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

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Real-Time Patient and Staff Radiation Dose Monitoring in IR Practice Cardiovasc Intervent Radiol DOI 10.1007/s00270-016-1526-8 CLINICAL INVESTIGATION Real-Time Patient and Staff Radiation Dose Monitoring in IR Practice 1,2 1 1 1 Anna M. Sailer • Leonie Paulis • Laura Vergoossen • Axel O. Kovac • 1 3,4 3 Geert Wijnhoven • Geert Willem H. Schurink • Barend Mees • 1,4 1,4 1 1 Marco Das • Joachim E. Wildberger • Michiel W. de Haan • Ce´cile R. L. P. N. Jeukens Received: 7 September 2016 / Accepted: 1 December 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com Abstract caval venous recanalization procedures (n = 68), Purpose Knowledge of medical radiation exposure permits endovascular aortic repair procedures (n = 63), biliary application of radiation protection principles. In our center, duct interventions (n = 58), and percutaneous gastrostomy the first dedicated real-time, automated patient and staff procedure (n = 28). dose monitoring system (DoseWise Portal, Philips Results Median (±IQR) DAP doses ranged from 2.0 Healthcare) was installed. Aim of this study was to obtain (0.8–3.1) (percutaneous gastrostomy) to 84 (53–147) insight in the procedural and occupational doses. Gy cm2 (aortic repair procedures). Median (±IQR) first Materials and Methods All interventional radiologists, operator doses ranged from 1.6 (1.1–5.0) lSv to 33.4 vascular surgeons, and technicians wore personal dose (12.1–125.0) for these procedures, respectively. The rela- meters (PDMs, DoseAware, Philips Healthcare). The dose tive exposure, determined as first operator dose normalized monitoring system simultaneously registered for each to procedural DAP, ranged from 1.9 in biliary interventions procedure dose-related data as the dose area product (DAP) to 0.1 lSv/Gy cm2 in cerebral interventions, indicating and effective staff dose (E) from PDMs. Use and type of large variation in staff dose per unit DAP among the pro- shielding were recorded separately. All procedures were cedure types. analyzed according to procedure type; these included Conclusion Real-time dose monitoring was able to iden- among others cerebral interventions (n = 112), iliac and/or tify the types of interventions with either an absolute or & Anna M. Sailer Michiel W. de Haan [email protected] [email protected] Leonie Paulis Ce´cile R. L. P. N. Jeukens [email protected] [email protected] Axel O. Kovac 1 Department of Radiology, Maastricht University Medical [email protected] Centre, P. Debyelaan 25, 6229 HX Maastricht, The Geert Wijnhoven Netherlands [email protected] 2 Department of Radiology, Stanford University Medical Geert Willem H. Schurink Centre, 300 Pasteur Drive, R354, Stanford, CA 94303, USA [email protected] 3 Department of Vascular Surgery, Maastricht University Barend Mees Medical Centre, Debyelaan 25, 6229 HX Maastricht, The [email protected] Netherlands Marco Das 4 CARIM School of Cardiovascular Diseases, Maastricht [email protected] University Medical Centre, 6229 HX Maastricht, The Netherlands Joachim E. Wildberger [email protected] 123 A. M. Sailer et al.: Real-Time Patient and Staff Radiation Dose Monitoring in IR Practice relatively high staff dose, and may allow for specific Materials and Methods optimization of radiation protection. A dedicated real-time dose monitoring system (DoseWise Keywords Endovascular procedures Á Radiation Portal, Philips Healthcare, Best, the Netherlands) was exposure Á Radiation dosimetry Á Patient dose Á installed in our angio-suite and hybrid operating room Radiation monitoring Á Interventional radiology Á (Allura Xper with ClarityIQ, Philips Healthcare, Best, the Radiation protection Netherlands). This system automatically and simultane- ously registered patient and staff dose for each procedure by combining (1) radiation dose structured reports from the Introduction X-ray system that contained all the system performance data such as the dose area product (DAP) and acquisition The number and complexity of vascular and non-vascular type (fluoroscopy, DSA, roadmap, or 3D imaging) with (2) fluoroscopy-guided interventions continuously increased real-time personal dose meters (PDM, DoseAware, Philips and have led to an increased radiation exposure for inter- Healthcare, Best, the Netherlands) worn by all the staff ventional radiologists, surgeons, and supporting medical members. staff members [1–4]. Radiation safety in fluoroscopy-gui- Each medical staff member (physicians and radiology ded interventions is crucial for patient care quality assur- technicians) was equipped with a PDM attached to the left ance as well as for occupational safety. Occupational breast pocket outside their protective lead apron. The radiation exposure results predominantly from scattered PDMs were calibrated to measure the personal dose radiation originating from the patient toward the medical equivalent Hp(10) [Sv], which served as an estimator for staff [5]. Levels of procedural radiation exposure are the