Keywords:
Neuroradiology brain, Radioprotection / Radiation dose, Fluoroscopy, Radiation safety, Quality assurance
Authors:
R. M. Sanchez, E. Vano, J. M. Fernández Soto, L. Lopez-Ibor, M. M. Moreu, S. Rosati; Madrid/ES
DOI:
10.26044/ecr2019/C-2342
Aims and objectives
High fluoroscopy doses may be delivered to patients’ skin during neuro-interventional procedures.
Depending on patient radio-sensitivity,
radiation doses between 2-5 Gy at the skin may produce transient erythema,
doses between 5 and 10 Gy can result in permanent erythema and/or epilation,
and doses between 10-15 Gy may produce dermal atrophy and telangiectasia.
With doses greater than 15 Gy,
surgical interventions are likely to be required to treat the skin [1,2].
Some therapeutic neuro-interventional procedures may require several interventions in the same patient at intervals of days or weeks,
with peak skin doses (PSD) of several Gy.
The clinical indications for such procedures are well-established,
and interventionalists have the duty of managing the patient radiation dose and apply the optimisation criteria.
As regards the management of patient skin dose,
the European and North American societies for interventional radiology recommend [3]: 1) to include in the medical record the peak skin dose (PSD) and 2) to programme a clinical follow-up to investigate the possible skin lesions when the peak skin dose is greater than 3 Gy.
The peak skin dose is difficult to estimate,
even in modern interventional radiology units and that is an important factor to be considered.
Different subrogates are usually used such as the kerma area product (KAP),
the kerma at the patient entrance reference point (KPERP) or the fluoroscopy time.
But these indicators are not directly related to the peak skin dose and in some cases do not give an acceptable approach [4].
Several prototypes have been proposed to estimate the peak skin dose from interventional procedures [5-7]: some of them,
commercially available,
give the peak skin dose on a reference plane or standard phantom [8-10],
and others,
the dose map in real time in an anthropomorphic model [11].
In addition,
in order to help optimize the future interventional procedures,
it is important to estimate the skin dose received by patients who have undergone two or more interventions within a few weeks,
that is not only the cumulative peak skin dose,
but also the skin dose distribution.
This work presents a methodology and preliminary results to improve the radiation management for complex interventional cerebral procedures requiring repetitions in the same patient.
The system permits the estimation of the peak skin dose and the skin dose distribution in patients treated with several neuro-interventional procedures.