title: Establishment of trigger levels to steer the follow-up of radiation effects in patients undergoing fluoroscopically-guided interventional procedures in Belgium.
abstract: The accumulated dose to the skin of the patient during fluoroscopically-guided procedures can exceed the thresholds for tissue reactions. In practice, interventionalists have no direct information about the local procedure-related skin doses in their patient, causing suboptimal or delayed treatment. In current study, the accumulated Kerma-Area-Product (KAP) values were registered, as well as the reference air kerma (Ka,r) values, if available, for almost 200 cases undergoing seven different procedures. A sheet filled with 50 thermoluminescent dosemeters was wrapped around each patient to measure the peak skin dose. In a significant part of the Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedures, chemo-embolizations of the liver and cerebral embolizations, the threshold values for deterministic skin damage (2 Gy) were attained. Trigger values in terms of KAP, corresponding to a peak skin dose of 2 Gy, were determined. In general, our results comply reasonably well with the values proposed in the NCRP 168 report, with a KAP value of 425 Gy cm² and a Ka,r value of 3 Gy, corresponding to a peak skin dose of 3 Gy. Only for the TIPSS procedure a considerably lower value of 2 Gy was obtained at the published Ka,r and for the RF ablations we obtained a considerably lower value of 250 Gy cm² in terms of KAP.
authors.affiliation: Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, 2400 Mol, Belgium. Electronic address: Lara.struelens@sckcen.be.
authors.forename: L
authors.initials: L
authors.lastname: Struelens
authors.affiliation: Department of Basic Medical Sciences, Gent University (UGent), Proeftuinstraat 86, 9000 Gent, Belgium. Electronic address: Klaus.Bacher@ugent.be.
authors.forename: K
authors.initials: K
authors.lastname: Bacher
authors.affiliation: KU Leuven - University of Leuven, University Hospitals, Herestraat 49, 3000 Leuven, Belgium. Electronic address: Hilde.Bosmans@uzleuven.be.
authors.forename: H
authors.initials: H
authors.lastname: Bosmans
authors.affiliation: Centres Hospitaliers Jolimont, 159 rue Ferrer, 7100 Haine Saint-Paul, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Bleeser
authors.affiliation: Centres Hospitaliers Jolimont, 159 rue Ferrer, 7100 Haine Saint-Paul, Belgium. Electronic address: Marie-Therese.HOORNAERT@entitejolimontoise.be.
authors.forename: M T
authors.initials: MT
authors.lastname: Hoornaert
authors.affiliation: Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart-Tilman Bâtiment B 35, 4000 Liège, Belgium. Electronic address: Francoise.malchair@zephyra.be.
authors.forename: F
authors.initials: F
authors.lastname: Malchair
authors.affiliation: Columbia University, 630 West 168th St, New York, NY 10032, United States. Electronic address: Sb2455@columbia.edu.
authors.forename: S
authors.initials: S
authors.lastname: Balter
mesh_terms: D001530:Belgium; D002138:Calibration; D003020:Clothing; D005471:Fluoroscopy / Q000295:instrumentation* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007700:Kinetics; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation* / Q000379:methods; D015642:Radiology, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012867:Skin / Q000293:injuries* / Q000528:radiation effects*; D013819:Thermoluminescent Dosimetry / Q000379:methods; D014965:X-Rays
keywords: Fluoroscopically-guided interventional procedures; Kerma-area-product; Pathways for care; Radiation skin injury; Skin dose; Trigger level