Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures |
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| Institution: | 1. Radiation and Nuclear Safety Authority (STUK), P.O. Box 14, 00881 Helsinki, Finland;2. Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP17, 92262 Fontenay-aux-Roses Cedex, France;3. Vinca Institute of Nuclear Sciences (VINCA), University of Belgrade, P.O. Box 522, 11001 Belgrade, Serbia;4. Belgian Nuclear Research Centre (SCK-CEN), Boeretang 200, BE-2400 Mol, Belgium;5. Greek Atomic Energy Commission (GAEC), P.O. Box 60092, Ag. Paraskevi, 15310 Athens, Greece;6. Nofer Institute of Occupational Medicine (NIOM), 8 Sw. Teresy, Str., 91-348 Łódź, Poland;7. National Centre for Radiation Protection in Health Care, 6 Smugowa St., 91-433 Lodz, Poland;8. Ruđer Bošković Institute (RBI), Bijenička c. 54, 10000 Zagreb, Croatia;9. Institute of Nuclear Physics Polish Academy of Sciences, ul Radzikowskiego 152, PL-31-342 Kraków, Poland;10. Centre Hospitalier Universitaire de Liège (CHULg), Sart-Tilman, 4000 Liège, Belgium;11. Istituto Oncologico Veneto (IOV), Via Gattamelata 64, 35124 Padova, Italy;12. Medical Physics, Radiobiology and Radiation Protection Group of IPO Porto Research Center (CI-IPOP) and Medical Physics Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal;13. Udine University Hospital (AOUD), ple S. Maria della Misericordia, 15, 33100 Udine, Italy;1. Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok 16424, Indonesia;2. Medical Imaging Research Center, Catholic University of Leuven, Leuven 3000, Belgium;1. National and Kapodistrian University of Athens, Medical School, 2nd Dpt. of Radiology, Medical Physics Unit, ATTIKON University Hospital, 1 Rimini St, 124 62 Haidari, Athens, Greece;2. Hygeia Hospital, 4 Erythrou Stavrou & Kifisias Av., Marousi 151 23, Athens, Greece;3. Konstantopoulio General Hospital–Agia Olga, 3 Agias Olgas St, Nea Ionia, 142 33, Athens, Greece;1. Medical Radiation Physics, Department of Oncology and Pathology, Karolinska Institutet, Sweden;2. RaySearch Laboratories AB, Stockholm Sweden;3. Department of Radiation Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands;4. The Skandion Clinic, Uppsala, Sweden;5. Karolinska University Hospital, Department of Medical Physics, Stockholm, Sweden;6. Medical Radiation Physics, Department of Physics, Stockholm University, Sweden;1. Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain;2. Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain;1. Radiation Therapy Section, Department of Clinical Support, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan;2. Medical and Dental Sciences Course, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan;3. Hiroshima Heiwa Clinic, State of the Art Treatment Center, 1-31 Kawara-machi, Naka-ku, Hiroshima City, Hiroshima 730-0856, Japan;4. Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan;5. Hiroshima High-Precision Radiotherapy Cancer Center, 10-52 Motomachi, Naka-ku, Hiroshima City, Hiroshima 730-8511, Japan;6. Department of Nuclear Engineering and Management, School of Engineering, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8656, Japan;1. A.O.U. Città della Salute e della Scienza, Torino, Italy;2. Fondazione IRCCS Policlinico San Matteo Pavia, Italy;3. Fondazione IRCCS Policlinico San Matteo Pavia e Università degli Studi di Milano, Italy;4. USL Toscana Centro, Firenze, Italy;5. AUSL, Piacenza, Italy;6. Azienda USL della Romagna AT Rimini, Italy;7. ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy;8. Ospedale San Giovanni Calibita - Fatebenefratelli - Isola Tiberina - Roma, Italy;9. IRCCS Ospedale San Raffaele, Milano, Italy;10. Fondazione IRCCS Policlinico San Matteo Pavia – ASST di Lodi, Italy;11. Azienda USL della Romagna, Ambito di Ravenna, Italy;12. Azienda Ospedaliero - Universitaria di Parma, Parma, Italy;13. Azienda Toscana Nord Ovest, Massa, Italy;14. IEO, Istituto Europeo di Oncologia IRCCS, Milano, Italy;15. ASST Monza, San Gerardo, Italy;p. AO Ordine Mauriziano, Torino, Italy;q. Azienda Toscana Nord Ovest, Lucca, Italy;r. Veneto Institute of Oncology IOV- IRCCS, Padua, Italy;s. Ospedale Maggiore - AUSL Bologna, Italy;t. ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Polo Universitario Varese, Italy;u. Azienda Sanitaria Universitaria Integrata di Udine, Italy;v. Azienda USL della Romagna AT Forlì, Italy |
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| Abstract: | PurposeThe feasibility of setting-up generic, hospital-independent dose alert levels to initiate vigilance on possible skin injuries in interventional procedures was studied for three high-dose procedures (chemoembolization (TACE) of the liver, neuro-embolization (NE) and percutaneous coronary intervention (PCI)) in 9 European countries.MethodsGafchromic® films and thermoluminescent dosimeters (TLD) were used to determine the Maximum Skin Dose (MSD). Correlation of the online dose indicators (fluoroscopy time, kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (Ka,r)) with MSD was evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy. The uncertainties of alert levels in terms of DAP and Ka,r, and uncertainty of MSD were calculated.ResultsAbout 20–30% of all MSD values exceeded 2 Gy while only 2–6% exceeded 5 Gy. The correlations suggest that both DAP and Ka,r can be used as a dose indicator for alert levels (Pearson correlation coefficient p mostly >0.8), while fluoroscopy time is not suitable (p mostly <0.6). Generic alert levels based on DAP (Gy cm2) were suggested for MSD of both 2 Gy and 5 Gy (for 5 Gy: TACE 750, PCI 250 and NE 400). The suggested levels are close to the lowest values published in several other studies. The uncertainty of the MSD was estimated to be around 10–15% and of hospital-specific skin dose alert levels about 20–30% (with coverage factor k = 1).ConclusionsThe generic alert levels are feasible for some cases but should be used with caution, only as the first approximation, while hospital-specific alert levels are preferred as the final approach. |
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| Keywords: | Interventional radiology Maximum skin dose Online dose indicator Skin dose alert level |
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