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International Atomic Energy Agency Example of Practice of Radiation Protection L 9.2.

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Presentation on theme: "International Atomic Energy Agency Example of Practice of Radiation Protection L 9.2."— Presentation transcript:

1 International Atomic Energy Agency Example of Practice of Radiation Protection L 9.2

2 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection2 Educational Objectives 1.How awareness of radiation protection and close cooperation with medical physics / radiation safety staff helps 2.Avoidance of skin injuries

3 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection3Introduction The evaluation of maximum local skin dose from an interventional procedure is difficult: On-line evaluation: dosemeter or computer code Off-line methods more accurate: use of large area detectors, time consuming (adopted for a limited number of patients) It should be important to periodically evaluate incidence of skin injuries in cardiac centres A follow-up protocol has been developed in Dimond European research project (www.dimond3.org):www.dimond3.org Purpose to identify patients with an high probability of an high localised skin dose to be submitted to a follow-up. The protocol adopts a trigger value in terms of dose-area product (DAP) as a dose quantity indicator of possible localised high skin dose.

4 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection4 Retrospective evaluation of skin injuries on patients of Udine cardiac centre Patient can be submitted to repeated cardiac procedures in short period of time Methodology: Analyse database of patients submitted to diagnostic and therapeutic procedures in a 4 years period Detect patients with highest cumulative DAPs (due to repeated procedures) selecting an appropriate DAP trigger value Evaluate maximum local skin dose Submit selected patients to a clinical evaluation to detect possible skin injuries

5 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection5 Patient database: CA and PTCA in Udine hospital from 1998 to 2002 SAMPLE COLLECTION21 April April 2002 NUMBER OF PROCEDURES5517 N. OF PTCA PROCEDURES1843 N. OF CA PROCEDURES3674 N. OF PATIENTS3332

6 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection6 CA and diagnostic procedures No. of procedures3674 Mean DAP 37.5 Gycm 2 Median DAP 31.2 Gycm 2 No. of procedures with DAP>300Gycm 2 1 DAP distribution of CA procedures

7 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection7 PTCA procedures No. of procedures 1843 Mean DAP 66.1 Gycm 2 Median DAP 48.3 Gycm 2 No. procedures with DAP>300Gycm 2 13 (0.7%) DAP distribution of PTCA procedures

8 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection8 No. of procedures per patient >7 No. of patients No. of patients3332 Mean DAP 78.6 Gycm 2 Median DAP 50.6 Gycm 2 No. of patients with DAP>300Gycm 2 87 (2.6%) Frequencies of repeated procedures and cumulative dose

9 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection9 Sample of patients extracted for the follow-up study 79 patients with a cumulative DAP>300 Gycm 2 extracted from the database Distribution of number of procedures performed and cumulative DAP

10 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection10 Sample of patients extracted for the follow-up study Maximum local skin dose evaluated for the 79 patients

11 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection11 Maximum local skin dose (MSD) assessment Correlation between DAP and MSD has been evaluated: operator and installation dependent Skin dose distributions measured on a sample of patients with radiochromic films  MSD= *DAP

12 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection12 Skin dose assessment (patient no. 1) Patient no. 1: Total maximum local skin dose 6,7 Gy Procedure typeDAP per procedure(Gycm 2 ) Maximum local skin dose (Gy) Diagnostic86.90,416 Diagnostic86.30,413 Diagnostic26.80,128 Ad hoc PTCA57.10,509 Diagnostic108.60,520 Diagnostic73.80,354 Ad hoc PTCA135.61,208 Diagnostic28.40,136 Ad hoc PTCA33.80,301 Election PTCA84.70,755 Diagnostic58.40,280 Ad hoc PTCA115.31,027 Diagnostic27.20,130 Diagnostic33.5 Ad hoc PTCA39.2

13 Radiation Protection in Cardiology Lecture 9.2: Example of practice of radiation protection13 Conclusions 56 patients received medical examination with particular focus on the more exposed skin area. None of visited patients presented skin lesions that could be attributed to high dose X-ray irradiation The result assures cardiologists and medical physicists that, if proper quality assurance and radiation protection programme is established, the frequency of skin injuries can be very low also when repeated procedures are taken into account


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