TY  - JOUR
AU  - O’Connor, Una M.
AU  - Carinou, Eleftheria
AU  - Clairand, Isabelle
AU  - Ciraj-Bjelac, Olivera
AU  - de Monte, Francesca
AU  - Domienik-Andrzejewska, Joanna
AU  - Ferrari, Paolo
AU  - Ginjaume, Merce
AU  - Hršak, Hrvoje
AU  - Hupe, Oliver
AU  - Knežević, Željka
AU  - Sans Merce, Marta
AU  - Sarmento, Sandra
AU  - Siiskonen, Teemu
AU  - Vanhavere, Filip
PY  - 2021
UR  - https://vinar.vin.bg.ac.rs/handle/123456789/9863
AB  - Occupational radiation doses from interventional procedures have the potential to be relatively high. The requirement to optimise these doses encourages the use of electronic or active personal dosimeters (APDs) which are now increasingly used in hospitals. They are typically used in tandem with a routine passive dosimetry monitoring programme, with APDs used for real-time readings, for training purposes and when new imaging technology is introduced. However, there are limitations when using APDs. A survey in hospitals to identify issues related to the use of APDs was recently completed, along with an extensive series of APD tests by the EURADOS Working Group 12 on Dosimetry for Medical Imaging. The aim of this review paper is to summarise the state of the art regarding the use of APDs. We also used the results of our survey and our tests to develop a set of recommendations for the use of APDs in the clinical interventional radiology/cardiology settings, and draw attention to some of the current challenges.
T2  - Physica Medica
T1  - Recommendations for the use of active personal dosemeters (APDs) in interventional workplaces in hospitals
VL  - 87
SP  - 131
EP  - 135
DO  - 10.1016/j.ejmp.2021.05.015
ER  - 

@article{
author = "O’Connor, Una M. and Carinou, Eleftheria and Clairand, Isabelle and Ciraj-Bjelac, Olivera and de Monte, Francesca and Domienik-Andrzejewska, Joanna and Ferrari, Paolo and Ginjaume, Merce and Hršak, Hrvoje and Hupe, Oliver and Knežević, Željka and Sans Merce, Marta and Sarmento, Sandra and Siiskonen, Teemu and Vanhavere, Filip",
year = "2021",
abstract = "Occupational radiation doses from interventional procedures have the potential to be relatively high. The requirement to optimise these doses encourages the use of electronic or active personal dosimeters (APDs) which are now increasingly used in hospitals. They are typically used in tandem with a routine passive dosimetry monitoring programme, with APDs used for real-time readings, for training purposes and when new imaging technology is introduced. However, there are limitations when using APDs. A survey in hospitals to identify issues related to the use of APDs was recently completed, along with an extensive series of APD tests by the EURADOS Working Group 12 on Dosimetry for Medical Imaging. The aim of this review paper is to summarise the state of the art regarding the use of APDs. We also used the results of our survey and our tests to develop a set of recommendations for the use of APDs in the clinical interventional radiology/cardiology settings, and draw attention to some of the current challenges.",
journal = "Physica Medica",
title = "Recommendations for the use of active personal dosemeters (APDs) in interventional workplaces in hospitals",
volume = "87",
pages = "131-135",
doi = "10.1016/j.ejmp.2021.05.015"
}

O’Connor, U. M., Carinou, E., Clairand, I., Ciraj-Bjelac, O., de Monte, F., Domienik-Andrzejewska, J., Ferrari, P., Ginjaume, M., Hršak, H., Hupe, O., Knežević, Ž., Sans Merce, M., Sarmento, S., Siiskonen, T.,& Vanhavere, F.. (2021). Recommendations for the use of active personal dosemeters (APDs) in interventional workplaces in hospitals. in Physica Medica, 87, 131-135.
https://doi.org/10.1016/j.ejmp.2021.05.015

O’Connor UM, Carinou E, Clairand I, Ciraj-Bjelac O, de Monte F, Domienik-Andrzejewska J, Ferrari P, Ginjaume M, Hršak H, Hupe O, Knežević Ž, Sans Merce M, Sarmento S, Siiskonen T, Vanhavere F. Recommendations for the use of active personal dosemeters (APDs) in interventional workplaces in hospitals. in Physica Medica. 2021;87:131-135.
doi:10.1016/j.ejmp.2021.05.015 .

