Congress:
EuroSafe Imaging 2017
Keywords:
Radiation physics, Action 5 - Performance indicators for radiation protection management, Action 3 - Image quality assessment based on clinical indications, Action 2 - Clinical diagnostic reference levels (DRLs), Action 9 - Development of criteria for safe imaging procedures, Action 4 - Quality of radiological equipment, Action 3 - Optimisation, diagnostic reference levels, image quality, CT, Physics, Quality assurance
Authors:
J. Damilakis, M. Brambilla, V. Tsapaki, M. Kortesniemi, A. Torresin
DOI:
10.1594/esi2017/ESI-0003
Description of activity and work performed
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There are data on radiological incidents/accidents in the literature.
A recent review paper provides information on radiation overexposure accidents worldwide (1).
A well known accident occurred in 2009,
when more than 250 patients in the USA received overdoses from brain perfusion CT.
In some patients,
deterministic effects (skin injuries and hair loss) were observed after the exposure.
However,
there are also radiation incidents where radiation doses are not high enough to produce deterministic effects.
In these cases,
the problem may go undetected.
The possibility of pregnancy should always be evaluated before an X-ray diagnostic or interventional procedure.
Accidental irradiation of pregnant patients during the first post-conception weeks leads to unnecessary termination of pregnancies.
To avoid these radiation accidents,
proper pregnancy screening is needed.
Referring physicians must check a box on the examination request form if the patient is pregnant.
For abdominal procedures,
thorough investigation of the reproductive status of young female patients is needed.
It is very important to have pregnancy warning posters at the reception areas and patient waiting rooms
In fluoroscopically-guided interventional procedures with very long screening time,
there is a possibility of cell killing sufficient to result in radiation-induced injuries in certain tissues of patients.
Procedures typically involving extended fluoroscopic time include vascular embolization,
stent and filter placement,
thrombolytic and fibrinolytic procedures,
percutaneous transhepatic cholangiography,
percutaneous nephrostomy,
biliary drainage,
percutaneous transluminal angioplasty and urinary/biliary stone removal.
Interventional radiologists performing these procedures should be aware of the potential for injuries during these procedures.
To avoid radiation overexposure accidents in interventional suites,
interventional radiologists in cooperation with medical physicists should establish standard clinical protocols for each specific type of procedure performed.
Cumulative absorbed dose to the skin should be limited to the minimum necessary for the clinical task.
Medical physicists should perform detailed dose measurements to derive dose rates for each mode of operation used in each interventional system.
Dose information should be included in the patient's record to allow estimation of the absorbed dose to the skin in case of skin injury.
It is important to note that radiation-induced lesions from fluoroscopically interventional procedures are not immediately visible because the radiation effects may appear several days,
weeks or months following the exposure.
Thus,
patients sometimes are undiagnosed or misdiagnosed.
For this reason,
interventional radiologists should advise patients to provide information about their history of fluoroscopy exposure to the physician if they notice skin injuries.