Search

OBJECTIVE. The purpose of this article was to investigate the medical condition of patients who received substantial cumulative effective dose (CED) in fluoroscopically guided interventional (FGI) procedures. MATERIALS AND METHODS. We examined 25,253 patients (mean age, 58.2 years; 50.6% male) who underwent 46,491 FGI procedures at a tertiary care center in the United States from January 2010 to January 2019. Radiation dosage data were retrieved from an in-house semiautomated dose-tracking system. A cohort was identified as those who received a CED of 100 mSv or greater and was categorized by medical disorder from longitudinal medical records. Statistical software was used to determine mean value, five percentiles (10th, 25th, 50th, 75th, 95th), and interquartile range for age and dose. RESULTS. Among 1011 (4.0%) patients (30.4% female) with a CED of 100 mSv or more, the median number of procedures was 2.0, the median age at first procedure was 60.0 years old, and the median value of CED was 177.2 mSv. The patients' medical disorders included cancer (36.7%), chronic disease of the torso (30.0%), internal bleeding (24.8%), trauma (4.6%), organ transplant (3.2%) and cerebrovascular disease (0.7%). Eight-hundred (79.1%) patients underwent all of their procedures within 365 days. CONCLUSION. This is the first cohort study of the medical condition of patients receiving substantial cumulative doses from FGI procedures over a long period. In the critical care of patients with serious medical disorders, 4.0% of patients may be exposed to substantial radiation dose (CED ≥ 100 mSv). The risks associated with such a high level of radiation warrant continued attention.

OBJECTIVE. The purpose of this study was to establish procedure-specific air kerma-area product (KAP) and effective dose for a large number of fluoroscopically guided interventional (FGI) procedures. MATERIALS AND METHODS. This retrospective study collected dose data for consecutive adult cases from 12 examination rooms between May 2016 and October 2018. A total of 24,911 cases (50.9% men) were categorized by procedure. Effective dose was calculated using KAP and procedure-specific KAP to effective dose conversion coefficients, mostly from National Council on Radiation Protection and Measurements (NCRP) Report 160. Data analysis was conducted with statistical software to determine mean value and five percentiles (10th, 25th, 50th, 75th, 95th). RESULTS. KAP and effective dose were presented for 101 procedures; a national benchmark is not available from NCRP Reports 168 and 172 for the KAP value of 89 procedures and for the effective dose of all 101 procedures. Twelve procedures that comprised at least 50% of patient cases had median KAP values less than 3.26 Gy · cm 2 and a median effective dose of less than 0.70 mSv. However, some infrequent procedures might be associated with a higher dose. The 95th percentile of KAP was greater than or equal to 500 Gy · cm 2 for 16 procedures and 985 Gy · cm 2 for portography; for effective dose it was greater than or equal to 100 mSv for 21 procedures and 256 mSv for portography. CONCLUSION. The values for KAP and effective dose provided in this article can aid in design and review of clinical research protocols and dose management programs and in assessing compliance with the Joint Commission's standards for organizations providing fluoroscopy services in the absence of national benchmarks for more than 89 procedures.

Objective: Experience of continuous monitoring and control of patient doses in CT in Dubai Hospital over a period of approximately 4 years (January 2008 through August 2011) is presented., Materials and Methods: Dose measurements-in particular, weighted and volumetric CT dose index, dose-length product (DLP), and estimated effective dose-were regularly monitored using head (16 cm diameter) and body (32 cm diameter) CT phantoms. Patient radiation dose indexes were manually recorded during 2008 for common CT examinations: head, chest, and abdomen and pelvis scans. In 2009-2011, these CT dose data were recorded within the radiology information system and the PACS. Dose reduction actions were taken while maintaining a watch on image quality. The effects of these factors were monitored through change in average DLP on a monthly basis and third quartile annually. Adapted diagnostic reference levels were used for comparison., Results: The reduction in adult dose indexes in 2010 as compared with 2008 was 52%, 16.4%, and 34.8% for head, chest, and abdomen and pelvis examinations, respectively. For the pediatric group, the reduction was 45.23%, 39.6%, and 43.34% for head, chest, and abdomen and pelvis examinations, respectively., Conclusion: Substantial reduction in DLP for common examinations of adults and children is shown through a program of continuous monitoring and action. The results indicate the need to introduce local diagnostic reference levels to substitute for the adapted ones.

