Radiation doses in interventional radiology procedures: The RAD-IR study. Part II: Skin dose

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

Research output: Contribution to journalArticle

190 Citations (Scopus)

Abstract

PURPOSE: To determine peak skin dose (PSD), a measure of the likelihood of radiation-induced skin effects, for a variety of common interventional radiology and interventional neuroradiology procedures, and to identify procedures associated with a PSD greater than 2 Gy. MATERIALS AND METHODS: An observational study was conducted at seven academic medical centers in the United States. Sites prospectively contributed demographic and radiation dose data for subjects undergoing 21 specific procedures in a fluoroscopic suite equipped with built-in dosimetry capability. Comprehensive physics evaluations and periodic consistency checks were performed on each unit to verify the stability and consistency of the dosimeter. Seven of 12 fluoroscopic suites in the study were equipped with skin dose mapping software. RESULTS: Over a 3-year period, skin dose data were recorded for 800 instances of 21 interventional radiology procedures. Wide variation in PSD was observed for different instances of the same procedure. Some instances of each procedure we studied resulted in a PSD greater than 2 Gy, except for nephrostomy, pulmonary angiography, and inferior vena cava filter placement. Some instances of transjugular intrahepatic portosystemic shunt (TIPS) creation, renal/visceral angioplasty, and angiographic diagnosis and therapy of gastrointestinal hemorrhage produced PSDs greater than 3 Gy. Some instances of hepatic chemoembolization, other tumor embolization, and neuroembolization procedures in the head and spine produced PSDs greater than 5 Gy. In a subset of 709 instances of higher-dose procedures, there was good overall correlation between PSD and cumulative dose (r = 0.86; P < .000001) and between PSD and dose-area-product (r = 0.85, P < .000001), but there was wide variation in these relationships for individual instances. CONCLUSIONS: There are substantial variations in PSD among instances of the same procedure and among different procedure types. Most of the procedures observed may produce a PSD sufficient to cause deterministic effects in skin. It is suggested that dose data be recorded routinely for TIPS creation, angioplasty in the abdomen or pelvis, all embolization procedures, and especially for head and spine embolization procedures. Measurement or estimation of PSD is the best method for determining the likelihood of radiation-induced skin effects. Skin dose mapping is preferable to a single-point measurement of PSD.

Original languageEnglish (US)
Pages (from-to)977-990
Number of pages14
JournalJournal of Vascular and Interventional Radiology
Volume14
Issue number8
StatePublished - Aug 1 2003

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Interventional Radiology
Radiation
Skin
Transjugular Intrahepatic Portasystemic Shunt
Angioplasty
Spine
Head
Vena Cava Filters
Gastrointestinal Hemorrhage
Physics

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., Berenstein, A., Albert, R., ... Anderson, J. (2003). Radiation doses in interventional radiology procedures: The RAD-IR study. Part II: Skin dose. Journal of Vascular and Interventional Radiology, 14(8), 977-990.

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

In: Journal of Vascular and Interventional Radiology, Vol. 14, No. 8, 01.08.2003, p. 977-990.

Research output: Contribution to journalArticle

Miller, DL, Balter, S, Cole, PE, Lu, HT, Berenstein, A, Albert, R, Schueler, BA, Georgia, JD, Noonan, PT, Russell, EJ, Malisch, TW, Vogelzang, RL, Geisinger, M, Cardella, JF, St. George, J, Miller, GL & Anderson, J 2003, 'Radiation doses in interventional radiology procedures: The RAD-IR study. Part II: Skin dose', Journal of Vascular and Interventional Radiology, vol. 14, no. 8, pp. 977-990.
Miller DL, Balter S, Cole PE, Lu HT, Berenstein A, Albert R et al. Radiation doses in interventional radiology procedures: The RAD-IR study. Part II: Skin dose. Journal of Vascular and Interventional Radiology. 2003 Aug 1;14(8):977-990.
Miller, Donald L. ; Balter, Stephen ; Cole, Patricia E. ; Lu, Hollington T. ; Berenstein, Alejandro ; Albert, Robin ; Schueler, Beth A. ; Georgia, Jeffrey D. ; Noonan, Patrick T. ; Russell, Eric J. ; Malisch, Tim W. ; Vogelzang, Robert L. ; Geisinger, Michael ; Cardella, John F. ; St. George, James ; Miller, George L. ; Anderson, Jon. / Radiation doses in interventional radiology procedures : The RAD-IR study. Part II: Skin dose. In: Journal of Vascular and Interventional Radiology. 2003 ; Vol. 14, No. 8. pp. 977-990.
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abstract = "PURPOSE: To determine peak skin dose (PSD), a measure of the likelihood of radiation-induced skin effects, for a variety of common interventional radiology and interventional neuroradiology procedures, and to identify procedures associated with a PSD greater than 2 Gy. MATERIALS AND METHODS: An observational study was conducted at seven academic medical centers in the United States. Sites prospectively contributed demographic and radiation dose data for subjects undergoing 21 specific procedures in a fluoroscopic suite equipped with built-in dosimetry capability. Comprehensive physics evaluations and periodic consistency checks were performed on each unit to verify the stability and consistency of the dosimeter. Seven of 12 fluoroscopic suites in the study were equipped with skin dose mapping software. RESULTS: Over a 3-year period, skin dose data were recorded for 800 instances of 21 interventional radiology procedures. Wide variation in PSD was observed for different instances of the same procedure. Some instances of each procedure we studied resulted in a PSD greater than 2 Gy, except for nephrostomy, pulmonary angiography, and inferior vena cava filter placement. Some instances of transjugular intrahepatic portosystemic shunt (TIPS) creation, renal/visceral angioplasty, and angiographic diagnosis and therapy of gastrointestinal hemorrhage produced PSDs greater than 3 Gy. Some instances of hepatic chemoembolization, other tumor embolization, and neuroembolization procedures in the head and spine produced PSDs greater than 5 Gy. In a subset of 709 instances of higher-dose procedures, there was good overall correlation between PSD and cumulative dose (r = 0.86; P < .000001) and between PSD and dose-area-product (r = 0.85, P < .000001), but there was wide variation in these relationships for individual instances. CONCLUSIONS: There are substantial variations in PSD among instances of the same procedure and among different procedure types. Most of the procedures observed may produce a PSD sufficient to cause deterministic effects in skin. It is suggested that dose data be recorded routinely for TIPS creation, angioplasty in the abdomen or pelvis, all embolization procedures, and especially for head and spine embolization procedures. Measurement or estimation of PSD is the best method for determining the likelihood of radiation-induced skin effects. Skin dose mapping is preferable to a single-point measurement of PSD.",
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T2 - The RAD-IR study. Part II: Skin dose