O’Connor, Una M., Carinou, Eleftheria, Clairand, Isabelle, Ciraj-Bjelac, Olivera, de Monte, Francesca, Domienik-Andrzejewska, Joanna, Ferrari, Paolo, Ginjaume, Merce, Hršak, Hrvoje, Hupe, Oliver, Knežević, Željka, Sans Merce, Marta, Sarmento, Sandra, Siiskonen, Teemu, Vanhavere, Filip, "Recommendations for the use of active personal dosemeters (APDs) in interventional workplaces in hospitals" in Physica Medica, 87 (2021):131-135,
https://doi.org/10.1016/j.ejmp.2021.05.015 . .

TY  - JOUR
AU  - Siiskonen, Teemu
AU  - Ciraj-Bjelac, Olivera
AU  - Dabin, Jeremie
AU  - Diklić, Ana
AU  - Domienik-Andrzejewska, Joanna
AU  - Farah, Jad
AU  - Fernandez, Jose Miguel
AU  - Gallagher, Aoife
AU  - Hourdakis, Constantine J.
AU  - Jurković, Slaven
AU  - Jarvinen, Hannu
AU  - Jarvinen, J.
AU  - Knežević, Željka
AU  - Koukorava, Christina
AU  - Maccia, Carlo
AU  - Majer, Marija
AU  - Malchair, Francoise
AU  - Riccardi, Lucia
AU  - Rizk, C.
AU  - Sanchez, Roberto Mariano
AU  - Sandborg, Michael
AU  - Merce, Marta Sans
AU  - Segota, D.
AU  - Sierpowska, Joanna
AU  - Simantirakis, George
AU  - Sukupova, Lucie
AU  - Thrapsanioti, Zoi
AU  - Vano, Eliseo
PY  - 2018
UR  - https://vinar.vin.bg.ac.rs/handle/123456789/7889
AB  - Interventional cardiac procedures may be associated with high patient doses and therefore require special attention to protect the patients from radiation injuries such as skin erythema, cardiovascular tissue reactions or radiation-induced cancer. In this study, patient exposure data is collected from 13 countries (37 clinics and nearly 50 interventional rooms) and for 10 different procedures. Dose data was collected from a total of 14,922 interventional cardiology procedures. Based on these data European diagnostic reference levels (DRL) for air kerma-area product are suggested for coronary angiography (CA, DRL = 35 Gy cm2), percutaneous coronary intervention (PCI, 85 Gy cm2), transcatheter aortic valve implantation (TAVI, 130 Gy cm2), electrophysiological procedures (12 Gy cm2) and pacemaker implantations. Pacemaker implantations were further divided into single-chamber (2.5 Gy cm2) and dual chamber (3.5 Gy cm2) procedures and implantations of cardiac resynchronization therapy pacemaker (18 Gy cm2). Results show that relatively new techniques such as TAVI and treatment of chronic total occlusion (CTO) often produce relatively high doses, and thus emphasises the need for use of an optimization tool such as DRL to assist in reducing patient exposure. The generic DRL presented here facilitate comparison of patient exposure in interventional cardiology. © 2018 Associazione Italiana di Fisica Medica
T2  - Physica Medica
T1  - Establishing the European diagnostic reference levels for interventional cardiology
VL  - 54
SP  - 42
EP  - 48
DO  - 10.1016/j.ejmp.2018.09.012
ER  - 

