Download PDF
Rofo 2003; 175(11): 1545-1550
DOI: 10.1055/s-2003-43412
Dosimetrie
© Georg Thieme Verlag Stuttgart · New York

Standardization of Occupational Dose to Patient DAP Enables Reliable Assessment of Radiation-Protection Devices in Invasive Cardiology

Die Normierung beruflicher Untersucher-Körperdosen auf das Patienten-DFP erlaubt eine verlässliche Bewertung von Strahlenschutzvorrichtungen in der invasiven KardiologieE.  Kuon1 , M.  Günther1 , O.  Gefeller2 , J.  B.  Dahm3
  • 1Department of Cardiology, Klinik Fraenkische Schweiz, Ebermannstadt, Germany
  • 2Institute for Computer Sciences, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
  • 3Department of Cardiology, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
Further Information

Publication History

Publication Date:
10 November 2003 (online)

Also available at
    Permissions and Reprints

Abstract

Purpose: With the aim of assessing the effectiveness of radiation-protection devices in invasive cardiology, the goal of this study was to validate relative parameters for operator occupational exposure, standardized to the patient's primary dose. Material and Methods: One of these parameters was the local dose, measured in air at the operator's position per dose area product (DAP), applied to a male anthropomorphic Alderson-Rando phantom for simulation of coronary angiography. The second parameter was personal occupational dose to the operator per DAP, measured by thermoluminescence dosimeter stripes during 121 procedures in routine clinical work. Results: The local and personal doses per unit DAP - using typical 0.5-mm lead overcouch and undercouch protection - were comparable (left eye 180 vs. 360, thyroid 260 vs. 260, left shoulder 280 vs. 150, chest 400 vs. 500, hands 400 vs. 550, waist 900 vs. 400 nSv/Gy × cm2). The results, however, were far lower than typically reported values. Our findings therefore disclose a typically inadequate use or acceptance by individual operators of available table-attached lead protection devices, and of ceiling-attached lead-glass screens. The additional use of individual 1.0-mm lead-equivalent garments reduced local doses to levels between 1 ... 10 %. Conclusions: DAP-standardized dose parameters - determined experimentally (phantom measurements), or in routine clinical work - are not appreciably influenced by the equipment age and type, or by the image-intensifier entrance dose rate of the respective catheterization system. They are consequently best suited for obtaining eloquent comparisons of various radiation-protection devices, and for reliable estimation of local scatter radiation exposure by simple documentation of intervention DAP.

Zusammenfassung

Ziel: Bestimmung der Wirksamkeit von Strahlenschutzmitteln mittels Orts- bzw. Körperdosismessungen bei invasiv tätigen Kardiologen. Material und Methoden: Experimentell wurde an einem Alderson-Phantom eine Koronarangiographie simuliert und die Ortsdosis am Aufenthaltsort des kardiologischen Untersuchers in Abhängigkeit des applizierten Dosis-Flächen-Produktes (DFP) gemessen. Verglichen wurden diese Ergebnisse mit kumulativen Untersucher-Körperdosen, normiert auf das kumulative DFP im Verlauf von 121 koronaren Prozeduren. Ergebnisse: Unter Verwendung einer 0,5-mm bleiäquivalenten Über- und Untertischstreustrahlenabschirmung entsprach der experimentelle Quotient weitgehend den entsprechenden klinischen Messwerten: linkes Auge 180 vs. 360, Schilddrüse 260 vs. 260, linke Schulter 280 vs. 150, Brusthöhe 400 vs. 500, Hände 400 vs. 550, Bauchhöhe 900 vs. 400 nSv/Gy × cm2. Beide Quotienten lagen weit unterhalb publizierter Werte: Dies weist auf einen weithin inadäquaten Gebrauch fest installierter Strahlenschutzvorrichtungen in der invasiven Kardiologie hin. Die korrekte Anwendung zusätzlicher Schutzbekleidung von 1,0-mm Blei-Äquivalenz reduzierte die Untersucher-Körperdosis auf 1 … 10 %. Schlussfolgerungen: Da die DFP-normierten Körperdosiswerte des Untersuchers kaum von Alter, Typ oder Bildverstärkereingangsdosisleistung einer Herzkatheteranlage beeinflusst werden, ermöglichen sie eine verlässliche Bewertung von Strahlenschutzvorrichtungen und im Falle vergleichbarer Untersuchungsbedingungen eine Abschätzung der Untersucher-Körperdosis aus dem applizierten DFP.

