Eliseo Vano

Complutense University of Madrid | UCM · Department of Radiology

Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging ‘Clinical DRLs’ working group forme...

Objectives: The International Commission on Radiological Protection recommends managing patient and occupational doses as an integrated approach, for the optimisation of interventional procedures. The conventional passive personal dosimeters only allow one to know the accumulated occupational doses during a certain period of time. This information...

Interventional cardiology provides undisputable benefits for patients but uses a substantial amount of ionising radiation. The diagnostic reference level (DRL) is the tool recommended by the International Commission on Radiological Protection to optimise imaging procedures. In this work, a review of studies dealing with radiation dose or recommendi...

The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for paediatric interventional cardiology procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study is conducted in the framework of the OPRIPALC programme coordinated by the World Health Organiz...

The aim of this study is to evaluate the personal dose equivalent Hp(10) in the most frequent (non-cardiac) paediatric interventional radiology (PIR) procedures: central venous catheters (CVC), hepatic/biliary and sclerotherapy interventions. i2 active solid-state dosemeters placed over the lead apron were used to monitor the exposure of three inte...

An article on the status of radiological protection during procedures of interventional cardiology in pediatric patients in Chile was published in 2013. The present article relates the continuing efforts to improve radiological protection highlighting their results and proposing additional measures to improve radiological protection during the proc...

The terms “notifications” and “alerts” for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluor...

Introduction and objectives: It is relevant to estimate the uncertainties in the estimation of eye lens doses from a personal dosimeter over the protective apron without using additional dosimetry near the eyes. Additional dosimetry for interventionists represents a difficulty for routine clinical practice. This study analyses the estimated eye do...

Objectives Radiation dose management systems (DMS) are currently to help improve radiation protection in medical imaging and interventions. This study presents our experience using a homemade DMS called DOLQA (Dose On-Line for Quality Assurance). Methods Our DMS is connected to 14 X-ray systems in a university hospital linked to the central data r...

The goal of the present study was to estimate the radiation dose for a group of 45 Kawasaki disease (KD) patients undergoing fluoroscopically guided cardiac catheterization. The sample of procedures corresponds to a single hospital and was collected in 10 years. Anthropometric characteristics and the quantities of air kerma-area product (PKA) among...

In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting on Developing Effective Methods for Radiation Protection Education and Training of Health Professionals with attendance of 230 participants representing 66 Member States and 24 international organizations, professional bodies and safety alliances. By m...

This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative’s Call for Action in successfully achieving international radiation protection goals as set out by those fram...

This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity “effective dose” to compare doses delivered by different radiological procedures and different imaging modalities with its uncertain...

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control systems have reduced doses and improved image consistency. These changes a...

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These cha...

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These cha...

Purpose: This study presents a prototype smartphone application for occupational dosimetry in interventional practices based on electronic personal dosimeters to assist in dose monitoring. Methods: The prototype receives and records information from the Occupational Dose Report containing the cumulative dose of electronic personal dosimeters wor...

There are many aspects of radiological protection in medicine that are different than in other areas of activity using ionising radiations. In this paper, we present and justify some of these differences and highlight the reasons and benefits of this consideration for the medical field. It is important to understand the differences as we are all li...

The objective of the study was the construction of a generic curriculum development model for the use of biomedical physics (BMP) educators teaching the non-physics healthcare professions (HCP) in Europe. A comprehensive, qualitative cross-sectional Europe-wide survey of the curricula delivered by BMP in Faculties of Medicine and Health Sciences (F...

PurposeEvaluation and registration of patient and staff doses are mandatory under the current European legislation, and the occupational dose limits recommended by the ICRP have been adopted by most of the countries in the world.Methods Relevant documents and guidelines published by international organisations and interventional radiology societies...

Introduction Some concepts of radiation protection are not well understood and must be refreshed periodically. The basic knowledge that a vascular surgeon must have about radiation protection for patients and staff is summarised. Report Diagnostic reference levels are a form of investigation into the medical exposure of patients during diagnostic...

In recent years, the issue of cumulative effective dose received from recurrent computed tomography examinations has become a subject of increasing concern internationally. Evidence, predominantly from the USA, has shown that a significant number of patients receive a cumulative effective dose of 100 mSv or greater. To obtain a European perspective...

Purpose: To assess occupational lens exposure in a mixed interventional radiology department, comparing pediatric and adult procedures. To analyze the correlation between the lens dose and the doses measured at the chest and collar level and the kerma-area product (PKA ). Methods: For 17 months, three radiologists performing both pediatric and a...

