Radiation dose reduction during venous access port implantation: the importance of upgrading equipment and radiation-protection training.
Education
Fluoroscopy
Implantable port
Ionizing radiation
Venous access
Journal
Irish journal of medical science
ISSN: 1863-4362
Titre abrégé: Ir J Med Sci
Pays: Ireland
ID NLM: 7806864
Informations de publication
Date de publication:
13 Feb 2024
13 Feb 2024
Historique:
received:
29
03
2023
accepted:
29
01
2024
medline:
13
2
2024
pubmed:
13
2
2024
entrez:
13
2
2024
Statut:
aheadofprint
Résumé
Implantable central venous port systems are widely used in oncology. We upgraded our fluoroscopy machines, and all anesthetists completed two training courses focusing on the risks of ionizing radiation for patients and health workers. This study aimed to evaluate the impact of upgrading the machines and the radiation-protection training on ionizing radiation exposure during venous port system implantation. We retrospectively analyzed consecutive venous port implantations between 2019 and 2022. The older fluoroscopy machines were replaced by two new machines. A first training session about health worker radioprotection was organized. The medical staff completed a second training course focused on protecting patients from ionizing radiation. We defined four distinct time intervals (TI): venous port implantations performed with the old equipment, the new fluoroscopy machines, after the first training course, and after the second training course. The air kerma-area product (KAP) was compared between these four TI and fluoroscopy times and the number of exposures only with the new machines. We analyzed 2587 procedures. A 93% decrease in the median KAP between the first and last TI was noted (median KAP = 323.0 mGy.cm Upgrading the fluoroscopy equipment and completing two dedicated training courses allowed for a drastic decrease patient exposure to ionizing radiation during venous access port implantation by non-radiologist practitioners.
Sections du résumé
BACKGROUND
BACKGROUND
Implantable central venous port systems are widely used in oncology. We upgraded our fluoroscopy machines, and all anesthetists completed two training courses focusing on the risks of ionizing radiation for patients and health workers.
AIMS
OBJECTIVE
This study aimed to evaluate the impact of upgrading the machines and the radiation-protection training on ionizing radiation exposure during venous port system implantation.
METHODS
METHODS
We retrospectively analyzed consecutive venous port implantations between 2019 and 2022. The older fluoroscopy machines were replaced by two new machines. A first training session about health worker radioprotection was organized. The medical staff completed a second training course focused on protecting patients from ionizing radiation. We defined four distinct time intervals (TI): venous port implantations performed with the old equipment, the new fluoroscopy machines, after the first training course, and after the second training course. The air kerma-area product (KAP) was compared between these four TI and fluoroscopy times and the number of exposures only with the new machines.
RESULTS
RESULTS
We analyzed 2587 procedures. A 93% decrease in the median KAP between the first and last TI was noted (median KAP = 323.0 mGy.cm
CONCLUSIONS
CONCLUSIONS
Upgrading the fluoroscopy equipment and completing two dedicated training courses allowed for a drastic decrease patient exposure to ionizing radiation during venous access port implantation by non-radiologist practitioners.
Identifiants
pubmed: 38349509
doi: 10.1007/s11845-024-03623-7
pii: 10.1007/s11845-024-03623-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.
Références
Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom (2013) https://eur-lex.europa.eu/eli/dir/2013/59/oj
Kock H-J, Pietsch M, Krause U et al (1998) Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems. World J Surg 22:12–16. https://doi.org/10.1007/s002689900342
doi: 10.1007/s002689900342
pubmed: 9465755
Georges J-L, Livarek B, Gibault-Genty G et al (2009) Reduction of radiation delivered to patients undergoing invasive coronary procedures. Effect of a programme for dose reduction based on radiation-protection training. Arch Cardiovasc Dis 102:821–827. https://doi.org/10.1016/j.acvd.2009.09.007
doi: 10.1016/j.acvd.2009.09.007
pubmed: 19963193
von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573–577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010
doi: 10.7326/0003-4819-147-8-200710160-00010
Lamperti M, Biasucci DG, Disma N et al (2020) European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol | EJA 37:344. https://doi.org/10.1097/EJA.0000000000001180
doi: 10.1097/EJA.0000000000001180
pubmed: 32265391
Vano E, Gonzalez L (2001) Approaches to establishing reference levels in interventional radiology. Radiat Prot Dosimetry 94:109–112. https://doi.org/10.1093/oxfordjournals.rpd.a006451
doi: 10.1093/oxfordjournals.rpd.a006451
pubmed: 11487815
Vañó E, Miller DL, Martin CJ et al (2017) ICRP Publication 135: Diagnostic reference levels in medical imaging. Ann ICRP 46:1–144. https://doi.org/10.1177/0146645317717209
doi: 10.1177/0146645317717209
pubmed: 29065694
Hirshfeld JW, Balter S, Brinker JA et al (2005) ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures. Circulation 111:511–532. https://doi.org/10.1161/01.CIR.0000157946.29224.5D
doi: 10.1161/01.CIR.0000157946.29224.5D
pubmed: 15687141
SFPM (2020) Publication rapport SFPM n°40: Niveaux de référence pour les pratiques interventionnelles radioguidées à l’aide d’arceaux mobiles de bloc opératoire | Actualités | SFPM. https://www.sfpm.fr/actualites/publication-rapport-sfpm-ndeg40-niveaux-reference-pratiques-interventionnelles . Accessed 20 May 2022
Greffier J, Etard C, Mares O et al (2019) Patient dose reference levels in surgery: a multicenter study. Eur Radiol 29:674–681
doi: 10.1007/s00330-018-5600-2
pubmed: 30069810
Rehani MM, Ciraj-Bjelac O, Vañó E et al (2010) Radiological protection in fluoroscopically guided procedures performed outside the imaging department. Ann ICRP 40:1–102. https://doi.org/10.1016/j.icrp.2012.03.001
doi: 10.1016/j.icrp.2012.03.001
pubmed: 22732420
Etard C, Bigand E, Salvat C et al (2017) Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France. Eur Radiol 27:4281–4290. https://doi.org/10.1007/s00330-017-4780-5
doi: 10.1007/s00330-017-4780-5
pubmed: 28289939
Jonczyk M, Gebauer B, Rotzinger R et al (2018) Totally implantable central venous port catheters: radiation exposure as a function of puncture site and operator experience. In Vivo 32:179–184
pubmed: 29275317
pmcid: 5892650
Faroux L, Blanpain T, Nazeyrollas P et al (2018) Minimizing exposure to radiation in invasive cardiology using modern dose-reduction technology: evaluation of the real-life effects. Catheter Cardiovasc Interv 91:1194–1199. https://doi.org/10.1002/ccd.27245
doi: 10.1002/ccd.27245
pubmed: 28862392