Alerts to improve occupational protection during Interventional Radiology. More attention is needed for simple but frequent procedures.

Occupational protection could be improved in interventional radiology. The monthly personal dosimetry cannot alert on some occupational doses with anomalous values for certain procedures. Active electronic personal dosimeters linked wireless to a dose management system (DMS), allow for the measurement of occupational doses per procedure, integrating this information with patient dose indicators and with technical and geometrical conditions of the procedures. We analysed around 3100 occupational dose values for individual procedures collected during the last two years, in an interventional radiology laboratory of a University Hospital and two groups, with patient doses higher than 100 Gy.cm2, and lower than 30 Gy.cm2. An unshielded reference dosimeter located at the C-arm registers the ambient dose equivalent (ADE) per procedure to be compared with the personal dose equivalent (PDE) over the apron. The ratio between both values PDE/ADE is a good indication of occupational protection. Alerts for occupational protection optimisation are suggested. For the full sample, 8.4 % of occupational doses measured over the protective apron of the interventionists were higher than 100 µSv and 3.8 % higher than 200 µSv per procedure. Occupational protection for complex procedures (>100 Gy.cm2) had median values of 46 µSv for PDE and 3.3 % for PDE/ADE. However, for simple procedures, (<30 Gy.cm2) the median values were 10 µSv and 28.4 %. This last percentage is 9 times higher than the value for complex procedures. This lack of protection should be corrected and the need to reduce some occupational doses reinforced in radiation protection training programmes for interventionists.

Occupational and patient doses for interventional radiology integrated into a dose management system.

OBJECTIVES: The International Commission on Radiological Protection recommends managing patient and occupational doses as an integrated approach, for the optimisation of interventional procedures. The conventional passive personal dosimeters only allow one to know the accumulated occupational doses during a certain period of time. This information is not enough to identify if there is a lack of occupational radiation protection during some procedures. This paper describes the use of a dose management system (DMS) allowing patient and occupational doses for individual procedures to be audited. METHODS: The DMS manages patient and occupational doses measured by electronic personal dosimeters. One dosemeter located at the C-arm is used as a reference for scatter radiation. Data have been collected from five interventional rooms. Dosimetry data can be managed for the whole procedure and the different radiation events. Optimisation is done through auditing different sets of parameters for individual procedures: patient dose indicators, occupational dose values, the ratio between occupational doses, and the doses measured by the reference dosemeter at the C-arm, and the ratio between occupational and patient dose values. RESULTS: The managed data correspond to the year 2021, with around 4500 procedures, and 8000 records on occupational exposures. Patient and staff dose data (for 11 cardiologists, 7 radiologists and 8 nurses) were available for 3043 procedures. The DMS allows alerts for patient dose indicators and occupational exposures to be set. CONCLUSIONS: The main advantage of this integrated approach is the capacity to improve radiation safety for patients and workers together, auditing alerts for individual procedures. ADVANCES IN KNOWLEDGE: The management of patient and occupational doses together (measured with electronic personal dosimeters) for individual interventional procedures, using dose management systems, allows alerting optimisation on high-dose values for patients and staff.

Dose-reducing fluoroscopic system decreases patient but not occupational radiation exposure in chronic total occlusion intervention.

AIMS: Several novel low-dose fluoroscopic systems (LDS) developed recently, but real practice information of the net benefit for the patient and professionals is scarce. We evaluated separately patient and operator radiation exposure during percutaneous interventions of chronic total occlusions (CTO). METHODS: A total of 116 consecutive CTOs were analyzed (60 in LDS and 56 in standard-dose fluoroscopic system [SDS]). Digital dosimetry of patient and occupational (operator and scatter dose) exposure was prospectively recorded. RESULTS: Biometrics, demographics, CTO variables, and operators were distributed evenly. Patient radiation exposure was effectively decreased in LDS (dose area product [DAP] by 36%, Air Kerma [AK] by 47%). However, occupational data showed no statistical differences between LDS and SDS. The LDS uses less radiation amount but with higher energy (due to additional filtration) compared to SDS, therefore increasing the scatter dose. When comparing the C-arm scatter dose to the DAP we found higher scatter dose with the LDS (0.0139 mSv/gray (Gy)*cm2 vs. 0.0082 mSv/Gy*cm2, p < .001). This was confirmed in a larger dataset comprising 5,221 coronary procedures. CONCLUSIONS: LDS was safer for patients reducing DAP and AK compared to SDS. However, occupational doses were not lower and scatter dose higher. Radiological protection measures must be kept maximized even in LDS.

Contribution of interventional cardiology to the collective dose in Spain.

INTRODUCTION AND OBJECTIVES: To estimate the contribution of interventional cardiology (IC) to the collective dose in Spain. METHODS: Using the information on frequencies of examinations sourced from the Spanish Society of Cardiology and the patient dose values obtained by the national DOCCACI programme. RESULTS: The fraction of the collective dose per million inhabitants derived from IC was 34 man-Sv (a total of 1600 man-Sv in Spain with 46.5 million inhabitants). The contribution of the IC derived from the medical use of x-rays in Spain resulted in 0.66% of the procedures and 4% of the x-ray collective dose. CONCLUSIONS: Even if this collective radiation dose may seem moderate, at an individual level this medical practice delivers the greatest doses and, therefore, optimisation remains of paramount importance.

Experience with patient dosimetry and quality control online for diagnostic and interventional radiology using DICOM services.

OBJECTIVE: This article describes the different automatic approaches used to collect and process patient dose values and other procedural data during diagnostic and interventional radiology and discusses their benefits for clinical practice and quality control online. Approaches for automatic processing of patient dose and other procedural data for computed radiography and for flat-panel detectors extracting information from DICOM headers or via DICOM services are described. The method to perform image retake analysis is also discussed. CONCLUSION: Automatic systems to manage patient doses and procedural data are feasible and will improve radiation safety and quality in radiology. The current level of technology makes such systems achievable at a reasonable cost and with great benefit to clinical practice.