Radiation dose reduction in fluoroscopic procedures: left varicocele embolization as a model

Eur Radiol. 2015 Jun;25(6):1639-45. doi: 10.1007/s00330-014-3556-4. Epub 2014 Dec 19.

Abstract

Objectives: To investigate the effect of a radiation reduction program on total dose, fluoroscopy dose per second corrected for body habitus and degree of collimation in left varicocele embolizations (LVE).

Methods: A radiation reduction program for LVE was implemented, consisting of a technique minimizing fluoroscopy time, using low-dose presets, virtual collimation, and virtual patient positioning. Height, weight, fluoroscopy time, kerma area product (KAP) and reference air kerma (Ka,r) were recorded for 100 consecutive cases satisfying the inclusion criteria. For each patient, a device specific dose correction factor, determined using a phantom, was used to standardize the KAP to that of the cylindrical diameter of the standard man and a collimation index was derived from the KAP and Ka,r.

Results: Median fluoroscopy time was 3 minutes (mean 4.5, range 1-23.8). Median KAP was 0.54 Gy/cm(2) (mean 0.82, range 0.12-6.52). There was a significant decrease in KAP/second corrected for cylindrical diameter (p < 0.001) and the collimation index (p < 0.001) over time.

Conclusions: This study shows that a dedicated dose reduction program can achieve very low total radiation dose rates for LVE. The significant decrease in collimation index and standardized KAP per second during this study suggest a learning curve for collimation.

Key points: • Left varicocele embolization can be performed with very low radiation doses. • The most effective real time radiation reduction measure is collimation. • There is a learning curve to achieving optimal collimation.

MeSH terms

  • Adolescent
  • Adult
  • Embolization, Therapeutic*
  • Fluoroscopy
  • Humans
  • Male
  • Middle Aged
  • Models, Biological*
  • Phantoms, Imaging
  • Radiation Dosage*
  • Time Factors
  • Varicocele / diagnostic imaging*
  • Varicocele / therapy*
  • Young Adult