VERIDIC: validation and estimation of radiation skin dose in interventional cardiology

Interventne procedure u radiologiji i kardiologiji povezani su sa visokim dozama za kožu pacijenta i potencijalnim radijacionim povredama kože. Različita metodologije i rešenja razvijene us za procenu maksimalne doze za kožu, čija se svojsvta, uključujuši i tačnost značajno razlikuju. U radu su prokazani ciljevi, metode i preminiran a rešenja projekta VERIDIC usmerenoj na validaciju zaličitih ofline i online softvera za procenu doze za kožu pacijenta u intervenatnoj kardiologiji.In interventional cardiology (IC), patients may be exposed to high doses to the skin resulting in tissue reactions (skin burns) following single or multiple procedures. To address this issue, online and offline software has been developed to estimate the maximum skin dose (MSD) to the patient from IC procedures. However, the capabilities and accuracy of such skin dose calculation (SDC) software to estimate MSD and 2D dose distributions markedly differ among vendors. Hence, this project focuses onthe harmonisation of RDSR (radiation dose structured report) and on the validation of SDC software products in IC, which will optimise radiation protection of patients. The outcome of the project will include the standards for digital dose reporting, development of protocols for acceptance testing and Quality Control (QC)of SDC software and setting of diagnostic reference levels per clinical complexity, assessing thefrequency of high-dose procedures as well as dose reduction strategies based on the multi-centric data collection. This paper focuses on the work performed to investigate performance of solid state dosimeters used in clinical environment.Proceedings: [http://vinar.vin.bg.ac.rs/handle/123456789/8681]XXX симпозијум ДЗЗСЦГ (Друштва за заштиту од зрачења Србије и Црне Горе), 2- 4. октобар 2019. године, Дивчибаре, Србиј

Efficacy of MAVIG X-Ray Protective Drapes in Reducing Operator Radiation Dose in the Cardiac Catheterization Laboratory A Randomized Controlled Trial

BACKGROUND: Interventional cardiologists are occupationally exposed to high doses of ionizing radiation. The MAVIG X-ray protective drape (MXPD) is a commercially available light weight, lead-free shield placed over the pelvic area of patients to minimize operator radiation dose. The aim of this study was to examine the efficacy of the MXPD during routine cardiac catheterization, including percutaneous coronary interventions. METHODS: We performed a prospective, randomized controlled study comparing operator radiation dose during cardiac catheterization and percutaneous coronary intervention (n=632) with or without pelvic MXPD. We measured operator radiation dose at 4 sites: left eye, chest, left ring finger, and right ring finger. The primary outcomes were the difference in first operator radiation dose (µSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the 2 groups. RESULTS: The use of the MXPD was associated with a 50% reduction in operator radiation dose (median dose 30.5 [interquartile range, 23.0-39.7] µSv in no drape group versus 15.3 [interquartile range, 11.1-20.0] µSv in the drape group; P<0.001) and a 57% reduction in relative operator dose (P<0.001). The largest absolute reduction in dose was observed at the left finger (median left finger dose for the no drape group was 104.9 [75.7-137.4] µSv versus 41.9 [32.6-70.6] µSv in the drape group; P<0.001). CONCLUSIONS: The pelvic MXPD significantly reduces first operator radiation dose during routine cardiac catheterization and percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04285944.status: publishe

Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses

This study describes the retrospective lens dose calculation methods developed and applied within the European epidemiological study on radiation-induced lens opacities among interventional cardiologists. While one approach focuses on self-reported data regarding working practice in combination with available procedure-specific eye lens dose values, the second approach focuses on the conversion of the individual whole-body dose to eye lens dose. In contrast with usual dose reconstruction methods within an epidemiological study, a protocol is applied resulting in an individual distribution of possible cumulative lens doses for each recruited cardiologist, rather than a single dose estimate. In this way, the uncertainty in the dose estimate (from measurement uncertainty and variability among cardiologists) is represented for each individual. Eye lens dose and whole-body dose measurements have been performed in clinical practice to validate both methods, and it was concluded that both produce acceptable results in the framework of a dose-risk evaluation study. Optimal results were obtained for the dose to the left eye using procedure-specific lens dose data in combination with information collected on working practice. This method has been applied to 421 interventional cardiologists resulting in a median cumulative eye lens dose of 15.1 cSv for the left eye and 11.4 cSv for the right eye. From the individual cumulative eye lens dose distributions obtained for each cardiologist, maxima up to 9-10 Sv were observed, although with low probability. Since whole-body dose values above the lead apron are available for only a small fraction of the cohort and in many cases not for the entire working career, the second method has only been used to benchmark the results from the first approach. This study succeeded in improving the retrospective calculation of cumulative eye lens doses in the framework of radiation-induced risk assessment of lens opacities, but it remains dependent on self-reported information, which is not always reliable for early years. However, the calculation tools developed can also be used to make an assessment of the eye lens dose in current practice