Objective: The purposes of this study were to survey in 40 countries the availability and use of unique patient identification numbers for radiologic examinations to facilitate radiation exposure tracking and to address plans for nationwide use of PACS networks and regulations in support of tracking., Materials and Methods: The survey was conducted with a web-based questionnaire sent to contacts and counterparts of the International Atomic Energy Agency medical exposure projects unit., Results: A unique patient identification number was available in 33 of 40 countries (82.5%) that participated in the survey and is used in the medical record and for tracking of imaging examinations in 18 of the 33 (54.5%). PACS infrastructures connecting a few hospitals within a country are fairly widespread (32 of 40 countries [80%]), and a very good infrastructure connecting most hospitals in a country was available in 15% (6 of 40 countries). Approximately one half of the participating countries (21 of 40) have plans for establishing a national PACS. Regulations regarding tracking of patient x-ray radiation exposures were found to exist in 30% of the countries., Conclusion: It is highly encouraging to note that most of the countries in which the survey was administered already have unique identification numbers for citizens and that nearly one half of these countries are using the number whenever a patient undergoes a medical imaging examination. Furthermore, nearly one half of respondents indicated that lack of technology rather than confidentiality was the reason for not using a patient identifier. That nearly one third of the countries-all 12 in Europe-support regulations requiring the tracking of patient radiation exposure is an important finding.

Objective: The purpose of our study was to review the experience of tracking radiologic procedures and radiation dose for individual patients in terms of impact on justification and optimization., Materials and Methods: Examples were collected at the Hospital for Children and Adolescents in Helsinki, Finland, through a PACS system that covers 33 institutions in the Helsinki-Uusimaa Hospital District in which reviewing previous radiologic procedures or radiation doses helped in either avoiding the next procedure or provided insight that helped to strengthen dose optimization for CT., Results: With the help of four case reports, our results show that availability of previous imaging studies and radiation dose figures helped to avoid additional new CT examinations by providing required information from previously performed CT examinations, indicate the need for imaging parameter optimization in one facility in view of a better situation detected in another facility, observe the need for further optimization with a specific CT unit and validate the outcome of successful optimization, and make a value judgment in a situation in which a patient has already undergone a number of CT examinations and a critical evaluation could avoid another one. Patient-specific optimization provides a more reliable and effective method than that of comparing average patient group values. Collective dose for a patient was not used in any situation in decision making., Conclusion: Patient-specific justification and optimization becomes possible using the tracking of radiologic procedures and radiation dose of individual patients.

Objective: The purpose of this article is to presage the upcoming challenges in the area of radiation protection of patients in imaging for different stakeholders, such as dosimetrists, radiation biologists, patients, referring physicians, radiologists, radiographers, medical physicists, and manufacturers., Conclusion: Most of the challenges facing different stakeholders are actually based on the contribution required from industry; thus, manufacturers play the greatest role in making patients safer in this century.

Objective: The purpose of this article is to undertake a study on developing a prototype of a smart card that, when swiped in a system with access to the radiation exposure monitoring server, will locate the patient's radiation exposure history from that institution or set of associated institutions to which it has database access., Conclusion: Like the ATM or credit card, the card acts as a secure unique "token" rather than having cash, credit, or dose data on the card. The system provides the requested radiation history report, which then can be printed or sent by e-mail to the patient. The prototype system is capable of extending outreach to wherever the radiation exposure monitoring server extends, at county, state, or national levels. It is anticipated that the prototype shall pave the way for quick availability of patient exposure history for use in clinical practice for strengthening radiation protection of patients.

Objective: In view of increasing concern about radiation dose, this article aims to provide a summary of radiation doses in neuroradiologic applications of cone-beam CT., Conclusion: The conventional wisdom that cone-beam CT incurs a much lower radiation dose than MDCT may not be uniformly true, especially in intraoperative use if operators are tempted to overuse the 3D imaging capabilities. The emerging nature of cone-beam CT warrants extra caution to avoid overexposure of patients.

