title: Radiation doses from venous access procedures.
abstract: OBJECTIVE
  To retrospectively analyze radiation dose data for six common venous access procedures.
  
  
  METHODS
  Institutional review board approval was obtained for this HIPAA-compliant study; informed consent was not required. Data review was limited to a quality assurance database. Patient medical records were not reviewed. We retrospectively analyzed radiation dose data from a prospective quality assurance program. Dose data were analyzed for 1010 instances of six different venous access placement procedures performed between February 1998 and July 2004. Radiation dose measurements were generated automatically by the interventional fluoroscopy units and were recorded at the conclusion of each procedure. Descriptive and summary statistical analyses were performed to determine median, minimum, and maximum values of radiation dose for each procedure. A P value of less than .05 indicated a significant difference. Because the data distribution was highly skewed, logarithmic transformation was performed. Dose data for four different venous access procedures (excluding chest port placement and peripherally inserted central catheter placement) were compared with a one-way analysis of variance. Pairwise comparisons with the Tukey honestly significant difference test were subsequently performed for each analogue where analysis of variance demonstrated a significant result.
  
  
  RESULTS
  No procedure yielded a cumulative dose of more than 950 mGy or a peak skin dose of more than 760 mGy. The highest mean cumulative dose (ie, 88 mGy), mean dose-area product (ie, 873 cGy . cm(2)), and mean peak skin dose (ie, 43 mGy) were observed for tunneled dialysis catheter placements. Significant differences in dose were observed for tunneled catheter placement versus nontunneled catheter placement (<.001 to .027). No significant differences in dose were observed for larger-diameter versus smaller-diameter catheters.
  
  
  CONCLUSIONS
  Radiation doses from venous access procedures are low. Even extreme outlier cases are unlikely to produce doses high enough to cause skin effects, especially when knowledgeable operators using well-calibrated equipment perform the procedures.
authors.affiliation: Department of Radiology, National Naval Medical Center, Bethesda, Md., USA.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Storm
authors.forename: Donald L
authors.initials: DL
authors.lastname: Miller
authors.forename: Laurie Jean
authors.initials: LJ
authors.lastname: Hoover
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Georgia
authors.forename: Tara
authors.initials: T
authors.lastname: Bivens
mesh_terms: D000704:Analysis of Variance; D005471:Fluoroscopy; D006801:Humans; D011785:Quality Assurance, Health Care; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000379:methods*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures