Jose Miguel Fernandez

Objectives: The number of fluoroscopy-guided interventional procedures has increased in recent years due to their significant patient benefits. However, occupational radiation risks for interventionalists remain among the highest in medical practices. Electronic personal dosimeters can measure occupational doses for individual procedures, enabling immediate optimisation actions. An information system that effectively aggregates these records proves to be a powerful tool for this optimisation. Furthermore, implementing alerts to identify abnormal occupational doses is a practical method to improve radiation protection for interventionists. Methods: Electronic dosimeters were linked with the X-ray system to record both the occupational and patient doses on a per-procedure basis. The information, stored in a central database, is used to compute dose indicators and trigger alerts that warn operators about specific areas requiring optimisation. Results: The results from the first 9 months of 2024 were analysed, covering 3 interventional cardiology rooms and 2 interventional radiology rooms, with 19 interventionalists (8 cardiologists and 11 radiologists) performing a total of 3373 procedures. The initial alerts were configured on the basis of regulatory dose limits and the third quartile of occupational dose per procedure, as well as the ratio of occupational dose to kerma area product per procedure and the ratio between occupational dose and the C-arm measured dose. Conclusions: These alerts, along with personal dose data and other dosimetry information, are accessible to interventionalists and medical physics experts. This information system provides detailed, structured occupational dose data necessary to implement targeted optimisation measures. Graphical

Objectives: The radiology industry has been developing advanced X-ray systems which now deliver high-quality imaging while reducing radiation exposure. In this study, we analyse the impact of the new X-ray systems on patient and occupational radiation doses, compared with the previous ones (from the same manufacturer). Methods: A dose management system (DMS) was employed to analyse large datasets from interventional cardiology procedures to assess the radiation protection improvements. Interventionists wear electronic active dosimeters wirelessly linked to the DMS to record personal occupational doses. Our analysis was conducted at 4 levels for the old and new X-ray systems: patient doses, using the kerma area product (KAP); scatter radiation measured by the reference (ambient) dosimeter located on the C-arm; occupational doses using over-apron personal electronic dosimeters, and updating local diagnostic reference levels (DRLs) for the most frequent procedures. Results: This methodology enables the evaluation of the new technology’s impact at different levels: patient dose values (level 1), scatter radiation measured by the ambient dosimeters (level 2), occupational doses for interventionists (level 3), and updated local DRLs (level 4). Conclusions: Based on an analysis of 5002 interventional cardiology procedures, the new X-ray systems demonstrated a substantial reduction in radiation doses (median values): patient doses (KAP values) decreased by 56%-67%. Scatter radiation (ambient dose) decreased by 52%-68%. Occupational doses: interventionists’ doses decreased by 33%. The updated local DRLs (median values) for CA and PTCA with the new X-ray systems are 17 Gy·cm2 and 50 Gy·cm2 representing reductions of 62% and 52%, respectively. Advances in knowledge: The implementation of advanced X-ray technology has significantly reduced patient and occupational radiation exposure, all without compromising diagnostic accuracy. The effects on local diagnostic reference levels and the reduction in occupational doses should be regularly assessed to ensure that appropriate optimization actions are maintained.

Interventional radiology is a clinical practice with important benefits for patients, but which involves high radiation doses. The optimisation of radiation protection (RP) for paediatric interventional cardiology is a priority for both patients and staff. The use of diagnostic reference levels (DRLs) has been proposed by the International Commission on Radiological Protection to improve RP in imaging procedures. Dose management systems (DMSs) allow the automatic collection of dosimetric, geometric and technical data to assist the optimisation process, with a continuous audit of the procedures, generating alerts to implement corrective actions when necessary. Patient dose indicators may be analysed individually and for different radiation events (fluoroscopy and cine runs). Occupational doses per procedure may be analysed (if electronic dosimeters are available) and linked with patient doses for an integrated approach to RP. Regional optimisation programmes require data collection and processing from several countries to set and periodically update the DRLs. Patient data is anonymised, and each participating hospital has access to their data in a central computer server. Using DMSs may be one of the best ways to support these programs in the collection and analysis of data, raising alerts about high patient and occupational doses and suggesting optimisation actions.

Objectives: The International Commission on Radiological Protection recommends managing patient and occupational doses as an integrated approach, for the optimisation of interventional procedures. The conventional passive personal dosimeters only allow one to know the accumulated occupational doses during a certain period of time. This information is not enough to identify if there is a lack of occupational radiation protection during some procedures. This paper describes the use of a dose management system (DMS) allowing patient and occupational doses for individual procedures to be audited. Methods: The DMS manages patient and occupational doses measured by electronic personal dosimeters. One dosemeter located at the C-arm is used as a reference for scatter radiation. Data have been collected from five interventional rooms. Dosimetry data can be managed for the whole procedure and the different radiation events. Optimisation is done through auditing different sets of parameters for individual procedures: patient dose indicators, occupational dose values, the ratio between occupational doses, and the doses measured by the reference dosemeter at the C-arm, and the ratio between occupational and patient dose values. Results: The managed data correspond to the year 2021, with around 4500 procedures, and 8000 records on occupational exposures. Patient and staff dose data (for 11 cardiologists, 7 radiologists and 8 nurses) were available for 3043 procedures. The DMS allows alerts for patient dose indicators and occupational exposures to be set. Conclusions: The main advantage of this integrated approach is the capacity to improve radiation safety for patients and workers together, auditing alerts for individual procedures. Advances in knowledge: The management of patient and occupational doses together (measured with electronic personal dosimeters) for individual interventional procedures, using dose management systems, allows alerting optimisation on high-dose values for patients and staff.

