Analiza vpliva visokih doz na poškodbe kože pri interventnih posegih na Kliničnem inštitutu za radiologijo Univerzitetnega kliničnega centra Ljubljana

Kovačič, Miha (avtor), Žontar, Dejan (mentor), Mekiš, Nejc (komentor)

Cilji: Zanimalo nas je kako pogosto in kakšne poškodbe na koži je povzročila obsevanost pacientov pri interventnih radioloških posegih z dozo v interventni referenčni točki nad 3 Gy. Metode: V raziskavi smo retrospektivno pregledali 7607 pacientov. Med njimi smo izbrali paciente, za katere je kerma v intervencijski referenčni točki presegla 3 Gy in pri 72 od teh (1% celotnega vzorca) z anketnimi vprašalniki preverili morebitne poškodbe na koži. Da bi ovrednotili ustreznost kerme v intervencijski referenčni točki za oceno kožne doze smo pri 16 pacientih, pri katerih smo pričakovali visoko dozo, kožno dozo izmerili z GAF Chromic filmi. Rezultati: Izmed 7607 pacientov je kerma v intervencijski referenčni točki presegla 3 Gy pri 145 pacientih, pri čemer je bila ta meja najpogosteje presežena pri vstavitvah endovaskularnih stent graftov. Od 35 vrnjenih anketnih vprašalnikov 29% pacientov poroča o poškodbah na koži. Pri meritvah z GAF Chromic filmi smo v povprečju opazili dobro ujemanje z izpisano vrednostjo kerme v intervencijski referenčni točki, vendar so se pri posameznih pacientih pokazala velika odstopanja med obema vrednostnima. Sklepi: Vrednost doze v interventni referenčni točki, ki jo poda aparatura, pri večini pacientov relativno dobro odraža najvišjo vstopno kožno dozo. Kožna doza je presegla prag za nastanek determinističnih poškodb pri približno 2% pacientov, o poškodbah na koži pa je poročalo približno 0,6% pacientov. Zaključek: Raziskava predstavlja sistematičen pregled pogostosti pojavljanja determinističnih poškodb kože pri posegih v intervencijski radiologiji. Čeprav poročane vrednosti odražajo prakso na Kliničnem inštitutu za radiologijo UKC Ljubljana, rezultati podajajo orientacijske vrednosti, ki so relevantne tudi v širšem okviru.

• Jezik: Slovenski jezik
• Ključne besede: interventna radiologija, vstopna kožna doza, skupna doza v interventni referenčni točki
• Vrsta gradiva: Magistrsko delo/naloga
• Organizacija: ZF - Zdravstvena fakulteta
• Leto izida: 2016
• PID: 20.500.12556/RUL-88529
• COBISS.SI-ID: 5207147
• Datum objave v RUL: 15.01.2017

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Retrospective analysis of the frequency and severity of radiation-induced skin injuries from interventional radiology procedures

Izvleček

Objectives: We assessed the level and frequency of radiation-induced skin injuries to patients undergoing interventional radiology procedures at the University Medical Centre Ljubljana in the period from 2012 to 2014. . Methods: In the study 7,607 interventional radiology patients were retrospectively reviewed. Among them, we identified 145 patients for whom Kerma in the intervention reference point (K_IRP) exceeded 3 Gy. Data about the observed skin injuries were gathered by a questionnaire that was sent to 72 patients (1% of the total sample) of whom 35 responded. Reliability of K_IRP for assessing entrance skin dose was confirmed by measuring peak skin dose by GAF chromic dosimetry films in 16 patients for whom we expected high skin doses. Results: The peak skin dose as estimated by K_IRP exceeded 3 Gy threshold in approximately 2% of all interventional radiology patients includes in the study. This was most frequently the case in endovascular stent grafts insertions. Extrapolation of the received feedback to the questionnaires indicates that skin injury was observed by approximately 30 % of the patients with K_IRP above 3 Gy or in approximately 0.6 % of all patients included in the study. . Measurements with GAF chromic films in general showed good agreement with the Kerma in the intervention reference point as provided by the fluoroscopy system although significant discrepancies between the two values were observed for individual patients . Conclusions: In interventional radiology procedures peak skin dose can exceed the threshold for radiation-induces skin injuries in a significant number of patients (2 %) even if great attention is given to optimization of the use of ionizing radiation. The actual skin injuries were reported approximately 3 times less frequently than anticipated based on the accepted thresholds for deterministic effect and their severity was poorly related to the estimated peak skin doses. Advances in Knowledge: The study presents a systematic review of the incidence of deterministic skin injuries in interventions in interventional radiology. While the reported values reflect the specific practice at the Clinical Institute of Radiology, University Medical Centre Ljubljana, the results are relevant in a wider context.

• Ključne besede: interventional radiology, peak skin dose, kerma in the intervention reference point