Management of patient skin dose in fluoroscopically guided interventional procedures

Area of Science:

• Medical Physics
• Radiology
• Radiation Safety

Background:

• Fluoroscopic procedures deliver radiation dose to patients, necessitating careful management of skin exposure.
• Large patients may receive higher radiation doses, increasing the risk of adverse effects.
• Understanding the impact of operational parameters on skin dose is vital for patient safety.

Purpose of the Study:

• To simulate patient skin dose under various fluoroscopic conditions.
• To identify adjustments in operational parameters to maintain acceptable skin dose levels.
• To assess the multiplicative effects of operational parameters on radiation dose.

Main Methods:

• Estimated patient entrance skin dose using entrance air kerma measurements.
• Utilized a 280-mm water phantom for dose assessment.
• Examined the influence of kVp, source-to-skin distance, air gap, electronic magnification, and dose rate control settings.

Main Results:

• Operational parameter changes have a multiplicative effect on total skin dose.
• Significant dose variations (≥8 Gy) can occur with different operational techniques during long procedures.
• Doses exceeding injury thresholds are possible under certain conditions.

Conclusions:

• Skin dose effects from operational parameters are multiplicative, not additive.
• Appropriate adjustments to operational parameters can significantly reduce patient skin dose.
• Variable pulsed fluoroscopy is the most effective method for minimizing radiation exposure.