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Follow-up of radiation skin injuries in patients after fluoroscopically-guided interventional procedures: A preliminary study
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Abstracts/Physica Medica 32 (2016) e71–e96
Image quality parameters analyzed regarding dose reduction and in retrospective analysis, confirm CT iterative method as a powerful tool for optimization in CT study. http://dx.doi.org/10.1016/j.ejmp.2016.01.301 B.297 EVALUATION OF DIAGNOSTIC REFERENCE LEVELS FOR ANGIOGRAPHY SYSTEM USING A RADIATION DOSE MONITORING SYSTEM M. Quattrocchi *, V. Ravaglia, A. Lazzari. S.C. Fisica Sanitaria, ASL2 Lucca, Lucca, Italy Introduction: Although interventional cardiac procedures account for 12% of all radiological examinations, they are responsible for delivering the highest radiation dose (up to 50% of the total collective effective dose). Thus, radiation exposure is a significant concern for interventional cardiologists and patients due to the increasing workloads and the complexity of procedures over the last decade. Materials and Methods: Angiography system (Artis Zee, Siemens) installed at Cardiology Department of ASL2 Lucca was connected directly to Radiation Dose Monitor (RDM) (Medsquare-TA). From November 2014 to August 2015, we collected dosimetric data of about 560 procedures that included all form of coronary artery interventions and might also include a partial or complete diagnostic study. We investigated the capabilities of this software to evaluate Diagnostic Reference Levels (DRLs). Results: Angiography system send automatically XA images with dosimetric data to RDM at the end of each procedure. For each procedure we obtained many data as total air kerma area product, total air-kerma at the interventional reference point, total time and for every views the number of frame, frame rate and acquisition protocol. These data could be compared only to international DRLs, because national DRLs were not fixed. Average total air kerma area product was 8067 cGycm2. Average total airkerma at the interventional reference point was 1522 mGy. Average total time was about 14 min. Average number of frames was 1039 (min 53, max 3430). These were within the international DRLs. Analyzing data imported in RDM database, we obtained also data about the acquisition angles: in the 59,3% of cases the views were performed on the left side, prevalently at 0° (10%) and 35° (6%). Conclusions: Using a software directly connected to the angiography system it was possible to obtain all the dosimetric data in order to easily evaluate Diagnostic Reference Levels and to optimize the acquisition protocols. http://dx.doi.org/10.1016/j.ejmp.2016.01.302 B.298 COMPARISON OF TWO RADIATION DOSE MONITORING SYSTEMS M. Quattrocchi *, A. Lazzari. S.C. Fisica Sanitaria, ASL2 Lucca, Lucca, Italy Introduction: The radiation dose systems currently available from several vendors vary widely in their capabilities, degree of difficulty in implementing, ease of customizing the analyses of the data, and ability to grow with the change in clinical practice, imaging equipment, or regulatory requirements. Radiation dose monitoring systems may generally be identified as software that passively or actively collects radiation dose indices from diagnostic studies and store those indices in a relational database. Materials and Methods: Two radiation dose systems were under investigation. Since September 2014, Total Quality Monitoring (TQM) (QaelumFuji) software was integrated into RIS-PACS system to monitor the dose of 3 CT scanner used in Radiology Department of ASL2 Lucca. Since November 2014, only 2 CT scanners and 1 angiography system were connected directly to Radiation Dose Monitor (RDM) (Medsquare-TA). We investigated the capabilities of these software to optimize acquisition protocols, to evaluate Diagnostic Reference Levels (DRLs) and dosimetric quantities, like effective dose and organ absorbed dose, to be communicated to patients. Results: One of the software was connected directly to modalities, other one to RIS-PACS system. We investigated the advantages and disadvantages of these different connections in the implementation in the clinical practice. Using this software we were able to individuate those acquisition protocols that had to optimize. For example, average DLP for head protocol in