@article{
author = "Siiskonen, Teemu and Ciraj-Bjelac, Olivera and Dabin, Jeremie and Diklić, Ana and Domienik-Andrzejewska, Joanna and Farah, Jad and Fernandez, Jose Miguel and Gallagher, Aoife and Hourdakis, Constantine J. and Jurković, Slaven and Jarvinen, Hannu and Jarvinen, J. and Knežević, Željka and Koukorava, Christina and Maccia, Carlo and Majer, Marija and Malchair, Francoise and Riccardi, Lucia and Rizk, C. and Sanchez, Roberto Mariano and Sandborg, Michael and Merce, Marta Sans and Segota, D. and Sierpowska, Joanna and Simantirakis, George and Sukupova, Lucie and Thrapsanioti, Zoi and Vano, Eliseo",
year = "2018",
abstract = "Interventional cardiac procedures may be associated with high patient doses and therefore require special attention to protect the patients from radiation injuries such as skin erythema, cardiovascular tissue reactions or radiation-induced cancer. In this study, patient exposure data is collected from 13 countries (37 clinics and nearly 50 interventional rooms) and for 10 different procedures. Dose data was collected from a total of 14,922 interventional cardiology procedures. Based on these data European diagnostic reference levels (DRL) for air kerma-area product are suggested for coronary angiography (CA, DRL = 35 Gy cm2), percutaneous coronary intervention (PCI, 85 Gy cm2), transcatheter aortic valve implantation (TAVI, 130 Gy cm2), electrophysiological procedures (12 Gy cm2) and pacemaker implantations. Pacemaker implantations were further divided into single-chamber (2.5 Gy cm2) and dual chamber (3.5 Gy cm2) procedures and implantations of cardiac resynchronization therapy pacemaker (18 Gy cm2). Results show that relatively new techniques such as TAVI and treatment of chronic total occlusion (CTO) often produce relatively high doses, and thus emphasises the need for use of an optimization tool such as DRL to assist in reducing patient exposure. The generic DRL presented here facilitate comparison of patient exposure in interventional cardiology. © 2018 Associazione Italiana di Fisica Medica",
journal = "Physica Medica",
title = "Establishing the European diagnostic reference levels for interventional cardiology",
volume = "54",
pages = "42-48",
doi = "10.1016/j.ejmp.2018.09.012"
}

Siiskonen, T., Ciraj-Bjelac, O., Dabin, J., Diklić, A., Domienik-Andrzejewska, J., Farah, J., Fernandez, J. M., Gallagher, A., Hourdakis, C. J., Jurković, S., Jarvinen, H., Jarvinen, J., Knežević, Ž., Koukorava, C., Maccia, C., Majer, M., Malchair, F., Riccardi, L., Rizk, C., Sanchez, R. M., Sandborg, M., Merce, M. S., Segota, D., Sierpowska, J., Simantirakis, G., Sukupova, L., Thrapsanioti, Z.,& Vano, E.. (2018). Establishing the European diagnostic reference levels for interventional cardiology. in Physica Medica, 54, 42-48.
https://doi.org/10.1016/j.ejmp.2018.09.012

Siiskonen T, Ciraj-Bjelac O, Dabin J, Diklić A, Domienik-Andrzejewska J, Farah J, Fernandez JM, Gallagher A, Hourdakis CJ, Jurković S, Jarvinen H, Jarvinen J, Knežević Ž, Koukorava C, Maccia C, Majer M, Malchair F, Riccardi L, Rizk C, Sanchez RM, Sandborg M, Merce MS, Segota D, Sierpowska J, Simantirakis G, Sukupova L, Thrapsanioti Z, Vano E. Establishing the European diagnostic reference levels for interventional cardiology. in Physica Medica. 2018;54:42-48.
doi:10.1016/j.ejmp.2018.09.012 .

Siiskonen, Teemu, Ciraj-Bjelac, Olivera, Dabin, Jeremie, Diklić, Ana, Domienik-Andrzejewska, Joanna, Farah, Jad, Fernandez, Jose Miguel, Gallagher, Aoife, Hourdakis, Constantine J., Jurković, Slaven, Jarvinen, Hannu, Jarvinen, J., Knežević, Željka, Koukorava, Christina, Maccia, Carlo, Majer, Marija, Malchair, Francoise, Riccardi, Lucia, Rizk, C., Sanchez, Roberto Mariano, Sandborg, Michael, Merce, Marta Sans, Segota, D., Sierpowska, Joanna, Simantirakis, George, Sukupova, Lucie, Thrapsanioti, Zoi, Vano, Eliseo, "Establishing the European diagnostic reference levels for interventional cardiology" in Physica Medica, 54 (2018):42-48,
https://doi.org/10.1016/j.ejmp.2018.09.012 . .

