSv/min; P < .05). The IR attending physician dose decreased significantly for procedures for which the physicians were close to the patient, but not for ones for which they were far away.ConclusionsA radiation dose monitoring system that provides real-time feedback to the interventional staff can significantly reduce radiation exposure to the primary operator, most likely by increasing staff compliance with use of radiation protection equipment and dose reduction techniques.     

综合性放射防护措施在介入治疗防护中的应用

目的探讨综合性放射防护措施在介入治疗防护中的应用价值。方法在84例介入手术治疗中联合应用床下铅橡胶帘、铅玻璃防护屏、铅防护服、铅围脖、铅眼镜及距离等对介入操作人员进行综合性防护。利用FJ-2000个人剂量仪监测X射线辐射剂量,并对相关数据进行统计分析。结果床下铅橡胶帘防护效率为93.4%;铅玻璃防护屏防护效率为93.5%;铅防护服防护效率为88.4%这些放射防护器材前后X线辐射剂量差异均具有统计学意义(P<0.01)。距球管1 m处X线衰减量为58.6%,距球管3 m处的X线衰减量为86.4%。1 m与2 m之间,2 m与3 m之间的辐射剂量差异均具有统计学意义(P<0.01)。结论综合性防护措施在介入操作中可有效降低X射线辐射、减少对介入操作人员身体危害。     

Radiation Exposure of Patients and Interventional Radiologists during Prostatic Artery Embolization: A Prospective Single-Operator Study

Purpose

To prospectively analyze the radiation exposure of patients and interventional radiologists during prostatic artery embolization (PAE).

Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting

Introduction

Computed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking.

Materials and Methods

Radiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator’s finger skin was measured using thermoluminescent dosimeter rings.

Results

The mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator’s finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA.

Conclusion

Radiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.

     

介入手术中职业人员眼晶状体受照剂量测量方法及剂量水平研究

目的 建立介入手术中职业人员眼晶状体受照剂量测量方法,调查介入职业人员眼晶状体受照剂量,为降低介入职业人员眼晶状体受照剂量提供科学依据。方法 选择热释光剂量计(TLD)和光激发光剂量计(OSLD),以眼晶状体个人剂量当量H_p(3)刻度;选择包括单X射线管和双X射线管在内的5种型号的数字减影血管造影装置(DSA),选择心血管介入、脑血管介入等不同介入手术,开展介入职业人员的眼晶状体剂量水平测量。结果 调查的5种不同介入手术类型职业人员眼晶状体的个人剂量当量H_p(3)之间差别较大,其中冠状动脉造影术剂量最低,脑部支架植入术剂量最高;同一介入手术类型,第一术者剂量最高,第三术者剂量最低;同一术者的左眼剂量明显高于右眼剂量。此外OSLD测量结果明显高于TLD测量结果。结论 建立的个人剂量当量H_p(3)刻度方法可靠,使用TLD和OSLD两种剂量计用于介入职业人员眼晶状体剂量测量可行,TLD和OSLD两种剂量计现场测量结果有差异。     

Radiation Dose of Nurses during IR Procedures: A Controlled Trial Evaluating Operator Alerts before Nursing Tasks

PurposeTo compare radiation exposure of nurses when performing nursing tasks associated with interventional procedures depending on whether or not the nurses called out to the operator before approaching the patient.Materials and MethodsIn a prospective study, 93 interventional radiology procedures were randomly divided into a call group and a no-call group; there were 50 procedures in the call group and 43 procedures in the no-call group. Two monitoring badges were used to calculate effective dose of nurses. In the call group, the nurse first told the operator she was going to approach the patient each time she was about to do so. In the no-call group, the nurse did not say anything to the operator when she was about to approach the patient.ResultsIn all the nursing tasks, the equivalent dose at the umbilical level inside the lead apron was below the detectable limit. The equivalent dose at the sternal level outside the lead apron was 0.16 μSv ± 0.41 per procedure in the call group and 0.51 μSv ± 1.17 per procedure in the no-call group. The effective dose was 0.018 μSv ± 0.04 per procedure in the call group and 0.056 μSv ± 0.129 per procedure in the no-call group. The call group had a significantly lower radiation dose (P = .034).ConclusionsRadiation doses of nurses were lower in the group in which the nurse called to the operator before she approached the patient.     