effective dose, E [Sv] [11]. For reference, a PDM was affected by multiple factors and many are beyond operator mounted on the C-arm at an angle of 45°, under the control, e.g., the type and complexity of the performed table when the C-arm was in posterior–anterior position. procedure or the dimensions of the patient within the X-ray This reference PDM recorded the scattered dose at a fixed field of view. Other factors can be at least partially con- distance from the iso-center without any additional trolled, such as the position of the medical staff relative to shielding [2]. Use and type of additional in-room radiation the patient, the X-ray equipment and acquisition technique shielding as well as the presence and role of the staff (fluoroscopy, digital subtraction angiography (DSA), members during each procedure were recorded. To analyze roadmap, or 3D), and the radiation protection tools used. staff and patient exposure on both procedural and single Detailed knowledge of the radiation exposure during X-ray event level, an in-house software program was specific fluoroscopy-guided procedures, thereby optimizing written (Mathematica Version 10.2, Wolfram Research the layout of the angio-suites, should be an integral part of Inc., Champaign, IL). This software performed a co-reg- the development of X-ray systems and interventional istration of the radiation doses for the patient (reported as techniques in order to reduce exposure for both staff and DAP), first operator (FO), and first radiology technician patients [6]. (FT), with influencing factors such as procedure type, Several studies have evaluated either the patient or acquisition techniques, and use of radiation shielding tools. occupational radiation exposure during fluoroscopy-guided In this prospective study, all procedures performed in interventions, such as endovascular aortic repair (EVAR) our angio-suite and hybrid operating room between Octo- procedures and cardiologic interventions [7–10]. However, ber 2015 and June 2016 were consecutively included. studies presenting comprehensive data on the combined Procedures were grouped by procedure type, which was patient and staff dose are lacking due to the absence of dose based on both treated body part and position of the first monitoring systems that can efficiently and accurately co- operator. The ten most performed procedure types were register patient and staff dose. Given the need of compre- analyzed and included in the results of the current study hensive dose analysis in interventional radiology practice, (n = 587). The study pool consisted of a total of 112 the aim of the current study was to implement a compre- cerebral procedures, 82 visceral and renal artery interven- hensive procedural and occupational real-time dose moni- tions, 68 iliac and/or central venous chronic obstruction toring system to obtain insight in the procedural and recanalization procedures, 63 EVAR procedures, 62 AV occupational dose for a wide variety of procedures. This fistula procedures, 58 biliary interventions, 54 pelvic arte- might provide valuable and detailed insights in differences rial interventions, 32 percutaneous nephrostomy proce- in radiation exposure between patients and staff in various dures, 28 superficial femoral and/or crural artery types of procedures, based on which suggestions can be interventions, and 28 percutaneous gastrostomy procedures made to improve working habits and radiation safety. (Table 1). Fluoroscopy X-ray was used in low-dose mode 123 A. M. Sailer et al.: Real-Time Patient and Staff Radiation Dose Monitoring in IR Practice Table 1 Distribution of procedural DAP and medical staff doses for different groups of interventions Cerebral AV fistula Percutaneous Biliary Visceral and renal Endovascular Percutaneous Iliac artery Venous Femoral and crural interventions interventions gastrostomy interventions a. interventions aortic repair nephrostomy interventions recanalization a. interventions DAP (Gycm2) Median 29.8 3.5 2.0 8.7 79.9 84.2 5.0 31.9 47.6 13.2 25% Quartile 17.6 2.0 0.8 3.4 40.4 52.5 1.5 19.2 16.9 6.6 75% Quartile 44.5 5.5 3.1 16.9 145.3 147.0 8.3 59.9 97.3 20.7 Min 5.2 0.2 0.4 0.3 0.9 16.8 0.3 4.1 1.1 0.7 Max 211.5 25.5 12.4 69.0 365.2 931.9 211.5 289.4 399.4 52.4 n 112 62 28 58 82 63 32 54 68 28 FO dose (lSv) Median 3.2 1.9 1.6 13.7 29.9 33.4 3.1 19.7 17.4 12.8 25% Quartile 0.8 0.9 1.1 3.0 10.8 12.1 0.6 6.1 5.0 3.7 75% Quartile 12.2 5.4 5.0 43.0 91.2 125.0 12.0 45.4 33.7 30.1 Min \0.1 \0.1 \0.1 \0.1 0.7 1.2 \0.1 0.2 \0.1 \0.1 Max 55.3 64.4 47.4 118.0 603.9 614.0 38.0 274.1 172.9 45.8 n 71 48 21 47 69 60 19 45 52 16 FT dose (lSv) Median 1.4 1.8 1.4 2.8 4.4 3.5 1.6 2.9 2.6 1.3 25% Quartile 0.6 0.4 0.3 0.7 1.2 0.9 0.4 0.8 1.4 0.4 75% Quartile 3.6 4.1 4.4 6.9 7.8 11.4 5.5 6.0 8.3 3.0 Min \0.1 0.1 \0.1 \0.1 \0.1 \0.1 \0.1 \0.1 \0.1 \0.1 Max 75.8 19.4 11.1 51.2 136.7 547.0 11.7 32.3 124.6 75.3 n 82 49 22 39 63 50 17 45 51 20 a Arterial, SD standard deviation, FO first operator, FT first technician 123 A.
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