This review presents the challenges met by interventional radiologists in occupational dosimetry. The issues mentioned are derived from the recommendations of the International Commission on Radiological Protection, the CIRSE guidelines on “Occupational radiation protection in interventional radiology" and the requirements of the European directive...

The European Directive 2013/59/EURATOM requires member states of the European Union to ensure justification and optimisation of the radiological procedures and to include information on patient exposure as part of the report of the examinations. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on “Dosi...

Objectives In fluoroscopy-guided interventional practices, new dose reduction systems have proved to be efficient in the reduction of patient doses. However, it is not clear whether this reduction in patient dose is proportionally transferred to operators’ doses. This work investigates the secondary radiation fields produced by two kinds of interve...

Aim: During transcatheter aortic valve implantations (TAVI) and other percutaneous structural procedures, some patients may need close anesthesiological care, thus exposing the anaesthesiologist to X-rays. This work aims to investigate the radiation dose received by anaesthesiologists during these specific procedures in order to improve their radi...

Occupational protection is still a challenge for interventional cardiology. One of the main problems is the occasional improper use of the ceiling suspended screen. We present a methodology to audit the correct use of the shielding using active electronic dosimeters. To improve the protection, we suggest the use of an alert based on the ratio betwe...

The benefits of fluoroscopically guided interventional procedures are significant and have established new standards in the clinical management of many diseases. Despite the benefits, it is known that they come with known risks, such as the exposure to ionizing radiation. To minimize such risks, it is crucial that the health professionals involved...

The European Directive 2013/59/Euratom requires member states of the European Union to ensure justification and optimisation of radiological procedures and store information on patient exposure for analysis and quality assurance. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on “Dose Management” wit...

Aims: Several novel low-dose fluoroscopic systems (LDS) developed recently, but real practice information of the net benefit for the patient and professionals is scarce. We evaluated separately patient and operator radiation exposure during percutaneous interventions of chronic total occlusions (CTO). Methods: A total of 116 consecutive CTOs wer...

Objective: The International Commission on Radiological Protection (ICRP) has highlighted the large number of medical specialties using fluoroscopy outside imaging departments without programmes of radiation protection (RP) for patients and staff. Vascular surgery is one of these specialties and endovascular aneurysm repair (EVAR) is one of the mo...

Notwithstanding that 100 mSv is not a threshold for radiation effects, cumulative effective dose (CED) for patients of ≥100 mSv derived from recurrent imaging procedures with ionising radiationhas been recently the topic of several publications. The ICRP has alerted on the problems to use effective dose for risk estimation in individual patients bu...

Over recent years, an increasing number of fluoroscopically guided interventions (FGIs) have been performed by radiologists and non-radiologists. Also, the number of complex interventional procedures has increased. In the late nineties, first reports of skin injuries appeared in the literature. The medical community responded through increased awar...

Purpose To establish local diagnostic reference levels (DRLs) for non-cardiac interventional procedures in paediatrics. Methods The type of procedure, the patient’s weight and age and dose-related data from 279 interventions was recorded in a database completed by interventional radiologists, radiographers and technicians of the Medical Physics de...

The aim of this study is to propose national diagnostic reference levels (DRL) for updating in the field of interventional cardiology and to include technical details to help plan optimization. Medical physics experts and interventional cardiologists from 14 hospitals provided patient dose indicators from coronary angiography and percutaneous coron...

There is a large variation in the factors used to estimate effective doses from kerma area product (KAP) for interventional cardiology. These factors are required to estimate population doses. This paper presents the results for this conversion factor for cardiac procedures using tissue weighting factors of ICRP-103 and the impact of the added copp...

This work presents patient radiation dose data for paediatric interventional cardiology procedures in a large paediatric hospital in Chile. This will contribute to setting national diagnostic reference levels (DRLs) for Chile in the near future. The dosimetric data collection period was from January 2018 to December 2018. The local DRLs were calcul...

The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) has identified that medical exposures represent the largest human-made source of radiation exposure, accounting for more than 95% of radiation exposure [1]. Traditional nuclear medicine procedures (both imaging and therapy) represent about 1–5% or more of all medic...

The procedures of interventional cardiology provide an unquestionable benefit for patients who suffer from heart disease but require the intensive use of ionizing radiations that are somehow risky for the patients and the healthcare providers who participate in these interventional procedures. The radiological protection programs should be an impor...

It is known that medical exposition with ionizing radiation is currently the main exposition source to artificial radiation at global level. To prevent unnecessarily high doses during these patient expositions, the International Commission on Radiological Protection (ICRP) recommends the use of Diagnostic Reference Levels (DRLs), as an effective to...