心血管病介入操作时患者受照剂量研究

目的 对心血管介入手术中患者所受辐射剂量及与辐射剂量相关的指标进行采集和分析,为改善患者的辐射防护提供依据.方法 对在省属三级甲等医院进行的26例完整的心血管介入手术的患者进行临床数据采集,按手术类别分成冠状动脉血管造影术(CA)及行冠状动脉血管造影术(CA)后继续行经皮穿刺腔内冠状动脉成形术(PTCA)两组,采用TLD个人剂量计照射野矩阵测量法,检测患者荧光照射时间、入射皮肤剂量(ESD)、最高皮肤剂量(PSD)、剂量-面积乘积(DAP)等指标,用TLD测量在模拟心血管手术条件下体模器官剂量.结果 荧光透视时间为(17.7±15.6)min,范围为0.80～42.4 min;ESD范围为(159±138)mGy,4.40～459 mGy;PSD范围为(769±705)mGy,22.6～2.43×103mGy.CA+PTCA组的荧光照射时间、ESD、PSD均大于CA组,差异有统计学意义.最大皮肤受照剂量与透视时间有较好的相关性(r=0.84,P＜0.01).结论 心血管病放射性介入操作时,可通过透视时间来估算最大皮肤受照剂量.

Abstract：

Objective To collect and analyze the radiation dose to patients in cardiovascular interventional procedures and the radiation dose-related indicators,in order to provide a basis for improving radiation protection of patients.MethodsThe clinical data of 26 cases of complete cardiovascular interventional procedures was collected in the municipal Grade A Class Three hospitals,including coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA),and the patient-received radiation doses and other related factors was studied.TLD personal dosimeter radiation field matrix method was used to measure fluorescence time,the entrance skin dose (ESD),the peak skin dose (PSD),dosearea product (DAP) and other indicators.TLD was used to measure the organ dose of the phantom under the cardiovascular interventional procedure condition.ResultsThe fluoroscopy time was (17.7 ±15.6) min during the range of 0.80-42.4 min.The average entrance skin dose (ESD) was (159 ± 138)mGy during the range of 4.40-459 mGy.The peak skin dose (PSD) was (769 ± 705) mGy during the range of 22.6 - 2.43 × 103mGy.The fluorescence time,entrance skin dose (ESD) ,peak skin dose (PSD) of the group CA + PTCA are greater than the group CA and the difference has statistical significan.The peak skin dose and the fluoroscopy time have good linear correlation (r = 0.84,P ＜ 0.01 ).Conclusion The peak skin dose the patient received in cardiovascular interventional radiological operation can be estimated through the fluoroscopy time.     

Radiation exposure to cardiologists performing interventional cardiology procedures

Medical doctors, who practice interventional cardiology, receive a noticeable radiation dose. In this study, we measured the radiation dose to 9 cardiologists during 144 procedures (72 coronary angiographies and 70 percutaneus translumined coronary angioplasties) in two Greek hospitals. Absorbed doses were measured with TLD placed underneath and over the lead apron at the thyroid protective collar. Based on these measurements, the effective dose was calculated using the Niklason method. In addition, dose area product (DAP) was registered. The effective doses, E, were normalised to the total DAP measured in each procedure, producing the E/DAP index. The mean effective dose values were found to be in the range of 1.2-2.7 microSv while the mean E/DAP values are in the range of 0.010-0.035 microSv/Gycm2. The dependence of dose to the X-ray equipment, the exposure parameters and the technique of the cardiologist were examined. Taking under consideration the laboratories' annual workload, the maximum annual dose was estimated to be 1.9 and 2.8 mSv in the two hospitals.     

Radiation doses to the legs of radiologists performing interventional procedures: are they a cause for concern?

