Patient and staff dose measurement in dural arteriovenous fistula (DAVF) neurointervetional radiology

Abstract

Nuerointerventional radiology has recently been spread quickly used and achieved successfully in the treatment of vascular diseases. This procedure is complex and uses long fluoroscopy time that the patients and staff receiving high radiation dose and the increased risk of radiation skin injury, such as epilation and cataract. The purpose of this study is to measure radiation dose to show the regional distributions of the entrance skin doses (ESD) and the region of maximum ESD to the patients and staff. The correlation of patient dose and staff dose is determined. The ESD on 22 patients during dural arteriovenous fistula (DAVF) procedure using thermoluminescent dosimeter (TLD) 100 chips were recorded. TLD chips were placed on patient’s head and the body of staff who performed DAVF procedure. The results showed that the maximum ESD for 22 patients of DAVF procedures occurred in the right temporal region, it ranged from 0.36 to 4.46 Gy, the average maximum ESD was 1.08 Gy. The other area received average dose of 0.23 Gy. Three cases of patients showed the effect of epilation on right temporal area with the maximum ESD of 2.25-4.46 Gy after 3 weeks. For the staff, the left upper arm was higher than the other regions, the average ESD was 1.11 mGy, and most of the other areas ESDs were less than 1 mGy. The annual staff dose calculated from 100 procedures does not exceed the dose limit. The ESD of patient correlated on total number of digital subtraction angiographic frames and fluoroscopic time but more pronounced on number of angiographic frames, while the ESD of staff related only with the fluoroscopic time. So the poor correlation between the patient and staff were observed. However, the reduction of x-ray exposure to both patient and staff should be considered by providing suitable protection devices, training program, and standard devices.