Establishment of trigger levels to steer the follow-up of radiation effects in patients undergoing fluoroscopically-guided interventional procedures in Belgium

Lara Struelens, klaus Bacher, Hilde Bosmans, Frédéric Bleeser, Marie-Thérèse Hoornaert, Françoise Malchair, Steve Balter, Filip Vanhavere

Research outputpeer-review


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.
Original languageEnglish
Pages (from-to)934-940
JournalPhysica Medica
Issue number12
StatePublished - Sep 2014

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