Congress:
EuroSafe Imaging 2019
Keywords:
Action 2 - Clinical diagnostic reference levels (DRLs), Action 7 - Radiation protection of children, Action 9 - Facilitation of research in advanced topics of radiation protection, Eyes, Interventional vascular, Catheter arteriography, Chemoembolisation, Cancer
Authors:
S. leonini, A. Guasti, P. Gennari, S. Cioni, I. M. Vallone, R. Baldi, E. Bertelli, S. Bracco
DOI:
10.26044/esi2019/ESI-0011
Background/introduction
Intra-arterial chemotherapy (IAC) offers the hope of eye salvage to children with intraocular retinoblastoma.
It consists of locally delivered chemotherapy drug administration by direct catheterization of the ophthalmic artery (OA).
When performed by an experienced team,
IAC results a safe technique with mainly local and reversible side effects (1).
Concerns remain regarding irradiation toxic effects from repeated fluoroscopy (2-4).
This is particularly true for very young children (less than 1-year-old),
with hereditary bilateral or multifocal retinoblastoma whose elevated risk for subsequent bone tumors,
soft tissue sarcomas,
and melanomas has been widely reported after radiotheraphy (5-7).
Even if the usual rules of radiation safety (i.e using low-dose pediatric protocols) are followed by the main centers that employ this therapeutic procedure (2,3,8),
the radiation rate may change according to a number of variables including the equipment and the technique employed for IAC,
the operator experience and the orbital hemodynamic of the patient.
Irradiation times further increase when IAC is performed via alternative routes through the external carotid artery (ECA) in children with unfavorable patterns of OA flow (9-11) or employing the so-called “balloon technique” (11-12).
The aim of this study is: 1) to measure radiation parameters,
including fluoroscopic time,
dose area product (DAP),
and entrance skin dose (ESD) 2) to propose a guideline that can be adapted to estimate the absorbed doses in order to monitor long-term follow-ups for both ocular and systemic side-effects of irradiation.