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Bundy JJ, McCracken IW, Shin DS, Monroe EJ, Johnson GE, Ingraham CR, Kanal KM, Bundy RA, Jones ST, Valji K, Chick JFB. Fluoroscopically-guided interventions with radiation doses exceeding 5000 mGy reference point air kerma: a dosimetric analysis of 89,549 interventional radiology, neurointerventional radiology, vascular surgery, and neurosurgery encounters. CVIR Endovasc 2020; 3:69. [PMID: 32960372 PMCID: PMC7509020 DOI: 10.1186/s42155-020-00159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To quantify and categorize fluoroscopically-guided procedures with radiation doses exceeding 5000 mGy reference point air kerma (Ka,r). Ka,r > 5000 mGy has been defined as a "significant radiation dose" by the Society of Interventional Radiology. Identification and analysis of interventions with high radiation doses has the potential to reduce radiation-induced injuries. MATERIALS AND METHODS Radiation dose data from a dose monitoring system for 19 interventional suites and 89,549 consecutive patient encounters from January 1, 2013 to August 1, 2019 at a single academic institution were reviewed. All patient encounters with Ka,r > 5000 mGy were included. All other encounters were excluded (n = 89,289). Patient demographics, medical specialty, intervention type, fluoroscopy time (minutes), dose area product (mGy·cm2), and Ka,r (mGy) were evaluated. RESULTS There were 260 (0.3%) fluoroscopically-guided procedures with Ka,r > 5000 mGy. Of the 260 procedures which exceeded 5000 mGy, neurosurgery performed 81 (30.5%) procedures, followed by interventional radiology (n = 75; 28.2%), neurointerventional radiology (n = 55; 20.7%), and vascular surgery (n = 49; 18.4%). The procedures associated with the highest Ka,r were venous stent reconstruction performed by interventional radiology, arteriovenous malformation embolization performed by neurointerventional radiology, spinal hardware fixation by neurosurgery, and arterial interventions performed by vascular surgery. Neurointerventional radiology had the highest mean Ka,r (7,799 mGy), followed by neurosurgery (7452 mGy), vascular surgery (6849 mGy), and interventional radiology (6109 mGy). The mean Ka,r for interventional radiology performed procedures exceeding 5000 mGy was significantly lower than that for neurointerventional radiology, neurosurgery, and vascular surgery. CONCLUSIONS Fluoroscopically-guided procedures with radiation dose exceeding 5000 mGy reference point air kerma are uncommon. The results of this study demonstrate that a large proportion of cases exceeding 5000 mGy were performed by non-radiologists, who likely do not receive the same training in radiation physics, radiation biology, and dose reduction techniques as radiologists.
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Affiliation(s)
- Jacob J Bundy
- Wake Forest Baptist Health, One Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ian W McCracken
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - David S Shin
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Eric J Monroe
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Guy E Johnson
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | | | - Kalpana M Kanal
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Richa A Bundy
- Wake Forest Baptist Health, One Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Sean T Jones
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Karim Valji
- University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
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Visweswaran S, Joseph S, Dhanasekaran J, Paneerselvam S, Annalakshmi O, Jose MT, Perumal V. Exposure of patients to low doses of X-radiation during neuro-interventional imaging and procedures: Dose estimation and analysis of γ-H2AX foci and gene expression in blood lymphocytes. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2020; 856-857:503237. [PMID: 32928370 DOI: 10.1016/j.mrgentox.2020.503237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022]
Abstract
Radiation has widespread applications in medicine. However, despite the benefits of medical radiation exposures, adverse long-term health effects are cause for concern. Protein and gene biomarkers are early indicators of cellular response after low-dose exposure. We examined DNA damage by quantifying γ-H2AX foci and expression of twelve candidate genes in the blood lymphocytes of patients exposed to low doses of X-radiation during neuro-interventional procedures. Entrance surface dose (ESD; 10.92-1062.55 mGy) was measured by thermoluminescence dosimetry (TLD). Absorbed dose was estimated using γ-H2AX focus frequency and gene expression, with in vitro dose-response curves generated for the same biomarkers. γ-H2AX foci in post-exposure samples were significantly higher than in pre-exposure samples. Among the genes analysed, FDXR, ATM, BCL2, MDM2, TNFSF9, and PCNA showed increased expression; CDKN1A, DDB2, SESN1, BAX, and TNFRSF10B showed unchanged or decreased expression. Absorbed dose, estimated based on γ-H2AX focus frequency and gene expression changes, did not show any correlation with measured ESD. Patients undergoing interventional procedures receive considerable radiation doses, resulting in DNA damage and altered gene expression. Medical procedures should be carried out using the lowest radiation doses possible without compromising treatment.
