Dosimetry of Vascular and Interventional Radiology Procedures: Five-Year Analysis in a Tertiary Care Institution in Saudi Arabia

Objectives: To evaluate the dosimetry of vascular and interventional radiology (IR) procedures at a single tertiary care institution and compare it to the previously reported international diagnostic reference levels. Methods: This was a retrospective review of the radiation doses recorded by the dose management software (DoseWatch™) for all vascular and interventional procedures done between January 2015 and December 2018 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Pediatric procedures were excluded from the current analysis. The height, weight, age (>14 years), sex, reference dose point air kerma (mGy), dose area product (DAP) (Gy.cm2), and fluoroscopy time (s) were collected, and the body mass index (BMI) was calculated. Categorical data are presented as percent frequencies. Continuous variables are presented as mean, median, standard deviation, 25th and 75th percentile, and ranges. Two independent sample t-test was used to compare our study mean values with RAD-IR study and CIRD study. Person's correlation was performed to assess for the correlation between the study variables. Statistical significance was defined as P < 0.05. SAS Version 9.4 (Cary, NC, USA) was used for all the analyses. Graphic representations were created using spreadsheet software (Excel 2017; Microsoft, Redmond, Washington, USA). Results: Data of 3444 procedures in 2333 adults were recorded. The study included 1935 male patients (56.18%) and 1509 female patients (43.82%) with a mean age of 56.6 (15–117 years). Analysis of 22 different IR procedures was done. Peripherally inserted central catheter placement was the most commonly performed procedure (n = 1045, 30.3%) followed by tunneled catheter placement (n = 784, 22.76%), gastrostomy (n = 392, 11.4%), and percutaneous transhepatic cholangiography (n = 205, 5.95%). Trans jugular intrahepatic portosystemic shunt (TIPSS) creation had the highest mean fluoroscopy time (78.65 min) followed by uterine fibroid embolization (33.47 min), TIPSS revision (31.79 min), and varicocele embolization (31.75 min). TIPSS creation had the highest mean DAP (1649.35 Gy.cm2) followed by hepatic chemoembolization (588.64 Gy.cm2), hepatic artery mapping (573.75 Gy.cm2), and TIPSS revision (539.12 Gy.cm2). TIPSS creation was associated with the highest mean reference dose (6.72 Gy), followed by hepatic chemoembolization (3.18 Gy), hepatic artery mapping (2.44 Gy), and embolization (2.24 Gy). Compared to a recent and the RAD-IR studies, TIPSS creation and transarterial chemoembolization are associated with significantly longer fluoroscopy time and higher DAP and Dose reference (DR). Although nephrostomy, gastrostomy, and biliary interventions were performed in significantly shorter fluoroscopy times compared to prior studies, this did not translate into significant reduction in DAP or DR in most cases. The result showing a significant positive correlation of BMI and DAP (R = 0.09410, P < 0.0001). Conclusion: This analysis establishes the dosimetry of the most commonly performed vascular and interventional procedures in a tertiary care center in Saudi Arabia. This comparison indicates the need for stricter radiation precautions to further comply with international standards.

Publication History

Article published online:
26 April 2021