Key words

Radiation exposure - interventional radiology - radiation-protection devices - dose area product

Literatur

  • 1 Recommendations of the International Commission on Radiological Protection. Oxford; ICRP Publication 60. Pergamon Press 1991
    Search in Google Scholar
  • 2 Kuon E, Schmitt M, Dahm J B. Significant reduction of radiation exposure to operator and staff during cardiac interventions by analysis of radiation leakage and improved lead shielding.  Am J Cardiol. 2002;  89 44-49
    CrossrefPubMedSearch in Google Scholar
  • 3 Marx M V, Niklason L, Mauger E A. Occupational radiation exposure to interventional radiologists: a prospective study.  J Vasc Interv Radiol. 1992;  3 597-606
    CrossrefPubMedSearch in Google Scholar
  • 4 Watson R M. Radiation exposure: clueless in the cath lab, or sayonara ALARA.  Cathet Cardiovasc Diagn. 1997;  42 126-127
    CrossrefPubMedSearch in Google Scholar
  • 5 Padovani R, Rodella C A. Staff dosimetry in interventional cardiology.  Radiat Prot Dosimetry. 2001;  94 99-103
    PubMedSearch in Google Scholar
  • 6 Kuon E, Niederst P N, Dahm J B. Usefulness of rotational spin for coronary angiography in patients with advanced renal insufficiency.  Am J Cardiol. 2002;  90 369-373
    CrossrefPubMedSearch in Google Scholar
  • 7 Kuon E, Birkel J, Schmitt M, Dahm J B. Radiation exposure benefit of a lead cap in invasive cardiology.  Heart. 2003;  89 1205-1210
    CrossrefPubMedSearch in Google Scholar
  • 8 Watson L E, Riggs M W, Bourland P D. Radiation exposure during cardiology fellowship training.  Health Phys. 1997;  73 690-693
    PubMedSearch in Google Scholar
  • 9 Kuon E, Dahm J B. Effective training in radiation attenuating techniques requires long-term cardiology fellowship supervision.  Eur J Allied Health. 2002;  3 20-25
    PubMedSearch in Google Scholar
  • 10 Kuon E, Dorn C, Schmitt M, Dahm J B. Radiation dose reduction in invasive cardiology by restriction to adequate instead of optimized picture quality.  Health Phys. 2003;  84 626-631
    PubMedSearch in Google Scholar
  • 11 Marshall N W, Faulkner K. The dependence of the scattered radiation dose to personnel on technique factors in diagnostic radiology.  Br J Radiol. 1992;  65 44-49
    PubMedSearch in Google Scholar
  • 12 Williams J R. Scatter dose estimation based on dose-area product and the specification of radiation barriers.  Br J Radiol. 1996;  69 1032-1037
    PubMedSearch in Google Scholar
  • 13 Finci L, Meier B, Steffenino G, Roy P, Rutishauser W. Radiation exposure during diagnostic catheterization and single and double vessel transluminal coronary angioplasty.  Am J Cardiol. 1987;  60 1401-1403
    CrossrefPubMedSearch in Google Scholar
  • 14 Vano E, Gonzalez L, Guibelalde E, Fernandez J M, Ten J I. Radiation exposure to medical staff in interventional and cardiac radiology.  Br J Radiol. 1998;  71 954-960
    PubMedSearch in Google Scholar
  • 15 Vano E, Gonzalez L, Fernandez J M, Guibelalde E. Patient dose values in interventional radiology.  Br J Radiol. 1995;  68 1215-1220
    PubMedSearch in Google Scholar
  • 16 Janssen R J, Hadders R H, Henkelman M S, Bos A JJ. Exposure to operating staff during cardiac catheterization measured by thermoluminescence dosimetry.  Radiat Prot Dosimetry. 1992;  43 175-177
    PubMedSearch in Google Scholar
  • 17 McKetty M H. Study of radiation doses to personnel in a cardiac catheterization laboratory.  Health Phys. 1996;  70 563-567
    PubMedSearch in Google Scholar
  • 18 Cusma J T, Bell M R, Wondrow M A, Taubel J P, Holmes D R. Real-time measurement of radiation exposure to patients during diagnostic coronary angiography and percutaneous interventional procedures.  J Am Coll Cardiol. 1999;  33 427-435
    CrossrefPubMedSearch in Google Scholar
  • 19 Clark A L, Brennan A G, Robertson L J, McArthur J D. Factors affecting patient radiation exposure during routine coronary angiography in a tertiary referral centre.  Br J Radiol. 2000;  73 184-189
    PubMedSearch in Google Scholar