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Affiliation(s)
- Shangamithra Visweswaran
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, 600116, India
| | - Santhosh Joseph
- Department of Neuro-Radiology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, 600116, India
| | - Jagadeesan Dhanasekaran
- Department of Neuro-Radiology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, 600116, India
| | - S Paneerselvam
- Department of Neuro-Radiology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, 600116, India
| | - O Annalakshmi
- Radiation Safety Division Unit, Indira Gandhi Centre for Atomic Research (IGCAR), Kalpakkam, 603102, Tamil Nadu, India
| | - M T Jose
- Radiation Safety Division Unit, Indira Gandhi Centre for Atomic Research (IGCAR), Kalpakkam, 603102, Tamil Nadu, India
| | - Venkatachalam Perumal
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, 600116, India.
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Weyland CS, Seker F, Potreck A, Hametner C, Ringleb PA, Möhlenbruch MA, Bendszus M, Pfaff JAR. Radiation exposure per thrombectomy attempt in modern endovascular stroke treatment in the anterior circulation. Eur Radiol 2020; 30:5039-5047. [PMID: 32328765 PMCID: PMC7431433 DOI: 10.1007/s00330-020-06837-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To quantify radiation exposure (RE) of endovascular stroke treatment (EST) in the anterior circulation per thrombectomy attempt and determine causes for interventions associated with high RE. METHODS A retrospective single-center study of an institutional review board-approved stroke database of patients receiving EST for large vessel occlusions in the anterior circulation between January 2013 and April 2018 to evaluate reference levels (RL) per thrombectomy attempt. ESTs with RE above the RL were analyzed to determine causes for high RE. RESULTS Overall, n = 544 patients (occlusion location, M1 and M2 segments of the middle cerebral artery 53.5% and 27.2%, carotid artery 17.6%; successful recanalization rate 85.7%) were analyzed. In the overall population, DAP (in Gy cm2, median (IQR)) was 113.7 (68.9-181.7) with a median fluoroscopy time of 31 min (IQR, 17-53) and a median of 2 (IQR, 1-4) thrombectomy attempts. RE increased significantly with every thrombectomy attempt (DAP1, 68.7 (51.2-106.8); DAP2, 106.4 (84.8-115.6); p value1vs2, < 0.001; DAP3, 130.2 (89.1-183.6); p value2vs3, 0.044; DAP4, 169.9 (128.4-224.1); p value3vs4, 0.001; and DAP5, 227.6 (146.3-294.6); p value4vs5, 0.019). Procedures exceeding the 90th percentile of the attempt-dependent radiation exposure level were associated with procedural complications (n = 17/52, 29.8%) or a difficult vascular access (n = 8/52, 14%). CONCLUSIONS Radiation exposure in endovascular stroke treatment is depending on the number of thrombectomy attempts. Radiation exposure doubles when three attempts and triples when five attempts are necessary compared with single-maneuver interventions. Procedural complications and difficult vascular access were associated with a high radiation exposure in this collective. KEY POINTS • Radiation exposure of endovascular stroke treatment (EST) is dependent on the number of thrombectomy attempts. • Reference levels as means for quality control in hospitals performing endovascular stroke treatment should be defined by the number of thrombectomy attempts-we suggest 107 Gy cm2, 156 Gy cm2, 184 Gy cm2, 244 Gy cm2, and 295 Gy cm2 for 1 to 5 maneuvers, respectively, for EST of the anterior circulation • Cases with high rates of radiation exposure are associated with periprocedural complications and difficult anatomical access as a probable cause for a high radiation exposure.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Arne Potreck
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Hametner
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter A Ringleb
