Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optim... more Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging 'Clinical DRLs' working group formed with the purpose to produce scientific and educational material on DRLs and promote the concept of local DRLs. Guidelines on how to establish and how to use local DRLs presented herein can be implemented using a multidisciplinary team approach. Local DRLs are easy to determine and implement and they reflect local equipment performance and local clinical needs. They can be updated more frequently than the national DRLs, especially if a dose management system is available. To establish local DRLs, a practical approach could be to collect a reasonable set, i.e., at least 20-30 procedures, of data for well-defined clinical indications and calculate the 3rd quartile values. The median values of the distribution can be set to define the 'typical values'. The International Commission of Radiological Protection (ICRP) suggests setting 'typical values' for newer technologies that enable decreased amounts of radiation exposure for a similar level of image quality. Local DRLs should be similar or lower to the national DRLs. They could be higher only if the clinical benefits for some medical indications are fully explained and reported. Local DRLs may be used as a quality benchmark to track outliers and can be also used as alert values. Key points • Guidelines on how to establish and use local DRLs are presented. • Local DRLs are easy to determine and implement and can be updated frequently • Additionally, local DRLs can be used to track outliers.
In interventional cardiology, a wide variation in patient dose for the same type of procedure has... more In interventional cardiology, a wide variation in patient dose for the same type of procedure has been recognised by different studies. Variation is almost due to procedure complexity, equipment performance, procedure protocol and operator skill. The SENTINEL consortium has performed a survey in nine european centres collecting information on near 2000 procedures, and a new set of reference levels (RLs) for coronary angiography and angioplasty and diagnostic electrophysiology has been assessed for air kerma-area product: 45, 85 and 35 Gy cm 2 , effective dose: 8, 15 and 6 mSv, cumulative dose at interventional reference point: 650 and 1500 mGy, fluoroscopy time: 6.5, 15.5 and 21 min and cine frames: 700 and 1000 images, respectively. Because equipment performance and setup are the factors contributing to patient dose variability, entrance surface air kerma for fluoroscopy, 13 mGy min 21 , and image acquisition, 0.10 mGy per frame, have also been proposed in the set of RLs.
The purpose of the study was to analyse the technical characteristics of a newly installed flat-p... more The purpose of the study was to analyse the technical characteristics of a newly installed flat-panel fluoroscopy (FPF) system in an interventional cardiology (IC) department and compare it with an older conventional system. A patient survey was performed to investigate the radiation doses delivered by the X-ray systems. Finally, methods of technique optimization regarding the new digital system were investigated. Dose rates in all fluoroscopic and cine modes were measured and image quality assessed using a dedicated test tool. 200 patients were investigated, half using the conventional and half using the digital FPF system. Patient data collected were: sex, age, weight, height, dose-area product (DAP), fluoroscopy time (T) and total number of frames (F). Our results are: (1) Digital FPF system: high contrast resolution (HCR) is not affected by fluoroscopic mode, whereas low contrast resolution (LCR) is slightly decreased in the low mode. (2) The digital FPF system has 2.5 times better HCR than the conventional system, with 5 times lower dose in the fluoroscopy mode. (3) Median values of DAP, T and F, respectively, in coronary angiography (CA) are: 27.7 Gycm 2 , 4.1 min and 876 for the digital and 39.3 Gycm 2 , 5.3 min and 1600 for the conventional system. Median values for percutaneous transluminal coronary angioplasty (PTCA) are: 51.1 Gycm 2 , 12.7 min and 1184 for the digital and 44.3 Gycm 2 , 7.4 min and 1936 for the conventional system. Digital DAP in CA is reduced by 30%, suggesting that a dose reduction in the FPF system is possible. The results of the study concerning the FPF system lead to the conclusion that the lowest fluoroscopic mode and the lowest frame rate should be used in routine practice.
This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the ye... more This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative’s Call for Action in successfully achieving international radiation protection goals as set out by those frameworks is detailed.
