Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures

Hannu Jarvinen, Jad Farah, Teemu Siiskonen, Olivera Ciraj-Bjelac, Jérémie Dabin, Eleftheria Carinou, Joanna Domienik, Darius Kluszczynski, Zeljka Knezevic, Renata Kopec, Marija Majer, Françoise Malchair, Anna Negri, Piotr Pankowski, Sandra Sarmento, Annalisa Trianni

Research outputpeer-review


Purpose: The feasibility of setting-up generic, hospital-independent dose alert levels to initiate vigilance on possible skin injuries in interventional procedures was studied for three high-dose procedures (chemoembolization (TACE) of the liver, neuro-embolization (NE) and percutaneous coronary intervention (PCI)) in 9 European countries. Methods: Gafchromic® films and thermoluminescent dosimeters (TLD) were used to determine the Maximum Skin Dose (MSD). Correlation of the online dose indicators (fluoroscopy time, kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (Ka,r)) with MSD was evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy. The uncertainties of alert levels in terms of DAP and Ka,r, and uncertainty of MSD were calculated. Results: About 20–30% of all MSD values exceeded 2 Gy while only 2–6% exceeded 5 Gy. The correlations suggest that both DAP and Ka,r can be used as a dose indicator for alert levels (Pearson correlation coefficient p mostly>0.8), while fluoroscopy time is not suitable (p mostly
Original languageEnglish
Pages (from-to)64-74
JournalPhysica Medica
StatePublished - 13 Jan 2018

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