title: Radiation doses in interventional radiology procedures: the RAD-IR study: part I: overall measures of dose.
abstract: OBJECTIVE
  To determine patient radiation doses for interventional radiology and neuroradiology procedures, to identify procedures associated with higher radiation doses, and to determine the effects of various parameters on patient doses.
  
  
  METHODS
  A prospective observational study was performed at seven academic medical centers. Each site contributed demographic and radiation dose data for subjects undergoing specific procedures in fluoroscopic suites equipped with built-in cumulative dose (CD) and dose-area-product (DAP) measurement capability compliant with International Electrotechnical Commission standard 60601-2-43. The accuracy of the dosimetry was confirmed by comprehensive measurements and by frequent consistency checks performed over the course of the study.
  
  
  RESULTS
  Data were collected on 2,142 instances of interventional radiology procedures, 48 comprehensive physics evaluations, and 581 periodic consistency checks from the 12 fluoroscopic units in the study. There were wide variations in dose and statistically significant differences in fluoroscopy time, number of images, DAP, and CD for different instances of the same procedure, depending on the nature of the lesion, its anatomic location, and the complexity of the procedure. For the 2,142 instances, observed CD and DAP correlate well overall (r = 0.83, P <.000001), but correlation in individual instances is poor. The same is true for the correlation between fluoroscopy time and CD (r = 0.79, P <.000001). The correlation between fluoroscopy time and DAP (r = 0.60, P <.000001) is not as good. In 6% of instances (128 of 2,142), which were principally embolization procedures, transjugular intrahepatic portosystemic shunt (TIPS) procedures, and renal/visceral artery stent placements, CD was greater than 5 Gy.
  
  
  CONCLUSIONS
  Most procedures studied can result in clinically significant radiation dose to the patient, even when performed by trained operators with use of dose-reducing technology and modern fluoroscopic equipment. Embolization procedures, TIPS creation, and renal/visceral artery stent placement are associated with a substantial likelihood of clinically significant patient dose. At minimum, patient dose data should be recorded in the medical record for these three types of procedures. These data should include indicators of the risk of deterministic effects as well as the risk of stochastic effects.
authors.affiliation: Department of Radiology, National Naval Medical Center, Bethesda, MD 20889-5600, USA. dm72v@nih.gov
authors.forename: Donald L
authors.initials: DL
authors.lastname: Miller
authors.forename: Stephen
authors.initials: S
authors.lastname: Balter
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Cole
authors.forename: Hollington T
authors.initials: HT
authors.lastname: Lu
authors.forename: Beth A
authors.initials: BA
authors.lastname: Schueler
authors.forename: Michael
authors.initials: M
authors.lastname: Geisinger
authors.forename: Alejandro
authors.initials: A
authors.lastname: Berenstein
authors.forename: Robin
authors.initials: R
authors.lastname: Albert
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Georgia
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Noonan
authors.forename: John F
authors.initials: JF
authors.lastname: Cardella
authors.forename: James
authors.initials: J
authors.lastname: St  George
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Russell
authors.forename: Tim W
authors.initials: TW
authors.lastname: Malisch
authors.forename: Robert L
authors.initials: RL
authors.lastname: Vogelzang
authors.forename: George L
authors.initials: GL
authors.lastname: Miller
authors.forename: Jon
authors.initials: J
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009485:Neuroradiography; D015588:Observer Variation; D011446:Prospective Studies; D011829:Radiation Dosage; D015641:Radiography, Interventional; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D014656:Vascular Surgical Procedures