TY  - JOUR
AU  - Domienik-Andrzejewska, Joanna
AU  - Ciraj-Bjelac, Olivera
AU  - Askounis, Panagiotis
AU  - Covens, Peter
AU  - Dragusin, Octavian
AU  - Jacob, Sophie
AU  - Farah, Jad
AU  - Gianicolo, Emilio
AU  - Padovani, Renato
AU  - Teles, Pedro
AU  - Widmark, Anders
AU  - Struelens, Lara
PY  - 2018
UR  - http://stacks.iop.org/0952-4746/38/i=3/a=934?key=crossref.841f3416432180a6c59d9cdaf3af811f
UR  - https://vinar.vin.bg.ac.rs/handle/123456789/7775
AB  - This paper investigates over five decades of work practices in interventional cardiology, with an emphasis on radiation protection. The analysis is based on data from more than 400 cardiologists from various European countries recruited for a EURALOC study and collected in the period from 2014 to 2016. Information on the types of procedures performed and their annual mean number, fluoroscopy time, access site choice, x-ray units and radiation protection means used was collected using an occupational questionnaire. Based on the specific European data, changes in each parameter have been analysed over decades, while country-specific data analysis has allowed us to determine the differences in local practices. In particular, based on the collected data, the typical workload of a European cardiologist working in a haemodynamic room and an electrophysiology room was specified for various types of procedures. The results showed that when working in a haemodynamic room, a transparent ceiling-suspended lead shield or lead glasses are necessary in order to remain below the recommended eye lens dose limit of 20 mSv. Moreover, the analysis revealed that new, more complex cardiac procedures such as chronic total occlusion, valvuloplasty and pulmonary vein isolation for atrial fibrillation ablation might contribute substantially to annual doses, although they are relatively rarely performed. The results revealed that considerable progress has been made in the use of radiation protection tools. While their use in electrophysiology procedures is not generic, the situation in haemodynamic procedures is rather encouraging, as ceiling-suspended shields are used in 90% of cases, while the combination of ceiling shield and lead glasses is noted in more than 40% of the procedures. However, we find that still 7% of haemodynamic procedures are performed without any radiation protection tools.
T2  - Journal of Radiological Protection
T1  - Past and present work practices of European interventional cardiologists in the context of radiation protection of the eye lens—results of the EURALOC study
VL  - 38
IS  - 3
SP  - 934
EP  - 950
DO  - 10.1088/1361-6498/aac64b
ER  - 

@article{
author = "Domienik-Andrzejewska, Joanna and Ciraj-Bjelac, Olivera and Askounis, Panagiotis and Covens, Peter and Dragusin, Octavian and Jacob, Sophie and Farah, Jad and Gianicolo, Emilio and Padovani, Renato and Teles, Pedro and Widmark, Anders and Struelens, Lara",
year = "2018",
abstract = "This paper investigates over five decades of work practices in interventional cardiology, with an emphasis on radiation protection. The analysis is based on data from more than 400 cardiologists from various European countries recruited for a EURALOC study and collected in the period from 2014 to 2016. Information on the types of procedures performed and their annual mean number, fluoroscopy time, access site choice, x-ray units and radiation protection means used was collected using an occupational questionnaire. Based on the specific European data, changes in each parameter have been analysed over decades, while country-specific data analysis has allowed us to determine the differences in local practices. In particular, based on the collected data, the typical workload of a European cardiologist working in a haemodynamic room and an electrophysiology room was specified for various types of procedures. The results showed that when working in a haemodynamic room, a transparent ceiling-suspended lead shield or lead glasses are necessary in order to remain below the recommended eye lens dose limit of 20 mSv. Moreover, the analysis revealed that new, more complex cardiac procedures such as chronic total occlusion, valvuloplasty and pulmonary vein isolation for atrial fibrillation ablation might contribute substantially to annual doses, although they are relatively rarely performed. The results revealed that considerable progress has been made in the use of radiation protection tools. While their use in electrophysiology procedures is not generic, the situation in haemodynamic procedures is rather encouraging, as ceiling-suspended shields are used in 90% of cases, while the combination of ceiling shield and lead glasses is noted in more than 40% of the procedures. However, we find that still 7% of haemodynamic procedures are performed without any radiation protection tools.",
journal = "Journal of Radiological Protection",
title = "Past and present work practices of European interventional cardiologists in the context of radiation protection of the eye lens—results of the EURALOC study",
volume = "38",
number = "3",
pages = "934-950",
doi = "10.1088/1361-6498/aac64b"
}

