Optimising patient dose in transarterial radioembolisation

Congress:

EuroSafe Imaging 2017

Poster Number:

ESI-0020

Type:

EuroSafe Imaging

Keywords:

Interventional non-vascular, Action 8 - Radiation protection training and learning material, Action 2 - Clinical diagnostic reference levels (DRLs), Action 6 - Clinical audit tool for imaging, Action 6 - Education and training in medical radiation protection, Action 3 - Optimisation, diagnostic reference levels, image quality, Action 2 - Clinical audit, Fluoroscopy, Embolisation, Dosimetric comparison

Authors:

P. Hughes, M. Rowan, L. O'Hora, L. Lawler

DOI:

10.1594/esi2017/ESI-0020

DOI-Link:

https://dx.doi.org/10.1594/esi2017/ESI-0020

Fig. 1: Table 1: Combined mean cumulative dose for planning and treatment procedures.

Fig. 2: Table 2: Dose analysis of the relative contribution of DSA acquisitions and CT...

Fig. 3: Graph 1: Overall there was a downward trend in Pka.

Fig. 4: Graph 2: Overall there was a downward trend in Kar.

Background/Introduction

As the number and scope of procedures carried out by interventional radiologists expands year on year, so too does the complexity of these procedures. Increasing complexity in turn results in prolonged procedure and fluoroscopy time and inevitably leads to concern with regard to patient skin dose. Most modern interventional suites will provide visual dose estimate feedback to the operator through kerma–area product (Pka) and/or cumulative air kerma at interventional reference point (Kar). While these parameters provide a reasonable approximation of the mean skin dose (MSD),...

Description of activity and work performed

The focus of our review was cumulative patient skin dose during SIRT procedures. The NCRP recommend a threshold dose of 5Gy for any fluoroscopic procedure, above which clinical follow up should be triggered to assess for radiation dermatitis. Therefore we aimed to establish if patients undergoing SIRT in our institution were at risk for reaching this threshold dose. We retrospectively collated the Pka and Kar for the first 21 patients to undergo SIRT in our institution and calculated the cumulative dose across both planning and...

Conclusion and Recommendations

SIRT is a complex two stage procedure with the potential for high Pka and Kar doses to patients. In our cohort, the planning stage was associated with a significantly higher contribution to the cumulative dose secondary to an increased number of DSA acquisitions and CT rotations. Operators should be cognisant of the need to keep these acquisitions to the minimum required, allowing for interpatient variability and the individual complexity of each case. As with any prolonged fluoroscopic procedure, alternating the angle of the incident X-ray...

Personal/Organisational information

Department of Radiology, Mater Misericordiae University Hospital, Eccles St. Dublin 7, Ireland.

References

NCRP Report No. 168. Radiation dose management for fluoroscopically-guided interventional medical procedures: National Council on Radiation Protection and Measurements; 2010. NCRP. Report No. 160. Ionizing Radiation Exposure of the Population of the United States: National Council on Radiation Protection and Measurements; 2009. EPA. Radiation doses received by the Irish Population: Environmental Protection Agency (Formerly Radiological Protection Agency of Ireland); 2014. Information on patient radiation doses, Ireland. Medical exposures radiation unit (MERU), 2013. Farah J et al. Measurement of maximum skin dose in interventional radiology and...