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Radiation Dose Management
Published in Lawrence T. Dauer, Bae P. Chu, Pat B. Zanzonico, Dose, Benefit, and Risk in Medical Imaging, 2018
The other dose indicator for fluoroscopic procedures is the dose area product (DAP), also more recently known as the kerma area product (KAP). KAP takes into account variation of collimation during a procedure, so that the magnitude of KAP is the same anywhere along the central line from the X-ray tube focal spot. However, as KAP may be equivalent for high AK with a tight-field collimation and lower AK with wide-field collimation, it is difficult to predict deterministic effects from KAP, but KAP would likely be a better estimator of stochastic effects possibly leading to carcinogenesis. Because deterministic effects are the primary concern for fluoroscopically guided interventional procedures, AK is the preferred dose indicator.
Comprehensive strategies to minimize radiation exposure during Interventional electrophysiology procedures: state-of-the-art review
Published in Expert Review of Medical Devices, 2020
Miraj Desai, Omar Kahaly, Adil Aslam, Jonnie Saifa-Bonsu, Maham Usmani, Toshimasa Okabe, Muhammad R. Afzal, Mahmoud Houmsse
In order to properly recognize the detrimental effects of radiation exposure and minimizing these effects, it will be important to familiarize oneself with the definition and dose metrics that were highlighted by the Expert on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness [2]. Absorbed dose is the amount of energy deposition per unit body mass. It is measured in grays (Gy).Effective dose is the measurement of the total body amount of radiation compared to potential risk of complications. It is measured in millisieverts (mSv). Effective dose >100 mSv will result in radiation complication including future development of cancer.ED50 is the median effective dose (ED50) of radiation to prevent from unwanted adverse effects of these procedures.ALARA (As Low As Reasonably Achievable) is a concept has been used to lower radiation exposure to prevent from accumulative long-term risk of cancer.Air kerma (AK) is the energy/dose delivered from an x-ray beam to a specific volume of air. KERMA stands for kinetic energy released per unit mass (of air). It is used clinically to estimate the energy/dose delivered to a specific point (typically skin surface) and is a measure of deterministic risk and absorbed dose. A point that is far from the radiation source will have a lower AK value, a point close to the radiation source will have a higher AK. It is measured in grays (Gy) [3,4].Dose-area product (DAP) is a measure of the total amount of x-ray energy delivered to the entire area being irradiated. Unlike AK, DAP does not vary with location, it is a clinical estimate of the total radiation dose delivered to the patient. DAP can be calculated by multiplying the average AK value in the irradiated field by the cross-sectional area of the x-ray beam. Thus, the units are Gy*cm2. DAP is also occasionally referred to as the kerma area product (KAP). DAP is a measure of stochastic risk and can be used to estimate effective doses and organ doses [3,4].