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Radiation exposure of patients in interventional radiology
MALÍNSKÁ, Karla
The issue of patient radiation exposure remains an important topic in the field of radiology. The objective of the bachelor's thesis was to determine the average effective doses of patients who underwent fluoroscopy-guided interventional procedures at a selected workplace. The theoretical part of the thesis discusses the use of ionizing radiation in medical practice and describes the specific radiation exposure for patients in the given area. Additionally, it provides an overview of the current possibilities of interventional radiology. In the practical part of the bachelor's thesis, a sample of data from the radiology department of České Budějovice Hospital, a.s. was used. The effective dose was chosen as the measure to evaluate patient radiation exposure, as it allows for the assessment of risks associated with medical radiation using a single value. The estimation of average effective doses was conducted using conversion factors, which enable the conversion of the directly measurable KAP value into an effective dose. The results of the practical part of the study revealed that the risks associated with radiation exposure from fluoroscopy-guided interventional procedures can be considered minimal to low. Furthermore, the results indicate that the values of effective doses vary significantly among individual patients.
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The comparism of dose aquivalents interventional radiology and cardiology
GOMOLOVÁ, Iveta
The main topics of this work are personal doses of ionizing radiation and their comparison with workers in the interventional radiology and interventional cardiology. National Radiation Protection draws attention to the fact that doses of interventional cardiologists are higher than doses of interventional radiologists. In the framework of this bachelor thesis it was examined whether this hypothesis is true for the assisting mid staff, range of the doses and what to do to reduce them. The doses for radiology assistant and nurses assisting with the operations in interventional cardiology and nurses assisting with performances in interventional radiology were compared over a period of seven years for these purposes. These data are processed by methods of descriptive statistics and recorded in graphic form. The theoretical part of the thesis mentions properties of ionizing radiation. It explains the interaction of ionizing radiation with matter and cells and its effects on human health. Finally, the issue of radiation hygiene in terms of occupational exposure and the legislation that governs records of dosage parameters throughout the European Union is outlined it the thesis as well. The practical part deals with personal dose equivalents of individual employees of interventional cardiology and interventional radiology obtained from the Prague Institute of National Service of Personal Dosimetry, which evaluates these doses. Given the results, both hypotheses can be considered as confirmed. This confirmation is caused by lower number of employees and lower number of IC workplaces that focus on larger numbers of patients. This implies that the reduction of occupational exposure is achieved with a sufficient number of qualified personnel to enable more frequent substitution, proactive approach in compliance with radiation hygiene and very good cooperation of the entire team. The work's benefits can be seen especially in the ODE quantification differences within IC and IR and in defining the possibility of reducing the radiation load.
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Special access of the radiology assistant to interventional procedures in diagnostics of oncological patients
CANDROVÁ, Daniela
In my work I deal with the peculiarities in approach of a radiology assistant to interventions in diagnostics of oncological patients. Biopsy has a special importance in diagnostics of neoplasm. It is essential for histological and cytological diagnostics. The aim of this work was to find out the incidence of bioptic interventions on oncological patients during one year at radiology department at České Budějovice hospital plc, and to compare the advantages and disadvantages of used modalities. The work proceeds from the presumption that the number of interventions carried out under the sight control without the use of ionizing radiation methods is growing. In the theoretical part of my work appear descriptions of bioptic methods of intervention radiology regarding oncology and its methods, biopsies, screening methods used at biopsy (ultrasound controlled biopsy, computer tomography controlled biopsy, magnetic resonance controlled biopsy, skiascopic controlled biopsy), instrumentarium, especially the needles used for tissue extraction (puncture and bioptic needles), characteristics of oncological patients, the principle of tumour disease, carcinogenesis, oncologically changed tissue, and basic diagnostics of oncology disease. The practical part reveals the number of biopsies performed in 2012 at České Budějovice hospital plc, under computer tomography, ultrasound and mammography machine control, and the number of other interventions on oncological patients, namely localization of impalpable breast lesion, percutaneous drainage of the urinary tract under skiascopic control. Standard methods regarding these interventions and biopsies are described focusing on the advantages and disadvantages of their use for different organs in the body. I also described radiology assistant?s work and created photo documentation of given interventions. In 2012, 96 biopsies were performed under any of the mentioned diagnostic screening methods at radiology department of České Budějovice hospital. They represent 0,06% of the total of 171 466 diagnostic interventions at this department in the respective year. At the same time they represent 3,4% of the total of 2844 interventions of the ČB radiodiagnostic department of that period. From the whole number of 96 biopsies, 79% were performed on oncological patients. No biopsies were performed under magnetic resonance or skiascopic- skiagraphic control. Since the formation of a tumour is supposed to be the main somatic risk which an individual after a low intensity radiation faces, I supposed that the number of bioptic samples taken under sight control without the use of non ionizing radiation is rising, which significantly contributes to radiation protection. It is not univocally assigned which screening method is the best for biopsy. Usually we chose the biopsy that can screen best the site in different organs and that allows the safest, the fastest and the economically most convenient procedure. The chosen method should allow the doctor chose the site for sample extraction. The choice also depends on the habits and the technical equipment of given hospital. In view of the fact that according to this work computer tomography is the most commonly used method for bioptic extractions, and under magnetic resonance control no biopsies are performed, the prestige and importance of a radiology assistant grows up, because their presence at modalities using ionizing radiation is commonly indispensable. The hypothesis of my work has not been proved. Concrete results do not support the operative hypothesis of y work. However, I can recommend concessive long-term type and multicentrically elaborated sample studies. I would be grateful if this work provided an information base for radiology assistants´ training and for interventions in the diagnostics of oncologically ill people.