Use of out-of-field contact shielding on patients in medical imaging: A review of current guidelines, recommendations and legislative documents

The use of patient contact-shielding has become a topic of intensive scientific debate. While it has been common practice during the last decades, some studies have questioned the efficiency of using such shielding while others have highlighted the inconsistencies in its application. The objective of this work is to review current recommendations and legislative documents on the use of out-of-field shielding in X-ray imaging, including those from national authorities and from international and national organisations and professional bodies. The review, performed within the framework of the activities of EURADOS Working Group 12, covers available recommendations on use of contact shielding in adult, pregnant and paediatric patients in general radiography, fluoroscopy, computed tomography, mammography and dental radiology. It includes a comprehensive search of 83 documents from 32 countries and 6 international organisations over the last 39 years. In general, using shielding is recommended only under two conditions: if it does not compromise the diagnostic task and the performance of the procedure and/or if it reassures the patient and comforters that they are appropriately protected against potentially harmful effects of radiation. There are very few specific regulatory requirements to use shielding in a particular imaging modality, although they may consider use of shielding either as part of good radiological practice or as requirements for availability of protective or ancillary tools, without further specification of their use. There is a wide variety of positions among documents that recommend out-offield shielding, those that do not recommend it and those that are not specific. Therefore, evidence-based consensus is still needed to ensure best and consistent practice

VERIDIC: validation and estimation of radiation skin dose in interventional cardiology

Interventne procedure u radiologiji i kardiologiji povezani su sa visokim dozama za kožu pacijenta i potencijalnim radijacionim povredama kože. Različita metodologije i rešenja razvijene us za procenu maksimalne doze za kožu, čija se svojsvta, uključujuši i tačnost značajno razlikuju. U radu su prokazani ciljevi, metode i preminiran a rešenja projekta VERIDIC usmerenoj na validaciju zaličitih ofline i online softvera za procenu doze za kožu pacijenta u intervenatnoj kardiologiji.In interventional cardiology (IC), patients may be exposed to high doses to the skin resulting in tissue reactions (skin burns) following single or multiple procedures. To address this issue, online and offline software has been developed to estimate the maximum skin dose (MSD) to the patient from IC procedures. However, the capabilities and accuracy of such skin dose calculation (SDC) software to estimate MSD and 2D dose distributions markedly differ among vendors. Hence, this project focuses onthe harmonisation of RDSR (radiation dose structured report) and on the validation of SDC software products in IC, which will optimise radiation protection of patients. The outcome of the project will include the standards for digital dose reporting, development of protocols for acceptance testing and Quality Control (QC)of SDC software and setting of diagnostic reference levels per clinical complexity, assessing thefrequency of high-dose procedures as well as dose reduction strategies based on the multi-centric data collection. This paper focuses on the work performed to investigate performance of solid state dosimeters used in clinical environment.Proceedings: [http://vinar.vin.bg.ac.rs/handle/123456789/8681]XXX симпозијум ДЗЗСЦГ (Друштва за заштиту од зрачења Србије и Црне Горе), 2- 4. октобар 2019. године, Дивчибаре, Србиј

Intercomparison of Gafchromic™ films, TL detectors and TL foils for the measurements of skin dose in interventional radiology

Several passive solid state dosemeters, such as GafchromicTM films and thermoluminesscence (TL) detectors, are used to estimate and monitor patient skin doses in interventional radiology. To determine the suitability of XR-TypeR GafchromicTM films and of detectors based on TL materials: pellets, chips and foils to measure skin dose, an intercomparison exercise has been organized within European Dosimetry Radiation Group - Working Group 12 “European Medical ALARA Network” (EURADOS WG12). To test response detectors were exposed to X-ray beams of energies and qualities applied clinically. A blind test was also performed to investigate the accuracy of the dose estimate by detectors exposed to unknown doses. We found the response of films to be strongly dependent on beam quality and filtration (increasing by up to 80 % with respect to reference beam quality). The response of TL detectors was found to be less dependent on beam quality (less than 25% variation), with TL foils showing less than 10% variation with respect to reference beam quality. To accurately estimate patient skin doses in interventional radiology it is important to choose the quality of the calibration beam to be as close as possible to the quality of beams actually applied in clinical work

