An international survey of patient radiation dose management practice in interventional radiology

Interventional radiology (IR) is a rapidly evolving imaging domain with potential to deliver high patient radiation doses resulting in stochastic effects of radiation but also tissue reactions. As a result of the potential for high patient doses and in some cases tissue reactions, high standards of radiation safety practice are imperative and much work has been done on the development of patient radiation dose management strategies internationally by organizations, professional societies, countries, and individuals. These strategies can be deployed before, during and after IR procedures through appropriate patient consent, dose monitoring and patient follow-up. This questionnaire-based study surveyed fixed (non-mobile) IR departments across seven countries incorporating a wide range of IR specialties including cardiology, neurology and vascular interventional radiology which collectively completing over 250,000 IR procedures annually. Patient radiation dose management was investigated. Respondents indicated that pre-procedure IR patient consent included all radiation effects in only 35% of cases. The patient skin dose surrogate parameter of Kerma to air at a reference point (Kar) is under-reported by respondents suggesting a lack of familiarity with this dose parameter which is highlighted as surrogate for peak skin dose (PSD). Only 23% of respondents indicated that their facility uses a substantial radiation dose level (SRDL) and only half of those reporting to use SRDLs inform the patient after these dose levels have been reached. Poor compliance with unambiguous, readily available best practice guidance was observed highlighting patient communication, patient dose quantification and subsequent patient dose management concerns.