Abstract
The purpose of this work has been to dosimetrically investigate four fluoroscopically guided interventions: the percutaneous vertebroplasty (PVP), the percutaneous disc decompression (PDD), the radiofrequency medial branch neurolysis (RF) (hereafter named spine procedures), and the endovascular treatment for the critical limb ischemia (CLI). The X‐ray equipment used was a Philips Integris Allura Xper FD20 imaging system provided with a dose‐area product (DAP) meter. The parameters investigated were: maximum skin dose (MSD), air kerma (Ka,r), DAP, and fluoroscopy time (FT). In order to measure the maximum skin dose, we employed a system based on MOSFET detectors. Before using the system on patients, a calibration factor Fc and correction factors for energy (CkV) and field size (CFD) dependence were determined. Ka,r, DAP, and FT were extrapolated from the X‐ray equipment. The analysis was carried out on 40 patients, 10 for each procedure. The average fluoroscopy time and DAP values were compared with the reference levels (RLs) proposed in literature. Finally, the correlations between MSD, FT, Ka,r, and DAP values, as well as between DAP and FT values, were studied in terms of Pearson's product‐moment coefficients for spine procedures only. An Fc value of 0.20 and a very low dependence of CFD on field size were found. A third‐order polynomial function was chosen for CkV. The mean values of MSD ranged from 2.3 to 10.8 cGy for CLI and PVP, respectively. For these procedures, the DAP and FT values were within the proposed RL values. The statistical analysis showed little correlation between the investigated parameters. The interventional procedures investigated were found to be both safe with regard to deterministic effects and optimized for stochastic ones. In the spine procedures, the observed correlations indicated that the estimation of MSD from Ka,r or DAP was not accurate and a direct measure of MSD is therefore recommended.PACS number: 87
Highlights
In the past twenty years, the clinical practice of fluoroscopically guided interventions (FGIs) that use image guidance has been greatly improved
Since this value was below the experimental uncertainties (Δ1) in the calibration process, we decided to average the MOSFET readings measured in both filtering
As the MOSFET readings with field size varied by at least 2%, we decided to consider the field size correction factor CFD equal to 1 in all the investigated experimental conditions
Summary
In the past twenty years, the clinical practice of fluoroscopically guided interventions (FGIs) that use image guidance has been greatly improved. FGIs are less intrusive with respect to surgery and their benefits are clear: high safety, accuracy, and low morbidity.[1] some procedures use either long fluoroscopy times or high numbers of frames, exposing the patients to relevant doses which increase the probability of stochastic effects and can, in extreme cases, exceed the threshold of deterministic ones. Only few refer ences in the scientific literature suggest reference levels (RL) for some FGIs.[8,9,10] In literature, the RLs are stated in terms of maximum skin dose (MSD) and dose-area product (DAP), and other parameters, such as fluoroscopy time, number of frames or effective dose, are typically used.[2,11,12]. If the MSD value exceeds the 2 Gy deterministic threshold, skin injuries will arise, such as transient erythema
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