title: Patient radiation dose management in the follow-up of potential skin injuries in neuroradiology.
abstract: OBJECTIVE
  Radiation exposure from neurointerventional procedures can be substantial, with risk of radiation injuries. We present the results of a follow-up program applied to potential skin injuries in interventional neuroradiology based on North American and European guidelines.
  
  
  METHODS
  The following guidelines approved in 2009 by SIR and CIRSE have been used over the last 2 years to identify patients with potential skin injuries requiring clinical follow-up: peak skin dose >3 Gy, air kerma at the patient entrance reference point >5 Gy, kerma area product >500 Gy · cm(2), or fluoroscopy time >60 minutes.
  
  
  RESULTS
  A total of 708 procedures (325 in 2009 and 383 in 2010) were included in the study. After analyzing each dose report, 19 patients (5.9%) were included in a follow-up program for potential skin injuries in 2009, while in 2010, after introducing several optimizing actions and refining the selection criteria, only 4 patients (1.0%) needed follow-up. Over the last 2 years, only 3 patients required referral to a dermatology service.
  
  
  CONCLUSIONS
  The application of the guidelines to patient radiation dose management helped standardize the selection criteria for including patients in the clinical follow-up program of potential skin radiation injuries. The peak skin dose resulted in the most relevant parameter. The refinement of selection criteria and the introduction of a low-dose protocol in the x-ray system, combined with a training program focused on radiation protection, reduced the number of patients requiring clinical follow-up.
authors.affiliation: Medical Physics Service and Radiology Department, Instituto de Investigación Sanitaria Hospital Clinico San Carlos and Complutense University, Madrid, Spain. eliseov@med.ucm.es
authors.forename: E
authors.initials: E
authors.lastname: Vano
authors.forename: J M
authors.initials: JM
authors.lastname: Fernandez
authors.forename: R M
authors.initials: RM
authors.lastname: Sanchez
authors.forename: D
authors.initials: D
authors.lastname: Martinez
authors.forename: L Lopez
authors.initials: LL
authors.lastname: Ibor
authors.forename: A
authors.initials: A
authors.lastname: Gil
authors.forename: C
authors.initials: C
authors.lastname: Serna-Candel
mesh_terms: D016208:Databases, Factual / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000175:diagnosis* / Q000453:epidemiology; D011835:Radiation Protection / Q000379:methods; D012307:Risk Factors; D012867:Skin / Q000528:radiation effects*; D012871:Skin Diseases / Q000453:epidemiology* / Q000209:etiology