Clinical Studies
Radiation Doses in Interventional Radiology Procedures: The RAD-IR Study Part I: Overall Measures of Dose

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PURPOSE

To determine patient radiation doses for interventional radiology and neuroradiology procedures, to identify procedures associated with higher radiation doses, and to determine the effects of various parameters on patient doses.

MATERIALS AND METHODS

A prospective observational study was performed at seven academic medical centers. Each site contributed demographic and radiation dose data for subjects undergoing specific procedures in fluoroscopic suites equipped with built-in cumulative dose (CD) and dose–area–product (DAP) measurement capability compliant with International Electrotechnical Commission standard 60601–2–43. The accuracy of the dosimetry was confirmed by comprehensive measurements and by frequent consistency checks performed over the course of the study.

RESULTS

Data were collected on 2,142 instances of interventional radiology procedures, 48 comprehensive physics evaluations, and 581 periodic consistency checks from the 12 fluoroscopic units in the study. There were wide variations in dose and statistically significant differences in fluoroscopy time, number of images, DAP, and CD for different instances of the same procedure, depending on the nature of the lesion, its anatomic location, and the complexity of the procedure. For the 2,142 instances, observed CD and DAP correlate well overall (r = 0.83, P < .000001), but correlation in individual instances is poor. The same is true for the correlation between fluoroscopy time and CD (r = 0.79, P < .000001). The correlation between fluoroscopy time and DAP (r = 0.60, P < .000001) is not as good. In 6% of instances (128 of 2,142), which were principally embolization procedures, transjugular intrahepatic portosystemic shunt (TIPS) procedures, and renal/visceral artery stent placements, CD was greater than 5 Gy.

CONCLUSIONS

Most procedures studied can result in clinically significant radiation dose to the patient, even when performed by trained operators with use of dose-reducing technology and modern fluoroscopic equipment. Embolization procedures, TIPS creation, and renal/visceral artery stent placement are associated with a substantial likelihood of clinically significant patient dose. At minimum, patient dose data should be recorded in the medical record for these three types of procedures. These data should include indicators of the risk of deterministic effects as well as the risk of stochastic effects.

Section snippets

Case and Subject Selection

Instances of procedures were included in the study if the subject underwent one of the medically indicated interventional radiology procedures listed in the first column of Table 1, the procedure was performed in an interventional radiology suite that had previously been registered into the study, and informed consent had been obtained for the procedure. For subjects who underwent more than one interventional procedure on different occasions, each procedure was eligible for inclusion as a

Physics Evaluations

During the course of the project, 48 comprehensive physics evaluations and 581 periodic consistency checks were reported for the 12 fluoroscopic units included in the study. For the comprehensive physics evaluations, the normalized data sets yielded a mean of 1.03 (95% CI: 1.00–1.05) for the fluoroscopic data and a mean of 0.93 (95% CI: 0.90–0.96) for the fluorographic data. For the periodic consistency checks, the normalized data sets yielded a mean of 1.00 (95% CI: 0.98–1.02) for the

DISCUSSION

The dose data in this study represent current practice among radiologists at selected academic medical centers in the United States. The RAD-IR Study was designed and is intended to provide data on “real-world” doses for a variety of interventional radiology and interventional neuroradiology procedures, with no attempt to standardize either the technical factors for each fluoroscopic unit or the way in which each procedure was performed.

The procedures included in this study were chosen for one

CONCLUSIONS

The dose data in the RAD-IR Study represent current practice among interventional radiologists and interventional neuroradiologists at selected academic medical centers in the United States. These data are not intended as a guide to the lowest practically achievable dose or as a guideline or indication of the highest “acceptable” dose. It is also essential to understand that radiation effects are only one factor to be considered in planning and conducting interventional radiology and

APPENDIX 1: GLOSSARY OF RADIOBIOLOGY TERMS

This glossary is provided for the convenience of the reader. It is not intended to be authoritative. These brief definitions may not match precisely the formal ICRP definitions of these terms.

Air kerma: The energy released in a small volume of air when it is irradiated by an x-ray beam. For diagnostic x-rays, air kerma is equivalent to the dose delivered to the volume of air in the absence of scatter. Kerma is measured in grays (Gy).

Biologic variation: With respect to radiation, the differences

Acknowledgment

The authors thank Henry Krakauer, MD, PhD, for his careful and helpful review of the manuscript.

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  • Cited by (0)

    None of the authors have identified a potential conflict of interest.

    Supported in part by a grant from the Cardiovascular and Interventional Radiology Research and Education Foundation. The opinions expressed herein are those of the authors and do not necessarily reflect those of the United States Navy, the Department of Defense, or the Department of Health and Human Services.

    1

    Current address: Department of Radiology, Hahnemann University Hospital, Drexel College of Medicine, Philadelphia, PA.

    2

    Current address: Division of Neuroendovascular Surgery, University of Illinois at Chicago, Chicago, IL.

    3

    Current address: Trinity Imaging and Intervention, Trinity Clinic, Tyler, TX.

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