PATIENT SAFETY Patient Radiation DoseManagement in the Follow-Up of Potential Skin Injuries in Neuroradiology

BACKGROUND AND PURPOSE: Radiation exposure from neurointerventional procedures can be substantial, with risk of radiation injuries. We present the results of a follow-up program applied to potential skin injuries in interventional neuroradiology based on North American and European guidelines. MATERIALS ANDMETHODS: The following guidelines approved in 2009 by SIR and CIRSE have been used over the last 2 years to identify patients with potential skin injuries requiring clinical follow-up: peak skin dose 3 Gy, air kerma at the patient entrance reference point 5 Gy, kerma area product 500 Gy · cm, or fluoroscopy time 60 minutes. RESULTS: A total of 708 procedures (325 in 2009 and 383 in 2010) were included in the study. After analyzing each dose report, 19 patients (5.9%) were included in a follow-up program for potential skin injuries in 2009, while in 2010, after introducing several optimizing actions and refining the selection criteria, only 4 patients (1.0%) needed follow-up. Over the last 2 years, only 3 patients required referral to a dermatology service. CONCLUSIONS: The application of the guidelines to patient radiation dose management helped standardize the selection criteria for including patients in the clinical follow-up program of potential skin radiation injuries. The peak skin dose resulted in the most relevant parameter. The refinement of selection criteria and the introduction of a low-dose protocol in the x-ray system, combined with a training program focused on radiation protection, reduced the number of patients requiring clinical follow-up. ABBREVIATIONS: CIRSE Cardiovascular and Interventional Radiology Society of Europe; DAP dose-area product; DOLIR dose on-line for interventional radiology; ICRP International Commission on Radiologic Protection; SIR Society of Interventional Radiology In recent years, the benefits and complexity of interventional procedures have increased substantially and the radiation dose to patients and staff is a matter of concern. Among medical specialties, interventional neuroradiology is of utmost benefit to patients, but it uses high radiation doses in a significant number of procedures. Radiation injuries in patients may occur and should be listed as a risk in the informed consent. In their quality programs, interventional radiology units include the evaluation of patient radiation doses and the criteria for including patients in a clinical follow-up as part of postprocedural care when relevant dosimetric parameters indicate potential skin radiation injuries. In 2000, the ICRP published a set of recommendations on how to avoid radiation injuries in medical interventional procedures. These recommendations have been developed in several guidelines and adopted by interventional radiology medical societies. The European Directive on Medical Exposures 97/43/Euratom requires Member States of the European Union (article 9) to use appropriate radiologic equipment submitted to quality assurance programs and to assess patient doses. Preventing high-dose exposures with diagnostic equipment is another requirement (ar-