title: Radiation dose and risk from fluoroscopically guided percutaneous transhepatic biliary procedures.
abstract: OBJECTIVE
  To estimate radiation dose and associated risks after fluoroscopically guided percutaneous transhepatic biliary (PTB) drainage and stent implantation procedures.
  
  
  METHODS
  Organ and effective doses, normalized to dose-area product (DAP), were estimated for PTB procedures with use of a Monte Carlo transport code and an adult mathematical phantom. Exposure parameters from 51 consecutive patients were used to determine average examination parameters for biliary drainage and stent implantation procedures. Thermoluminescent dosimeters were used in an anthropomorphic phantom to verify Monte Carlo calculations. Radiation-induced cancer and genetic risks were estimated.
  
  
  RESULTS
  The results consist of doses normalized to DAP so patient dose from any technique and x-ray unit can be easily calculated for left and right biliary access and for separate or combined biliary and metallic stent implantation sessions. A good agreement was found between Monte Carlo-calculated data and data derived from thermoluminescent dosimetry. The average effective dose varied from 1.8 to 5.4 mSv depending on procedure approach (left vs right access) and procedure scheme. A maximum effective dose of 13 mSv was estimated for 30 minutes of fluoroscopy.
  
  
  CONCLUSIONS
  Doses delivered to patients undergoing PTB procedures are comparable to those that arise from computed tomography protocols. Radiation-induced cancer risk may be considerable for young patients undergoing PTB drainage and stent implantation procedures.
authors.affiliation: Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 1393, 71409 Iraklion, Crete, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Stratakis
authors.forename: John
authors.initials: J
authors.lastname: Damilakis
authors.forename: Adam
authors.initials: A
authors.lastname: Hatzidakis
authors.forename: Kostas
authors.initials: K
authors.lastname: Perisinakis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Gourtsoyiannis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000528:radiation effects*; D001662:Biliary Tract Surgical Procedures; D002779:Cholestasis / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009381:Neoplasms, Radiation-Induced; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D015641:Radiography, Interventional; D012062:Relative Biological Effectiveness; D012307:Risk Factors; D015607:Stents; D013819:Thermoluminescent Dosimetry; D014781:Viscera / Q000528:radiation effects