Radiation exposure and its reduction in the fluoroscopic examination and fluoroscopy-guided interventional radiology

Woo Kyoung Jeong

doi:10.5124/jkma.2011.54.12.1269

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Jeong: Radiation exposure and its reduction in the fluoroscopic examination and fluoroscopy-guided interventional radiology

Focused Issue of This Month

Radiation exposure in diagnostic areas

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2011; 54(12): 1269-1276.

Published online: 13 December 2011

DOI: https://doi.org/10.5124/jkma.2011.54.12.1269

Radiation exposure and its reduction in the fluoroscopic examination and fluoroscopy-guided interventional radiology

Woo Kyoung Jeong, MD

Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.

Corresponding author: Woo Kyoung Jeong, jeongwk@hanyang.ac.kr

Received 6 September 2011 Accepted 20 September 2011

(open-access):

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Radiation exposure during fluoroscopy has been of consistent interest because fluoroscopy is used not only for diagnostic purposes such as upper gastrointestinal series but for many minimally-invasive treatments in various clinical fields. In 2000, the International Commission on Radiological Protection published the important report about the avoidance of radiation injuries from medical interventional procedures, and this report defined harm during fluoroscopic-guided interventional procedure and how to reduce the radiation dose of patients and staff. Two aspects of fluoroscopy exposure differ from other types of medical radiation exposure, including computed tomography. One is that the entrance surface dose during an interventional procedure may be very high, so the deterministic effects of radiation such as skin or corneal injury should be emphasized more than stochastic effects such as cancer risk. The other is that the variation in radiation exposure is great for the same kind of procedure, so it is very difficult to generate a reference level for the radiation dose. Therefore, it is necessary to develop a guideline for the use of fluoroscopy through a nationwide survey about irradiation during fluoroscopic examinations and fluoroscopy-guided intervention procedures. In conclusion, radiation exposure by fluoroscopic guided intervention is not negligible, and the practitioner should always aim to reduce radiation exposure during interventional procedures.

Keywords: Radiation dosage, Fluoroscopy, Interventional radiography, Radiation monitoring, Radiation skin injury

Figures and Tables

Figure 1

Fixed reference point. DAP, dose-area product.

Figure 2

Kerma (dose)-area product. DAP₁, dose-area product at the upper position; d₁, radiation dose at the upper position; a₁, irradiated area at the upper position; DAP₂, dose-area product at the lower position; d₂, radiation dose at the lower position; a₂, irradiated area at the lower position.

Table 1

Comparison of radiation dose metrics between the USA and Korea surveys

DAP, dose-area product; TACE, transcatheter arterial chemoembolization; TIPS, transjugular intrahepatic portosystemic shunt; AVF, arteriovenous fistula; PTBD, percutaneous transhepatic biliary drainage; GDC, Guglielmi detachable coils.

From Miller DL, et al. J Vasc Interv Radiol 2003;14:711-727, with permission from Elsevier [13] and Chung JW; Korea Food & Drug Administration. Evaluation of patient dose in interventional radiology. Seoul: Korea Food & Drug Administration; 2007 [16]

Table 2

Maximum, minimum, and mean values of entrance skin doses and their standard deviations during the interventional procedures in Korea

From Chung JW; Korea Food & Drug Administration. Evaluation of patient dose in interventional radiology. Seoul: Korea Food & Drug Administration; 2007 [16].

TACE, transcatheter arterial chemoembolization; AVF, arteriovenous fistula; PTBD, percutaneous transhepatic biliary drainage; GDC, Guglielmi detachable coils

^a)Entrance skin dose on occipital area

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