Study of Interventional Radiology Dosimetry Shows Reduction of Radiation Exposure

July 17, 2018—Jacob J. Bundy, MD, et al published a study that sought to report dosimetry of commonly performed interventional radiology procedures and compare dose analogues to known reference levels. The findings are available online ahead of print in Journal of the American College of Radiology.

In commentary provided to Endovascular Today on behalf of the team of investigators, Jeffrey Forris Beecham Chick, MD, stated, "The aim of this study was to assess the mean radiation exposure to patients undergoing a variety of common vascular and interventional radiology procedures. With advances in imaging acquisition technology, including pulse fluoroscopy and copper filtration integrated into flat-panel–based detectors, the overall radiation exposure to patients should be decreased from older imaging intensifier units. This analysis was performed by comparing dosimetric data from the current study in 4,784 patients to the results obtained from the Radiation Doses in Interventional Radiology Procedures study. The results of the current study showed that radiation doses were significantly reduced for nephrostomy, inferior vena cava filter placement, hepatic chemoembolization, and biliary drain placement. These results confirmed the original hypothesis that the newer imaging units, along with radiation hygiene education, have reduced the mean radiation to which patients are exposed."

As summarized in Journal of the American College of Radiology, demographic and dosimetry data were collected between June 12, 2014 and April 26, 2018 using integrated dosimetry software for the following procedures: gastrostomy, nephrostomy, peripherally inserted central catheter placement, visceral arteriography, hepatic chemoembolization, tunneled catheter placement, inferior vena cava filter placement, vascular embolization, transjugular liver biopsy, adrenal vein sampling, transjugular intrahepatic portosystemic shunt (TIPS) creation, and biliary drainage.

The investigators analyzed 4,784 procedures at a single institution, University of Michigan Health System in Ann Arbor, Michigan. The study included 2,691 (56.2%) male patients and 2,093 (43.8%) female patients with a mean age of 55 ± 21 years (range, 0–104 years) and with a mean weight of 76.9 ± 29.4 kg (range, 0.9–268.1 kg). Fluoroscopy time, dose area product (DAP), and reference dose were evaluated.

The investigators reported that TIPS had the highest mean fluoroscopy time (49.1 ± 16 min), followed by vascular embolization (25.2 ± 11.4 min), hepatic chemoembolization (18.8 ± 12.5 min), and visceral arteriography (17.7 ± 3.2 min). TIPS had the highest mean DAP (429.2 ± 244.8 Gy.cm²), followed by hepatic chemoembolization (354.6 ± 78.6 Gy.cm²), visceral arteriography (309.5 ± 39 Gy.cm²), and vascular embolization (298.5 ± 29 Gy.cm²). TIPS was associated with the highest mean reference dose (2.002 ± 1.420 Gy), followed by hepatic chemoembolization (1.746 ± 0.435 Gy), vascular embolization (1.615 ± 0.381 Gy), and visceral arteriography (1.558 ± 1.72 Gy). Of the six procedures available for comparison with the reference levels, the mean fluoroscopy time, DAP, and reference dose for each procedure were below the proposed reference levels.

The findings demonstrated that advances in image acquisition technology and radiation safety protocols have significantly reduced the radiation exposure for a variety of interventional radiology procedures, concluded the investigators in Journal of the American College of Radiology.