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Title: SU-F-I-71: Fetal Protection During Fluoroscopy: To Shield Or Not to Shield?

Abstract

Purpose: Lead aprons are routinely used to shield the fetus from radiation during fluoroscopically guided interventions (FGI) involving pregnant patients. When placed in the primary beam, lead aprons often reduce image quality and increase fluoroscopic radiation output, which can adversely affect fetal dose. The purpose of this work is to identify an effective and practical method to reduce fetal dose without affecting image quality. Methods: A pregnant patient equivalent abdominal phantom is set on the table along with an image quality test object (CIRS model 903) representing patient anatomy of interest. An ion chamber is positioned at the x-ray beam entrance to the phantom, which is used to estimate the relative fetal dose. For three protective methods, image quality and fetal dose measurements are compared to baseline (no protection):1. Lead apron shielding the entire abdomen; 2. Lead apron shielding part of the abdomen, including the fetus; 3. Narrow collimation such that fetus is excluded from the primary beam. Results: With lead shielding the entire abdomen, the dose is reduced by 80% relative to baseline along with a drastic deterioration of image quality. With lead shielding only the fetus, the dose is reduced by 65% along with complete preservation of imagemore » quality, since the image quality test object is not shielded. However, narrow collimation results in 90% dose reduction and a slight improvement of image quality relative to baseline. Conclusion: The use of narrow collimation to protect the fetus during FGI is a simple and highly effective method that simultaneously reduces fetal dose and maintains sufficient image quality. Lead aprons are not as effective at fetal dose reduction, and if placed improperly, they can severely degrade image quality. Future work aims to investigate a wider variety of fluoroscopy systems to confirm these results across many different system geometries.« less

Authors:
;  [1]
  1. Henry Ford Health System, Detroit, MI (United States)
Publication Date:
OSTI Identifier:
22632132
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; ABDOMEN; FETUSES; FLUOROSCOPY; IMAGES; IONIZATION CHAMBERS; PATIENTS; PHANTOMS; RADIATION DOSES; RADIATION PROTECTION; SAFETY; SHIELDING; SHIELDS

Citation Formats

Joshi, S, and Vanderhoek, M. SU-F-I-71: Fetal Protection During Fluoroscopy: To Shield Or Not to Shield?. United States: N. p., 2016. Web. doi:10.1118/1.4955899.
Joshi, S, & Vanderhoek, M. SU-F-I-71: Fetal Protection During Fluoroscopy: To Shield Or Not to Shield?. United States. doi:10.1118/1.4955899.
Joshi, S, and Vanderhoek, M. 2016. "SU-F-I-71: Fetal Protection During Fluoroscopy: To Shield Or Not to Shield?". United States. doi:10.1118/1.4955899.
@article{osti_22632132,
title = {SU-F-I-71: Fetal Protection During Fluoroscopy: To Shield Or Not to Shield?},
author = {Joshi, S and Vanderhoek, M},
abstractNote = {Purpose: Lead aprons are routinely used to shield the fetus from radiation during fluoroscopically guided interventions (FGI) involving pregnant patients. When placed in the primary beam, lead aprons often reduce image quality and increase fluoroscopic radiation output, which can adversely affect fetal dose. The purpose of this work is to identify an effective and practical method to reduce fetal dose without affecting image quality. Methods: A pregnant patient equivalent abdominal phantom is set on the table along with an image quality test object (CIRS model 903) representing patient anatomy of interest. An ion chamber is positioned at the x-ray beam entrance to the phantom, which is used to estimate the relative fetal dose. For three protective methods, image quality and fetal dose measurements are compared to baseline (no protection):1. Lead apron shielding the entire abdomen; 2. Lead apron shielding part of the abdomen, including the fetus; 3. Narrow collimation such that fetus is excluded from the primary beam. Results: With lead shielding the entire abdomen, the dose is reduced by 80% relative to baseline along with a drastic deterioration of image quality. With lead shielding only the fetus, the dose is reduced by 65% along with complete preservation of image quality, since the image quality test object is not shielded. However, narrow collimation results in 90% dose reduction and a slight improvement of image quality relative to baseline. Conclusion: The use of narrow collimation to protect the fetus during FGI is a simple and highly effective method that simultaneously reduces fetal dose and maintains sufficient image quality. Lead aprons are not as effective at fetal dose reduction, and if placed improperly, they can severely degrade image quality. Future work aims to investigate a wider variety of fluoroscopy systems to confirm these results across many different system geometries.},
doi = {10.1118/1.4955899},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • The various radiation sources that may act on living beings and the variability of the tolerance doses according to various Commissions and Committees are discussed. Determinations were made at various levels of the human body during fluoroscopy and radiography, using precise constants. It appears that for reducing the irradiation dose, the diaphragm opening plays an important role and also the addition of a 2 mm Al filter. Under such conditions, there exist no risks of serious ovarian lesions, a fact demonstrated by Kaplan. It is necessary for the safety of the roentgenologist to check the protection given by his machinemore » by performing determinations, so that the radiation absorbed weekly does not exceed 100 mr. (auth)« less
  • Purpose: An accurate dose estimate is necessary for effective patient management after a fetal exposure. In the case of a high-dose exposure, it is critical to use all resources available in order to make the most accurate assessment of the fetal dose. This work will demonstrate a methodology for accurate fetal dose estimation using tools that have recently become available in many clinics, and show examples of best practices for collecting data and performing the fetal dose calculation. Methods: A fetal dose estimate calculation was performed using modern data collection tools to determine parameters for the calculation. The reference pointmore » air kerma as displayed by the fluoroscopic system was checked for accuracy. A cumulative dose incidence map and DICOM header mining were used to determine the displayed reference point air kerma. Corrections for attenuation caused by the patient table and pad were measured and applied in order to determine the peak skin dose. The position and depth of the fetus was determined by ultrasound imaging and consultation with a radiologist. The data collected was used to determine a normalized uterus dose from Monte Carlo simulation data. Fetal dose values from this process were compared to other accepted calculation methods. Results: An accurate high-dose fetal dose estimate was made. Comparison to accepted legacy methods were were within 35% of estimated values. Conclusion: Modern data collection and reporting methods ease the process for estimation of fetal dose from interventional fluoroscopy exposures. Many aspects of the calculation can now be quantified rather than estimated, which should allow for a more accurate estimation of fetal dose.« less
  • Purpose: To evaluate the peripheral dose (PD) to a fetus during radiation therapy of pregnant patients when using a newly designed fetal lead shield (FLS). Methods: A custom FLS has been designed and fabricated for our department. The FLS (1.1 TVLs for 6 MV) is mounted on a mobile frame and can be adjusted vertically with a motor actuator. PD measurements were acquired for multiple simple square fields and for a variety of potential treatment sites a pregnant patient may be treated for including brain, head and neck (H&N) and thorax. For measurements of the brain, H&N, and thorax, anmore » ionization chamber and OSLDs were positioned on average at a distance of 48, 29 and 26 cm, respectively, from the edge of treatment fields to mimic the approximate position of the fundus. Results: Based on our measurements, applying a 90┬░ collimator rotation and using tertiary MLCs to define the field aperture in combination with jaws resulted in an average dose reduction of 60%. When using these planning strategies in combination with the FLS, on average, the PD was reduced by additional 25% for simple square fields and 20% for clinical plans. Conclusion: The custom FLS is a safe, effective, and relatively easy system to position. Commissioning measurements have demonstrated that the PD to the fetus can be significantly reduced when using the FLS. The comprehensive dataset obviates the need for individual patient pre-treatment dose measurements as long as the geometry falls within the commissioning limits.« less