| Abstract |
Interventionalists and patients are exposed to considerable radiation doses during fluoroscopically guided procedures. A substantial increase in the annual number of fluoroscopically guided procedures has been observed. Determination of the operator’s and patient’s radiation exposure is of utmost importance. Furthermore, the use of new, effective radiation protection equipment will contribute to the efficient radiation protection of the medical staff. The first aim of our study was to determine the radiation exposure of primary interventionalist’s different body parts during complex fluoroscopically guided interventions and to determine the maximum permissible annual workload. Occupational doses for 36 consecutive aortoiliac PTA procedures and 17 consecutive EVAR procedures were estimated using thermoluminescence dosimetry (TLD) chips (TLD-200, Hashaw, Solon, OH). The efficacy of a radio protective drape and a radio protective cap were also evaluated. Median ED for a typical EVAR and PTA procedure was 4.7 ± 1.4 μSv and 4.4 ± 3.6 μSv, respectively. The highest radiation doses were measured for the operator’s hands in both procedures. Occupational radiation exposure can be reduced significantly with the proper use of a radioprotective drape and a radioprotective cap.
Diagnostic reference levels (DRLs) are suggested by many authorities as a tool for dose optimization of the applied techniques in interventional examinations. Article 56.2 of the European Union Basic Safety Standards states that: “Member States shall ensure the establishment, regular review and use of DRLs for radio-diagnostic examinations, having regard to the recommended European diagnostic reference levels where available, and where appropriate, for interventional radiology procedures, and the availability of guidance for this purpose”. The second aim of our study was to establish complexity-based local DRLs for different fluoroscopically guided interventions. Dosimetric and anthropometric data were collected prospectively for 35 patients who underwent femoropopliteal PTA, 38 patients who underwent iliac PTA, 52 patients who underwent transarterial chemoembolization and for 73 patients who underwent EVAR procedures. Moreover, the complexity of each procedure was evaluated. The median DAP for femoropopliteal PTA, iliac PTA, transarterial chemoembolization and EVAR were 59.9 Gycm2, 4.8 Gycm2, 116.8 Gycm2 και 153.2 Gycm2 respectively.
Patients with an abdominal aortic aneurysm are exposed to considerable radiation doses due to the fluoroscopically guided procedure as well as due to the pre and post-operative CT scans. In the literature there is a limited number of studies concerning radiation exposure of EVAR patients. The third aim of our study was the development of a novel patient specific dosimetry method for fluoroscopically guided interventions. Moreover, radiation doses of the primarily exposed tissues and organs of EVAR patients were determined. Patient-specific Monte Carlo simulations were performed with ImpactMC version 1.0.1 (VAMP GmbH, Erlangen, Germany) to determine organ/tissue radiation doses. The median dose values for the skin, bone marrow, kidneys and spleen were 192.4 mGy, 97.0 mGy, 72.9 mGy and 33.6 mGy, respectively, while the median dose of heart, liver, pancreas and stomach were 6.3 mGy, 14.4 mGy, 21.6 mGy and 11.2 mGy, respectively.
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