Congress:
EuroSafe Imaging 2019
Keywords:
Chemoembolisation, Percutaneous, Cone beam CT, Radiation physics, Radioprotection / Radiation dose, Interventional vascular, Action 2 - Clinical diagnostic reference levels (DRLs), Embolisation, Embolism / Thrombosis
Authors:
�. KNEZEVIC MEDIJA, T. Siiskonen, M. Sans Merce, F. L. MALCHAIR, M. Majer, A. Gallagher, J. Farah, J. Dabin, O. Ciraj-Bjelac
DOI:
10.26044/esi2019/ESI-0091
Description of activity and work performed
n the framework of EURADOS WG12,
European consortium has been established with the aim to analyze patient exposure data and to propose new European DRLs for selected IR/IC procedures.
Concerning IC,
the data was collected from 13 EU countries (37 clinics and nearly 50 interventional rooms) for the following procedures: coronary angiography (CA),
percutaneous coronary intervention (PCI),
pacemaker implantation (PI),
electrophysiological procedures (EF) and transcatheter aortic valve implantations (TAVI).
This work is summarized in a publication (1).
Overall,
dose data was collected from a total of 14,922 interventional cardiology procedures.
Based on these data,
the following European DRLs are suggested: for CA 35 Gy cm2,
for PCI,
85 Gy cm2,
for TAVI 130 Gy cm2 and,
12 Gy cm2 for electrophysiological procedures and pacemaker implantations.
Pacemaker implantations were further divided into single-chamber (2.5 Gy cm2) and dual chamber (3.5 Gy cm2) procedures and implantations of cardiac resynchronization therapy pacemaker (18 Gy cm2).
The study shows that relatively new techniques such as TAVI and PCI for the and treatment of chronic total occlusion (CTO) often produce relatively high doses,
and thus emphasizes the need for use of an optimization tool such as DRL to assist in reducing patient exposure.
The WG12 group also worked on the feasibility of setting-up generic,
hospital-independent dose alert levels (2).
The following high dose interventional procedures were studied in 9 European countries: transarterial chemoembolization (TACE) of the liver,
neuro-embolization (NE) and percutaneous coronary intervention (PCI).
In order to determine Maximum Skin Dose (MSD),
Gafchromic® films and thermoluminescent dosimeters (TLD) were used to determine a correlation of the online dose indicators (fluoroscopy time,
kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (Kair)) with MSD.
The results were evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy.
The example of alert levels corresponding to MSD = 5 Gy for PCI,
TACE and NE in different countries are given in Figures 1-3.
Additionally,
the WG12 group undertook a survey aimed at establishing European DRL values for common dental Cone Beam CT (CBCT) examinations.
The review showed that although limited information was available for patient studies,
numerous experimental studies have been undertaken using phantoms of various types in conjunction with a range of radiation detectors.
It is evident from the published literature that the most appropriate dose metric for dental CBCT imaging has yet to be agreed upon.
While many studies have estimated effective doses,
there is a noticeable lack of published data on the existence of DRLs at the local and national level for CBCT examinations in dental radiology.
Before establishing European DRLs,
the following challenges have to be addressed: lack of optimisation performed on these systems,
the necessity of more complementary training to educate users of dental CBCT X-ray and the need for the medical physics/engineering professions to become more closely involved in the management of dental CBCT imaging equipment.