The HARMONIC project: study design for the assessment of radiation doses and associated cancer risks following cardiac fluoroscopy in childhood

The HARMONIC project (Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Paediatrics) is a European study aiming to improve our understanding of the long-term health risks from radiation exposures in childhood and early adulthood. Here, we present the study design for the cardiac fluoroscopy component of HARMONIC. A pooled cohort of approximately 100 000 patients who underwent cardiac fluoroscopy procedures in Belgium, France, Germany, Italy, Norway, Spain or the UK, while aged under 22 years, will be established from hospital records and/or insurance claims data. Doses to individual organs will be estimated from dose indicators recorded at the time of examination, using a lookup-table-based dosimetry system produced using Monte Carlo radiation transport simulations and anatomically realistic computational phantom models. Information on beam geometry and x-ray energy spectra will be obtained from a representative sample of radiation dose structured reports. Uncertainties in dose estimates will be modelled using 2D Monte Carlo methods. The cohort will be followed up using national registries and insurance records to determine vital status and cancer incidence. Information on organ transplantation (a major risk factor for cancer development in this patient group) and/or other conditions predisposing to cancer will be obtained from national or local registries and health insurance data, depending on country. The relationship between estimated radiation dose and cancer risk will be investigated using regression modelling. Results will improve information for patients and parents and aid clinicians in managing and implementing changes to reduce radiation risks without compromising medical benefits

Dose estimation for the european epidemiological study on pediatric computed tomography (EPI-CT)

International audienceWithin the European Epidemiological Study to Quantify Risks for Paediatric Computerized Tomography (EPI-CT study), a cohort was assembled comprising nearly one million children, adolescents and young adults who received over 1.4 million computed tomography (CT) examinations before 22 years of age in nine European countries from the late 1970s to 2014. Here we describe the methods used for, and the results of, organ dose estimations from CT scanning for the EPI-CT cohort members. Data on CT machine settings were obtained from national surveys, questionnaire data, and the Digital Imaging and Communications in Medicine (DICOM) headers of 437,249 individual CT scans. Exposure characteristics were reconstructed for patients within specific age groups who received scans of the same body region, based on categories of machines with common technology used over the time period in each of the 276 participating hospitals. A carefully designed method for assessing uncertainty combined with the National Cancer Institute Dosimetry System for CT (NCICT, a CT organ dose calculator), was employed to estimate absorbed dose to individual organs for each CT scan received. The two-dimensional Monte Carlo sampling method, which maintains a separation of shared and unshared error, allowed us to characterize uncertainty both on individual doses as well as for the entire cohort dose distribution. Provided here are summaries of estimated doses from CT imaging per scan and per examination, as well as the overall distribution of estimated doses in the cohort. Doses are provided for five selected tissues (active bone marrow, brain, eye lens, thyroid and female breasts), by body region (i.e., head, chest, abdomen/pelvis), patient age, and time period (1977-1990, 1991-2000, 2001-2014). Relatively high doses were received by the brain from head CTs in the early 1990s, with individual mean doses (mean of 200 simulated values) of up to 66 mGy per scan. Optimization strategies implemented since the late 1990s have resulted in an overall decrease in doses over time, especially at young ages. In chest CTs, active bone marrow doses dropped from over 15 mGy prior to 1991 to approximately 5 mGy per scan after 2001. Our findings illustrate patterns of age-specific doses and their temporal changes, and provide suitable dose estimates for radiation-induced risk estimation in epidemiological studies

Cohort Profile:the EPI-CT study: a European pooled epidemiological study to quantify the risk of radiation-induced cancer from paediatric CT

International audience•The multinational EPI-CT study was set-up in 2011 to provide direct estimates of risk of solid tumours and leukaemia among children and young adults who underwent computed tomography (CT) scanning and to consolidate the scientific basis for optimization of paediatric CT protocols and patient protection.•Under a common protocol, cohort studies were conducted in Belgium, Denmark, France, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom, coordinated by the International Agency for Research on Cancer (IARC). •The study recruited a total of about 950,000 patients having undergone at least one CT-scan before the age of 22 years. A total of 8.7 million person-years of incidence follow-up were accrued between 1977 and 2014. Cohort members were followed up passively through linkage with population-based cancer and mortality registries. A methodology was developed to reconstruct individual organ doses and estimate associated uncertainties, using data available in electronic archiving systems of the radiology departments of participating hospitals. Description of the cohort and analysis of mortality risk are presented here.•Proposals for possible collaboration in further analyses of the data should be addressed to Dr. Ausrele Kesminiene ([email protected]) and will be reviewed by the EPI-CT steering committe