1. MEASURING PEAK SKIN DOSE John H. O’Connell Adela Salame-Alfie, Ph.D. NYSDOH David F. Lewis, Ph.D. Poppy Pattanayak International Specialty Products

2. THE NEW YORK STATE DEPARTMENT OF HEALTH BEGAN TO MEASURE PATIENT ENTRANCE SKIN EXPOSURE DURING INTERVENTIONAL CARDIOLOGY PROCEDURES SEVERAL YEARS AGO OUR INITIAL MEASUREMENTS WERE PERFORMED USING TLD’S MOUNTED ON PLASTIC STRIPS THE RESULTS WERE SPORADIC SINCE WE DID NOT HAVE THE ABILITY TO COMPLETELY COVER THE PATIENT’S BACK WITH TLD’S.

3. BEFORE BEGINNING THIS STUDY A PROTOCOL WAS DEVELOPED AND APPROVED BY THE DEPARTMENT’S INSTITUTIONAL REVIEW BOARD EACH PARTICIPATING HOSPITAL HAS USED OUR IRB APPROVAL TO SECURE AN EXPEDITED REVIEW FROM THEIR INTERNAL IRB EACH PATIENT IS GIVEN AN INFORMED CONSENT

4. DR. LEWIS FROM INTERNATIONAL SPECIALTY PRODUCTS COLLABORATED WITH US TO PROVIDE A METHOD TO SURVEY THE ACTUAL PEAK SKIN DOSE THE DOSIMETRY WAS PERFORMED USING A WIDE-AREA FILM DOSIMETER CALLED GAFCHROMIC ® XR FILM 80 MEASUREMENTS HAVE NOW BEEN PERFORMED WITH ANOTHER 40 CURRENTLY UNDERWAY.

5. THE FILM DOSIMETER PROVIDES A DOSE DISTRIBUTION OR MAPPING FORMAT THAT WOULD NOT BE AVAILABLE WHEN UTILIZING TLD’S ALONE FOR THE PATIENTS WHO HAVE BEEN STUDIED SO FAR, THE MINIMUM DOSE MEASUREMENT HAS BEEN ABOUT 150 RADS WITH A MAXIMUM OF 700 RADS

6. 100 Rads 200 Rads 700 Rads 400 Rads

7. Peak Skin Dose : Comparison of Measurement with GAFCHROMIC  XR film vs. Estimate with DAP

8.  Skin dose can only be estimated from DAP values  DAP seriously under estimates the max peak skin dose Error in DAP Measurement 49% 40% 198% 78% -6% 118% -74% -3% 101% 4%

9. GAFCHROMIC  XR Type R  Details the dose distribution  Immediate visualization of patient exposure – magnitude and location GAFCHROMIC  XR Type R film - a simple tool for comprehensive monitoring of patient exposure and physician training L R

10. A picture is worth a thousand words GAFCHROMIC  XR Type R film - a simple tool for comprehensive monitoring of patient exposure and physician training L R  Raises physicians’ awareness  Know where to treat a latent skin injury  Define where to avoid exposure in future procedures

11. WE BELIEVE THAT DOSE MEASUREMENTS FOR PATIENTS UNDERGOING INTERVENTIONAL PROCEDURES IS AN AREA THAT NEEDS TO BE LOOKED AT FURTHER WE ENCOURAGE ALL FACILITIES TO ESTABLISH THRESHOLDS FOR INTER- VENTIONAL PROCEDURES SO THAT, IF THE THRESHOLD IS EXCEEDED IN TERMS OF FLUOROSCOPY TIME AND/OR IMAGING RUNS, THAT PATIENT WILL BE MONITORED POST- PROCEDURE FOR THE EFFECTS OF IONIZING RADIATION

12. THANK YOU NYSDOH