Radiation dose management systems-requirements and recommendations for users from the ESR EuroSafe Imaging initiative.

The European Directive 2013/59/Euratom requires member states of the European Union to ensure justification and optimisation of radiological procedures and store information on patient exposure for analysis and quality assurance. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on "Dose Management" with the aim to provide European recommendations on the implementation of dose management systems (DMS) in clinical practice. The WG follows Action 4: "Promote dose management systems to establish local, national, and European diagnostic reference levels (DRL)" of the EuroSafe Imaging Call for Action 2018. DMS are designed for medical practitioners, radiographers, medical physics experts (MPE) and other health professionals involved in imaging to support their tasks and duties of radiation protection in accordance with local and national requirements. The WG analysed requirements and critical points when installing a DMS and classified the individual functions at different performance levels. KEY POINTS: • DMS are very helpful software tools for monitoring patient exposure, optimisation, compliance with DRLs and quality assurance. • DMS can help to fulfil dosimetric aspects of the European Directive 2013/59/Euratom. • The EuroSafe WG analyses DMS requirements and gives recommendations for users.

Enhancing transjugular intrahepatic portosystemic shunt puncture by using three-dimensional path planning based on the back projection of two two-dimensional portographs.

The purpose of this study was to prevent transjugular intrahepatic portosystemic shunt (TIPS) puncture failure by using three-dimensional (3D) path planning. This study was approved by the institutional review board; informed consent was obtained for the TIPS procedure. In four patients, a 3D path was planned from two two-dimensional (2D) CO2 portograms obtained at projections of 0 degrees and right anterior oblique 30 degrees . This path was overlaid onto the live fluoroscopy to guide the puncture image. In three of four patients, the target vessel was entered in the first attempt. In one patient with portal vein (PV) stenosis, the PV was entered with the third pass. This method has high potential to improve safety of the procedure and to reduce intervention time.