Patients dose and risk assessment in fluoroscopically guided interventional procedures in Ghana

• Published in: Health and technology 2025-01, Vol.15 (1), p.119-130
• Main Authors: Issahaku, Shiraz, Hasford, Francis, Azantillow, Norbert, Sackey, Theophilus Akumea, Nunoo, George, Dzefi-Tettey, Klenam, Mensah, Yaw Boateng, Sarkodie, Benjamin, Amponsah, Becky Appiah, Tagoe, Samuel, Esposito, Marco, Padovani, Renato
• Format: Article
• Language: English
• Subjects: Aorta; Biological and Medical Physics; Biological effects; Biomedical Engineering and Bioengineering; Biomedicine; Biophysics; Charts; Computational Biology/Bioinformatics; Correlation; Engineering; Evaluation; Fluoroscopy; Image acquisition; Image quality; Ionizing radiation; Medical imaging; Medicine/Public Health; Monte Carlo simulation; Optimization; Original Paper; Parameter estimation; Patients; Prediction models; Quality assessment; Quality control; R & D/Technology Policy; Radiation; Radiation dosage; Radiation effects; Radiation protection; Radiology; Risk levels; Sensors; Surgeons
• ISSN: 2190-7188; 2190-7196
• DOI: 10.1007/s12553-024-00919-7

Introduction The significant increases in the use of imaging and interventional procedures in recent times have brought along the issue of safety and protection of patients and users of diagnostic and interventional radiology equipment for complex procedures. Additionally, due to potential risk associated with these procedures, patients’ radiation protection issues have become the focus of most fluoroscopy guided interventional procedures globally. The objective of this study is to evaluate optimized angiographic exposure parameters, radiation dose, estimated risk levels and develop a radiation dose reference chart for the most commonly routine protocol in interventional procedures in Ghana. Methodology Patients dose parameters were obtained from the structured dose reports of the PAC system of five diagnostic interventional equipment facilities, together with number of images per procedure and image quality assessment for dose optimisation protocols. The data retrieved from the PAC System include patients’ biodata, input and output indices including Kerma-Area Product (KAP) Fluoro and total Kerma-Area Product values. Additionally, fluoroscopy time and the number of radiographic images of at least 50 patients for each FGI procedure based on ICRP Publication 135 recommendations were also collected. The PC based Monte Carlo simulation software (PCXMC) was used to estimate ED from the total KAP and the KAP Fluoro values. Image quality (IQ) was assessed using human observer assessment and evaluation based on the assessment of the radiologists, who ranked the images from most acceptable images to least acceptable images and whether accepted on not accepted for clinical use. Patient radiation exposure was evaluated using estimated KAP Fluoro and Total KAP to estimate ED from each of the measured parameters. That is radiation risk levels were estimated based on Biological Effects of Ionising radiation (BEIR) report VII predictive models. These were done by assessing the dose and risk to patients and practioners during fluoroscopy guided interventional procedures for each of the nine most common routine procedure and the possible corrective measures needed for effective management of these procedure. Results The study shows that the total KAP median dose value was 109 with a minimum and maximum values in the range of 2 to 835 Gy.cm 2 were recorded during Abdominal Aorta Endoprosthesis procedure. While KAP Fluoro minimum and maximum dose value were ranged from 1.59