Radiation doses in interventional radiology procedures: The RAD-IR study part I: Overall measures of dose

Donald L. Miller, Stephen Balter, Patricia E. Cole, Hollington T. Lu, Beth A. Schueler, Michael Geisinger, Alejandro Berenstein, Robin Albert, Jeffrey D. Georgia, Patrick T. Noonan, John F. Cardella, James St. George, Eric J. Russell, Tim W. Malisch, Robert L. Vogelzang, George L. Miller, Jon Anderson

Research output: Contribution to journalArticle

259 Citations (Scopus)

Abstract

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 modem 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.

Original languageEnglish (US)
Pages (from-to)711-727
Number of pages17
JournalJournal of Vascular and Interventional Radiology
Volume14
Issue number6
StatePublished - Jun 1 2003

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Interventional Radiology
Radiation
Fluoroscopy
Transjugular Intrahepatic Portasystemic Shunt
Renal Artery
Stents
Modems
Physics
Medical Records
Observational Studies
Demography
Prospective Studies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Miller, D. L., Balter, S., Cole, P. E., Lu, H. T., Schueler, B. A., Geisinger, M., ... Anderson, J. (2003). Radiation doses in interventional radiology procedures: The RAD-IR study part I: Overall measures of dose. Journal of Vascular and Interventional Radiology, 14(6), 711-727.

Radiation doses in interventional radiology procedures : The RAD-IR study part I: Overall measures of dose. / Miller, Donald L.; Balter, Stephen; Cole, Patricia E.; Lu, Hollington T.; Schueler, Beth A.; Geisinger, Michael; Berenstein, Alejandro; Albert, Robin; Georgia, Jeffrey D.; Noonan, Patrick T.; Cardella, John F.; St. George, James; Russell, Eric J.; Malisch, Tim W.; Vogelzang, Robert L.; Miller, George L.; Anderson, Jon.

In: Journal of Vascular and Interventional Radiology, Vol. 14, No. 6, 01.06.2003, p. 711-727.

Research output: Contribution to journalArticle

Miller, DL, Balter, S, Cole, PE, Lu, HT, Schueler, BA, Geisinger, M, Berenstein, A, Albert, R, Georgia, JD, Noonan, PT, Cardella, JF, St. George, J, Russell, EJ, Malisch, TW, Vogelzang, RL, Miller, GL & Anderson, J 2003, 'Radiation doses in interventional radiology procedures: The RAD-IR study part I: Overall measures of dose', Journal of Vascular and Interventional Radiology, vol. 14, no. 6, pp. 711-727.
Miller, Donald L. ; Balter, Stephen ; Cole, Patricia E. ; Lu, Hollington T. ; Schueler, Beth A. ; Geisinger, Michael ; Berenstein, Alejandro ; Albert, Robin ; Georgia, Jeffrey D. ; Noonan, Patrick T. ; Cardella, John F. ; St. George, James ; Russell, Eric J. ; Malisch, Tim W. ; Vogelzang, Robert L. ; Miller, George L. ; Anderson, Jon. / Radiation doses in interventional radiology procedures : The RAD-IR study part I: Overall measures of dose. In: Journal of Vascular and Interventional Radiology. 2003 ; Vol. 14, No. 6. pp. 711-727.
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abstract = "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 modem 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.",
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AU - Miller, Donald L.

AU - Balter, Stephen

AU - Cole, Patricia E.

AU - Lu, Hollington T.

AU - Schueler, Beth A.

AU - Geisinger, Michael

AU - Berenstein, Alejandro

AU - Albert, Robin

AU - Georgia, Jeffrey D.

AU - Noonan, Patrick T.

AU - Cardella, John F.

AU - St. George, James

AU - Russell, Eric J.

AU - Malisch, Tim W.

AU - Vogelzang, Robert L.

AU - Miller, George L.

AU - Anderson, Jon

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N2 - 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 modem 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.

AB - 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 modem 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.

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