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Risk evaluation in patients undergoing coronary angiographic and angioplastic procedures with radial access
Abstracts / Physica Medica 32 (2016) 222–250
measurements with the radiation qualities RQR2 to RQR10 that provide better approximation of X-ray spectra used in interventional radiology, especially compared to narrow spectra applied for calibration of personal dosemeters. Materials and methods. The conversion coefficients hp,k(3) were determined using the formula mat H p ð3Þ len hp;k ð3Þ ¼ ¼ BSF PDD Ka q air The backscatter factors, BSF, were measured using LiF:Mn,Ti thermoluminescent detectors on a homogeneous cylindrical phantom and free in air kerma. RQRs radiation qualities were reproduced in the Secondary Standards Dosimetry Laboratory – Sofia, Bulgaria. Data for dry air and ICRU soft tissue were taken from NIST. Results. The Percentage Depth Dose, PDD, for RQR2 to RQR10 were calculated, BSFs were measured and conversion coefficients hpK(3, RQR,0°) were determined for the new cylindrical phantom. The results are in good agreement with those published by Principi et all. Conclusions. The conversion coefficients from the air kerma (Ka) to Hp(3) for radiation qualities RQR 2 to RQR 10 can be used in occupational dosimetry for interventional radiology. http://dx.doi.org/10.1016/j.ejmp.2016.07.487
EFFECTIVENESS OF RADIATION PROTECTIVE DRAPE TO REDUCE EXPOSURE IN FLUOROSCOPICALLY-GUIDED INTERVENTIONAL PROCEDURES Giulia Tamborino a, Clarita Saldarriaga Vargas b, Jérémie Dabin b,*, Danielle Berus c, Jo Dens d,e, Peter Kayaert c, Joren Maeremans d, Lara Struelens b a
Polytechnic University of Turin (POLITO), Turin, Italy Belgian Nuclear Research Centre (SCKCEN), Mol, Belgium c University Hospital UZ Brussels, Brussels, Belgium d Hasselt Univiversity, Hasselt, Belgium e Hospital Oost Limburg ZOL, Genk, Belgium ⇑ Corresponding author. b
Introduction. Because of the increasing number of fluoroscopically-guided interventional procedures, physicians may be exposed to high annual dose. Radioprotective equipment is therefore desirable. Purpose. This study aimed to evaluate the effect of a disposable lead-free drape in reducing scatter radiation exposure for physicians and patients during percutaneous coronary intervention. Materials and methods. Eye lens and extremity dose measurements, for CTO treatment, performed for about 30 procedures in two Belgian hospitals. Monte Carlo simulations performed with the MCNP-X code to investigate the influence of parameters such as beam projection, position of operator, shield-combinations, drape shapes and position on the scatter radiation to staff and patient. Doses to selected organs, eye lenses, hands, wrists and legs were calculated. Results. Simulations showed an effective dose reduction to the physician ranging from 2% to 36%, mainly observable for RAO projections; physician’s hands were significantly affected (35% 80%). If the position of the pad is shifted upward by 5 cm the effective dose could be further decreased with 8%. Maximum 86%, 60% and 44% dose reductions were observed for the patient’s genitalia, bladder and gonads, respectively. Measurements showed reductions ranging from 34% to 90% to the eyes, without the use of glasses, mainly for less complex procedures.
