Gabriel Bartal

Guidelines for Patient Radiation Dose Management

Michael S. Stecker, MD, Stephen Balter, PhD, Richard B. Towbin, MD, Donald L. Miller, MD, Eliseo Vano, PhD,Gabriel Bartal, MD, J. Fritz Angle, MD, Christine P. Chao, MD, Alan M. Cohen, MD, Robert G. Dixon, MD,Kathleen Gross, MSN, RN-BC, CRN, George G. Hartnell, MD, Beth Schueler, PhD, John D. Statler, MD,Thierry de Baere, MD, and John F. Cardella, MD, for the SIR Safety and Health Committee and the CIRSEStandards of Practice Committee

Quality Improvement Guidelines for Recording Patient Radiation Dose in the Medical Record for Fluoroscopically Guided Procedures

ACR American College of Radiology, CRCPD Conference of Radiation Control Program Directors, FDA Food and Drug Administration, ICRU International Commission on Radiation Units and Measurements, IEC International Electrotechnical Commission, IRP interventional reference point, Ka,r total air kerma at the interventional reference point, NCRP National Council on Radiation Protection and Measurements, PKA kerma–area product, PSD peak skin dose, RDSR Radiation Dose Structured Report

Management of Patient and Staff Radiation Dose in Interventional Radiology: Current Concepts

The increasing complexity and numbers of interventional fluoroscopy procedures have led to increasing patient doses of radiation and to increasing concern over staff doses. Hybrid rooms incorporate multiple imaging modalities and are used by multidisciplinary teams in interventional fluoroscopy suites and operating theaters. These rooms present additional radiation protection challenges. The new low annual exposure limit for the lens of the eye also requires specific measures to prevent cataracts in operators. The traditional attitude of radiation protection must be changed to one of proactive management of radiation dose and image quality. Incorporation of a comprehensive dose management program into the departmental quality assurance program is now essential. Physicians, radiographers, and medical physicists play an essential role in the safe use of fluoroscopy in medical practice. Efficient use of all imaging modalities (e.g., fluoroscopy, digital subtraction angiography, cone-beam CT) requires knowledge of the effects of different equipment settings on patient and staff doses as well as the skill and competence to optimize these settings for each procedure and patient. Updates and recommendations on radiation protection and dose management programs, including aspects of education and training, are presented.

Radiation management for interventions using fluoroscopic or computed tomographic guidance during pregnancy: A joint guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe with endorsement by the Canadian Interventional Radiology Association

Lawrence T. Dauer, PhD, CHP, Raymond H. Thornton, MD, Donald L. Miller, MD, John Damilakis, PhD, Robert G. Dixon, MD, M. Victoria Marx, MD, Beth A. Schueler, PhD, Eliseo Vano, PhD, Aradhana Venkatesan, MD, Gabriel Bartal, MD, Dimitrios Tsetis, MD, PhD, and John F. Cardella, MD, for the Society of Interventional Radiology Safety and Health Committee and the Cardiovascular and Interventional Radiology Society of Europe Standards of Practice Committee

Occupational radiation protection of pregnant or potentially pregnant workers in IR: A joint guideline of the society of interventional radiology and the cardiovascular and interventional radiological society of europe

Lawrence T. Dauer, PhD, Donald L. Miller, MD, Beth Schueler, PhD, James Silberzweig, MD, Stephen Balter, PhD, Gabriel Bartal, MD, Charles Chambers, MD, Jeremy D. Collins, MD, John Damilakis, PhD, Robert G. Dixon, MD, M. Victoria Marx, MD, Michael S. Stecker, MD, Eliseo Vano, PhD, Aradhana M. Venkatesan, MD, and Boris Nikolic, MD, MBA, for the Society of Interventional Radiology Safety and Health Committee and the Cardiovascular and Interventional Radiological Society of Europe Standards of Practice Committee

Call for Implementing a Radiation Protection Culture in Fluoroscopically Guided Interventional Procedures

OBJECTIVE The purpose of this article is to discuss the first prospective study published to date that followed a large cohort of radiologic technologists; the authors examined the risks of cancer incidence and mortality in U.S. radiologic technologists (radiographers) assisting in fluoroscopically guided interventional procedures. CONCLUSION There is an urgent need for implementing a radiation protection culture for medical procedures that use ionizing radiation.