The purpose of this study was to ascertain the magnitude and distribution of doses to the legs of radiologists when performing interventional procedures. LiF:Mg,Ti TLD100 chips were used to measure simultaneously doses to the lower limbs and, for comparison, the hands during 100 interventional procedures. Results show leg dose was dependent upon type and complexity of procedure, equipment used and whether lead protection was available. Where no lead protection was used, the doses to the lower limbs were frequently similar to or higher than those received by the hands. The mean dose to the legs ranged from 0.19 mSv to 2.61 mSv per procedure, compared with 0.04 mSv to 1.25 mSv to the hands. During transjugular intrahepatic portosystemic shunt and embolisation procedures the leg dose could be as much as 2-3 times greater than that to the hands. When lead protection was used, the dose to the legs was reduced significantly to 0.02 mSv to 0.5 mSv per procedure. A clear linear relationship was shown between the dose-area product (DAP) reading and the dose to the feet of the radiologist. As a "rule of thumb", a DAP reading of 100 Gy cm(2) will give a dose of 1 mSv to the legs, if no lead protection was used, dropping to approximately 0.02 mSv if lead protection was present. This study demonstrates that the dose to the legs of radiologists can be higher than that to the hands when no lead protection is used. The inclusion of a lead screen to protect the legs is an effective method of dose reduction when performing interventional procedures.     

Evaluation of Radiation Exposure of Medical Staff During CT-Guided Interventions

PurposeThe purpose of this prospective study was to investigate absolute radiation exposure values and factors that influence radiation exposure of interventionists during CT-guided interventions (CTGIs). To our knowledge, no data exist regarding the radiation dose to which the interventionist is exposed during these procedures.MethodsAbsolute radiation dose values from a total of 131 CTGIs were analyzed. Radiation dose values were collected by thermoluminescent dosimeters that were positioned above the lead protection being worn, on the forehead, thyroid, chest, gonads, and right and left hand and foot.The radiation doses were analyzed with respect to the experience level of the person performing the procedure, the degree of difficulty measured on a 4-point Likert scale, the lesion size measured on a 3-point Likert scale, and the CT system used.ResultsMedian whole-body dose was 12 μSv. With the exception of the forehead, all whole-body radiation doses were statistically significantly lower in CTGIs performed using the modern dual-source CT system compared with the 16-slice multi-detector CT. For CTGIs rated as more complex, the radiation exposure of the radiologist performing the procedure was statistically significantly higher, with the exception of the left hand. A statistically significantly lower median whole-body dose was measured for inexperienced compared with experienced radiologists. However, a few dose measurements of more than 1 mSv were found at the right hand.ConclusionsRadiation exposure measured during CTGIs is low (<50 μSv). Because the radiation dose was higher in more-complex interventions and for 16-slice multi-detector row CT, inexperienced radiologists should focus on less-complex procedures.     

Radiation exposure of operator performing interventional procedures using a flat panel angiography system: evaluation with photoluminescence glass dosimeters

Purpose  

Using glass rod dosimeters we investigated the radiation dose to the operator performing interventional procedures in 43 patients with the aid of a monoplane flat detector-based angiography system.     

Substantial CT radiation dose reduction does not affect the preference for CT over direct digital radiography to diagnose isolated zygomatic fractures – A study in human cadavers

IntroductionZygomatic fractures can be diagnosed with either computed tomography (CT) or direct digital radiography (DR). The aim of the present study was to assess the effect of CT dose reduction on the preference for facial CT versus DR for accurate diagnosis of isolated zygomatic fractures.Materials and methodsEight zygomatic fractures were inflicted on four human cadavers with a free fall impactor technique. The cadavers were scanned using eight CT protocols, which were identical except for a systematic decrease in radiation dose per protocol, and one DR protocol. Single axial CT images were displayed alongside a DR image of the same fracture creating a total of 64 dual images for comparison. A total of 54 observers, including radiologists, radiographers and oral and maxillofacial surgeons, made a forced choice for either CT or DR.ResultsForty out of 54 observers (74%) preferred CT over DR (all with P < 0.05). Preference for CT was maintained even when radiation dose reduced from 147.4 μSv to 46.4 μSv (DR dose was 6.9 μSv). Only a single out of all raters preferred DR (P = 0.0003). The remaining 13 observers had no significant preference.ConclusionThis study demonstrates that preference for axial CT over DR is not affected by substantial (∼70%) CT dose reduction for the assessment of zygomatico-orbital fractures.     

