Typical air kerma area product values for trauma orthopaedic surgical procedures.

BACKGROUND: The aim of study was to establish the typical radiation quantity values for the most common trauma orthopaedic surgical procedures and to compare them with reference values of equivalent procedures performed in other institutions. In addition, we assess the impact of image intensifier and flat panel detector technology used for fluoroscopically guidance on patient exposure. MATERIALS AND METHODS: Five most frequently performed fluoroscopically guided trauma orthopaedic procedures in University Medical Centre Ljubljana were analysed. Data on 199 cases over a 6 months period from December 2016 to June 2017 were gathered retrospectively. Study covered 40 dynamic hip screw fixations (DHS), 23 proximal femoral nail insertions (PFN), 20 proximal humeral nail insertions (PHN), 77 partial hip endoprosthesis implantations (PEP) and 39 percutaneous posterior spine fixations (PPS). The median and average along with the first and third quartile values of air kerma area product (KAP) for each procedure type were calculated as well as median and average value of fluoroscopy screening time. RESULTS: Typical KAP value for dynamic hip screw fixation was set at 0.52 Gycm2; for proximal femoral nail insertion at 0.53 Gycm2 and for proximal humeral nail insertion at 0.26 Gycm2. For implantation of partial endoprosthesis typical KAP value utilizing flat panel technology was set at 0.08 Gycm2 and at 0.21 Gycm2 when the image intensifier technology was used. Typical KAP value for percutaneous posterior spine fixation was set at 1.26 Gycm2, using flat panel technology and at 3.98 Gycm2 using image intensifier technology. CONCLUSIONS: Established typical KAP levels of surgical orthopaedic procedures in traumatology will serve as a valuable tool for further radiation exposure optimization.

Harmonisation of imaging dosimetry in clinical practice: practical approaches and guidance 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 the radiological procedures and to include information on patient exposure as part of the report of the examinations. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on "Dosimetry for imaging in clinical practice" with the aim to help with the dosimetry aspects required by European and national regulations. The primary focus topics were selected and a survey among the experts of the WG, allowed suggesting some initial consensus approaches.For information on patient exposure, it was agreed to include the dosimetric values reported by the imaging modalities (validated by a medical physics expert). It was also suggested to prepare educational material on dosimetric quantities for patients. Individual optimisation was considered a challenge, especially for interventional procedures. In these cases, patient and occupational doses should be part of the global optimisation process and trigger levels should be defined to avoid skin radiation injuries. Diagnostic Reference Levels (DRLs) always need to be considered for comparison with periodic patient dose audits. In the case of accidental or unintended exposures, a report should be produced for the Quality Assurance programme, together with an educational note to avoid the repetition of incidents. Dose registry and management systems should allow fulfilling the regulatory requirements of national and European regulations. In a second step, and after the initial experience with the Directive implementation, a wider survey will be considered.

INTERVENTIONAL RADIOLOGICAL PROCEDURES MOST PRONE TO CAUSE HIGH PATIENT PEAK SKIN DOSES BASED ON REVIEW OF 7607 PROCEDURES.

Peak skin doses to patients undergoing interventional radiological procedures in a 3-year period were assessed to identify the most critical procedures and evaluate probability for occurrence of radiation-induced tissue injuries. Data of 7607 patients were reviewed, identifying those with cumulative air kerma at a reference point (Ka,r) exceeding 3 Gy. Observed tissue injuries in patients with exceeded levels were gathered by a questionnaire. Ka,r exceeded 3 Gy in 145 patients, all during vascular procedures; most frequently in preparations for liver radioembolization (SIRT), transjugular intrahepatic portosystemic shunt (TIPS), endovascular abdominal aortic repair (EVAR), adrenal venous sampling (AVS), endovascular thoracic aortic repair (TEVAR) and embolizations in abdominal/pelvic area (30, 21.4, 13.4, 12.6, 9.6 and 3.5% of patients, respectively). A total of 10 patients, extrapolating to ~0.6% of all patients, reported tissue injuries. During interventional radiological procedures threshold for radiation-induces tissue injuries can be exceeded in a significant number of patients (1.9%). Tissue injuries were reported approximately three times less frequently than anticipated; their severity was poorly related to those expected.

Estimated collective effective dose to the population from radiological examinations in Slovenia.

BACKGROUND: The aim of the study was to systematically evaluate population exposure from diagnostic and interventional radiological procedures in Slovenia. METHODS: The study was conducted in scope of the "Dose Datamed 2" project. A standard methodology based on 20 selected radiological procedures was adopted. Frequencies of the procedures were determined via questionnaires that were sent to all providers of radiological procedures while data about patient exposure per procedure were collected from existing databases. Collective effective dose to the population and effective dose per capita were estimated from the collected data (DLP for CT, MGD for mammography and DAP for other procedures) using dose conversion factors. RESULTS: The total collective effective dose to the population from radiological in 2011 was estimated to 1300 manSv and an effective dose per capita to 0.6 mSv of which approximately 2/3 are due to CT procedures. CONCLUSIONS: The first systematic study of population exposure to ionising radiation from radiological procedures in Slovenia was performed. The results show that the exposure in Slovenia is under the European average. It confirmed large contributions of computed tomography and interventional procedures, identifying them as the areas that deserve special attention when it comes to justification and optimisation.