Prog Med Phys.  2019 Dec;30(4):75-88. 10.14316/pmp.2019.30.4.75.

Review of National Diagnostic Reference Levels for Interventional Procedures

• Lee MY
• Kwon J
• Ryu GW
• Kim KH
• Nam HW
• Kim KP

• KMID: 2468168
• DOI: http://doi.org/10.14316/pmp.2019.30.4.75

Abstract

Diagnostic reference level (DRL) is employed to optimize the radiation doses of patients. The objective of this study is to review the DRLs for interventional procedures in Korea and abroad. Literature review was performed to investigate radiation dose index and measurement methodology commonly used in DRL determination. Dose area product (DAP) and fluoroscopy time within each major procedure category were systematically abstracted and analyzed. A wide variation was found in the radiation dose. The DAP values and fluoroscopy times ranged 0.01-3,081 Gy·cm² and 2-16,878 seconds for all the interventional procedures, 8.5-1,679 Gy·cm² and 32-5,775 seconds for the transcatheter arterial chemoembolization (TACE), and 0.1-686 Gy·cm² and 16-6,636 seconds for the transfemoral cerebral angiography (TFCA), respectively. The DRL values of the DAP and fluoroscopy time were 238 Gy·cm² and 1,224 seconds for the TACE and 189 Gy·cm² and 686 seconds for the TFCA, respectively. Generally, the DRLs of Korea were lower than those of other developed countries, except for the percutaneous transluminal angioplasty with stent in arteries of the lower extremity (LE PTA and stent), aneurysm coil embolization, and Hickman insertion procedures. The wide variation in the radiation doses of the different procedures suggests that more attention must be paid to reduce unnecessary radiation exposure from medical imaging. Furthermore, periodic nationwide survey of medical radiation exposures is necessary to optimize the patient dose for radiation protection, which will ultimately contribute to patient dose reduction and radiological safety.

Keyword

Interventional radiology; Radiation protection; Diagnostic reference level; Patient dose; Radiation exposure

MeSH Terms

Aneurysm
Angioplasty
Arteries
Cerebral Angiography
Developed Countries
Diagnostic Imaging
Embolization, Therapeutic
Fluoroscopy
Humans
Korea
Lower Extremity
Radiation Exposure
Radiation Protection
Radiology, Interventional
Stents

Figure

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  Fig. 1 Number of interventional procedures per year in Korea.

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  Fig. 2 Dose distributions of diagnostic radiology and diagnostic reference level (DRL).

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  Fig. 3 Concept of the dose area product (DAP) measurement.

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  Fig. 4 Concept of the reference air kerma (RAK) measurement. DAP, dose area product.

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  Fig. 5 Dose area products (DAPs) for interventional procedures by country. TACE, transcatheter arterial chemoembolization; PTBD, percutaneous transhepatic biliary drainage; PCN, percutaneous nephrostomy.

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  Fig. 6 Fluoroscopy times for interventional procedures by country. TACE, transcatheter arterial chemoembolization; PTBD, percutaneous transhepatic biliary drainage; PCN, percutaneous nephrostomy.

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