[Multicenter Study on Evaluation of the Entrance Skin Dose by a Direct Measurement Method in Cardiac Interventional Procedures].

Deterministic effects have been reported in cardiac interventional procedures. To prevent radiation skin injuries in percutaneous coronary intervention (PCI), it is necessary to measure accurate patient entrance skin dose (ESD) and maximum skin absorbed dose (MSD). We measured the MSD on 62 patients in four facilities by using the Chest-RADIREC(Ⓡ) system. The correlation between MSD and fluoroscopic time, dose area product (DAP), and cumulative air kerma (AK) showed good results, with the correlation between MSD and AK being the strongest. The regression lines using MSD as an outcome value (y) and AK as predictor variables (x) was y=1.18x (R(2)=0.787). From the linear regression equation, MSD is estimated to be about 1.18 times that of AK in real time. The Japan diagnostic reference levels (DRLs) 2015 for IVR was established by the use of dose rates using acrylic plates (20- cm thick) at the interventional reference point. Preliminary reference levels proposed by International Atomic Energy Agency (IAEA) were provided using DAP. In this study, AK showed good correlation most of all. Hence we think that Japanese DRLs for IVR should reconsider by clinical patients' exposure dose such as AK.

[Estimation of Maximum Entrance Skin Dose during Cerebral Angiography].

Using radio-photoluminescence glass dosimeter, we measured the entrance skin dose (ESD) in 46 cases and analyzed the correlations between maximum ESD and angiographic parameters [total fluoroscopic time (TFT); number of digital subtraction angiography (DSA) frames, air kerma at the interventional reference point (AK), and dose-area product (DAP)] to estimate the maximum ESD in real time. Mean (± standard deviation) maximum ESD, dose of the right lens, and dose of the left lens were 431.2 ± 135.8 mGy, 33.6 ± 15.5 mGy, and 58.5 ± 35.0 mGy, respectively. Correlation coefficients (r) between maximum ESD and TFT, number of DSA frames, AK, and DAP were r=0.379 (P<0.01), r=0.702 (P<0.001), r=0.825 (P<0.001), and r=0.709 (P<0.001), respectively. AK was identified as the most useful parameter for real-time prediction of maximum ESD. This study should contribute to the development of new diagnostic reference levels in our country.

[Study on the development of a patient dosimetry gown for interventional cardiology procedures].

In recent years, dose justification and optimization have been attempted in percutaneous coronary intervention (PCI); however, deterministic effects have been reported. To prevent radiation skin injuries in PCI, it is necessary to measure the patient entrance skin dose (ESD), but an accurate dose measurement method has not yet been established. In this study, we developed a dosimetry gown that can measure the ESD during PCI using multiple radiophotoluminescence dosimeters (RPLDs). The RPLDs were placed into 84 pockets that were sewn into a dosimetry gown. Patients wear the original dosimetry gown during the procedures, after which we obtain accurate ESD measurements. We believe that this method using RPLDs and a newly-designed dosimetry gown provides accurate ESD measurements during PCI. We expect this system to become a standard method for measuring ESD during PCI.

Note: Complementary approach for radiation dosimetry with Ag+-activated phosphate glass.

Silver ion-activated phosphate glass (Ag+-glass) has a good potential for application to radiation dosimetry in various radiation fields due to its multifunctional properties as a detector. The Ag+-glass provides three independent signals of radiophotoluminescence, optical absorption, and nuclear track. The combination of these signals allows the dynamic range of the measured dose (10 µGy-10 kGy) and linear energy transfer (<10 keV/µm and >1 MeV/µm) to be widened.

OPTIMIZATION OF A RADIOPHOTOLUMINESCENT GLASS DOSEMETER FOR OCCUPATIONAL EYE LENS DOSIMETRY IN INTERVENTIONAL RADIOLOGY/CARDIOLOGY.

Hospital based workers that perform interventional radiology are at risk of reaching the eye lens dose limit of 20 mSv/y. These workers are exposed to the radiation scattered by the patient, which creates a complex field, with low radiation energy reaching the eyes of the medical staff from wide angles. Therefore, the dosemeter used in the assessment of the eye lens dose of interventional radiologists needs to respond accurately in such conditions. In this study, the angular response of a commercially available radiophotoluminescent glass dosemeter, GD-352M, was optimized via Monte Carlo simulations, aiming at its use as eye lens dosemeter in interventional radiology. The improved dosemeter was manufactured and then characterized in terms of Hp(3), the quantity recommended for eye lens dosimetry. Its response was compared to the IEC 62387:2012 requirements for Hp(3) and to requirements proposed specifically for eye lens dosemeters used in interventional radiology. The improved dosemeter meets the IEC 62387:2012 requirements for energy and angular response for Hp(3) and also shows good agreement with the more strict requisites proposed for eye lens dosemeters to be used in interventional radiology.

DEVELOPMENT OF THE NEW GLASS BADGE.