Variations of Patient Doses in Interventional Examinations at Different Angiographic Units

Purpose We analyzed doses for various angiographic procedures using different X-ray systems in order to assess dose variations. Methods Dose-area product (DAP), skin doses from thermoluminescent dosimeters and air kerma measurements of 308 patients (239 diagnostic and 69 interventional) were assessed for five different angiographic units. All fluoroscopic and radiographic exposure parameters were recorded online for single and multiprojection studies. Radiation outputs of each X-ray system were also measured for all the modes of exposure using standard protocols for such measurements. Results In general, the complexity of the angiographic procedure was found to be the most important reason for high radiation doses. Skill of the radiologist, management of the exposure parameters and calibration of the system are the other factors to be considered. Lateral cerebral interventional studies carry the highest risk for deterministic effects on the lens of the eye. Effective doses were calculated from DAP measurements and maximum fatal cancer risk factors were found for carotid studies. Conclusions Interventional radiologists should measure patient doses for their examinations. If there is a lack of necessary instrumentation for this purpose, then published dose reports should be used in order to predict the dose levels from some of the exposure parameters. Patient dose information should include not only the measured quantity but also the measured radiation output of the X-ray unit and exposure parameters used during radiographic and fluoroscopic exposures.     

Radiation dose reduction in direct digital panoramic radiography

Objectives

(a) To measure the absorbed radiation doses at 16 anatomical sites of a Rando phantom and (b) to calculate the effective doses including and excluding the salivary gland doses in panoramic radiography using a conventional and a digital panoramic device.

Study design

Thermoluminescent dosimeters (TLD-100) were placed at 16 sites in a Rando phantom, using a conventional, Planmeca Promax and a digital, Planmeca PM2002CC Proline 2000 (Planmeca Oy, 00880 Helsinki, Finland) panoramic device for panoramic radiography. During conventional radiography the selected exposure settings were 66 kVp, 6 mA and 16 s, while during digital radiography two combinations were selected 60 kVp, 4 mA, 18 s and 66 kVp, 8 mA, 18 s with and without image processing function. The dosimeters were annealed in a PTW-TLDO Harshaw oven. TLD energy response was studied using RQN beam narrow series at GAEC's Secondary Standard Calibration Laboratory. The reader used was a Harshaw, 4500. Effective dose was estimated according to ICRP₆₀ report (E_ICRP60). An additional estimation of the effective dose was accomplished including the doses of the salivary glands (E_SAL). A Wilcoxon signed ranks test was used for statistical analysis.

Results

The effective dose, according to ICRP report (E_ICRP60) in conventional panoramic radiography was 17 μSv and E_SAL was 26 μSv. The respective values in digital panoramic radiography were E_ICRP60 = 23 μSv and E_SAL = 38 μSv; while using the lowest possible radiographic settings E_ICRP60 was 8 μSv and E_SAL was 12 μSv.

Conclusions

The effective dose reduction in digital panoramic radiography can be achieved, if the lowest possible radiographic settings are used.     

Optimizing Staff Dose in Fluoroscopy-Guided Interventions by Comparing Clinical Data with Phantom Experiments

PurposeTo evaluate conditions for minimizing staff dose in interventional radiology, and to provide an achievable level for radiation exposure reduction.Materials and MethodsComprehensive phantom experiments were performed in an angiography suite to evaluate the effects of several parameters on operator dose, such as patient body part, radiation shielding, x-ray tube angulation, and acquisition type. Phantom data were compared with operator dose data from clinical procedures (n = 281), which were prospectively acquired with the use of electronic real-time personal dosimeters (PDMs) combined with an automatic dose-tracking system (DoseWise Portal; Philips, Best, The Netherlands). A reference PDM was installed on the C-arm to measure scattered radiation. Operator exposure was calculated relative to this scatter dose.ResultsIn phantom experiments and clinical procedures, median operator dose relative to the dose-area product (DAP) was reduced by 81% and 79% in cerebral procedures and abdominal procedures, respectively. The use of radiation shielding decreased operator exposure up to 97% in phantom experiments; however, operator dose data show that this reduction was not fully achieved in clinical practice. Both phantom experiments and clinical procedures showed that the largest contribution to relative operator dose originated from left-anterior-oblique C-arm angulations (59%–75% of clinical operator exposure). Of the various x-ray acquisition types used, fluoroscopy was the main contributor to procedural DAP (49%) and operator dose in clinical procedures (82%).ConclusionsAchievable levels for radiation exposure reduction were determined and compared with real-life clinical practice. This generated evidence-based advice on the conditions required for optimal radiation safety.     