CT scanner was 1109 mGycm before optimization and it was 892 mGycm after. In order to use them to evaluate DRLs, it was necessary to identify the dosimetric data that the software manages and to verify the data accuracy and if the corresponding DICOM tags on the modalities were correctly filled. Conclusions: The software was yet not fully ready to satisfy the dosimetric data management. They require continuous monitoring at updates of the equipment, the RIS-PACS system and the software itself. http://dx.doi.org/10.1016/j.ejmp.2016.01.303 B.299 FOLLOW-UP OF RADIATION SKIN INJURIES IN PATIENTS AFTER FLUOROSCOPICALLY-GUIDED INTERVENTIONAL PROCEDURES: A PRELIMINARY STUDY A. Radice *,a, P. Camisasca b, N. Paruccini a, P. Remida c, M. Patassini c, L. Rossi d, R. Corso c, A. Crespi a. a A.O. San Gerardo, S.C. Fisica Sanitaria, Monza, Italy; b A.O. San Gerardo, U.O Cardiologia, Monza, Italy; c A.O. San Gerardo, U.O. Radiodiagnostica, Monza, Italy; d A.O. San Gerardo, U.O. Chirurgia Vascolare, Monza, Italy Introduction: In the last years the fluoroscopically-guided interventional (FGI) procedures are increased in frequency replacing invasive surgical techniques. Despite the great benefits introduced in the patient’s quality of life, radiation dose to the skin remains an open issue mainly in more complex procedures. A clinical follow-up (FUP) is recommended when the patient peak skin dose (PSD) exceeds the threshold for tissue reaction [1]. Materials and Methods: 2165 FGI procedures were performed from May to September 2015 in interventional cardiology (IC), radiology (IR), neuroradiology (IN) and vascular surgery (VS) departments. For each exam, air-kerma (AK), kerma-area product (PKA) and fluoroscopy time were daily analyzed by the medical physicist using a dose monitoring software (DoseWatch®, GE). The AK threshold value, corresponding to a PSD of 3 Gy, was determined with Gafchromic® XR-RV3 films in 35 percutaneous coronary interventions (PCI). Then a 3 level protocol was defined taking into account the severity of the skin reaction expected and moreover the FUP duration. The 1st investigation level was set at AK > 4 Gy (or PKA > 400 Gycm2), above which a dermatological check-up within 48 hr and a phone call at 1 month were performed by the physician. In addition, the FUP was prolonged from 3 months to 1 year in case of exceeded the 2nd (AK > 8 Gy or PKA > 800 Gycm2) or the 3rd level (AK > 12 Gy or PKA > 1200 Gycm2). Results: The AK value corresponding to a PSD of 3 Gy was 4 ± 1 Gy (R2 = 0.89; p < 0.001). 32 patients were enrolled in the FUP program: 26 IC; 4 IN; 1 VS; 1 IR. The maximum AK was 9.6 Gy (PCI) and a transient alopecia was observed at 1 month (cerebral aneurysm embolization; AK = 4.2 Gy). Conclusions. The follow-up of patient at risk of skin injuries due to high dose FGI procedures has increased physicians’ awareness and has become an integral part of a radiation dose management protocol. Reference [1] Stecker MS et al. Guidelines for patient radiation dose management.J Vasc Interv Radiol 2009;20:S263–73 http://dx.doi.org/10.1016/j.ejmp.2016.01.304 B.300 CBCT DOSE INDICATORS: EVALUATION OF DIFFERENT APPROACHES AND CORRELATION WITH PATIENT DOSE O. Rampado *,a, F.R. Giglioli a, V. Rossetti a, S.D. Bianchi b, R. Ropolo a. a S.C. Fisica Sanitaria, A.O.U. Città della Salute e della Scienza, Torino, Italy; b Dipartimento Scienze Medico Chirurgiche, Università degli Studi di Torino, Torino, Italy Introduction: The purpose of this study was the evaluation of the role of currently proposed dose indicators for CBCT equipments, considering also the experimental challenges and the correlation with patient organ and effective doses. Materials and Methods: Measurements were performed on a radiotherapy CBCT (Elekta XVI) and on two dental CBCT (Morita Acquitomo and Newtom VGI). Several acquisition protocols were considered for each equipment, focused on different anatomical districts for the radiotherapy CBCT (head, chest and pelvis) and on different FOVs for dental CBCT (from 4 × 4 cm
