Patient follow-up for possible radiation injury from fluoroscopically-guided interventions: Need to consider high cumulative exposure from multiple procedures

Abstract

PurposePatient skin dose from interventional fluoroscopy procedures may exceed the threshold of tissue injuries and established guidelines recommend patient follow-up for air kerma at reference point (Ka,r) ≥ 5 Gy for individual procedures. Patients may undergo multiple procedures and skin injuries may be possible by cumulative exposure, even when individually insufficient to cause injury. This study sought to quantify the frequency of patients whose individual procedure doses are below 5 Gy but whose cumulative Ka,r is ≥ 5 Gy. MethodsThis retrospective study analyzed 37,917 consecutive procedures in interventional radiology and vascular surgery at a tertiary-care hospital between January 2016 and June 2021. Radiation dosage was retrieved from the fluoroscopy acquisition systems. For a patient receiving multiple procedures, but each with Ka,r < 5 Gy, cumulative Ka,r within 2, 7, 14, 30, 183, and 365 days was assessed. ResultsNearly 1/3rd (37.4 %) patients underwent multiple procedures. With individual procedures of Ka,r < 5 Gy exclusively, 1.9, 4.4, and 5.6 in 1000 patients received cumulative Ka,r of 5–14.1 Gy from the procedures within 30, 183, and 365 days, respectively. From the procedures within 14 days, 1.3 in 1000 patients received cumulative Ka,r of 5–11.4 Gy; and from those within 7 days, 0.87 in 1000 patients received 5–9.1 Gy. In comparison, 4.3 in 1000 patients received Ka,r of 5–12 Gy from a single procedure. ConclusionsIn the absence of guidelines on patient follow-up for multiple procedures, our study may provide good material for setting up such guidelines.