Patient radiation doses and references levels in interventional radiology

PURPOSE: To set Diagnostic Reference Levels (DRLs) in interventional radiology by means of dose area product (DAP) measurements and the grouping of homogeneous procedures, and to quantify the associated errors in the DRL estimates. To evaluate the Mean Effective Doses per single procedure. MATERIALS AND METHODS: Interventional radiology procedures were divided into four main groups: neuroradiological, vascular, extravascular and paediatric. Neuroradiological and vascular procedures were further divided into diagnostic and interventional procedures. Starting from DAP and total fluoroscopy time measurements in 1,256 patients, the DRLs were determined for 17 procedures, together with an estimate of their uncertainty. The correlation between fluoroscopy time and DAP was assessed. Mean effective dose estimates were obtained from measured DAP values and from the analysis of the dosimetric data reported in the literature for similar procedures. RESULTS: The main features of DAP distributions are long high-dose tails, indicating asymmetric distributions, together with a large interquartile range. Rounded third-quartile values of DAP distributions showed a large range in the procedures taken into consideration. Values of 147, 198, 338 Gy cm(2)were obtained for supra-aortic angiography, cerebral angiography and embolization. Values of 86-101 and 459-438 Gy cm(2)were obtained for diagnostic and interventional vascular procedures on the lower limbs and on the abdomen, respectively. Values of 25-33 Gy cm(2)were obtained for retrograde cystourethrographies and ERCP, and values of 62-158 Gy cm(2)were obtained for nephrostomy and percutaneous transhepatic cholangiography. The correlation between total fluoroscopy time and the DAP values was poor. Mean effective dose estimates showed lower values for extravascular procedures (4.8-28.2 mSv), intermediate values for neuroradiological procedures (12.6-32.9 mSv) and higher values for vascular procedures involving the abdomen (36.5-86.8 mSv). DISCUSSION: DAP values were generally higher in vascular than in extravascular procedures. In generally, interventional vascular procedures show higher DAP values than the corresponding diagnostic procedures, with the exception of the abdominal region where the values were similar. Extravascular procedures with percutaneous access show significantly higher DAP values than those with endoscopic access. Total fluoroscopy time is a poor predictor of patient doses in interventional radiology. CONCLUSIONS: The systematic recording of DAP values, together with adequate grouping of similar procedures makes it possible to establish stable DRLs on a local basis and to carry out dosimetric evaluations, although on a statistical rather than individual basis. Patient radiation doses during interventional radiological procedures may be high, particularly when the abdominal region is involved.     

Radiation-Shielding Devices: The Best Combination for Spine Interventional Procedures

PurposeAlthough many studies have examined the efficiency of various protective devices for reducing the dose of radiation exposure to physicians during interventional pain procedures, no study has compared the protective effect of these devices when they are used in combination. The purpose of this prospective experimental study was to determine the best combination of radiation-shielding devices.Materials and MethodsUsing anthropomorphic phantoms of a physician and patient, we measured the radiation protection efficiency (RPE) of each of the following protection methods and in combination during C-arm–guided simulated lumbar epidural injection: (a) personal protective equipment (PPE), (b) bedside curtain shield (Curtain), (c) x-ray tube filter (Filter), and (d) fluoroscopic collimation method (Collimation). We measured exposure doses using personal electronic dosimeters at the eye, thyroid, and gonad levels for 1 minute. Each experiment was repeated 15 times.ResultsThe radiation exposure dose and RPE with the best single-, double-, and triple-protection methods were as follows: PPE for the single-protection method (11.82 μSv/min, 80.04%), PPE + Collimation for the double-combination method (4.68 μSv/min, 92.09%), and PPE + Collimation + Curtain for the triple-combination method (3.08 μSv/min, 93.39%). Additionally, PPE + Collimation + Curtain + Filter for the quadruple-combination method resulted in a radiation exposure and RPE of 2.91 μSv/min and 93.61%, respectively, compared with nonprotection.ConclusionsThe best single-, double-, and triple-protection method was PPE, PPE + Collimation, and PPE + Collimation + Curtain, respectively. While preparing protective equipment, we recommend prioritizing equipment in this order.