Radioprotection 2025, 60( 1), 28 – 36 © M. Alvarez et al., Published by EDP Sciences, 2025 https:// doi. org / 10.1051 / radiopro / 2024031 Available online at: www. radioprotection. org
ARTICLE
Advancing patient safety in interventional radiology: effective dose evaluation and LDRL
M. Alvarez 1, R. A. C. Guassu 2, A. A. Rosa 3, R. R. de Sousa 2 and D. R. de Pina 4,*
1 Medical Physics and Radioprotection Nucleus, Botucatu Medical School, Clinics Hospital, Botucatu, Brazil. 2 Institute of Bioscience, São Paulo State University, Botucatu, Brazil. 3 Medical Physics of Radiodiagnosis, Hospital de Clínicas, Botucatu Medical School, Botucatu, Brazil. 4 Department of Infectious Diseases, Dermatology, Diagnostic Imaging and Radiotherapy / Botucatu Medical School, São Paulo State
University, Botucatu, Brazil. Received: 8 May 2024 / Accepted: 31 July 2024
Abstract – This study highlights the significance of radioprotection in interventional radiology, focusing on the assessment of Effective Dose values to which patients are exposed. To facilitate this, we developed a semi-automatic software employing Optical Character Recognition technology. This software analysed 1334 interventional procedures conducted between January 2021 and September 2023 at a large Brazilian hospital. The database includes the type of procedure, Air Kerma value, Kerma-Area Product, number of cineangiography images, and exposure duration, all realized on an Artis Zee ®( Siemens Healthineers, Germany) C-arm. We established Local Diagnostic Reference Levels( LDRLs) and calculated Effective Dose values using the PCXMC 2.0 Monte Carlo simulation software. These calculations were based on data from the hospital and LDRLs determined in subsequent studies. The findings reveal that both the LDRLs and the calculated Effective Dose generally fall below the values reported in existing literature. This underscores the efficacy of our methodology in enhancing radioprotection and dose monitoring within the studied hemodynamics sector.
Keywords: radiation protection / fluoroscopy / radiation dose
1 Introduction
In recent decades, there has been a significant increase in the number of interventional radiology procedures( Kim et al., 2012). These procedures require special attention in terms of the harmful effects of ionizing radiation, since the complication of some procedures, the long exposure time and the number of exposures increase the dose absorbed by patients( Triedman and Newburger, 2016). In view of the growing number of procedures, an in-depth study of the Dose levels used in the procedures is essential.
One of the ways to evaluate clinical practice in interventional radiology sectors is to determine Diagnostic Reference Levels( DRLs). These levels serve as an indication of whether, for a given procedure performed, the Dose value received by a patient is higher or lower than a typical Dose value for this procedure( ICRP Publication 103, 2007; Talbi et al., 2022). The first DRLs were implemented in
* Corresponding author: diana. pina @ unesp. br conventional radiography procedures in the 1980s and were developed for other modalities in the 1990s( Vañó Carruana et al., 2013; Semghouli et al., 2024). The determination of DRLs is associated with dose optimization( Damilakis and Vassileva, 2021) and considers dozens of institutions and equipment to values determination, established by the International Commission on Radiological Protection( ICRP) as the third quartile value of the distribution dosimetric magnitude evaluated for a given clinical diagnostic procedure( Vañó Carruana et al., 2013). However, the study of the typical Dose value for a procedure can be carried out within a single institution or a single piece of equipment, through the determination of Local Diagnostic Reference Levels( LDRLs). LDRLs indicate whether, for a given procedure performed in specific equipment and institution, the dose value received by a patient is higher or lower than normal for this procedure( Semghouli et al., 2024).
The ICRP enforces that, in the absence of national DRLs, LDRLs can be introduced to assist in the Dose optimization process( Vañó et al., 2017). The advantages of this approach are its relative ease in being calculated and updated according to the needs of the evaluated clinic. Furthermore, its determina-
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