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes A R Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Feasibility of low-dose digital subtraction angiography protocols for the endovascular treatment of intracranial dural arteriovenous fistulas. Neuroradiology 2020; 63:267-273. [PMID: 32857215 DOI: 10.1007/s00234-020-02537-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among neurointerventional procedures, the embolization of complex shunt lesions usually requires more radiation dose. We aimed to evaluate the procedural outcome and safety in using low-dose DSA protocols for intracranial dural arteriovenous fistula (AVF) embolization treatment. METHODS Between January 2014 and July 2018, 55 patients with dural AVFs who underwent endovascular treatment were included in the study. The low-dose group (n = 27) included from January 2016 used various low-dose DSA protocols made by modifying the thickness of the copper filter or the detector entrance dose. We compared radiation dose metrics, such as air-kerma, kerma-air product (KAP), and fluoroscopy time, as well as clinical and imaging outcomes with the conventional-dose group (n = 28) included before January 2016. RESULTS The total KAP was 40.1% lower in the low-dose group (87.9 vs. 146.7 Gy cm2, p = 0.002). The average number of DSA runs (25.1 vs. 25.5, p = 0.86) and fluoroscopy times (77.4 vs. 69.7 min, p = 0.48) were similar between the groups. An immediate favorable occlusion rate (total or near total occlusion) was achieved in 41 (74.5%) patients. Ten patients (18.2%) underwent additional procedures due to residual (n = 6) and/or recurrent (n = 5) lesions. At a median of 10 months follow-up, 45 patients (86.5%) had achieved favorable occlusion. Treatment outcomes showed no significant between-group differences. There was one case (1.8%) of procedure-related complications in the low-dose group. All but one patient showed favorable clinical outcomes (modified Rankin score ≤ 2). CONCLUSION The low-dose protocols were feasible by showing significant radiation dose reduction and acceptable procedural outcome.
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Ključevšek T, Pirnovar V, Ključevšek D. Percutaneous Nephrostomy in the Neonatal Period: Indications, Complications, and Outcome-A Single Centre Experience. Cardiovasc Intervent Radiol 2020; 43:1323-1328. [PMID: 32462222 DOI: 10.1007/s00270-020-02528-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the indications, technique for percutaneous nephrostomy (PCN) insertion, the complications related to PCN, duration of PCN, and outcome following PCN removal regarding the kidney function. MATERIAL AND METHODS Medical charts of 31 neonates (22 boys and 9 girls, mean age 13.9 days) treated with 43 PCN were reviewed. Collected data included indications for PCN, PCN complications, duration of PCN, and outcome of these patients by analysing the kidney function. RESULTS The indications for PCN insertion were obstructive urinary tract dilation in 24 neonates (four with associated infection), and non-obstructive urinary tract dilation with urosepsis or pyonephrosis in seven cases. Primary technical success of PCN placement using Seldinger technique was 97.7%. The following complications were reported: self-limited post-procedural bleeding into the pelvicalyceal system in two, chronic microscopic haematuria in five, and clinically manifested urinary tract infection in five children. Four PCN were dislocated. Cellulitis was present at the skin entry of 5 PCN, urinary leak in 5 PCN, and mechanical damage of 5 PCN. Eight PCN had to be replaced. Mean duration of PCN was 5 months. Kidney insufficiency was detected in 5/29 children with the mean follow-up of 3.9 years. CONCLUSIONS PCN is a safe, effective transient solution in neonates with pyonephrosis or when surgery of obstructed urinary system has to be postponed. The rate of minor complications increased with PCN duration. If kidney insufficiency is present after PCN removal, it is related to the complexity of kidney anomalies.
