INTRODUCTION: Central venous access devices (CVAD) are used to deliver intravenous therapy to the bloodstream. CVAD insertion is sometimes fluoroscopically guided and thus associated with radiation dose to both the patient and the staff members within the room. The objective of this study is to assess the radiation dose to the patient through a retrospective audit and directly measure the exposure to staff members in simulated procedures. A secondary objective is to evaluate the radiation exposure to the staff and patients when utilising fluoroscopic pulse rate of 7.5 pps and 4 pps.
MATERIAL AND METHODS: A retrospective audit of patients undergoing Permcath and Hickman line insertions was conducted. The patients were grouped by the pulse rate used for the duration of the study; 4 pulses per second (pps) (n=24) and 7.5 pps (n=33). A STEP OD-2 monitor and PMMA was used in a simulated environment to estimate the radiation exposure to locations that a Radiologist, Nurse and Radiographer would be standing during the procedures using the average procedure details collected in the retrospective audit. Measurements were conducted at heights to reflect a whole body estimate and an estimate to the lens of the eye.
RESULTS: The results show that the median dose area product (DAP) for CVAD insertion is 0.7Gy.cm2 and 0.3Gy.cm2 for procedures done at 7.5 pps and 4 pps, respectively. This corresponded to an effective dose of 0.22 mSv and 0.1 mSv. The radiologist, nurse and radiographer were exposed to a whole-body shielded dose of 0.36μSv, 0.1μSv and 0.05μSv when 7.5 pps was utilised and 0.13μSv, 0.03μSv and 0.02μSv when 4 pps was used. The exposure to the head of radiologist, nurse and radiographer was 2.1μSv, 1.4μSv, and 0.6μSv in the 7.5 pps studies and 0.7μSv, 0.5μSv, and 0.2μSv when 4pps was used.
CONCLUSION: The patient effective dose was estimated to be 0.1-0.22 mSv depending on the fluoroscopic pulse rate utilised during CVAD insertions. Additionally, The radiologist, nurse and radiographer whole body and lens exposure was estimated in a simulated setting. In all cases, there was a statistically significant dose reduction when the lower fluoroscopic pulse rate was used. Thus, where possible, consideration should be given to utilising a lower pulse rate during CVAD insertions to reduce the exposure to both staff and patients.
Reference:Badawy, M.K., Witkowski, C.J., Baldoni, R., Carrion, D. and Yildirim, E. (2020) Radiation dose during fluoroscopically guided central venous access device insertion: retrospective observational study. Radiologia. April 9th. doi: 10.1016/j.rx.2020.01.011. (Epub ahead of print).(Article in English, Spanish).