Abstracts/Physica Medica 32 (2016) e71–e96
Image quality parameters analyzed regarding dose reduction and in retrospective analysis, confirm CT iterative method as a powerful tool for optimization in CT study. http://dx.doi.org/10.1016/j.ejmp.2016.01.301 B.297 EVALUATION OF DIAGNOSTIC REFERENCE LEVELS FOR ANGIOGRAPHY SYSTEM USING A RADIATION DOSE MONITORING SYSTEM M. Quattrocchi *, V. Ravaglia, A. Lazzari. S.C. Fisica Sanitaria, ASL2 Lucca, Lucca, Italy Introduction: Although interventional cardiac procedures account for 12% of all radiological examinations, they are responsible for delivering the highest radiation dose (up to 50% of the total collective effective dose). Thus, radiation exposure is a significant concern for interventional cardiologists and patients due to the increasing workloads and the complexity of procedures over the last decade. Materials and Methods: Angiography system (Artis Zee, Siemens) installed at Cardiology Department of ASL2 Lucca was connected directly to Radiation Dose Monitor (RDM) (Medsquare-TA). From November 2014 to August 2015, we collected dosimetric data of about 560 procedures that included all form of coronary artery interventions and might also include a partial or complete diagnostic study. We investigated the capabilities of this software to evaluate Diagnostic Reference Levels (DRLs). Results: Angiography system send automatically XA images with dosimetric data to RDM at the end of each procedure. For each procedure we obtained many data as total air kerma area product, total air-kerma at the interventional reference point, total time and for every views the number of frame, frame rate and acquisition protocol. These data could be compared only to international DRLs, because national DRLs were not fixed. Average total air kerma area product was 8067 cGycm2. Average total airkerma at the interventional reference point was 1522 mGy. Average total time was about 14 min. Average number of frames was 1039 (min 53, max 3430). These were within the international DRLs. Analyzing data imported in RDM database, we obtained also data about the acquisition angles: in the 59,3% of cases the views were performed on the left side, prevalently at 0° (10%) and 35° (6%). Conclusions: Using a software directly connected to the angiography system it was possible to obtain all the dosimetric data in order to easily evaluate Diagnostic Reference Levels and to optimize the acquisition protocols. http://dx.doi.org/10.1016/j.ejmp.2016.01.302 B.298 COMPARISON OF TWO RADIATION DOSE MONITORING SYSTEMS M. Quattrocchi *, A. Lazzari. S.C. Fisica Sanitaria, ASL2 Lucca, Lucca, Italy Introduction: The radiation dose systems currently available from several vendors vary widely in their capabilities, degree of difficulty in implementing, ease of customizing the analyses of the data, and ability to grow with the change in clinical practice, imaging equipment, or regulatory requirements. Radiation dose monitoring systems may generally be identified as software that passively or actively collects radiation dose indices from diagnostic studies and store those indices in a relational database. Materials and Methods: Two radiation dose systems were under investigation. Since September 2014, Total Quality Monitoring (TQM) (QaelumFuji) software was integrated into RIS-PACS system to monitor the dose of 3 CT scanner used in Radiology Department of ASL2 Lucca. Since November 2014, only 2 CT scanners and 1 angiography system were connected directly to Radiation Dose Monitor (RDM) (Medsquare-TA). We investigated the capabilities of these software to optimize acquisition protocols, to evaluate Diagnostic Reference Levels (DRLs) and dosimetric quantities, like effective dose and organ absorbed dose, to be communicated to patients. Results: One of the software was connected directly to modalities, other one to RIS-PACS system. We investigated the advantages and disadvantages of these different connections in the implementation in the clinical practice. Using this software we were able to individuate those acquisition protocols that had to optimize. For example, average DLP for head protocol in