In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting... more In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting on Developing Effective Methods for Radiation Protection Education and Training of Health Professionals with attendance of 230 participants representing 66 Member States and 24 international organizations, professional bodies and safety alliances. By means of a pre-meeting survey, presentations by experts, topical panel discussions and post-meeting feedback to the meeting summary, the meeting identified strengths, common weaknesses and possible solutions and actions for improving radiation protection education and training of health professionals. Available guidelines and resources for radiation protection training were also reviewed. The meeting discussion resulted in a strong consensus for the need of: (a) international guidance on education and training in radiation protection and safety for health professionals, (b) an international description of minimum standards of initial and on...
The terms “notifications” and “alerts” for medical exposures are used by several national and int... more The terms “notifications” and “alerts” for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to...
Se presentan las nuevas implicaciones de la directiva europea 2013/59 en las estimaciones de dosi... more Se presentan las nuevas implicaciones de la directiva europea 2013/59 en las estimaciones de dosis de radiación a la población y en los niveles de referencia para diagnóstico, teniendo en cuanta el Proyecto DOPOES II, las nueva Directiva de Normas Básicas de Seguridad, las recomendaciones propuestas por la ICRP sobre Niveles de referencia de dosis (DRLs), asi como los datos requeridos por UNSCEAR. Por último la presentación del Programa EUCLID de la Comisión Europea donde España aportará datos.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech
Purpose Evaluation and registration of patient and staff doses are mandatory under the current Eu... more Purpose Evaluation and registration of patient and staff doses are mandatory under the current European legislation, and the occupational dose limits recommended by the ICRP have been adopted by most of the countries in the world. Methods Relevant documents and guidelines published by international organisations and interventional radiology societies are referred. Any potential reduction of patient and staff doses should be compatible with the clinical outcomes of the procedures. Results The review summarises the most common protective measures and the needed quality control for them, the criteria to select the appropriate protection devices, and how to avoid unnecessary occupational radiation exposures. Moreover, the current and future advancements in personnel radiation protection using medical simulation with virtual and augmented reality, robotics, and artificial intelligence (AI) are commented. A section on the personnel radiation protection in the era of COVID-19 is introduced, showing the expanding role of the interventional radiology during the pandemic. Conclusion The review is completed with a summary of the main factors to be considered in the selection of the appropriate radiation protection tools and practical advices to improve the protection of the staff.
Poster: "ECR 2018 / C-1616 / Validation of a quick skin dose map estimator for interventiona... more Poster: "ECR 2018 / C-1616 / Validation of a quick skin dose map estimator for interventional cardiology procedures" by: "R. M. Sanchez, E. Vano, J. M. Fernandez Soto, J. I. Ten; Madrid/ES"
Poster: "EuroSafe Imaging 2018 / ESI-0018 / The new ICRP Recommendations on Diagnostic Refer... more Poster: "EuroSafe Imaging 2018 / ESI-0018 / The new ICRP Recommendations on Diagnostic Reference Levels for Medical Imaging" by: "E. Vano1, D. L. Miller2, C. J. Martin3, M. M. Rehani4, K. Kang5, M. Rosenstein2, P. Ortiz-Lopez6, S. Mattsson7, R. Padovani8, A. T. Rogers9; 1ICRP Working Group Madrid/XX, 2ICRP Working Group Bethesda/US, 3ICRP Working Group Glasgow/UA, 4ICRP Working Group Boston/US, 5ICRP Working Group Seoul/KP, 6ICRP Working Group Vienna/AT, 7ICRP Working Group Malmo/SE, 8ICRP Working Group Udine/IT, 9ICRP Working Group Nottingham/UK"
<b>Copyright information:</b>Taken from "The American College of Radiology white... more <b>Copyright information:</b>Taken from "The American College of Radiology white paper on radiation dose in medicine:deep impact on the practice of cardiovascular imaging"http://www.cardiovascularultrasound.com/content/5/1/37Cardiovascular Ultrasound 2007;5():37-37.Published online 31 Oct 2007PMCID:PMC2186301. In the x-axis, we listed some common cardiologic examinations with the corresponding doses (1 mSv = 50 chest x-rays). The threshold of 50 mSv of epidemiological evidence is surpassed by a typical cardiologic patient with known or suspected coronary artery disease, in one single hospital admission.