The glass dosemeter, which is a component of the glass badge (GB), is used on the basis of radiophotoluminescence phenomenon. Chiyoda Technol Corporation has been providing it for personal monitoring services since the year 2000. Through the experience acquired over 15 y, Chiyoda Technol Corporation has developed the New GB, which was brought into service in Japan for radiation monitoring in January 2014. The New GB was developed with the aim of improving radiation measurement methods, streamlining the provision of GB monitoring services and realising a user-friendly dosemeter. As the result, in this study, the measurable energy range covered for beta rays was expanded to include those emitted from 147Pm, the directional dependency was improved, a film was designed to remove secondary electrons arising from interactions between incident photons and the metallic filters, and the arrangement of the metallic filters was optimised.

Fundamental study on the characteristics of a radiophotoluminescence glass dosemeter with no energy compensation filter for measuring patient entrance doses in cardiac interventional procedures.

Cardiac interventional procedures have been increasing year by year. However, radiation skin injuries have been still reported. There is a necessity to measure the patient entrance skin dose (ESD), but an accurate dose measurement method has not been established. To measure the ESD, a lot of radiophotoluminescence dosemeters (RPLDs) provide an accurate measurement of the direct actual ESD at the points they are arrayed. The purpose of this study was to examine the characteristics of RPLD to measure the ESD. As a result, X-ray permeable RPLD (with no tin filter) did not interfere with the percutaneous coronary intervention procedure. The RPLD also had good fundamental performance characteristics. Although the RPLD had a little energy dependence, it showed excellent dose and dose-rate linearity, and good angular dependence. In conclusion, by calibrating the energy dependence, RPLDs are useful dosemeter to measure the ESD in cardiac intervention.

Direct measurement of a patient's entrance skin dose during pediatric cardiac catheterization.

Children with complex congenital heart diseases often require repeated cardiac catheterization; however, children are more radiosensitive than adults. Therefore, radiation-induced carcinogenesis is an important consideration for children who undergo those procedures. We measured entrance skin doses (ESDs) using radio-photoluminescence dosimeter (RPLD) chips during cardiac catheterization for 15 pediatric patients (median age, 1.92 years; males, n = 9; females, n = 6) with cardiac diseases. Four RPLD chips were placed on the patient's posterior and right side of the chest. Correlations between maximum ESD and dose-area products (DAP), total number of frames, total fluoroscopic time, number of cine runs, cumulative dose at the interventional reference point (IRP), body weight, chest thickness, and height were analyzed. The maximum ESD was 80 ± 59 (mean ± standard deviation) mGy. Maximum ESD closely correlated with both DAP (r = 0.78) and cumulative dose at the IRP (r = 0.82). Maximum ESD for coiling and ballooning tended to be higher than that for ablation, balloon atrial septostomy, and diagnostic procedures. In conclusion, we directly measured ESD using RPLD chips and found that maximum ESD could be estimated in real-time using angiographic parameters, such as DAP and cumulative dose at the IRP. Children requiring repeated catheterizations would be exposed to high radiation levels throughout their lives, although treatment influences radiation dose. Therefore, the radiation dose associated with individual cardiac catheterizations should be analyzed, and the effects of radiation throughout the lives of such patients should be followed.

Background radiation and individual dosimetry in the costal area of Tamil Nadu, India.

South coast of India is known as the high-level background radiation area (HBRA) mainly due to beach sands that contain natural radionuclides as components of the mineral monazite. The rich deposit of monazite is unevenly distributed along the coastal belt of Tamil Nadu and Kerala. An HBRA site that laid in 2×7 m along the sea was found in the beach of Chinnavillai, Tamil Nadu, where the maximum ambient dose equivalent reached as high as 162.7 mSv y(-1). From the sands collected at the HBRA spot, the high-purity germanium semi-conductor detector identified six nuclides of thorium series, four nuclides of uranium series and two nuclides belonging to actinium series. The highest radioactivity observed was 43.7 Bq g(-1) of Th-228. The individual dose of five inhabitants in Chinnavillai, as measured by the radiophotoluminescence glass dosimetry system, demonstrated the average dose of 7.17 mSv y(-1) ranging from 2.79 to 14.17 mSv y(-1).

Direct measurement of patient's entrance skin dose during neurointerventional procedure to avoid further radiation-induced skin injuries.

Although several cases of radiation-induced skin injury (RSI) have been reported in association with neurointerventional procedures such as endovascular embolization for cerebral aneurysm, cerebral arteriovenous malformation, and dural arteriovenous fistula, in most cases the absorbed doses are not measured directly; therefore, we built the first direct measurement system that enables the ideal dosimetry for entrance skin dose (ESD) during neurointerventional procedures to be easily determined. This system was then applied to a 55-year-old man who underwent two transvenous embolizations with a 2-month interval, for a right cavernous sinus dural arteriovenous fistula, to establish the efficacy of precise mapping of ESDs. Throughout the procedures, the patient wore a fitted dosimetry cap that contained 60 radiophotoluminescence glass dosimeter (RPLGD) chips. After the first procedure, temporary epilation occurred in the occipital region. Precise mapping of ESDs revealed that this region was exposed to 4.2Gy. In the first procedure, the X-ray tube was generally positioned straight for an optimal posterior-anterior view; however, in the second procedure we intermittently used the second-best position to prevent further RSI. In this position, the maximum ESD was 1.0Gy in the right posterior-temporal region and the epilation site was exposed to