Proposed local diagnostic reference levels in angiography and interventional neuroradiology and a preliminary analysis according to the complexity of the procedures |
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| Authors: | Loredana D’Ercole Federico Zappoli Thyrion Milena Bocchiola Laura Mantovani Catherine Klersy |
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| Affiliation: | 1. Department of Medical Physics, Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy;2. Department of Radiology, Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy;3. Service of Biometry and Clinical Epidemiology, Scientific Direction Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy;1. Laboratório de Ciências Radiológicas (LCR), Universidade do Estado do Rio de Janeiro (UERJ), São Francisco Xavier, 524 Maracanã, sala 136, Pavilhão Lisboa da Cunha, Rio de Janeiro 20550-900, Brazil;2. Instituto Militar de Engenharia, Praça General Tibúrcio 90, Praia Vermelha, Rio de Janeiro 22290-270, Brazil;1. Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA;2. Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA;1. University of Sharjah, College of Health Sciences, Medical Diagnostic Imaging Department, United Arab Emirates;2. Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Saudi Arabia;3. Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia;4. Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK;1. Department of Physics, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia;2. Centre for Nuclear & Radiation Physics, Department of Physics, University of Surrey, Guildford GU2 7XH, UK;3. Public Health Division, Johor State Health Department, 80100 Johor Bahru, Johor, Malaysia;4. Department of Radiology, Hospital Sultanah Aminah, 80100 Johor Bahru, Johor, Malaysia;5. Oncology Treatment Centre, Sultan Ismail Hospital, 81100 Johor Bahru, Malaysia;6. Radiation Safety Section, Engineering Division, Ministry of Health, Putrajaya, Malaysia |
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| Abstract: | The aim of this study was to propose local diagnostic reference levels (DRL) for exposure to radiation during diagnostic procedures and neuroradiological interventions such as cerebral angiography and embolisation of cerebral aneurysms (intra-cranial aneurysms and arteriovenous malformations). Hospitals should adopt the national DRLs for use locally or establish their own DRLs based on local practice, if sufficient local data are available.For this purpose we studied a sample of 113 cerebral angiography procedures and 82 embolisations of cerebral aneurysms. The data recorded included the kerma-area product (KAP), the fluoroscopy time and the number of frames for each procedure: third quartiles from the total dosimetric databank were calculated and proposed as provisional local DRL. Since the complexity of a procedure must be taken into account when evaluating the radiation dose, in the case of embolisation of aneurysms (intra-cranial), in this initial phase we assessed whether the complexity of the embolisation procedure is related to the size of the aneurysm and/or its site. We, therefore, re-calculated the DRL for only intra-cranial aneurysms, leaving aside the arteriovenous malformations. Considering that the DRL calculated for all the therapeutic procedures are similar to those calculated considering only intra-cranial aneurysms, at the moment we propose, besides the DRL for cerebral angiography, a single DRL for all interventional procedures, even when the clinical pictures are very different. Local preliminary DRLs were proposed as follows: 180 Gy cm2, 12 min and 317 frames for cerebral angiography and 487 Gy cm2, 46 min and 717 frames for interventional procedures (intra-cranial aneurysms and arteriovenous malformations). |
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