<b>Copyright information:</b>Taken from "The American College of Radiology white... more <b>Copyright information:</b>Taken from "The American College of Radiology white paper on radiation dose in medicine:deep impact on the practice of cardiovascular imaging"http://www.cardiovascularultrasound.com/content/5/1/37Cardiovascular Ultrasound 2007;5():37-37.Published online 31 Oct 2007PMCID:PMC2186301. Modified from ref. 7, on the basis of novel estimates of BEIR VII (ref. 21).
Practical ways to reduce radiation dose for patients and staff during device implantations and el... more Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures
This review presents basic information on the dosimetric quantities used in medical imaging for r... more This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity “effective dose” to compare doses delivered by different radiological procedures and different imaging modalities with its uncertainties and limitations, is summarised. The estimates of population doses required by the European Directive on Basic Safety Standards is commented on. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits. The application of effective dose on the cumulative doses from recurrent imaging procedures is also discussed. Patient summary: Basic information on the measurement units (dosimetric quantities) used in medical imaging for reporting radiation doses should be understandable to patients. The Working Group on “Dosimetry for imaging in clinical practice” recommended that a ...
This paper presents the design and some preliminary results of a pilot programme on patient dosim... more This paper presents the design and some preliminary results of a pilot programme on patient dosimetry in paediatric interventional cardiology (PIC) in Chile. The collected parameters during the survey have been: procedure identification, patient age, gender, weight, height, kerma area product (Pka), cumulative dose at the interventional reference point, number of cine series, total number of frames and fluoroscopy time. These data will also permit the estimation of typical radiological risks of the procedures for different age groups. Preliminary results are being calculated for the following age groups: <1; 1<5; 5<10 and 10<16 years. Kerma area product values and parameters related to imaging protocols of the procedures have been initially obtained from one of the most representative paediatrics centres of Chile. The x-ray system used in this centre was a biplane Siemens Axiom Artis with image intensifiers. The sample contains patients aged between 6 days and < 16 ye...
Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optim... more Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging 'Clinical DRLs' working group formed with the purpose to produce scientific and educational material on DRLs and promote the concept of local DRLs. Guidelines on how to establish and how to use local DRLs presented herein can be implemented using a multidisciplinary team approach. Local DRLs are easy to determine and implement and they reflect local equipment performance and local clinical needs. They can be updated more frequently than the national DRLs, especially if a dose management system is available. To establish local DRLs, a practical approach could be to collect a reasonable set, i.e., at least 20-30 procedures, of data for well-defined clinical indications and calculate the 3rd quartile values. The median values of the distribution can be set to define the 'typical values'. The International Commission of Radiological Protection (ICRP) suggests setting 'typical values' for newer technologies that enable decreased amounts of radiation exposure for a similar level of image quality. Local DRLs should be similar or lower to the national DRLs. They could be higher only if the clinical benefits for some medical indications are fully explained and reported. Local DRLs may be used as a quality benchmark to track outliers and can be also used as alert values. Key points • Guidelines on how to establish and use local DRLs are presented. • Local DRLs are easy to determine and implement and can be updated frequently • Additionally, local DRLs can be used to track outliers.
In interventional cardiology, a wide variation in patient dose for the same type of procedure has... more In interventional cardiology, a wide variation in patient dose for the same type of procedure has been recognised by different studies. Variation is almost due to procedure complexity, equipment performance, procedure protocol and operator skill. The SENTINEL consortium has performed a survey in nine european centres collecting information on near 2000 procedures, and a new set of reference levels (RLs) for coronary angiography and angioplasty and diagnostic electrophysiology has been assessed for air kerma-area product: 45, 85 and 35 Gy cm 2 , effective dose: 8, 15 and 6 mSv, cumulative dose at interventional reference point: 650 and 1500 mGy, fluoroscopy time: 6.5, 15.5 and 21 min and cine frames: 700 and 1000 images, respectively. Because equipment performance and setup are the factors contributing to patient dose variability, entrance surface air kerma for fluoroscopy, 13 mGy min 21 , and image acquisition, 0.10 mGy per frame, have also been proposed in the set of RLs.