AU - Miller, Donald L.

AU - Balter, Stephen

AU - Cole, Patricia E.

AU - Lu, Hollington T.

AU - Berenstein, Alejandro

AU - Albert, Robin

AU - Schueler, Beth A.

AU - Georgia, Jeffrey D.

AU - Noonan, Patrick T.

AU - Russell, Eric J.

AU - Malisch, Tim W.

AU - Vogelzang, Robert L.

AU - Geisinger, Michael

AU - Cardella, John F.

AU - St. George, James

AU - Miller, George L.

AU - Anderson, Jon

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N2 - PURPOSE: To determine peak skin dose (PSD), a measure of the likelihood of radiation-induced skin effects, for a variety of common interventional radiology and interventional neuroradiology procedures, and to identify procedures associated with a PSD greater than 2 Gy. MATERIALS AND METHODS: An observational study was conducted at seven academic medical centers in the United States. Sites prospectively contributed demographic and radiation dose data for subjects undergoing 21 specific procedures in a fluoroscopic suite equipped with built-in dosimetry capability. Comprehensive physics evaluations and periodic consistency checks were performed on each unit to verify the stability and consistency of the dosimeter. Seven of 12 fluoroscopic suites in the study were equipped with skin dose mapping software. RESULTS: Over a 3-year period, skin dose data were recorded for 800 instances of 21 interventional radiology procedures. Wide variation in PSD was observed for different instances of the same procedure. Some instances of each procedure we studied resulted in a PSD greater than 2 Gy, except for nephrostomy, pulmonary angiography, and inferior vena cava filter placement. Some instances of transjugular intrahepatic portosystemic shunt (TIPS) creation, renal/visceral angioplasty, and angiographic diagnosis and therapy of gastrointestinal hemorrhage produced PSDs greater than 3 Gy. Some instances of hepatic chemoembolization, other tumor embolization, and neuroembolization procedures in the head and spine produced PSDs greater than 5 Gy. In a subset of 709 instances of higher-dose procedures, there was good overall correlation between PSD and cumulative dose (r = 0.86; P < .000001) and between PSD and dose-area-product (r = 0.85, P < .000001), but there was wide variation in these relationships for individual instances. CONCLUSIONS: There are substantial variations in PSD among instances of the same procedure and among different procedure types. Most of the procedures observed may produce a PSD sufficient to cause deterministic effects in skin. It is suggested that dose data be recorded routinely for TIPS creation, angioplasty in the abdomen or pelvis, all embolization procedures, and especially for head and spine embolization procedures. Measurement or estimation of PSD is the best method for determining the likelihood of radiation-induced skin effects. Skin dose mapping is preferable to a single-point measurement of PSD.

AB - PURPOSE: To determine peak skin dose (PSD), a measure of the likelihood of radiation-induced skin effects, for a variety of common interventional radiology and interventional neuroradiology procedures, and to identify procedures associated with a PSD greater than 2 Gy. MATERIALS AND METHODS: An observational study was conducted at seven academic medical centers in the United States. Sites prospectively contributed demographic and radiation dose data for subjects undergoing 21 specific procedures in a fluoroscopic suite equipped with built-in dosimetry capability. Comprehensive physics evaluations and periodic consistency checks were performed on each unit to verify the stability and consistency of the dosimeter. Seven of 12 fluoroscopic suites in the study were equipped with skin dose mapping software. RESULTS: Over a 3-year period, skin dose data were recorded for 800 instances of 21 interventional radiology procedures. Wide variation in PSD was observed for different instances of the same procedure. Some instances of each procedure we studied resulted in a PSD greater than 2 Gy, except for nephrostomy, pulmonary angiography, and inferior vena cava filter placement. Some instances of transjugular intrahepatic portosystemic shunt (TIPS) creation, renal/visceral angioplasty, and angiographic diagnosis and therapy of gastrointestinal hemorrhage produced PSDs greater than 3 Gy. Some instances of hepatic chemoembolization, other tumor embolization, and neuroembolization procedures in the head and spine produced PSDs greater than 5 Gy. In a subset of 709 instances of higher-dose procedures, there was good overall correlation between PSD and cumulative dose (r = 0.86; P < .000001) and between PSD and dose-area-product (r = 0.85, P < .000001), but there was wide variation in these relationships for individual instances. CONCLUSIONS: There are substantial variations in PSD among instances of the same procedure and among different procedure types. Most of the procedures observed may produce a PSD sufficient to cause deterministic effects in skin. It is suggested that dose data be recorded routinely for TIPS creation, angioplasty in the abdomen or pelvis, all embolization procedures, and especially for head and spine embolization procedures. Measurement or estimation of PSD is the best method for determining the likelihood of radiation-induced skin effects. Skin dose mapping is preferable to a single-point measurement of PSD.

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