31 celldeath. Further late effects can be necrotic changes in the tissue of the skin. (ICRP, 2011) It has been established threshold values for the skin with possible tissue damages that can appear with the different threshold values. Definition of threshold dose values: The minimum amount of radiation dose where a deterministic effect can appear. The threshold values have an individual variation because of biological differences in each patient. Stecker et al (2009) If we want to reduce the risk of deterministic effects from interventional procedures we need to be able to evaluate MSD for these procedures. The challenge is how to manage this in the daily care at the interventional department. This is what I have tried to do in my project. Methods: I have measured skin doses in two different cardiac interventional procedures. The measuring of MSD is done with Gafchromic film, and the film is put directly under the patients back during the procedures. Results: It is a very good correlation between actual measured MSD and both dose values from the apparatus. DAP is found to be the most suited dose value. We have now a good foundation for setting threshold DAP values in the daily care, and perform follow up procedures for patient at risk of getting deterministic skin damages. 1 of 43 patients that had their MSD measured received a dose over 3 Gy. A retrospectiv study shows that 1,1 % of our cardiac patients receive over 3 Gy. 9.3. The Image-guided trans arterial chemoembolization and radiofrequency ablation Presenter: Maria Venäläinen, Päijät-Häme central hospital, Finland Author: Maria Venäläinen Introduction: The rates of hepatocellular carcinoma and colorectal carcinoma are increasing worldwide and most patients can only be offered palliative treatment. Interventional radiology offers palliative treatments like image-guided trans arterial chemoembolization (TACE) and radiofrequency ablation (RF ablation). The interventional radiologist makes yearly dozens of these image guided treatments at Päijät-Häme central hospital. In the RF ablation treatment there is utilized heat energy. The interventional radiologist guides a small needle or needles into the tumor during x-ray examination. Radiofrequency energy is transmitted to the tip of the needle where it produces heat in the tumor tissues. TACE is a treatment where the interventional radiologist threads a tiny catheter up the femoral artery in the groin into the artery veins the liver tumor. Then the interventional radiologist administers the chemotherapy drug eluting beads directly into the tumor. The beads keep the chemotherapy drug in the tumor by blocking the flow to other areas of the liver. TACE and RF ablation can cause pain to the patient during the treatment. The patient`s pain is usually treated with epidural anesthesia. TACE and RF ablation involve a stay in hospital for a couple of days. Radiographers are part of the team in TACE and RF ablation. The Radiographer assists the interventional radiologist and take care of the patient trough the treatment. Methods: The purpose of TACE treatment is to make necrosis in tumor with drug eluting beads. RF ablation system with needles utilizes heat energy that raises the temperature of tissue in order to cause its destruction. Results: Image-guided treatments trans arterial chemoembolisation (TACE) and radiofrequency ablation (RF ablation) are safe and effective treatments of unresectable liver metastases. TACE and RF ablation have also minimal complications and the acceptable tumor response is good. The benefits of TACE and RF ablation are short hospitalization time and low complication rates. The radiographer functions in both TACE and RF ablation are challenging and interesting. 9.4. Is extra corporeal shockwave lithotripsy more effective when conducted under general anaesthetic compared with conscious sedation? : A retrospective review. Presenter: James Hayes, Christchurch Polytechnic Institute of Technology, New Zealand Authors: James Hayes, Cindy Grobler, Chris Frampton Introduction: Extra corporeal shockwave lithotripsy (ESWL) is a noninvasive but painful treatment for urolithiasis. Within New Zealand one lithotripter provides the majority of lithotripsy treatments as it travels the length of the country. The local urologist will decide the treatment pattern and, in conjunction with their anaesthetist, the type of anaesthesia given. This is usually conscious sedation or general anaesthetic. The objective of this study is to compare the efficacy of conscious sedation with that of general anaesthesia in the setting of ESWL. Methods: Data was collected from 5266 patients with a single primary nonstaghorn calculi who were treated with a Dornier S1 or Dornier S2 lithotripter between June 1995 and May 2011. Success was no remaining fragment greater than 4mm. Results: Treatment of primary, non stag-horn stones with the Dornier S1 or Dornier S2 lithotripter under general anaesthesia was significantly more successful than treatment under conscious sedation. 9.5. Interventional radiology dose distributions for vascular procedures undertaken at Universitas hospital Presenter: Henra Muller, Department Clinial Imaging Sciences, Universitas Hospital, Bloemfontein, South Africa Authors: H Muller, WID Rae, H Friedrich-Nel, CP Herbst,1 Department Clinical Imaging Sciences, Universitas Hospital, Bloemfontein, South Africa, 2 Department of Medical Physics, Universitas Hospital, Bloemfontein, South Africa 3Department of Clinical Sciences, Central University of Technology, Bloemfontein, South Introduction: Medical exposure contributes more than 95% of the dose that the global population receives from man-made sources. Radiation exposure to patients during interventional radiology delivers the highest skin doses. In some procedures, skin doses to patients approach the lower limit for biological effects (2Gy). It is thus important that referring clinicians, radiologists, radiographers and patients are aware of these potentially high doses and long imaging times. From the early 1990s radiation induced skin injuries associated with interventional procedures have increased. These procedures are complicated and, require longer fluoroscopy times. It is therefore important to identify procedures with a real risk of radiation injury. If a patient is knowledgeable about the radiation dose received and the possibility of radiation injuries the patient would be able to seek help sooner if for example skin changes occurred. If personnel members were informed about the radiation doses associated with interventional procedures, and took note of the potential radiation injuries associated with procedures beyond threshold dose values, they would be able to answer specific questions or concerns raised by the patient. Personnel members would also be more aware of dose optimization by making use of different techniques of radiation protection during these high dose procedures. The aim of this study was to determine dose distribution for specific diagnostic and interventional procedure types, to determine which procedures undertaken at Universitas Hospital contribute the highest radiation dose to individual patients and to the population. Methods: The study included 3310 patients for diagnostic and interventional procedures, involving fluoroscopic x-ray exposure from 2006 to 2009. Patient data and doses were entered into a database, which included dose-area products (DAP) and screening times. Results: The maximum dose was during a renal arteriogram.Four vessel angiograms and transfemoral outflows delivered highest population doses.Arterial outflows were most performed and embolizations delivered the highest mean dose.Diagnostic procedures deliver higher population doses vs interventional procedures high dose to the individual patient.Procedures identified which may require patient follow-up to monitor skin effects.Dose reduction measures must be taken, especially for the identified procedures. 9.6. Application of Angio-CT System for Treatment of Recurrent Breast Cancer with Superselective Drug-eluting Microsphere Transcatheter arterial Chemoembolization (DEM-TACE) Presenter: Yang Sheng Chen, Taipei Veterans General Hospital, Taiwan Authors: Yang-Sheng Chen, Yen-Chun Shen, Chieu-An Liu Introduction: Breast cancer is one of the most common malignancy affecting women worldwide. In Taiwan, the incidence gradually increases and younger population is affected in the past decade. Surgical resection is a mainstay of treatment. The role of adjuvant chemotherapy is to achieve tumor down staging, to increase the possibility of surgical resection and to reduce tumor recurrence and metastasis. Local or regional chemotherapy has been used for local control or palliative treatment of primary or metastatic diseases. Interventional radiology provides minimally invasive treatment for locally advanced breast cancer, such as intraarterial chemotherapy (IAC) and transcatheter arterial chemoembolization (TACE), by means of angiography alone conventionally. Computed tomography
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