The purpose of this study is to define a site and procedure specific trigger levels, using online dose indicator, able to inform the interventional radiologist when the peak skin dose (PSD) has reached a value of 2 Gy during the procedure. In this way, the radiologist can consider the benefit-risk balance taking into account the possibility that the skin of the patient is at risk for delayed erythema or other implications . It is extremely relevant to define these values locally due to the wide...
Description of activity and work performed
PSD has been obtained using a Radiation Dose Index Monitoring (RDIM) software NEXO[DOSE]® (Bracco Injeneering SA, Lausanne, Switzerland), which permitted to manage patient and dosimetric data retrospectively  and provide a tool for estimate PSD and skin dose map for angiographic procedures. To estimate the PSD, the software uses exposure parameters (primary and secondary angles, source to isocentre distance, kV, KAP, air-kerma, additional filters) taken from the Radiation Dose Structured Report (RDSR) and other information specific to each angiographic system (the attenuation of the table...
Conclusion and recommendations
For the procedures considered, a better correlation has been found between PSD and Ka,r. Specific trigger levels corresponding to a 2 Gy of PSD have been established for each procedure: 1.5 Gy ± 0.3 for TIPS, 2.5 ± 0.5 Gy for PAE and 2.0 ± 0.5 Gy for TACE, EUF and EVAR. In particular, the lowest alert level was found for TIPS procedures, for which very few X-ray beam angles are used; this causes a small dose spread on patient’s skin and the accumulation of...
S. Riga1, M. M. J. Felisi1,F. Campanaro1,P. E. Colombo1,F. Barbosa2,A. Rampoldi2,A. Torresin1
1Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
2Department of Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza OspedaleMaggiore 3, 20162 Milan, Italy.
Author contact:[email protected]
 Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. Fluoroscopically guided interventional procedures: a review of radiation on patients’ skin and hair. Radiology 2010;254(2):326–341.doi: 10.1148/radiol.2542082312.
 IEC 60601-2-43:2000 Medical electrical equipment - Part 2-43: Particular requirements for the safety of X-ray equipment for interventional procedures.
 Jones AK, Ensor JE, Pasciak AS. How accurately can the peak skin dose in fluoroscopy be determined using indirect dose metrics? Med Phys. 2014 Jul;41 (7) :071913. doi: 10.1118/1.4884020.
 National Council on Radiation Protection and Measurements....