Domienik-Andrzejewska, J., Ciraj-Bjelac, O., Askounis, P., Covens, P., Dragusin, O., Jacob, S., Farah, J., Gianicolo, E., Padovani, R., Teles, P., Widmark, A.,& Struelens, L.. (2018). Past and present work practices of European interventional cardiologists in the context of radiation protection of the eye lens—results of the EURALOC study. in Journal of Radiological Protection, 38(3), 934-950.
https://doi.org/10.1088/1361-6498/aac64b

Domienik-Andrzejewska J, Ciraj-Bjelac O, Askounis P, Covens P, Dragusin O, Jacob S, Farah J, Gianicolo E, Padovani R, Teles P, Widmark A, Struelens L. Past and present work practices of European interventional cardiologists in the context of radiation protection of the eye lens—results of the EURALOC study. in Journal of Radiological Protection. 2018;38(3):934-950.
doi:10.1088/1361-6498/aac64b .

Domienik-Andrzejewska, Joanna, Ciraj-Bjelac, Olivera, Askounis, Panagiotis, Covens, Peter, Dragusin, Octavian, Jacob, Sophie, Farah, Jad, Gianicolo, Emilio, Padovani, Renato, Teles, Pedro, Widmark, Anders, Struelens, Lara, "Past and present work practices of European interventional cardiologists in the context of radiation protection of the eye lens—results of the EURALOC study" in Journal of Radiological Protection, 38, no. 3 (2018):934-950,
https://doi.org/10.1088/1361-6498/aac64b . .

TY  - JOUR
AU  - Struelens, Lara
AU  - Dabin, Jeremie
AU  - Carinou, Eleftheria
AU  - Askounis, Panagiotis
AU  - Ciraj-Bjelac, Olivera
AU  - Domienik-Andrzejewska, Joanna
AU  - Berus, Danielle
AU  - Padovani, Renato
AU  - Farah, Jad
AU  - Covens, Peter
PY  - 2018
UR  - https://vinar.vin.bg.ac.rs/handle/123456789/7654
AB  - This study describes the retrospective lens dose calculation methods developed and applied within the European epidemiological study on radiation-induced lens opacities among interventional cardiologists. While one approach focuses on self-reported data regarding working practice in combination with available procedure-specific eye lens dose values, the second approach focuses on the conversion of the individual whole-body dose to eye lens dose. In contrast with usual dose reconstruction methods within an epidemiological study, a protocol is applied resulting in an individual distribution of possible cumulative lens doses for each recruited cardiologist, rather than a single dose estimate. In this way, the uncertainty in the dose estimate (from measurement uncertainty and variability among cardiologists) is represented for each individual. Eye lens dose and whole-body dose measurements have been performed in clinical practice to validate both methods, and it was concluded that both produce acceptable results in the framework of a dose-risk evaluation study. Optimal results were obtained for the dose to the left eye using procedure-specific lens dose data in combination with information collected on working practice. This method has been applied to 421 interventional cardiologists resulting in a median cumulative eye lens dose of 15.1 cSv for the left eye and 11.4 cSv for the right eye. From the individual cumulative eye lens dose distributions obtained for each cardiologist, maxima up to 9-10 Sv were observed, although with low probability. Since whole-body dose values above the lead apron are available for only a small fraction of the cohort and in many cases not for the entire working career, the second method has only been used to benchmark the results from the first approach. This study succeeded in improving the retrospective calculation of cumulative eye lens doses in the framework of radiation-induced risk assessment of lens opacities, but it remains dependent on self-reported information, which is not always reliable for early years. However, the calculation tools developed can also be used to make an assessment of the eye lens dose in current practice.
T2  - Radiation Research
T1  - Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses
VL  - 189
IS  - 4
SP  - 399
EP  - 408
DO  - 10.1667/RR14970.1
ER  - 