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Dosimetric determination of radiation exposure of patients and personnel during diagnostic and interventional endovascular procedures at the DSA department of UVN, recovery plan for a potential extraordinary event
KRAHULA, Ondřej
Intervention radiology is a discipline that is achieving a great advancement due to its significant success in the treatment of various diseases. Also, it relates to the increase of the number of angiographic performances in the last years. The extension of radiological methods has increased the share of this discipline on the overall medical irradiation of the population. All angiographic performances are accompanied by certain risk related to the exposure of the patient and staff to the ionizing radiation. Several cases were reported where the surface doses were reaching the limits of deterministic effects of radiation in some types of examination. This study monitors three core criteria related to the radiation burden in the set of 141 patients, which have undertaken different endovascular interventions. These criteria are: the dose area product (DAP), surface dose, and effective dosage. The relevant criterion was the value of DAP, read from the DAP meter directly during the examination. Other data were calculated. On basis of these results, this study tries to determine the strenuousness of singular examinations from the point of the radiation burden. It is the understanding the principles of the influencing the patient{\crq}s burden of the radiation in angiographic examinations, what can help in reducing the dosages. The analysis of this study results can help to prevent the occurrence of abnormal events during the examination.
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Radiographers role in biliary interventions.
MINÁŘOVÁ, Olga
Radiological assistance during non-vascular interventions on the biliary tract. The presented Bachelor's thesis includes information from the practical course in an interventional facility of the Department of Imaging Techniques, Motol University Hospital, while assisting during PTC and PTD procedures. In the Czech Republic, these procedures are most frequently performed in patients with inoperable malignant stenosis of the biliary tract where the method of first choice, the endoscopic approach (ERCP), is not possible. I would like to emphasise the importance of knowledge and use of the state-of-the-art materials and technologies that facilitate our work and ensure a non-complicated course of examination for the patient. By comparing the radiation burden in assisted and non-assisted procedures, I would like to demonstrate that the overall final effective dose during assisted procedures is lower than during the procedures performed by the surgeon alone. Data obtained from two groups of thirty patients with an identical diagnosis, who received treatment with or without assistance, was statistically compared and plotted in a graph. In the selected sample of sixty patients in whom this procedure was indicated, I used the parameters obtained to perform a final calculation of the effective dose. The results confirmed the hypothesis that the assisted procedures require less time than the unassisted procedures, and that the effective doses are lower and not dependent on the BMI value. We should also take into account the factors that might influence the overall course of the examination, such as for example the patient?s overall health and his/her diagnosis. The length of the procedure depends on the experience, length of practice and skills of the radiologist. The radiology assistant, as a practicing specialist, plays an important role in the entire interventional team. PTC/PTD is a method which has a low burden for the patients, a low occurrence of complications, and is life-saving in some cases. The possibility of reducing the burden on the patient and the personnel can be achieved by having a sufficient number of qualified staff at the interventional radiology facilities. The symbiosis of the entire examination team is a guarantee that the procedures will be performed in the best possible way and in the shortest possible time, with a low radiation burden for the patient.