The purpose of the study was to analyse the technical characteristics of a newly installed flat-p... more The purpose of the study was to analyse the technical characteristics of a newly installed flat-panel fluoroscopy (FPF) system in an interventional cardiology (IC) department and compare it with an older conventional system. A patient survey was performed to investigate the radiation doses delivered by the X-ray systems. Finally, methods of technique optimization regarding the new digital system were investigated. Dose rates in all fluoroscopic and cine modes were measured and image quality assessed using a dedicated test tool. 200 patients were investigated, half using the conventional and half using the digital FPF system. Patient data collected were: sex, age, weight, height, dose-area product (DAP), fluoroscopy time (T) and total number of frames (F). Our results are: (1) Digital FPF system: high contrast resolution (HCR) is not affected by fluoroscopic mode, whereas low contrast resolution (LCR) is slightly decreased in the low mode. (2) The digital FPF system has 2.5 times better HCR than the conventional system, with 5 times lower dose in the fluoroscopy mode. (3) Median values of DAP, T and F, respectively, in coronary angiography (CA) are: 27.7 Gycm 2 , 4.1 min and 876 for the digital and 39.3 Gycm 2 , 5.3 min and 1600 for the conventional system. Median values for percutaneous transluminal coronary angioplasty (PTCA) are: 51.1 Gycm 2 , 12.7 min and 1184 for the digital and 44.3 Gycm 2 , 7.4 min and 1936 for the conventional system. Digital DAP in CA is reduced by 30%, suggesting that a dose reduction in the FPF system is possible. The results of the study concerning the FPF system lead to the conclusion that the lowest fluoroscopic mode and the lowest frame rate should be used in routine practice.
This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the ye... more This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative’s Call for Action in successfully achieving international radiation protection goals as set out by those frameworks is detailed.
In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting... more In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting on Developing Effective Methods for Radiation Protection Education and Training of Health Professionals with attendance of 230 participants representing 66 Member States and 24 international organizations, professional bodies and safety alliances. By means of a pre-meeting survey, presentations by experts, topical panel discussions and post-meeting feedback to the meeting summary, the meeting identified strengths, common weaknesses and possible solutions and actions for improving radiation protection education and training of health professionals. Available guidelines and resources for radiation protection training were also reviewed. The meeting discussion resulted in a strong consensus for the need of: (a) international guidance on education and training in radiation protection and safety for health professionals, (b) an international description of minimum standards of initial and on...
The terms “notifications” and “alerts” for medical exposures are used by several national and int... more The terms “notifications” and “alerts” for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to...
Se presentan las nuevas implicaciones de la directiva europea 2013/59 en las estimaciones de dosi... more Se presentan las nuevas implicaciones de la directiva europea 2013/59 en las estimaciones de dosis de radiación a la población y en los niveles de referencia para diagnóstico, teniendo en cuanta el Proyecto DOPOES II, las nueva Directiva de Normas Básicas de Seguridad, las recomendaciones propuestas por la ICRP sobre Niveles de referencia de dosis (DRLs), asi como los datos requeridos por UNSCEAR. Por último la presentación del Programa EUCLID de la Comisión Europea donde España aportará datos.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech
Purpose Evaluation and registration of patient and staff doses are mandatory under the current Eu... more Purpose Evaluation and registration of patient and staff doses are mandatory under the current European legislation, and the occupational dose limits recommended by the ICRP have been adopted by most of the countries in the world. Methods Relevant documents and guidelines published by international organisations and interventional radiology societies are referred. Any potential reduction of patient and staff doses should be compatible with the clinical outcomes of the procedures. Results The review summarises the most common protective measures and the needed quality control for them, the criteria to select the appropriate protection devices, and how to avoid unnecessary occupational radiation exposures. Moreover, the current and future advancements in personnel radiation protection using medical simulation with virtual and augmented reality, robotics, and artificial intelligence (AI) are commented. A section on the personnel radiation protection in the era of COVID-19 is introduced, showing the expanding role of the interventional radiology during the pandemic. Conclusion The review is completed with a summary of the main factors to be considered in the selection of the appropriate radiation protection tools and practical advices to improve the protection of the staff.