CT scanner was 1109 mGycm before optimization and it was 892 mGycm after. In order to use them to evaluate DRLs, it was necessary to identify the dosimetric data that the software manages and to verify the data accuracy and if the corresponding DICOM tags on the modalities were correctly filled. Conclusions: The software was yet not fully ready to satisfy the dosimetric data management. They require continuous monitoring at updates of the equipment, the RIS-PACS system and the software itself. http://dx.doi.org/10.1016/j.ejmp.2016.01.303 B.299 FOLLOW-UP OF RADIATION SKIN INJURIES IN PATIENTS AFTER FLUOROSCOPICALLY-GUIDED INTERVENTIONAL PROCEDURES: A PRELIMINARY STUDY A. Radice *,a, P. Camisasca b, N. Paruccini a, P. Remida c, M. Patassini c, L. Rossi d, R. Corso c, A. Crespi a. a A.O. San Gerardo, S.C. Fisica Sanitaria, Monza, Italy; b A.O. San Gerardo, U.O Cardiologia, Monza, Italy; c A.O. San Gerardo, U.O. Radiodiagnostica, Monza, Italy; d A.O. San Gerardo, U.O. Chirurgia Vascolare, Monza, Italy Introduction: In the last years the fluoroscopically-guided interventional (FGI) procedures are increased in frequency replacing invasive surgical techniques. Despite the great benefits introduced in the patient’s quality of life, radiation dose to the skin remains an open issue mainly in more complex procedures. A clinical follow-up (FUP) is recommended when the patient peak skin dose (PSD) exceeds the threshold for tissue reaction [1]. Materials and Methods: 2165 FGI procedures were performed from May to September 2015 in interventional cardiology (IC), radiology (IR), neuroradiology (IN) and vascular surgery (VS) departments. For each exam, air-kerma (AK), kerma-area product (PKA) and fluoroscopy time were daily analyzed by the medical physicist using a dose monitoring software (DoseWatch®, GE). The AK threshold value, corresponding to a PSD of 3 Gy, was determined with Gafchromic® XR-RV3 films in 35 percutaneous coronary interventions (PCI). Then a 3 level protocol was defined taking into account the severity of the skin reaction expected and moreover the FUP duration. The 1st investigation level was set at AK > 4 Gy (or PKA > 400 Gycm2), above which a dermatological check-up within 48 hr and a phone call at 1 month were performed by the physician. In addition, the FUP was prolonged from 3 months to 1 year in case of exceeded the 2nd (AK > 8 Gy or PKA > 800 Gycm2) or the 3rd level (AK > 12 Gy or PKA > 1200 Gycm2). Results: The AK value corresponding to a PSD of 3 Gy was 4 ± 1 Gy (R2 = 0.89; p < 0.001). 32 patients were enrolled in the FUP program: 26 IC; 4 IN; 1 VS; 1 IR. The maximum AK was 9.6 Gy (PCI) and a transient alopecia was observed at 1 month (cerebral aneurysm embolization; AK = 4.2 Gy). Conclusions. The follow-up of patient at risk of skin injuries due to high dose FGI procedures has increased physicians’ awareness and has become an integral part of a radiation dose management protocol. Reference [1] Stecker MS et al. Guidelines for patient radiation dose management.J Vasc Interv Radiol 2009;20:S263–73 http://dx.doi.org/10.1016/j.ejmp.2016.01.304 B.300 CBCT DOSE INDICATORS: EVALUATION OF DIFFERENT APPROACHES AND CORRELATION WITH PATIENT DOSE O. Rampado *,a, F.R. Giglioli a, V. Rossetti a, S.D. Bianchi b, R. Ropolo a. a S.C. Fisica Sanitaria, A.O.U. Città della Salute e della Scienza, Torino, Italy; b Dipartimento Scienze Medico Chirurgiche, Università degli Studi di Torino, Torino, Italy Introduction: The purpose of this study was the evaluation of the role of currently proposed dose indicators for CBCT equipments, considering also the experimental challenges and the correlation with patient organ and effective doses. Materials and Methods: Measurements were performed on a radiotherapy CBCT (Elekta XVI) and on two dental CBCT (Morita Acquitomo and Newtom VGI). Several acquisition protocols were considered for each equipment, focused on different anatomical districts for the radiotherapy CBCT (head, chest and pelvis) and on different FOVs for dental CBCT (from 4 × 4 cm