Objectives: Radiation dose management systems (DMS) are currently used to help improve radiation protection in medical imaging and interventions. This study presents our experience using a homemade DMS called DOLQA (Dose On-Line for Quality Assurance). Methods: Our DMS is connected to 14 X-ray systems in a university hospital linked to the central data repository of a large network of 16 public hospitals in the Autonomous Community of Madrid, with 6.7 million inhabitants. The system allows us to manage individual patient dose data and groups of procedures with the same clinical indications, and compare them with diagnostic reference levels (DRLs). The system can also help to prioritise optimisation actions. Results: This study includes results of imaging examinations from 2020, with 37,601 procedures and 286,471 radiation events included in the radiation dose structured reports (RDSR), for computed tomography (CT), interventional procedures, positron emission tomography-CT (PET-CT) and mammography. Conclusions: The benefits of the system include: automatic registration and management of patient doses, creation of dose reports for patients, information on recurrent examinations, high dose alerts, and help to define optimisation actions. The system requires the support of medical physicists and implication of radiologists and radiographers. DMSs must undergo periodic quality controls and audit reports must be drawn up and submitted to the hospital’s quality committee. The drawbacks of DMSs include the need for continuous external support (medical physics experts, radiologists, radiographers, technical services of imaging equipment and hospital informatics services) and the need to include data on clinical indication for the imaging procedures. Advances in knowledge: DMS perform automatic management of radiation doses, produces patient dose reports, and registers high dose alerts to suggest optimisation actions. Benefits and limitations are derived from the practical experience in a large university hospital.

: It is relevant to estimate the uncertainties in the measurement of eye lens doses from a personal dosimeter over the protective apron without using additional dosimetry near the eyes. Additional dosimetry for interventionists represents a difficulty for routine clinical practice. This study analyses the estimated eye doses from dosimeter values taken at chest level over the apron and their uncertainties. Measurements of H _p(0.07) using optically stimulated luminescence dosimeters located on the chest over the apron and on the glasses (in the inner and outer part of the protection) were taken from ten interventionalists in a university hospital, in the period 2018–2019 during standard clinical practice. For a total sample of 133 interventional procedures included in our study, the ratio between the H _p(0.07) on the glasses (left-outer side) and on the chest over the apron had an average of 0.74, with quartiles of 0.47, 0.64, 0.88. Statistically significant differences were found among operators using the U-Mann–Whitney test. The average transmission factor for the glasses was 0.30, with quartiles of 0.21, 0.25, and 0.32. Different complexity in the procedures, in the quality of the scatter radiation and in the individual operational practices, involve a relevant dispersion in the results for lens dose estimations from the over apron dosimeter. Lens doses may be between a 64% and an 88% of the over apron dosimeter values (using median or 3rd quartile). The use of 88% may be a conservative approach.

This review presents the challenges met by interventional radiologists in occupational dosimetry. The issues mentioned are derived from the recommendations of the International Commission on Radiological Protection, the CIRSE guidelines on “Occupational radiation protection in interventional radiology" and the requirements of the European directive on Basic Safety Standards. The criteria for a proper use of personal dosimeters and the need to introduce optimization actions in some cases are set out in this review. The pros and cons of the electronic real-time dosimeters are outlined and the potential pitfalls associated with the use of personal dosimeters summarized. The electronic dosimeters, together with the appropriate software, allow an active optimization of the interventional procedures.

Objectives: In fluoroscopy-guided interventional practices, new dose reduction systems have proved to be efficient in the reduction of patient doses. However, it is not clear whether this reduction in patient dose is proportionally transferred to operators’ doses. This work investigates the secondary radiation fields produced by two kinds of interventional cardiology units from the same manufacturer with and without dose reduction systems. Methods: Data collected from a large sample of clinical procedures over a 2-year period (more than 5000 procedures and 340,000 radiation events) and the DICOM radiation dose structured reports were analysed. Results: The average cumulative H p(10) per procedure measured at the C-arm was similar for the standard and the dose reduction systems (452 vs 476 μSv respectively). The events analysis showed that the ratio H p(10)/KAP at the C-arm was (mean ± SD) 5 ± 2, 10 ± 4, 14 ± 4 and 14 ± 6 μSv·Gy−1·cm−2 for the beams with no added filtration, 0.1, 0.4 and 0.9 mm Cu respectively and suggested that the main cause for the increment of the ratio H p(10)/KAP vs the “standard system” is the use of higher beam filtration in the “dose reduction” system. Conclusion: Dose reduction systems are beneficial to reduce KAP in patients and their use should be encouraged, but they may not be equally effective to reduce occupational doses. Interventionalists should not overlook their own personal protection when using new technologies with dose reduction systems. Advances in knowledge: Dose reduction technology in interventional systems may increase scatter dose for operators. Personal protection should not be overlooked with dose reduction systems.