Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures

Research output: Contribution to journalArticle


  • Hannu Jarvinen
  • Jad Farah
  • Teemu Siiskonen
  • Olivera Ciraj-Bjelac
  • Jérémie Dabin
  • Eleftheria Carinou
  • Joanna Domienik
  • Darius Kluszczynski
  • Zeljka Knezevic
  • Renata Kopec
  • Marija Majer
  • Françoise Malchair
  • Anna Negri
  • Piotr Pankowski
  • Sandra Sarmento
  • Annalisa Trianni

Institutes & Expert groups

  • STUK - Radiation and Nuclear Safety Authority - Finland
  • IRSN - Institute for Radioprotection and Nuclear Safety - Institut Radioprotection Sûreté Nucléaire
  • National Centre for Radiation Protection in Health Care
  • RBI - Ruđer Bošković Institute
  • IFJ–PAN - The Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences
  • CHU - Centre Hospitalier Universitaire de Liège
  • IOV IRCCS - Istituto Oncologico Veneto - Italy
  • IPO - Portuguese Oncology Institute of Porto
  • University Hospital of Udine
  • Vinča Institute of Nuclear Sciences
  • EEAE – Greek Atomic Energy Commission
  • NIOM - Nofer Institute of Occupational Medicine

Documents & links


Purpose: The feasibility of setting-up generic, hospital-independent dose alert levels to initiate vigilance on possible skin injuries in interventional procedures was studied for three high-dose procedures (chemoembolization (TACE) of the liver, neuro-embolization (NE) and percutaneous coronary intervention (PCI)) in 9 European countries. Methods: Gafchromic® films and thermoluminescent dosimeters (TLD) were used to determine the Maximum Skin Dose (MSD). Correlation of the online dose indicators (fluoroscopy time, kerma- or dose-area product (KAP or DAP) and cumulative air kerma at interventional reference point (Ka,r)) with MSD was evaluated and used to establish the alert levels corresponding to a MSD of 2 Gy and 5 Gy. The uncertainties of alert levels in terms of DAP and Ka,r, and uncertainty of MSD were calculated. Results: About 20–30% of all MSD values exceeded 2 Gy while only 2–6% exceeded 5 Gy. The correlations suggest that both DAP and Ka,r can be used as a dose indicator for alert levels (Pearson correlation coefficient p mostly>0.8), while fluoroscopy time is not suitable (p mostly


Original languageEnglish
Pages (from-to)64-74
JournalPhysica Medica
Publication statusPublished - 13 Jan 2018


  • Interventional radiology , Skin dose alert level, Online dose indicator, Maximum skin dose

ID: 4110436