@article{
author = "Struelens, Lara and Dabin, Jeremie and Carinou, Eleftheria and Askounis, Panagiotis and Ciraj-Bjelac, Olivera and Domienik-Andrzejewska, Joanna and Berus, Danielle and Padovani, Renato and Farah, Jad and Covens, Peter",
year = "2018",
abstract = "This study describes the retrospective lens dose calculation methods developed and applied within the European epidemiological study on radiation-induced lens opacities among interventional cardiologists. While one approach focuses on self-reported data regarding working practice in combination with available procedure-specific eye lens dose values, the second approach focuses on the conversion of the individual whole-body dose to eye lens dose. In contrast with usual dose reconstruction methods within an epidemiological study, a protocol is applied resulting in an individual distribution of possible cumulative lens doses for each recruited cardiologist, rather than a single dose estimate. In this way, the uncertainty in the dose estimate (from measurement uncertainty and variability among cardiologists) is represented for each individual. Eye lens dose and whole-body dose measurements have been performed in clinical practice to validate both methods, and it was concluded that both produce acceptable results in the framework of a dose-risk evaluation study. Optimal results were obtained for the dose to the left eye using procedure-specific lens dose data in combination with information collected on working practice. This method has been applied to 421 interventional cardiologists resulting in a median cumulative eye lens dose of 15.1 cSv for the left eye and 11.4 cSv for the right eye. From the individual cumulative eye lens dose distributions obtained for each cardiologist, maxima up to 9-10 Sv were observed, although with low probability. Since whole-body dose values above the lead apron are available for only a small fraction of the cohort and in many cases not for the entire working career, the second method has only been used to benchmark the results from the first approach. This study succeeded in improving the retrospective calculation of cumulative eye lens doses in the framework of radiation-induced risk assessment of lens opacities, but it remains dependent on self-reported information, which is not always reliable for early years. However, the calculation tools developed can also be used to make an assessment of the eye lens dose in current practice.",
journal = "Radiation Research",
title = "Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses",
volume = "189",
number = "4",
pages = "399-408",
doi = "10.1667/RR14970.1"
}

Struelens, L., Dabin, J., Carinou, E., Askounis, P., Ciraj-Bjelac, O., Domienik-Andrzejewska, J., Berus, D., Padovani, R., Farah, J.,& Covens, P.. (2018). Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses. in Radiation Research, 189(4), 399-408.
https://doi.org/10.1667/RR14970.1

Struelens L, Dabin J, Carinou E, Askounis P, Ciraj-Bjelac O, Domienik-Andrzejewska J, Berus D, Padovani R, Farah J, Covens P. Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses. in Radiation Research. 2018;189(4):399-408.
doi:10.1667/RR14970.1 .

Struelens, Lara, Dabin, Jeremie, Carinou, Eleftheria, Askounis, Panagiotis, Ciraj-Bjelac, Olivera, Domienik-Andrzejewska, Joanna, Berus, Danielle, Padovani, Renato, Farah, Jad, Covens, Peter, "Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses" in Radiation Research, 189, no. 4 (2018):399-408,
https://doi.org/10.1667/RR14970.1 . .

TY  - JOUR
AU  - Jarvinen, Hannu
AU  - Farah, Jad
AU  - Siiskonen, Teemu
AU  - Ciraj-Bjelac, Olivera
AU  - Dabin, Jeremie
AU  - Carinou, Eleftheria
AU  - Domienik-Andrzejewska, Joanna
AU  - Kluszczynski, Dariusz
AU  - Knežević, Željka
AU  - Kopec, Renata
AU  - Majer, Marija
AU  - Malchair, Francoise
AU  - Negri, Anna
AU  - Pankowski, Piotr
AU  - Sarmento, Sandra
AU  - Trianni, Annalisa
PY  - 2018
UR  - https://vinar.vin.bg.ac.rs/handle/123456789/7621
AB  - Purpose: The feasibility of setting-up generic, hospital-independent dose alert levels to initiate vigilance on possible skin injuries in interventional procedures was studied for three high-dose procedures (chemoembolization (TACE) of the liver, neuro-embolization (NE) and percutaneous coronary intervention (PCI)) in 9 European countries. Methods: Gafchromic (R) films and thermoluminescent dosimeters (TLD) were used to determine the Maximum Skin Dose (MSD). Correlation of the online dose indicators (fluoroscopy time, kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (K-a,K-r)) with MSD was evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy. The uncertainties of alert levels in terms of DAP and K-a,K-r, and uncertainty of MSD were calculated. Results: About 20-30% of all MSD values exceeded 2 Gy while only 2-6% exceeded 5 Gy. The correlations suggest that both DAP and K-a,K-r can be used as a dose indicator for alert levels (Pearson correlation coefficient p mostly > 0.8), while fluoroscopy time is not suitable (p mostly < 0.6). Generic alert levels based on DAP (Gy cm(2)) were suggested for MSD of both 2 Gy and 5 Gy (for 5 Gy: TACE 750, PCI 250 and NE 400). The suggested levels are close to the lowest values published in several other studies. The uncertainty of the MSD was estimated to be around 10-15% and of hospital-specific skin dose alert levels about 20-30% (with coverage factor k = 1). Conclusions: The generic alert levels are feasible for some cases but should be used with caution, only as the first approximation, while hospital-specific alert levels are preferred as the final approach.
T2  - Physica Medica
T1  - Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures
VL  - 46
SP  - 67
EP  - 74
DO  - 10.1016/j.ejmp.2018.01.010
ER  - 

