High-Dose Fluoroscopically Guided Procedures in Patients: Radiation Management Recommendations for Interventionalists
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REVIEW
RADIATION PROTECTION
High-Dose Fluoroscopically Guided Procedures in Patients: Radiation Management Recommendations for Interventionalists Madan M. Rehani1
•
Donald L. Miller2 • Vinit Baliyan1
Received: 26 June 2020 / Accepted: 31 October 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. In addition to the risks from fluoroscopic-guided interventional procedures of tissue injuries, recent studies have drawn attention to the risk of stochastic effects. Guidelines exist for preprocedural planning and radiation management during the procedure. The concept of a substantial radiation dose level (SRDL) is helpful for patient follow-up for tissue injury. The uncommon nature of tissue injuries requires the interventionalist to be responsible for follow-up of patients who receive substantial radiation doses. Dose management systems for recognizing and avoiding higher patient exposures have been introduced. The European Directive provides a legal framework and requirements for equipment, training, dose monitoring, recording and optimization that are helpful in radiation risk management. Keywords Fluoroscopic-guided interventions (FGI) Radiation-induced skin injuries Stochastic risks Cancer risks Radiation dose management European directive Legal framework radiation protection Abbreviations CBCT Cone-beam computed tomography CT Computed tomography & Madan M. Rehani [email protected]; [email protected] 1
Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA 02114, USA
2
U.S. Food and Drug Administration, Silver Spring, MD, USA
DMS DRL DSA EURATOM FGI ICRP IR NCRP PSD RDSR SRDL TIPS
Dose management systems, also called dose monitoring systems Diagnostic reference level Digital subtraction angiography European atomic energy community Fluoroscopically guided intervention International commission on radiological protection Interventional radiology National council on radiation protection and measurements Peak skin dose Radiation dose-structured report Substantial radiation dose level Transjugular intrahepatic portosystemic shunt creation
Introduction Fluoroscopically guided interventional (FGI) procedures have a well-established and important role in the management of a variety of health conditions. It is well known that some FGI procedures can impart high-radiation doses to patients, and that these doses can result in radiationinduced skin injuries, which may be severe and extend into subcutaneous tissues and bone [1, 2]. Reports of patients with these injuries began appearing in the early 1990s and continue to appear [3–12]. These injuries also include hair loss, which is more commonly seen with procedures that
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M. M. Rehani et al.: High Dose Fluoroscopically Guided Procedures in Patients
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