Patient radiation dose ranges for procedures in Universitas Hospital vascular laboratories

Abstract

Over the past two decades, interventional radiology has been a fast developing field with great advances in technology in the diagnosing and treatment of patients. Interventional radiology procedures are minimally invasive and require little to no hospitalisation time. These procedures are fluoroscopically guided and serial runs are used for documentation, so they have the potential to deliver high doses to patients. Reports about deterministic skin reactions resulting from interventional radiology have become more and more prevalent from the early 1990s. Worldwide concern thus led to legislation for the limitation, justification and optimisation of these doses. Setting of diagnostic reference levels (DRLs) for these procedures is difficult, as they can be complex in nature and are often clinically open-ended. In the case where DRLs were used, they needed to be for a specific locality and had to be refined for the specific circumstances. Patients must be informed of the doses they will be receiving during diagnostic or interventional procedures before consent can be obtained from them. Little information on dose audits was available for South Africa at the time of the study, and it was decided to determine dose ranges at a local level. The research question of this study was: “What radiation doses do patients receive when undergoing vascular, diagnostic and interventional procedures in the interventional suites at a tertiary training hospital in the Free State?” The primary objective was to determine the doses and dose ranges to patients. A secondary objective was to identify specific high dose procedures to individual patients and to the population. A third objective was to investigate the factors influencing these doses. The data of patients who received procedures in two fluoroscopic rooms at the research site were documented over a three-year period. The dose area product (DAP) values were used to calculate skin dose. With the information gathered, dose ranges for frequently performed procedures were determined and specific high dose procedures to individuals and the population identified. Factors influencing the dose were also investigated. This included the relationship of the level of technology, a VI patient’s BMI and practitioners’ level of experience on dose as the research site was a training facility. The results indicated that both diagnostic and interventional procedures have the potential to deliver high doses, as was evident with the isolated occurrences where the response threshold for deterministic effects was exceeded. Most of the locally performed procedures delivered lower or on par radiation dose, compared to values in the literature. Increased BMI values of patients can negatively influence doses received. The level of a practitioner’s experience also plays a vital role in the dose that the patient will receive. Specific recommendations and the implementing of a dose optimisation protocol are proposed to reduce and optimise doses at the research site. This dose optimisation programme will create greater awareness about radiation dose and effects, follow-up procedures and dose reduction methods amongst role-payers. Key words: interventional radiology; limitation, justification and optimisation of radiation dose; deterministic effects; radiation dose awareness