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Background: Interventional radiology (IR) is becoming more relevant in patient care and is associated with increased patient radiation exposure and radiation-induced adverse effects. Diagnostic reference levels (DRLs) are crucial for radiation control. There is a paucity of published DRLs for IR in South Africa and sub-Saharan Africa. Objectives: This study aimed to determine local DRLs for fluoroscopically-guided IR procedures and compare the achieved DRLs with published local and international DRLs. Method: Retrospective, descriptive, single-centre study. Kerma air product (KAP), reference point air kerma (Ka,r) and fluoroscopy time (FT) were collected for patients (12 years and older) who underwent IR procedures at a university hospital from 01 January 2019 to 31 December 2019. The 75th percentile of the distribution of each dose parameter (KAP, Ka,r and FT) per procedure was calculated and taken as the local diagnostic reference levels (LDRL). The established LDRLs were compared to published DRLs. Results: A total of 564 cases were evaluated. The 13 most frequent procedures (with 15 or more cases) represented 86.1% (487/564). Percutaneous transhepatic biliary drainage was the most common procedure (n = 146, 25.9%). Diagnostic cerebral angiogram DRLs exceeded the published DRL data ranges for all parameters (DRL 209.3), and interventional cerebral angiogram exceeded published ranges (DRL 275). Uterine artery embolisation (UAE) exceeded these ranges for KAP and Ka,r. (KAP-954.9 Gy/cm2, Ka,r-2640.8 mGy). Conclusion: The LDRLs for diagnostic cerebral angiogram, interventional cerebral angiogram and UAE exceeded published international DRL ranges. These procedures require radiation optimisation as recommended by the International Commission on Radiological Protection (ICRP). Contribution: In addition to informing radiation protection practices at the level of the institution, the established LDRLs contribute towards Regional and National DRLs. [ABSTRACT FROM AUTHOR]

Objective: To assess the radiation exposure in cardiovascular implantable electronic device(CIED) implantation procedures, the effect of fluoroscopy frame rate on various radiation exposure indices, and in-hospital outcomes. Methods: Data of CIED implantation procedures from September 2015 to December 2019 of all the CIED implantation procedures performed at our institute were retrospectively analyzed. The procedural data were divided into two groups: a) pre-group: procedures that were performed under fluoroscopy frame rate of 7.5 frames per second(fps); b) post-group: procedures that were performed under fluoroscopy frame rate of 3.75 fps. We compared procedure time, fluoroscopy time, Kerma air product, effective dose, and in-hospital outcomes between the two groups. Results: A total of 2,225 procedures were included in the analysis with mean age of (62 ​± ​15) years. The procedures consisted of the implantation of single-chamber (n ​= ​1,436), double chamber (n ​= ​656), and biventricular devices (n ​= ​133). Procedure time and radiation indices showed a significant reduction over the study period (P ​

Background: Interventional radiology (IR) is becoming more relevant in patient care and is associated with increased patient radiation exposure and radiation-induced adverse effects. Diagnostic reference levels (DRLs) are crucial for radiation control. There is a paucity of published DRLs for IR in South Africa and sub-Saharan Africa. Objectives: This study aimed to determine local DRLs for fluoroscopically-guided IR procedures and compare the achieved DRLs with published local and international DRLs. Method: Retrospective, descriptive, single-centre study. Kerma air product (KAP), reference point air kerma (Ka,r) and fluoroscopy time (FT) were collected for patients (12 years and older) who underwent IR procedures at a university hospital from 01 January 2019 to 31 December 2019. The 75th percentile of the distribution of each dose parameter (KAP, Ka,r and FT) per procedure was calculated and taken as the local diagnostic reference levels (LDRL). The established LDRLs were compared to published DRLs. Results: A total of 564 cases were evaluated. The 13 most frequent procedures (with 15 or more cases) represented 86.1% (487/564). Percutaneous transhepatic biliary drainage was the most common procedure (n = 146, 25.9%). Diagnostic cerebral angiogram DRLs exceeded the published DRL data ranges for all parameters (DRL 209.3), and interventional cerebral angiogram exceeded published ranges (DRL 275). Uterine artery embolisation (UAE) exceeded these ranges for KAP and Ka,r. (KAP-954.9 Gy/cm2, Ka,r-2640.8 mGy). Conclusion: The LDRLs for diagnostic cerebral angiogram, interventional cerebral angiogram and UAE exceeded published international DRL ranges. These procedures require radiation optimisation as recommended by the International Commission on Radiological Protection (ICRP). Contribution: In addition to informing radiation protection practices at the level of the institution, the established LDRLs contribute towards Regional and National DRLs.