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Conclusion. In real practice several projections, shielding devices and operator positions are combined altogether and the overall effect of the pad could be less, but the significant result achieved for the unprotected cardiologist’s hands (observable in any set-up) is a significant accomplishment. http://dx.doi.org/10.1016/j.ejmp.2016.07.488
RISK EVALUATION IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHIC AND ANGIOPLASTIC PROCEDURES WITH RADIAL ACCESS Luca Vigna a,*, Domenico Lizio a, Roberta Matheoud a, Barbara Cannillo a, Paolo Chiappino b, Marco Brambilla a a
Medical Physics, AOU Maggiore della Carità, Novara, Italy University of Eastern Piedmont, Novara, Italy ⇑ Corresponding author. b
Introduction. Nowadays interventional cardiac procedures are of concern for the relatively high doses delivered to patients. Purpose. To estimate the effective dose (E), the organ doses (Ht) and the related risk for cancer induction in terms of radiation exposure-induced death (REID) in patients undergoing coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures with radial access. Materials and methods. 65 patients underwent CA and PTCA interventions on a Philips Allura XPer FD10 angiographic equipment. For each patient, Xray tube voltage, projection, filtration, field dimensions and DAP were obtained by filming the monitor of the workstation during the entire procedure. E and Ht were evaluated by means of the MonteCarlo code PCXMC that models radiation beam and transport in an anthropomorphic phantom, allowing also the evaluation of REID. Results. Mean fluoroscopy time, DAP and E were: 3.1 min, 29.9 Gyxcm2, 9.1 mSv and 8.9 min, 60.9 Gyxcm2, 20.3 mSv for CA and PTCA, respectively; the correlation with DAP was very good in CA (r = 0.99) and in PTCA (r = 0.93). For both CA and PTCA, the most irradiated organs were lungs, oesophagus and red marrow, whose mean Ht were 32.5 mSv, 30.7 mSv, 11.6 mSv for CA and 58.5 mSv, 66.7 mSv, 24.9 mSv for PTCA; the highest REIDs were for induction of leukemia (0.04% and 0.08%) and lung cancer (0.14% and 0.20%). Conclusions. Cardiac interventional procedures with radial access improves patient compliance, reduces haemorrhagic complications compared to femoral access with comparable E and Ht values. http://dx.doi.org/10.1016/j.ejmp.2016.07.489
METHODS TO ESTIMATE FETAL DOSE FROM FLUOROSCOPICALLY GUIDED PROPHYLACTIC HYPOGASTRIC ARTERY BALLOON OCCLUSION (HABO) G. Solomou a,*, K. Perisinakis a,b, D. Tsetis a,b, J. Stratakis a, J. Damilakis a,b a
University of Crete, Faculty of Medicine, P.O. Box 2208, Heraklion 71003, Crete, Greece b University Hospital of Heraklion, P.O. Box 1352, Heraklion 71110, Crete, Greece ⇑ Corresponding author. Introduction. Parturient women diagnosed with abnormal placentation are at high risk of major haemorrhage that may cause maternal death. Despite the risk of a potential damage to adjacent organs and loss of child bearing ability, hysterectomy is the gold standard technique. An alternative effective treatment technique
measurements with the radiation qualities RQR2 to RQR10 that provide better approximation of X-ray spectra used in interventional radiology, especially compared to narrow spectra applied for calibration of personal dosemeters. Materials and methods. The conversion coefficients hp,k(3) were determined using the formula mat H p ð3Þ len hp;k ð3Þ ¼ ¼ BSF PDD Ka q air The backscatter factors, BSF, were measured using LiF:Mn,Ti thermoluminescent detectors on a homogeneous cylindrical phantom and free in air kerma. RQRs radiation qualities were reproduced in the Secondary Standards Dosimetry Laboratory – Sofia, Bulgaria. Data for dry air and ICRU soft tissue were taken from NIST. Results. The Percentage Depth Dose, PDD, for RQR2 to RQR10 were calculated, BSFs were measured and conversion coefficients hpK(3, RQR,0°) were determined for the new cylindrical phantom. The results are in good agreement with those published by Principi et all. Conclusions. The conversion coefficients from the air kerma (Ka) to Hp(3) for radiation qualities RQR 2 to RQR 10 can be used in occupational dosimetry for interventional radiology. http://dx.doi.org/10.1016/j.ejmp.2016.07.487
EFFECTIVENESS OF RADIATION PROTECTIVE DRAPE TO REDUCE EXPOSURE IN FLUOROSCOPICALLY-GUIDED INTERVENTIONAL PROCEDURES Giulia Tamborino a, Clarita Saldarriaga Vargas b, Jérémie Dabin b,*, Danielle Berus c, Jo Dens d,e, Peter Kayaert c, Joren Maeremans d, Lara Struelens b a
Polytechnic University of Turin (POLITO), Turin, Italy Belgian Nuclear Research Centre (SCKCEN), Mol, Belgium c University Hospital UZ Brussels, Brussels, Belgium d Hasselt Univiversity, Hasselt, Belgium e Hospital Oost Limburg ZOL, Genk, Belgium ⇑ Corresponding author. b
Introduction. Because of the increasing number of fluoroscopically-guided interventional procedures, physicians may be exposed to high annual dose. Radioprotective equipment is therefore desirable. Purpose. This study aimed to evaluate the effect of a disposable lead-free drape in reducing scatter radiation exposure for physicians and patients during percutaneous coronary intervention. Materials and methods. Eye lens and extremity dose measurements, for CTO treatment, performed for about 30 procedures in two Belgian hospitals. Monte Carlo simulations performed with the MCNP-X code to investigate the influence of parameters such as beam projection, position of operator, shield-combinations, drape shapes and position on the scatter radiation to staff and patient. Doses to selected organs, eye lenses, hands, wrists and legs were calculated. Results. Simulations showed an effective dose reduction to the physician ranging from 2% to 36%, mainly observable for RAO projections; physician’s hands were significantly affected (35% 80%). If the position of the pad is shifted upward by 5 cm the effective dose could be further decreased with 8%. Maximum 86%, 60% and 44% dose reductions were observed for the patient’s genitalia, bladder and gonads, respectively. Measurements showed reductions ranging from 34% to 90% to the eyes, without the use of glasses, mainly for less complex procedures.