The aims of the present study were to present the frequency of multiple interventional cardiac procedures for a certain group of patients obtained at one of the largest paediatric hospitals in Chile. In addition it has been analysed cumulative kerma area product (KAP) and cumulative air kerma (CAK), and calculated organ doses for the patient groups...

It is known that medical exposition with ionizing radiation is currently the main exposition source to artificial radiation at global level. To prevent unnecessarily high doses during these patient expositions, the International Commission on Radiological Protection (ICRP) recommends the use of Diagnostic Reference Levels (DRLs), as an effective to...

Interventional cardiac procedures may be associated with high patient doses and therefore require special attention to protect the patients from radiation injuries such as skin erythema, cardiovascular tissue reactions or radiation-induced cancer. In this study, patient exposure data is collected from 13 countries (37 clinics and nearly 50 interven...

Purpose: During interventional cardiology procedures, high doses of X-ray may be delivered to patients. This is especially critical in cases of obese patients and/or high obliquity projections. High dose rates can then be produced in patients' skin as well as insufficient image quality due to regulatory limitations in the X-ray tube output working...

Introduction: The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. Material and methods: The IAEA conference was conducted as a series of plenary sessions followed by va...

The International Commission on Radiological Protection recommends that occupational protection and patient protection be managed in an integrated approach. This paper describes the experience and the initial results of a system able to register and to process simultaneously staff and patient doses in interventional cardiology and the practical use...

Increasing numbers of medical specialists are performing fluoroscopy-guided interventional procedures (FGIP) (Ann ICRP 30(2):7–67, 2000; Vano, Curr Radiol Rep 1:11–22, 2013). The use of medical ionizing radiation in the USA was reported sevenfold higher in 2006 compared to 1980, when the amount due to FGIP increased 33 times (American College of Ra...

As in any medical intervention, there is either a known or an anticipated benefit to the patient from undergoing a medical imaging procedure. This benefit is generally significant as demonstrated by the manner in which medical imaging has transformed clinical medicine. At the same time, when it comes to imaging that deploys ionizing radiation, ther...

Radiation therapy of cancer patients involves a trade-off between a sufficient tumour dose for a high probability of local control and dose to organs at risk that is low enough to lead to a clinically acceptable probability of toxicity. The International Commission on Radiological Protection (ICRP) reviewed epidemiological evidence and provided upd...

During the International Conference on Radiation Protection in Medicine held in Bonn in 2012, several areas for improvement were identified, including specific actions related with justification, optimization, role of manufacturers, radiation protection education and training, strategic research, data collection on medical and occupational exposure...

In recent publications, such as Publications 117 and 120, the Commission provided practical advice for physicians and other healthcare personnel on measures to protect their patients and themselves during interventional procedures. These measures can only be effective if they are encompassed by a framework of radiological protection elements, and b...

Introduction and objectives: To estimate the contribution of interventional cardiology to the collective dose in Spain. Methods: Using the information on frequencies of examinations sourced from the Spanish Society of Cardiology and the patient dose values obtained by the national DOCCACI programme. Results: The fraction of the collective dose pe...

Medical staff should not be exposed to the primary X-ray beam during fluoroscopy-guided interventional procedures (FGIP). The main source of staff exposure is scatter radiation from the patient, which can be significant. Although many aspects of X-ray exposure to the patient as well as occupational exposure to interventional radiologists and other...

I did not think editorials had abstracts.

The goal of the present study is to propose a set of national diagnostic reference levels (DRLs) for paediatric interventional cardiology (IC) procedures classified by age and weight in Costa Rica and to estimate the collective dose to the paediatric population deriving from these intervention practices. The data collection period was from May 2016...

Optimization is one of the key concepts of radiation protection in medical imaging. In practice, it involves compromising between the image quality and dose to the patient; the dose should not be higher than necessary to achieve an image quality (or diagnostic information) needed for the clinical task. Monitoring patient dose is a key requirement t...

Purpose: This review summarizes the conclusions and recommendations of the new NCRP Commentary No. 26 guidance on radiation dose limits for the lens of the eye. The NCRP also addressed radiation protection principles with respect to the lens of the eye, discussed the current understanding of eye biology and lens effects, reviewed and evaluated epid...

Abstract –: The International Commission on Radiological Protection (ICRP) first introduced the term ‘diagnostic reference level’ (DRL) in 1996 in Publication 73. The concept was subsequently developed further, and practical guidance was provided in 2001. The DRL has been proven to be an effective tool that aids in optimisation of protection in th...

