To improve radiation safety awareness, our interventional radiology center is planning to organize systematic patient follow up in case of elevated peak skin dose (PSD) after interventional angiography. The aim of this study was to help prepare this action by estimating the workload this would have created last year and the severity of the lesions.According to the NCRP168, a first trigger warning for PSD and Dose Area product (DAP) should be given at 2Gy and 300Gy.cm², respectively. Furthermore, a PSD of 3Gy and a DAP...

This study examined all interventional radiology procedures performed last year (November 2017-October 2018) on a Philips Allura Clarity system in our university hospital. The DAP, air kerma at the reference point(Ka,r) and PSD were collected using the dose management platform DOSE (Qaelum, Belgium). This platform estimates PSD from geometric information (table position, tube orientation, patient size) and the Ka,r( Fig. 1). These calculations and the patient dose maps have been validated in previous studies using ionization chambers and Gafchromic film measurements. All cases with PSD...

Over a period of 12 months, 33 of a total of 1414 cases had a PSD above 2Gy, of which 11 cases were above 3Gy. The maximal PSD was 6.3 Gy.Also, 67 cases had a DAP above 300 Gy.cm² of which 17 were above 500 Gy.cm². These cases had a wide range of pathologies and treatments, meaning it is not simple to predict high PSD based on the type of procedure alone. Some examples of procedures were: Pre-SIRS, embolization epigastrica inferior, relining TIPPS, stent AMS,...

The use of Peak Skin Dose mapping software allows much better selection of cases for which follow up should be organized. Rather than including 17 cases with DAP value above 500 Gy.cm², 11 of 1414 cases with PSD above 3Gy would have been selected with the dose monitoring platform. When this kind of software is not available, Ka,r gives a better indication of the PSD than DAP. Patients who underwent procedures with a high number of lateral views and with small areas of irradiation are...

Michiel Dehairs is a PhD student in medical physics in radiology at the KU Leuven. His field of research is interventional radiology and cardiology and more particular how the choice of X-ray factors influences the overall system efficiency. He is involved in the Horizon2020 P3 Stroke project, where he is working on radiation protection, X-ray image quality and system optimization for the Angio-MR system.

NCRP Report No. 168. Radiation Dose Management for Fluoroscopically-guided Interventional Medical guided Interventional Medical Procedures. Bethesda, MD: National Council on Radiation Protecti Procedures. Bethesda, MD: National Council on Radiation Protection and Measurements, 2011. on and Measurements, 2011. Struelens L. et al. Establishment of trigger levels to steer the follow-up of radiation effects inpatients undergoing fluoroscopically-guided interventional procedures in Belgium.Phys Med.2014 Dec;30(8):934-40. QAELUM NV, Science Park Arenberg, Gaston Geenslaan 9, B-3001 Leuven – Heverlee, Belgium: https://qaelum.com (QAELUM)