Objective: The purpose of this study was to assess the frequency of pediatric CT in 40 less-resourced countries and to determine the level of appropriateness in CT use., Materials and Methods: Data on the increase in the number of CT examinations during 2007 and 2009 and appropriate use of CT examinations were collected, using standard forms, from 146 CT facilities at 126 hospitals., Results: The lowest frequency of pediatric CT examinations in 2009 was in European facilities (4.3%), and frequencies in Asia (12.2%) and Africa (7.8%) were twice as high. Head CT is the most common CT examination in children, amounting to nearly 75% of all pediatric CT examinations. Although regulations in many countries assign radiologists with the main responsibility of deciding whether a radiologic examination should be performed, in fact, radiologists alone were responsible for only 6.3% of situations. Written referral guidelines for imaging were not available in almost one half of the CT facilities. Appropriateness criteria for CT examinations in children did not always follow guidelines set by agencies, in particular, for patients with accidental head trauma, infants with congenital torticollis, children with possible ventriculoperitoneal shunt malfunction, and young children (< 5 years old) with acute sinusitis. In about one third of situations, nonavailability of previous images and records on previously received patient doses have the potential to lead to unnecessary examinations and radiation doses., Conclusion: With increasing use of CT in children and a lack of use of appropriateness criteria, there is a strong need to implement guidelines to avoid unnecessary radiation doses to children.

Objective: The objective of this article is to highlight strategies that can be used to implement changes locally for improved safety of pediatric patients. Specific examples of international organizations engaged with quality improvement are discussed., Conclusion: Large-scale quality improvement to promote radiation protection for children is being aggressively pursued by numerous international organizations. These international agencies use quality improvement methods on a global scale to optimize medical imaging for all diagnostic imaging modalities that use ionizing radiation with the intent of lowering radiation dose to children. This work, although vast in scope, requires highly focused project goals with access to scientific expertise. In addition, these coordinated efforts must provide education, collegial support, and resources (both financial and technical) that enable radiology professionals to implement change locally for improved safety of pediatric patients.

Objective: The purpose of our study was to investigate the level of radiation protection of patients and staff during interventional procedures in 20 countries of Africa, Asia, and Europe., Subjects and Methods: In a multinational prospective study, information on radiation protection tools, peak skin dose (PSD), and kerma-area product (KAP) was provided by 55 hospitals in 20 mainly developing countries (nine mostly in Eastern Europe, five in Africa, and six in Asia)., Results: Nearly 40% of the interventional rooms had an annual workload of more than 2,000 patients. It is remarkable that the workload of pediatric interventional procedures can reach the levels of adult procedures even in developing countries. About 30% of participating countries have shown a 100% increase in workload in 3 years. Lead aprons are used in all participating rooms. Even though KAP was available in almost half of the facilities, none had experience in its use. One hundred of 505 patients monitored for PSD (20%) were above the 2-Gy threshold for deterministic effects., Conclusion: Interventional procedures are increasing in developing countries, not only for adults but also for pediatric patients. The situation with respect to staff protection is considered generally acceptable, but this is not the case for patient protection. Many patients exceeded the dose threshold for erythema. A substantial number (62%) of percutaneous transluminal coronary angioplasty procedures performed in developing countries in this study are above the currently known dose reference level and thus could be optimized. Therefore, this study has significance in introducing the concept of patient dose estimation and dose management.

Objective: The purpose of this study was to survey image quality and the entrance surface air kerma for patients in radiographic examinations and to perform comparisons with diagnostic reference levels., Subjects and Methods: In this multinational prospective study, image quality and patient radiation doses were surveyed in 12 countries in Africa, Asia, and Eastern Europe, covering 45 hospitals. The rate of unsatisfactory images and image quality grade were noted, and causes for poor image quality were investigated. The entrance surface doses for adult patients were determined in terms of the entrance surface air kerma on the basis of X-ray tube output measurements and X-ray exposure parameters. Comparison of dose levels with diagnostic reference levels was performed., Results: The fraction of images rated as poor was as high as 53%. The image quality improved up to 16 percentage points in Africa, 13 in Asia, and 22 in Eastern Europe after implementation of a quality control (QC) program. Patient doses varied by a factor of up to 88, although the majority of doses were below diagnostic reference levels. The mean entrance surface air kerma values in mGy were 0.33 (chest, posteroanterior), 4.07 (lumbar spine, anteroposterior), 8.53 (lumbar spine, lateral), 3.64 (abdomen, anteroposterior), 3.68 (pelvis, anteroposterior), and 2.41 (skull, anteroposterior). Patient doses were found to be similar to doses in developed countries and patient dose reductions ranging from 1.4% to 85% were achieved., Conclusion: Poor image quality constitutes a major source of unnecessary radiation to patients in developing countries. Comparison with other surveys indicates that patient dose levels in these countries are not higher than those in developed countries.