The impact of interventional techniques on the radiation dose received by the population is relevant. The Spanish legislation requires since 1999, individual registration of the radiation dose received in interventional procedures and the new European Directive 2013/59/EURATOM supports this requirement. The Spanish Society of Cardiology and the Spa...

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived f...

The purpose of this work is to evaluate the impact of the imaging protocol as part of the optimization of patient doses in interventional cardiology. This paper reports the results of an initial study to refine the existing fluoroscopy and cine settings, evaluates a new imaging protocol by measuring the image quality and phantom entrance air kerma...

The aim of this study was to present the results of organ and effective doses for paediatric patients for different types of interventional cardiology procedures for age and weight groups, derived from a patient dosimetry pilot programme carried out in Chile, under the auspices of the International Atomic Energy Agency. Over seven years, a retrospe...

This Commentary has been prepared to provide guidance on whether existing dose limits to the lens of the eye should be changed in the United States. The guidance is based on a detailed evaluation of recent studies on the radiation dose response for the development of cataracts. A number of National Council on Radiation Protection and Measurements (...

Introduction Although Medical Physics scientific education is very well developed, leadership education is not. This is having a negative effect on the profession and needs to be remedied urgently. Purpose To develop, deliver and evaluate an EQF Level 8 leadership educational module for Medical Physics (Diagnostic and Interventional Radiology) wit...

Objectives To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. Methods Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray sys...

The aim of this study was to assess image quality and radiation dose of a biplane angiographic system with cone-beam CT (CBCT) capability tuned for pediatric cardiac procedures. The results of this study can be used to explore dose reduction techniques. For pulsed fluoroscopy and cine modes, polymethyl methacrylate phantoms of various thicknesses a...

Purpose:In 2013, the EURATOM authorities of the European Commission decided to support the Horizon2020 project submission ‘EUTEMPE-RX’ that aimed for a new set of course modules to train medical physicists in diagnostic and interventional radiology to expert level with small group deep learning. Each module would consist of 2 phases: an e-learning...

The aim of this study was to evaluate the occupational radiation dose in interventional cardiology by using a shielding drape on the patient. A random study with and without the protective material was conducted. The following control parameters were registered: demographic data, number of stents, contrast media volume, fluoroscopy time, number of...

Committee 3 of the International Commission on Radiological Protection (ICRP) develops recommendations and guidance for protection of patients, staff, and the public against radiation exposure when ionising radiation is used for medical diagnosis, therapy, or biomedical research. This paper presents a summary of the work that Committee 3 has accomp...

New European regulation regarding radiological protection of workers and more specifically the new occupational dose limit for the eye lens recently reduced to 20 mSv yr−1 may affect interventional cardiologists. This paper presents a set of measurements of occupational doses performed in five interventional cardiology centres and then compared wit...

Previous National Council on Radiation Protection and Measurements (NCRP) publications have addressed the issues of risk and dose limitation in radiation protection and included guidance on specific organs and the lens of the eye. NCRP decided to prepare an updated commentary intended to enhance the previous recommendations provided in earlier repo...

The aim of this paper was to determine experimentally the entrance surface air kerma (ESAK) and kerma-area product (KAP) levels to patients and scatter doses at the cardiologist's eyes during paediatric interventional cardiology (IC) procedures for Chile, on the basis of measurements taken from X-ray systems characterization for different thickness...

The purpose of this work is to evaluate radiation doses to the lens of urologists during interventional procedures and to compare them with values measured during interventional radiology, cardiology and vascular surgery. The measurements were carried out in a surgical theatre using a mobile C-arm system and electronic occupational dosimeters (worn...

Background and purpose: Eye lenses are among the most sensitive organs to x-ray radiation and may be considered at risk during neurointerventional radiology procedures. The threshold dose to produce eye lens opacities has been recently reduced to 500 mGy by the International Commission on Radiologic Protection. In this article, the authors investi...

Purpose: Demonstrate an objective procedure to quantify image quality in digital subtraction angiography (DSA) and suggest thresholds for acceptability and constancy tests. Methods: Series of images were obtained in a DSA system simulating a small (paediatric) and a large patient using the dynamic phantom described in the IEC and DIN standards f...

The aspects of the new European Directive 2013/59/Euratom most relevant to diagnostic imaging and intervention are summarised. The Directive, laying down basic safety standards for protection against the dangers from exposure to ionising radiation, emphasises the need for justification of medical exposure (including asymptomatic individuals), intro...