Purpose: To investigate the total fluoroscopy time and radiation exposure dose during endovascular aortic repairs using mobile, fixed, or fixed C-arms with 3-dimensional image fusion (3D-IF). Methods: A systematic search was performed to identify original articles reporting fluoroscopy time (FT) and the kerma area product (KAP) during endovascular aortic repairs. Data were grouped by noncomplex or complex (fenestrated, branched, or chimney) repairs and stratified by type of C-arm. The search identified 27 articles containing 51 study groups (35 noncomplex and 16 complex) that included 3444 patients. Random-effects meta-analysis and meta-regression models were used to calculate the pooled mean estimates of KAP and FT, as well as any effect of equipment or type of intervention. Results are presented with the 95% confidence interval and the statistical heterogeneity (I2). Results: Within the noncomplex procedure studies, a significant (p<0.001) increase was found in the pooled mean KAP estimate in the fixed C-arm group (181 Gy·cm2, 95% CI 129 to 233; I2=99.7) compared with the mobile C-arm (78 Gy·cm2, 95% CI 59.6 to 97.3; I2=99.6). For complex cases, use of 3D-IF showed a significantly (p<0.001) lower mean KAP (139 Gy·cm2, 95% CI 85 to 191; I2=94%) compared to using fixed C-arms without 3D-IF (487 Gy·cm2, 95% CI 331 to 643; I2=94%). Conclusion: For equivalent fluoroscopy times, the use of a fixed C-arm in noncomplex procedures leads to higher patient radiation doses compared to a mobile C-arm. Complex procedures, which are predominantly performed using fixed C-arms, are associated with the highest radiation dose per intervention. Using fixed C-arms combined with 3D-IF techniques during complex cases might seem an adequate method to compensate for the higher radiation doses measured when a fixed C-arm is used. [ABSTRACT FROM AUTHOR]

Background: Interventional radiology (IR) is becoming more relevant in patient care and is associated with increased patient radiation exposure and radiation-induced adverse effects. Diagnostic reference levels (DRLs) are crucial for radiation control. There is a paucity of published DRLs for IR in South Africa and sub-Saharan Africa., Objectives: This study aimed to determine local DRLs for fluoroscopically-guided IR procedures and compare the achieved DRLs with published local and international DRLs., Method: Retrospective, descriptive, single-centre study. Kerma air product (KAP), reference point air kerma (K a,r ) and fluoroscopy time (FT) were collected for patients (12 years and older) who underwent IR procedures at a university hospital from 01 January 2019 to 31 December 2019. The 75th percentile of the distribution of each dose parameter (KAP, K a,r and FT) per procedure was calculated and taken as the local diagnostic reference levels (LDRL). The established LDRLs were compared to published DRLs., Results: A total of 564 cases were evaluated. The 13 most frequent procedures (with 15 or more cases) represented 86.1% (487/564). Percutaneous transhepatic biliary drainage was the most common procedure ( n = 146, 25.9%). Diagnostic cerebral angiogram DRLs exceeded the published DRL data ranges for all parameters (DRL 209.3), and interventional cerebral angiogram exceeded published ranges (DRL 275). Uterine artery embolisation (UAE) exceeded these ranges for KAP and K a,r . (KAP-954.9 Gy/cm 2 , K a,r -2640.8 mGy)., Conclusion: The LDRLs for diagnostic cerebral angiogram, interventional cerebral angiogram and UAE exceeded published international DRL ranges. These procedures require radiation optimisation as recommended by the International Commission on Radiological Protection (ICRP)., Contribution: In addition to informing radiation protection practices at the level of the institution, the established LDRLs contribute towards Regional and National DRLs., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2023. The Authors.)

The objective of the study was to determine the radiation dose reduction achieved when rectangular collimation was used on various round collimators. In addition, we evaluated the tissue doses imparted to various head and neck organs. To evaluate the variation in radiation output based on the variable geometric configurations, the kerma area product (KAP) was measured using a commercially available KAP-meter with an internal ion chamber capable of detecting both radiation dose (µGy) and the primary X-ray beam area. The KAP was measured using standard 20.4, 25.7, and 31.7 cm2 round collimators with and without rectangular X-ray field restrictors. To evaluate the potential change in patient scatter radiation dose, an adult head phantom was loaded with thin strips of gafchromic film. A full mouth X-ray series was acquired with various geometric configurations. The films were quantified using a calibration factor to yield absorbed organ doses for the eyes, thyroid, and salivary glands. With the use of rectangular collimator, the KAP for a 31.7 cm2 round collimator was reduced by up to 60% while the 20.4 cm2 round collimator elicited a reduction from up to 40%. In the organ study, results of up to 81% reduction in scatter radiation dose were observed. Although, US FDA regulations allow a maximum beam size of 38.5 cm2 on the patient skin, this study suggests that the use of rectangular collimators provide clinically relevant dose reduction for patients, even when using smaller round collimation, hence the use of rectangular collimation for all intraoral radiographic procedures is highly recommended. [ABSTRACT FROM AUTHOR]

Objectives:: The objective of the study was to determine the radiation dose reduction achieved when rectangular collimation was used on various round collimators. In addition, we evaluated the tissue doses imparted to various head and neck organs., Methods:: To evaluate the variation in radiation output based on the variable geometric configurations, the kerma area product (KAP) was measured using a commercially available KAP-meter with an internal ion chamber capable of detecting both radiation dose (µGy) and the primary X-ray beam area. The KAP was measured using standard 20.4, 25.7, and 31.7 cm 2 round collimators with and without rectangular X-ray field restrictors. To evaluate the potential change in patient scatter radiation dose, an adult head phantom was loaded with thin strips of gafchromic film. A full mouth X-ray series was acquired with various geometric configurations. The films were quantified using a calibration factor to yield absorbed organ doses for the eyes, thyroid, and salivary glands., Results:: With the use of rectangular collimator, the KAP for a 31.7 cm 2 round collimator was reduced by up to 60% while the 20.4 cm 2 round collimator elicited a reduction from up to 40%. In the organ study, results of up to 81% reduction in scatter radiation dose were observed., Conclusions:: Although, US FDA regulations allow a maximum beam size of 38.5 cm 2 on the patient skin, this study suggests that the use of rectangular collimators provide clinically relevant dose reduction for patients, even when using smaller round collimation, hence the use of rectangular collimation for all intraoral radiographic procedures is highly recommended.