Patients’ radiation exposure during TIPS creation in a high-volume referral hospital

Abstract

Introduction: Transjugular Intrahepatic Portosystemic Shunt (TIPS) creation is one of the most complex and radiation-intensive procedures in abdominal interventional radiology. Radiation-induced skin injuries may occur at doses above 2 Gy. This study aimed to evaluate patient radiation exposure during TIPS performed in a single high-volume referral center (>20 procedures/year). Methods: A retrospective review was conducted of 359 consecutive TIPS performed between July 2017 and December 2024. Real-time ultrasound guidance was systematically used for portal vein targeting. Radiation exposure was assessed using cumulative air kerma at the interventional reference point (Ka,r) and fluoroscopy time (XrT). Data were analyzed according to patient body mass index (BMI) and angiographic equipment. Results: The mean Ka,r was 0.18 ± 0.22 Gy, with a maximum of 1.56 Gy. No patient exceeded the 2 Gy trigger level, and no skin injuries were reported at follow-up. Mean XrT was 775 ± 606 s, with only two cases exceeding 60 min (cumulative Ka,r 0.15 ± 0.18 Gy vs 0.24 ± 0.27 Gy, p = 0.0004). Obese patients showed higher Ka,r values (p < 0.0001), although none reached the 2 Gy threshold. Conclusion: Radiation exposure during TIPS creation in this high-volume center remained consistently below thresholds associated with skin injury, even in obese or complex patients. Implications for practice: Performing TIPS in high-volume referral centers with systematic ultrasound guidance and optimized low-dose protocols can maintain radiation exposure well below harmful thresholds with respect to tissue effects, even in complex patients. These findings emphasize not only the need for structured radiation protection strategies and centralization of complex procedures, but also the active involvement of all professionals responsible for radiation safety whose expertise is crucial in dose optimization and ensuring the highest standards of patient care. Levels of evidence 2b: retrospective cohort study.