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Monitoring the personnel radiation load in percutaneous interventions
SKÁCELOVÁ, Lada
The discovery of ionising radiation at the turn of the nineteenth and twentieth centuries was a landmark for medicine: the methods based on the principle and effects of ionising radiation are used even in the present medicine to a considerable extent. As early as in the very beginnings, adverse affects of ionising radiation were observed, and from this early period the first references to the need of radiation protection date. The fields of medicine dealing with the application of ionising radiation, whether in the diagnosis or in the therapy of diseases, went through an extensive development in their over hundred-year history. It was in the technical sphere in particular where the most important progress was accomplished, thanks to the ever more advanced instrumentation put on the market, meeting the strict criteria of radiation protection. On the one hand, a large group of diagnostic and therapeutic procedures was replaced by new methods (based on ultrasound and magnetic resonance) that are not based on ionising radiation, and thus the patient or the attending personnel are not exposed to the harmful effects of the radiation. On the other hand, the interventional radiology has attained an unprecedented expansion. With the development of new interventional methods and procedures, the number and duration of interventions has been growing. The radiation load to which the intervening personnel are exposed has thus been rising despite the state-of-the-art instrumentation. The theoretical part of the dissertation describes the origin and types of the ionising radiation, its properties and interactions with the environment; a proportional part has been devoted to the biological effects of the radiation. The prime attention has been concentrated on radiation protection, its objectives, principles and methods of radiation protection. An overview of the current legislation and list of requirements on the radiation monitoring has been elaborated. In the chapter on personal dosimetry, the fundamental relations and quantities used in the radiation dosimetry have been described, as well as the types of personal dosimeters and protective equipment. In the practical part, the radiation load of the personnel attending percutaneous interventions in the department of interventional radiology of the Clinic of Radiology of the Teaching Hospital Olomouc was measured. Personal electronic radiation dosimeters Rados, type RAD 60S, were used. All the data obtained were processed using statistical methods, and, on the basis of the results thus obtained, the effectiveness of protection was determined, and the importance of the observation of the principles of radiation hygiene was evaluated. The presumed use of the results of this work in practice is in the optimisation of procedures and measures leading to the maximum possible reduction of the radiation load in percutaneous interventions, and to the education and guidance of personnel towards consequential compliance with all principles of the radiation hygiene.
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Support - intervention radiology diagnostic methods at liver´s investigation
MÁDR, Robert
The special field of radiology, interventional radiology, is a logical result of the current technological development in medicine. The purpose of interventional radiology is to include the knowledge of clinical, especially surgical, procedures, and a considerable development of imaging methods for treatment some diseases and conditions with minimum damage of the exterior integtiry og human body. This is made possible only by using the current imaging methods based not only on the X-ray radiation but also on ultrasound and magnetic resonace imaging to guiding surgical instruments in body cavities and organs. Intervention radiological methods achieved considerable technological progress expressed mainly in quality and sensitivity of medical examinations which increases the possibilities to make the correct diagnosis and achieve succesful treatment. My thesis deals with liver, gallblader and gall ways diseases and the radiological imaging of these parts of the body. Together with the development of various hepatobiliary system diseases upgrade examination techniques are being developed. The examination techniques include classical radiological methods, endoscopic methods, CT and magnetic resonace imaging and also the intervention diagnostics and hepatobiliary surgical treatment. In the practical section of my thesis I describe the anatomy, pathology, examination indications and examination methods themselves. I also refer to the special instrumenarium {--} a collection of instruments and other equipment for an operation or for a medical procedure. The objective of my thesis was to give a complete survey of interventional radiological methods used by a radiologist in liver examinations.
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The Role of Imaging in Surgical Inflammatory Complications
KOPRDOVÁ, Eliška
The Role of Imaging in Surgical Inflammatory Complications Interventional radiology is a dynamic and fast developing specialization. Development of new methods and instruments extends possibilities of mini-invasive treatment of a wide range of illnesses. Introduction of a specific percutaneous drain in case of abdominal abscess in clinical practice counts among most important progress of 1980s concerning this field. The percutaneous drain is relatively fast and simple method and it belongs to urgent interventional operations. Indication for the percutaneous drain is a treatment or a palliative treatment of sepsis accompanied by an infected lesion. Most authors agree that there is no absolute contraindication of the percutaneous drain for pathological liquid collection. Therefore, this type of drain may be considered as a method selection. It is possible to execute it even before a possible surgical operation. The goal of my work was to assess retrospectively the experience of the Radiological Department of the Teaching Hospital in Plzeň Bory concerning this field within the selected period of time. For this reason, a single-purpose database has been created, which contains data of patients who underwent the percutaneous drain under the supervision of the CT or UZ within a certain period of time. Such data has been processed statistically. The work did not prove any of the hypotheses of mine that interventional techniques may in all cases substitute surgical operation while treating suppurative inflammatory lesions in the area of chest, abdomen and soft tissues. The percutaneous drain brings unquestionable advantages into clinical practice. Among most important ones, there are a removal of a surgical operation risk and of total anaesthesia, above all in the acute phase of illness. Simplification of post-operative care, shortening of the average hospitalization as well as economic advantages. This concerns a method that should always be considered as the first step among possible treatments of infected lesion.
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