  • 20 Fransson S G, Persliden J. Patient radiation exposure during coronary angiography and intervention.  Acta Radiol. 2000;  41 142-144
    CrossrefPubMedSearch in Google Scholar
  • 21 Putte S Van de, Verhaegen F, Taeymans Y, Thierens H. Correlation of patient skin doses in cardiac interventional radiology with dose-area product.  Br J Radiol. 2000;  73 504-513
    PubMedSearch in Google Scholar
  • 22 Boer A den, Feijter P J de, Serruys P W, Roelandt J R. Real-time quantification and display of skin radiation during coronary angiography and intervention.  Circulation. 2001;  104 1779-1784
    PubMedSearch in Google Scholar
  • 23 Lobotessi H, Karoussou A, Neofotistou V, Louisi A, Tsapaki V. Effective dose to a patient undergoing coronary angiography.  Radiat Prot Dosimetry. 2001;  94 173-176
    PubMedSearch in Google Scholar
  • 24 Bernardi G, Padovani R, Morocutti G, Vano E, Malisan M R, Rinuncini M, Spedicato L, Fioretti P M. Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: analysis in relation to radiation exposure parameters.  Cathet Cardiovasc Interv. 2000;  51 1-9
    CrossrefPubMedSearch in Google Scholar
  • 25 CEC Council Directive 97/43/Euratom of 30 June 1997. Article 4: On health protection of individuals against the dangers of ionizing radiation in relation to medical exposure. Euratom Amtsblatt 1997 L180: 22-27
    Search in Google Scholar
  • 26 Kuon E, Dahm J B. Variablen der Patienten-Strahlenexposition invasiver Verfahren: Diagnostik, PTCA, Laserangioplastie und Rotablation. Analyse 1929 koronarer Interventionen an 1500 Patienten.  Z Kardiol. 1999;  88 (Suppl 2) 22
    PubMedSearch in Google Scholar
  • 27 Hart D, Jones D G, Wall B F. Estimation of effective dose in diagnostic radiology from entrance surface dose and dose-area product measurements. NRPB-R 262. National Radiological Protection Board. Oxon Ox 11; Chilton Didcot 0RQ 1994: 36
  • 28 Golder W, Weiner G. Bodily structure and radiation exposures in static X-ray procedures: A contribution to determine national reference data.  Fortschr Röntgenstr. 2001;  173 563-568
    PubMedSearch in Google Scholar
  • 29 Saebel M, Aichinger U, Schulz-Wendtland R. Radiation exposure in X-ray mammography - A review.  Fortschr Röntgenstr. 2001;  173 79-91
    PubMedSearch in Google Scholar
  • 30 Golder W, Weiner G. Bodily structures and radiation exposures in dynamic X-ray procedures: A contribution to determine national reference data.  Fortschr Röntgenstr. 2001;  173 756-762
    PubMedSearch in Google Scholar
  • 31 Cohnen M, Poll L, Puttmann C, Ewen K, Modder U. Radiation exposure in multi-slice CT of the heart.  Fortschr Röntgenstr. 2001;  173 295-299
    PubMedSearch in Google Scholar
  • 32 Poll L W, Cohnen M, Brachten S, Ewen K, Modder U. Dose reduction in multi-slice CT of the heart by use of ECG controlled tube current modulation (“ECG pulsing”): phantom measurements.  Fortschr Röntgenstr. 2002;  174 1500-1505
    Thieme ConnectPubMedSearch in Google Scholar
  • 33 Herzog C, Ay M, Engelmann K, Abolmaali N, Dogani S, Diebold T, Vogl T J. Visualization techniques for multislice CT datasets of coronary arteries: correlation of axial, multiplanar, three-dimensional, and virtual endoscopic imaging with coronary angiography.  Fortschr Röntgenstr. 2001;  173 341-349
    PubMedSearch in Google Scholar
  • 34 Balter S, Sones F M, Brancato R. Radiation exposure to the operator performing cardiac angiography with U-arm systems.  Circulation. 1978;  58 925-932
    PubMedSearch in Google Scholar
  • 35 Begg F R, Hans L F. Radiation exposure to angiographer during coronary arteriography using u-arm amplifier.  Cathet Cardiovasc Diagn. 1975;  1 261-265
    PubMedSearch in Google Scholar
  • 36 Valentin J. Avoidance of radiation injuries from medical interventional procedures.  Ann ICRP. 2000;  30 7-67
    PubMedSearch in Google Scholar

Dr. med. E. Kuon

Klinik Fraenkische Schweiz

Feuersteinstraße 2

91320 Ebermannstadt

Phone: 09194/55386

Fax: 09194/55387

Email: Eberhard.Kuon@klinik-fraenkische-schweiz.de