Poster: "ECR 2018 / C-1616 / Validation of a quick skin dose map estimator for interventiona... more Poster: "ECR 2018 / C-1616 / Validation of a quick skin dose map estimator for interventional cardiology procedures" by: "R. M. Sanchez, E. Vano, J. M. Fernandez Soto, J. I. Ten; Madrid/ES"
Poster: "EuroSafe Imaging 2018 / ESI-0018 / The new ICRP Recommendations on Diagnostic Refer... more Poster: "EuroSafe Imaging 2018 / ESI-0018 / The new ICRP Recommendations on Diagnostic Reference Levels for Medical Imaging" by: "E. Vano1, D. L. Miller2, C. J. Martin3, M. M. Rehani4, K. Kang5, M. Rosenstein2, P. Ortiz-Lopez6, S. Mattsson7, R. Padovani8, A. T. Rogers9; 1ICRP Working Group Madrid/XX, 2ICRP Working Group Bethesda/US, 3ICRP Working Group Glasgow/UA, 4ICRP Working Group Boston/US, 5ICRP Working Group Seoul/KP, 6ICRP Working Group Vienna/AT, 7ICRP Working Group Malmo/SE, 8ICRP Working Group Udine/IT, 9ICRP Working Group Nottingham/UK"
<b>Copyright information:</b>Taken from "The American College of Radiology white... more <b>Copyright information:</b>Taken from "The American College of Radiology white paper on radiation dose in medicine:deep impact on the practice of cardiovascular imaging"http://www.cardiovascularultrasound.com/content/5/1/37Cardiovascular Ultrasound 2007;5():37-37.Published online 31 Oct 2007PMCID:PMC2186301. In the x-axis, we listed some common cardiologic examinations with the corresponding doses (1 mSv = 50 chest x-rays). The threshold of 50 mSv of epidemiological evidence is surpassed by a typical cardiologic patient with known or suspected coronary artery disease, in one single hospital admission.
<b>Copyright information:</b>Taken from "The American College of Radiology white... more <b>Copyright information:</b>Taken from "The American College of Radiology white paper on radiation dose in medicine:deep impact on the practice of cardiovascular imaging"http://www.cardiovascularultrasound.com/content/5/1/37Cardiovascular Ultrasound 2007;5():37-37.Published online 31 Oct 2007PMCID:PMC2186301. Modified from ref. 7, on the basis of novel estimates of BEIR VII (ref. 21).
Practical ways to reduce radiation dose for patients and staff during device implantations and el... more Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures
This review presents basic information on the dosimetric quantities used in medical imaging for r... more This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity “effective dose” to compare doses delivered by different radiological procedures and different imaging modalities with its uncertainties and limitations, is summarised. The estimates of population doses required by the European Directive on Basic Safety Standards is commented on. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits. The application of effective dose on the cumulative doses from recurrent imaging procedures is also discussed. Patient summary: Basic information on the measurement units (dosimetric quantities) used in medical imaging for reporting radiation doses should be understandable to patients. The Working Group on “Dosimetry for imaging in clinical practice” recommended that a ...
This paper presents the design and some preliminary results of a pilot programme on patient dosim... more This paper presents the design and some preliminary results of a pilot programme on patient dosimetry in paediatric interventional cardiology (PIC) in Chile. The collected parameters during the survey have been: procedure identification, patient age, gender, weight, height, kerma area product (Pka), cumulative dose at the interventional reference point, number of cine series, total number of frames and fluoroscopy time. These data will also permit the estimation of typical radiological risks of the procedures for different age groups. Preliminary results are being calculated for the following age groups: <1; 1<5; 5<10 and 10<16 years. Kerma area product values and parameters related to imaging protocols of the procedures have been initially obtained from one of the most representative paediatrics centres of Chile. The x-ray system used in this centre was a biplane Siemens Axiom Artis with image intensifiers. The sample contains patients aged between 6 days and < 16 ye...
Uploads
Papers by Eliseo Vano