@article{
author = "Jarvinen, Hannu and Farah, Jad and Siiskonen, Teemu and Ciraj-Bjelac, Olivera and Dabin, Jeremie and Carinou, Eleftheria and Domienik-Andrzejewska, Joanna and Kluszczynski, Dariusz and Knežević, Željka and Kopec, Renata and Majer, Marija and Malchair, Francoise and Negri, Anna and Pankowski, Piotr and Sarmento, Sandra and Trianni, Annalisa",
year = "2018",
abstract = "Purpose: The feasibility of setting-up generic, hospital-independent dose alert levels to initiate vigilance on possible skin injuries in interventional procedures was studied for three high-dose procedures (chemoembolization (TACE) of the liver, neuro-embolization (NE) and percutaneous coronary intervention (PCI)) in 9 European countries. Methods: Gafchromic (R) films and thermoluminescent dosimeters (TLD) were used to determine the Maximum Skin Dose (MSD). Correlation of the online dose indicators (fluoroscopy time, kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (K-a,K-r)) with MSD was evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy. The uncertainties of alert levels in terms of DAP and K-a,K-r, and uncertainty of MSD were calculated. Results: About 20-30% of all MSD values exceeded 2 Gy while only 2-6% exceeded 5 Gy. The correlations suggest that both DAP and K-a,K-r can be used as a dose indicator for alert levels (Pearson correlation coefficient p mostly > 0.8), while fluoroscopy time is not suitable (p mostly < 0.6). Generic alert levels based on DAP (Gy cm(2)) were suggested for MSD of both 2 Gy and 5 Gy (for 5 Gy: TACE 750, PCI 250 and NE 400). The suggested levels are close to the lowest values published in several other studies. The uncertainty of the MSD was estimated to be around 10-15% and of hospital-specific skin dose alert levels about 20-30% (with coverage factor k = 1). Conclusions: The generic alert levels are feasible for some cases but should be used with caution, only as the first approximation, while hospital-specific alert levels are preferred as the final approach.",
journal = "Physica Medica",
title = "Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures",
volume = "46",
pages = "67-74",
doi = "10.1016/j.ejmp.2018.01.010"
}

Jarvinen, H., Farah, J., Siiskonen, T., Ciraj-Bjelac, O., Dabin, J., Carinou, E., Domienik-Andrzejewska, J., Kluszczynski, D., Knežević, Ž., Kopec, R., Majer, M., Malchair, F., Negri, A., Pankowski, P., Sarmento, S.,& Trianni, A.. (2018). Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures. in Physica Medica, 46, 67-74.
https://doi.org/10.1016/j.ejmp.2018.01.010

Jarvinen H, Farah J, Siiskonen T, Ciraj-Bjelac O, Dabin J, Carinou E, Domienik-Andrzejewska J, Kluszczynski D, Knežević Ž, Kopec R, Majer M, Malchair F, Negri A, Pankowski P, Sarmento S, Trianni A. Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures. in Physica Medica. 2018;46:67-74.
doi:10.1016/j.ejmp.2018.01.010 .

Jarvinen, Hannu, Farah, Jad, Siiskonen, Teemu, Ciraj-Bjelac, Olivera, Dabin, Jeremie, Carinou, Eleftheria, Domienik-Andrzejewska, Joanna, Kluszczynski, Dariusz, Knežević, Željka, Kopec, Renata, Majer, Marija, Malchair, Francoise, Negri, Anna, Pankowski, Piotr, Sarmento, Sandra, Trianni, Annalisa, "Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures" in Physica Medica, 46 (2018):67-74,
https://doi.org/10.1016/j.ejmp.2018.01.010 . .