Effective dose and breast dose reduction in paediatric scoliosis X-ray radiography by an optimal positioning

The purpose of this article is to recommend positioning to reduce the effective and breast-absorbed-doses in paediatric scoliosis radiography. Effective and breast-absorbed-doses were evaluated using Monte Carlo simulations. Head directed towards the anode (HTA) positioning rather than head directed towards the cathode (HTC) reduces the effective dose to 98 % in anterior posterior (AP), 98 % in left lateral (L LAT) and 96 % in right lateral (R LAT) projections. HTC in posterior anterior (PA) projection contributes a smaller effective dose than HTA by <1 %, but causes a breast-absorbed-dose excess (HTA/HTC breast dose ratios were 85 and 87 % for 10- and 15-y- olds). With the preferential HTA positioning, R LAT projection reduced effective dose to 85 and 84 % compared with L LAT, for 10 and 15 y olds. AP-HTA projection caused 183 and 181 % larger effective doses than PA-HTA and breast-absorbed-dose excesses of 550 and 879 %, for 10 and 15 y olds. When possible, use R LAT and PA projections to reduce effective dose; Of secondary importance, whenever possible, use HTA, with the exception that for 15 y olds, PA-HTC reduces the effective dose more than HTA (1 %) but causes a breast-absorbed-dose excess.

Radiofrequency treatment has a beneficial role in reducing low back pain due to facet syndrome in octogenarians or older

Introduction Chronic low back pain is a disabling phenomenon that can cause a severe reduction in quality of life, especially in elderly patients. Surgical treatment is sometimes a big challenge for these elderly patients. Radiofrequency (RF) ablation is an increasingly popular method for treating low back pain caused by facet syndrome. The purpose of this study was to evaluate whether RF neurotomy is effective in terms of pain reduction and functional outcome in elderly patients. Patients and methods Fifty-eight patients aged 80 years and older who had chronic mechanical low back pain were examined after they underwent RF heat lesion of the medial branch. Follow-up occurred 1, 3, 6, and 12 months after treatment. Pain was measured on the visual analog scale and functional outcome was measured using the Oswestry Disability Index. Results After 1 month, 43 patients (74%) were satisfied with the results. After 3 months, 38 patients (66%) had clinically significant pain relief. After 6 months, 33 patients (57%) had pain relief, and at the 1-year follow-up, 30 patients (52%) showed good results while 28 patients (48%) showed no effect. The Oswestry Disability Index score was substantially improved even after 1 year. Minor complications occurred in eleven patients (19%), who had transient discomfort and burning pain. Conclusion RF is a safe and partially effective procedure for treating elderly patients with mechanical back pain due to facet syndrome.

Effective dose reduction in spine radiographic imaging by choosing the less radiation-sensitive side of the body

BACKGROUND CONTEXT X-ray absorption is highest in the organs and tissues located closest to the radiation source. The photon flux that crosses the body decreases from the entry surface toward the image receptor. The internal organs absorb x-rays and shield each other during irradiation. Therefore, changing the x-ray projection angle relative to the patient for specific spine procedures changes the radiation dose that each organ receives. Every organ has different radiation sensitivity, so irradiation from different sides of the body changes the biological influence and radiation risk potential on the total body, that is the effective dose (ED). PURPOSE The study aimed to determine the less radiation-sensitive sides of the body during lateral and anterior-posterior (AP) or posterior anterior (PA) directions. STUDY DESIGN The study used exposure of patient phantoms and Monte Carlo simulation of the effective doses. PATIENT SAMPLE Calculations for adults and 10-year-old children were included because the pediatric population has a greater lifetime radiation risk than adults. OUTCOME MEASURES Pediatric and adult tissue and organ doses and ED from cervical, thoracic, and lumbar x-ray spine examinations were performed from different projections. METHODS Standard mathematical phantoms for adults and 10-year-old children, using PCXMC 2.0 software based on Monte Carlo simulations, were used to calculate pediatric and adult tissue and organ doses and ED. The study was not funded. The authors have no conflicts of interest to declare. RESULTS Spine x-ray exposure from various right (RT) LAT projection angles was associated with lower ED compared with the same left (LT) LAT projections (up to 28% and 27% less for children aged 10 and adults, respectively). The PA spine projections showed up to 64% lower ED for children aged 10 and 65% for adults than AP projections. The AP projection at the thoracic spine causes an excess breast dose of 543.3% and 597.0% for children aged 10 and adults, respectively. CONCLUSIONS Radiation ED in spine procedures can be significantly reduced by performing x-ray exposures through the less radiation-sensitive sides of the body, which are PA in the frontal position and right lateral in the lateral position.

Society of Interventional Radiology IR Pre-Procedure Patient Safety Checklist by the Safety and Health Committee

Poyan Rafiei, MD, Eric M. Walser, MD, James R. Duncan, MD, PhD, Hunaid Rana, BS, Jason Robert Ross, MD, Robert K. Kerlan, Jr, MD, Kathleen A. Gross, MSN, BS, RN-BC, CRN, Stephen Balter, PhD, Gabriel Bartal, MD, Nadine Abi-Jaoudeh, MD, CCRP, Michael S. Stecker, MD, Alan M. Cohen, MD, Robert G. Dixon, MD, Raymond H. Thornton, MD, and Boris Nikolic, MD, MBA, for the Society of Interventional Radiology Health and Safety Committee