Radiation Dose to Patients and Radiologists During Transcatheter Arterial Embolization: Comparison of a Digital Flat-Panel System and Conventional Unit
Shigeru SuzukiShigeru FuruiIkuo KobayashiTeiyu YamauchiHiroshi KohtakeKoji TakeshitaKoichi TakadaMasafumi Yamagishi
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The objective of our study was to evaluate the exposure doses to patients and radiologists during transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) using a new angiographic unit with a digital flat-panel system.Doses were assessed for 24 procedures: 12 using a new unit with a digital flat-panel system and 12 using a conventional unit. Doses to patients' skin were evaluated with thermoluminescent dosimeters behind the left, middle, and right portions of the liver. The doses to the radiologists were measured by an electronic personal dosimeter placed on the chest outside a lead protector. The maximal skin doses to the patients and the dose equivalents, Hp(0.07), to the radiologists were compared between the two procedure groups with each angiographic unit.For procedures with the new unit, the mean maximal skin dose to the patients was 284 +/- 127 (SD) mGy (range, 130-467 mGy), and Hp(0.07) to the radiologists was 62.8 +/- 17.4 muSv. For procedures with the conventional unit, the maximal skin dose to the patients was 1,068 +/- 439 mGy (range, 510-1,882 mGy), and Hp(0.07) to the radiologists was 68.4 +/- 25.7 muSv. The maximal skin dose to the patients was significantly lower with the new unit than with the conventional unit (p < 0.0005). There was no significant difference in the Hp(0.07) to the radiologists between the two procedure groups.The new digital flat-panel system for angiographic imaging can reduce the radiation dose to patients' skin during TAE for HCC as compared with the conventional system.Keywords:
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Background:The physician's hands are close to the X-ray field in C-arm fluoroscopy-guided pain interventions.We prospectively investigated the radiation attenuation of Proguard RR-2 gloves. Methods:In 100 cases, the effective doses (EDs) of two dosimeters without a radiation-reducing glove were collected.EDs from the two dosimeters-one dosimeter wrapped with a glove and the other dosimeter without a glovewere also measured at the side of the table (Group 1, 140 cases) and at a location 20 cm away from the side of the table (Group 2, 120 cases).Mean differences such as age, height, weight, radiation absorbed dose (RAD), exposure time, ED, and ratio of EDs were analyzed. Results:In the EDs of two dosimeters without gloves, there were no significant differences (39.0 ± 36.3 μSv vs. 38.8± 36.4 μSv) (P = 0.578).The RAD (192.0 ± 182.0 radcm 2 ) in Group 2 was higher than that (132.3 ± 103.5 radcm 2 ) in Group 1 (P = 0.002).The ED (33.3 ± 30.9 μSv) of the dosimeter without a glove in Group 1 was higher than that (12.3 ± 8.8 μSv) in Group 2 (P ＜ 0.001).The ED (24.4 ± 22.4 μSv) of the dosimeter wrapped with a glove in Group 1 was higher than that (9.2 ± 6.8 μSv) in Group 2 (P < 0.001).No significant differences were noted in the ratio of EDs (73.5 ± 6.7% vs. 74.2± 9.3%, P = 0.469) between Group 1 and Group 2. Conclusions:Proguard RR-2 gloves have a radiation attenuation effect of 25.8-26.5%.The radiation attenuation is not significantly different by intensity of scatter radiation or the different RADs of C-arm fluoroscopy.(
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Abstract Purpose This study presents a prototype smartphone application for occupational dosimetry in interventional practices based on electronic personal dosimeters to assist in dose monitoring. Methods The prototype receives and records information from the occupational dose report containing the cumulative dose of electronic personal dosimeters worn over the apron at chest level and electronic area dosimeters located on C‐arms (reference dosimeters), for each fluoroscopy‐guided procedure. Using their smartphones, personnel involved in interventional practices can review and compare their occupational records with an investigation level, the dose limits, and their department colleagues (anonymously). The ratio between H p (10) measured by the personal and the reference dosimeters at the C‐arm is presented as an indicator of consistent use of suspended operator shield. Some general results extracted from the first months of use are presented. Results The reference dosimeter located at the C‐arm (without lead protection and acting as an ambient dosimeter) recorded in one of the laboratories 217 mSv during 308 procedures over 5 months, showing an indication of the radiation risk present in an interventional laboratory. The ratio between the personal cumulative dose and the dose at a reference C‐arm dosimeter ranged from 0.2% to 1.67% (a factor of 8.5) for different interventionalists. These differences suggest different protection habits among interventional operators, as well as a target for dose reduction. Conclusions With this system, professionals have easy access to their occupational dosimetry records (including information on the workload) in the setting of their interventional departments, to thereby actively engage in the protection process.
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Study Design Prospective study of patients who underwent single or multilevel kyphoplasty for vertebral fractures. Objective To quantify the radiation exposure to the surgeon and to the patient during kyphoplasty, and also to provide a procedural algorithm that effectively minimizes the radiation exposure to the surgeon during any fluoroscopic-guided procedure. Summary of Background Data Spine surgeons who perform minimally invasive procedures often employ fluoroscopy for intraoperative navigation. Methods Twenty-seven patients were enrolled. Two fluoroscopes (1 anterior/posterior and 1 lateral) were used for localization, navigation, and monitoring cement flow. All surgeons wore thyroid shields and lead aprons. The dose of radiation exposure was measured by dosimeter badges. One badge was attached to each patient. The surgeons wore 3 badges: under the thyroid shield (protected), under the lead apron over the left chest (protected), and outside the lead apron over the left chest (unprotected). A thermoluminescent ring dosimeter was worn on the right hand for 18 cases, and on the left hand for 9 cases. Results The exposure time was 5.7±2.0 minutes/vertebra for a single level (n=10), 3.9±0.8 minutes/vertebra for a 2 level (n=9), 2.9±1.2 minutes/vertebra for a 3 level kypholasty (n=8). The exposure time of single level kyphoplasy was significantly different from that of multilevel kyphoplasy (2 level, P=0.040; 3 level, P=0.002). Surgeon exposure as measured by the protected dosimeter was less than the minimum reportable dose (<0.010 mSv). Exposure as measured by the unprotected dosimeter, which is equivalent to deep whole body exposure was 0.248±0.170 mSv/vertebra. The eye exposure was 0.271±0.200 mSv/vertebra, and the shallow exposure (hand/skin) was 0.273±0.200 mSv/vertebra. The hand exposure was 1.744±1.173 mSv/vertebra. Conclusions Without eye or hand protection, the total radiation exposure dose to these areas would exceed the occupational exposure limit after 300 cases per year. Surgeons should wear lead lined glasses and keep their hands out of the radiation beam.
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