Reduction of effective dose in vascular interventions to enhance radiation safety

Abstract

Recent advancements in imaging devices have improved X-ray efficiency but also raised concerns about radiation exposure risks. To ensure safety, it is important to adopt dose reduction protocols, regular equipment maintenance, and the ALARA principle, alongside continuous staff education to minimize radiation-related health risks while optimizing procedure benefits. This study aims to assess the impact of a series of proposed dose reduction processes on reducing the absorbed X-ray dose for patients undergoing interventional procedures. A cohort of 64 medium-sized adult patients underwent numerous X-ray interventions including Transluminal Angioplasty, Biliary Drainage, Chemoembolization, Phlebography, and Fistulography. These interventional procedures were accomplished by using the fluoroscopic X-ray device (AXIOM Artis-Zee, Siemens) in the vascular room of Charles Nicolle Hospital in Tunisia. The dose reduction process applied different CARE techniques along with recommendations from the literature. Doses obtained after the reduction processes were assessed against those from daily practice. Statistical analyses were conducted using the H- test , implemented via R software, to assess the data. Physicians evaluated the image quality during the execution of the X-ray interventions. The reduction in terms of effective dose for diagnostic vascular interventions was 18% for fistulography and 25% for phlebography. For the therapeutic procedures, dose reductions were 19% for Transluminal Angioplasty, 27% for Chemoembolization, and 28% for Biliary Drainage. The statistical analysis of the three recorded indicators (Dose Area Product, exposure time, and effective dose) revealed significant differences ( p- value <0.05) before and after the dose reduction process. The image quality was maintained acceptable to perform interventional procedures (p > 0.05). The obtained results highlight how the dose reduction processes yielded considerable reductions across all studied X-ray vascular interventions while producing high-quality images that fulfilled diagnostic and therapeutic requirements.