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European Radiology
Published in: European Radiology 7/2019

01-07-2019 | Endoprosthesis | Interventional

Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study

Authors: Daniel Schmitz, Thomas Vogl, Nour-Eldin Abdelrehim Nour-Eldin, Boris Radeleff, Jens-Christian Kröger, Andreas H. Mahnken, Harald Ittrich, Hans-Björn Gehl, Bernd Plessow, Joachim Böttcher, Josef Tacke, Markus Wispler, Ulrich Rosien, Wolfgang Schorr, Markus Joerdens, Nicolas Glaser, Erik-Sebastian Fuchs, Andrea Tal, Bettina Friesenhahn-Ochs, Thomas Leimbach, Lars Höpner, Marko Weber, Stefan Gölder, Michael Böhmig, Svetlana Hetjens, Jochen Rudi, Alexander Schegerer

Published in: European Radiology | Issue 7/2019

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Abstract

Objective

Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs.

Methods

A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs.

Results

Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4–21,510 cGy·cm2) and FTs (range 0.07–180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm2) than those of follow-up PBIs (median 464 cGy·cm2). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm2) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm2) (p = 0.85). FT varied substantially (0.07–180.33 min).

Conclusions

DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm2 for initial PBIs and 1400 cGy·cm2 for follow-up PBIs are recommended.

Key Points

• DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI.
• PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture.
• DRLs of 4300 cGy·cm2for initial PBIs (establishing a transhepatic tract) and 1400 cGy·cm2for follow-up PBIs (transhepatic tract already established) are recommended.
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Metadata
Title
Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study
Authors
Daniel Schmitz
Thomas Vogl
Nour-Eldin Abdelrehim Nour-Eldin
Boris Radeleff
Jens-Christian Kröger
Andreas H. Mahnken
Harald Ittrich
Hans-Björn Gehl
Bernd Plessow
Joachim Böttcher
Josef Tacke
Markus Wispler
Ulrich Rosien
Wolfgang Schorr
Markus Joerdens
Nicolas Glaser
Erik-Sebastian Fuchs
Andrea Tal
Bettina Friesenhahn-Ochs
Thomas Leimbach
Lars Höpner
Marko Weber
Stefan Gölder
Michael Böhmig
Svetlana Hetjens
Jochen Rudi
Alexander Schegerer
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 7/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06208-6

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