Medical Physics Service and Radiology Department, Instituto de Investigación Sanitaria Hospital Clinico San Carlos and Complutense University, Madrid, Spain.
AJNR Am J Neuroradiol. 2013 Feb;34(2):277-82. doi: 10.3174/ajnr.A3211. Epub 2012 Aug 2.
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.
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(2), or fluoroscopy time >60 minutes.
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.
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.
神经介入手术会产生大量辐射，存在辐射损伤风险。我们根据北美和欧洲的指南，展示了一项针对介入神经放射学中潜在皮肤损伤的随访计划的结果。
过去两年中，我们使用了 2009 年 SIR 和 CIRSE 批准的以下指南，以确定需要临床随访的潜在皮肤损伤患者：峰值皮肤剂量>3Gy，患者入口参考点的空气比释动能>5Gy，比释动能面积乘积>500Gy·cm²，或透视时间>60 分钟。
共有 708 例（2009 年 325 例，2010 年 383 例）被纳入研究。在分析每个剂量报告后，2009 年有 19 名患者（5.9%）被纳入潜在皮肤损伤的随访计划，而在 2010 年，引入了几项优化措施并细化了选择标准后，只有 4 名患者（1.0%）需要随访。在过去的两年中，只有 3 名患者需要转介至皮肤科服务。
将指南应用于患者的辐射剂量管理有助于标准化选择标准，以将患者纳入潜在皮肤辐射损伤的临床随访计划中。峰值皮肤剂量是最相关的参数。选择标准的细化以及在 X 射线系统中引入低剂量方案，并结合以辐射防护为重点的培训计划，减少了需要临床随访的患者数量。
