A Peek into the Reported Radiation Exposures Discrepancies during Y90 Procedures In the IR Suite
Abstract
Purpose
Y90 radioembolization often requires both fluoroscopy and CBCT to guide the complex treatment procedure. However, radiation data in the form of RDSRs and Dose Sheets are usually combined across these imaging modalities, making it harder to understand their unique dose contributions. This study quantitatively compares dose contributions from fluoroscopy and CBCT across a large cohort of Y90 cases to improve characterization of radiation exposure and support effective reporting practices in the dose sheets.
Methods
Radiation Structured Dose Report and Dose Sheet data from all Y90 procedures over 15 years at a single academic institution were extracted (n = 459 patients, 54,866 radiation events). Patient demographics and procedure-specific radiation metrics were analyzed to identify reporting discrepancies across physicians and modalities.
Results
Significant discrepancies in numbers of recorded events and radiation dose contributed were noted as CBCT comprised only 2.8% of all recorded radiation events yet accounted for 44.2% of the total radiation dose. Furthermore, fluoroscopy comprised 97.2% of events and 55.8% of the total radiation dose. The number of recorded events per procedure on average were 3.3±2.6 acquisitions per procedure for CBCT and 116.2±80.6 acquisitions per procedure for fluoroscopy. Although the mean cumulative dose per procedure was greater for fluoroscopy (928.7±895.8 mGy) than for CBCT (735.4 ± 626.1 mGy), the per-acquisition dose was dramatically higher for CBCT (222.4±50.7 mGy vs 8.0±41.7, p < 0.0001). CBCT events demonstrated significantly higher DAP (68.5 ± 15.8 Gy·cm²) and larger collimated fields (1,096.7±37.6 cm²) than fluoroscopy (both p<0.0001). The high per-entry radiation intensity of CBCT underscores the need for separate, modality-specific reporting to improve accuracy in assessing patient exposure.
Conclusion
This study reveals significant discrepancies in radiation dose reporting between CBCT and fluoroscopy procedures during Y90 radioembolization procedures.