235
Conclusion. In real practice several projections, shielding devices and operator positions are combined altogether and the overall effect of the pad could be less, but the significant result achieved for the unprotected cardiologist’s hands (observable in any set-up) is a significant accomplishment. http://dx.doi.org/10.1016/j.ejmp.2016.07.488
RISK EVALUATION IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHIC AND ANGIOPLASTIC PROCEDURES WITH RADIAL ACCESS Luca Vigna a,*, Domenico Lizio a, Roberta Matheoud a, Barbara Cannillo a, Paolo Chiappino b, Marco Brambilla a a
Medical Physics, AOU Maggiore della Carità, Novara, Italy University of Eastern Piedmont, Novara, Italy ⇑ Corresponding author. b
Introduction. Nowadays interventional cardiac procedures are of concern for the relatively high doses delivered to patients. Purpose. To estimate the effective dose (E), the organ doses (Ht) and the related risk for cancer induction in terms of radiation exposure-induced death (REID) in patients undergoing coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures with radial access. Materials and methods. 65 patients underwent CA and PTCA interventions on a Philips Allura XPer FD10 angiographic equipment. For each patient, Xray tube voltage, projection, filtration, field dimensions and DAP were obtained by filming the monitor of the workstation during the entire procedure. E and Ht were evaluated by means of the MonteCarlo code PCXMC that models radiation beam and transport in an anthropomorphic phantom, allowing also the evaluation of REID. Results. Mean fluoroscopy time, DAP and E were: 3.1 min, 29.9 Gyxcm2, 9.1 mSv and 8.9 min, 60.9 Gyxcm2, 20.3 mSv for CA and PTCA, respectively; the correlation with DAP was very good in CA (r = 0.99) and in PTCA (r = 0.93). For both CA and PTCA, the most irradiated organs were lungs, oesophagus and red marrow, whose mean Ht were 32.5 mSv, 30.7 mSv, 11.6 mSv for CA and 58.5 mSv, 66.7 mSv, 24.9 mSv for PTCA; the highest REIDs were for induction of leukemia (0.04% and 0.08%) and lung cancer (0.14% and 0.20%). Conclusions. Cardiac interventional procedures with radial access improves patient compliance, reduces haemorrhagic complications compared to femoral access with comparable E and Ht values. http://dx.doi.org/10.1016/j.ejmp.2016.07.489
METHODS TO ESTIMATE FETAL DOSE FROM FLUOROSCOPICALLY GUIDED PROPHYLACTIC HYPOGASTRIC ARTERY BALLOON OCCLUSION (HABO) G. Solomou a,*, K. Perisinakis a,b, D. Tsetis a,b, J. Stratakis a, J. Damilakis a,b a
University of Crete, Faculty of Medicine, P.O. Box 2208, Heraklion 71003, Crete, Greece b University Hospital of Heraklion, P.O. Box 1352, Heraklion 71110, Crete, Greece ⇑ Corresponding author. Introduction. Parturient women diagnosed with abnormal placentation are at high risk of major haemorrhage that may cause maternal death. Despite the risk of a potential damage to adjacent organs and loss of child bearing ability, hysterectomy is the gold standard technique. An alternative effective treatment technique