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Affiliation(s)
- Tomaž Ključevšek
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Vesna Pirnovar
- Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Damjana Ključevšek
- Department of Radiology, University Medical Centre, Children's Hospital Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia
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Weinberg JH, Sweid A, Khanna O, Mouchtouris N, Asada A, Das S, Curtis D, Kim J, Romo V, Gooch MR, Herial N, Tjoumakaris S, Zarzour H, Rosenwasser RH, Jabbour P. Access Through the Anatomical Snuffbox for Neuroendovascular Procedures: A Single Institution Series. Oper Neurosurg (Hagerstown) 2020; 19:495-501. [DOI: 10.1093/ons/opaa141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/19/2020] [Indexed: 01/29/2023] Open
Abstract
Abstract
BACKGROUND
Distal transradial catheterization in the anatomic snuffbox is an alternate route of access that has started to gain consideration for neuroendovascular procedures.
OBJECTIVE
To assess the feasibility and outcomes and present our institution's experience in performing neuroendovascular procedures via distal transradial access (dTRA).
METHODS
We conducted a retrospective analysis and identified 120 patients who underwent consecutive neuroendovascular procedures via dTRA in the anatomic snuffbox. Data collection was performed on indication for procedure, sheath size, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success.
RESULTS
Of 120 patients with an average age of 54.7 yr ± 14.7, 73 (60.8%) underwent diagnostic angiograms, 38 (31.7%) underwent follow-up angiograms, and 9 (7.5%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.5 ± 0.1 per procedure, the mean procedure time was 68.3 min ± 43.4, the mean fluoroscopy time was 10.8 min ± 7.6, the mean contrast dose was 70.6 mL ± 39.1, and the mean radiation exposure was 27 672.2 mGycm2 ± 42 728.4. Successfully completed therapeutic procedures included aneurysm 1 (0.8%), arteriovenous malformation (AVM)/arteriovenous fistula/carotid cavernous fistula 7 (5.8%), and 1 (0.8%) other treatment. Three patients (2.5%) required adjunct transfemoral endovenous access for AVM embolization. Two minor complications (1.67%) were a local wrist hematoma and a radial artery vasospasm without any sequelae.
CONCLUSION
Distal radial artery catheterization in the anatomic snuffbox is a safe and effective access site to perform neuroendovascular procedures. Complications and conversion rate are low making it a safe alternative.
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Affiliation(s)
- Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ashlee Asada
- Drexel University College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Somnath Das
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Darcy Curtis
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julie Kim
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victor Romo
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nabeel Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Weyland CS, Neuberger U, Seker F, Nagel S, Arthur Ringleb P, Möhlenbruch MA, Bendszus M, Pfaff JA. Effect of treatment technique on radiation exposure in mechanical thrombectomy for acute ischaemic stroke: A matched-pair analysis. Neuroradiol J 2020; 33:286-291. [PMID: 32419602 DOI: 10.1177/1971400920925433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This study aimed to compare radiation exposure (RE) in patients receiving mechanical thrombectomy (MT) for large-vessel occlusions in the anterior circulation using direct thrombo-aspiration (DT) versus stent-retriever thrombectomy under continuous distal aspiration (STA). METHODS This was a retrospective single-centre analysis of an Institutional Review Board-approved stroke database of a comprehensive stroke centre focusing on RE per dose area product, procedure time (PT) and fluoroscopy time (FT) in patients receiving MT. Patients who received MT with DT were matched with patients treated using STA according to occlusion location, mode of anaesthesia, manoeuvre count and sex. RESULTS Apart from patient age (DT: M = 74 years (standard deviation (SD)=13 years); STA: M = 79 years (SD = 11 years); p = 0.023), there was no difference in baseline patient characteristics (n = 68 per group). PT (DT: median = 26 minutes (interquartile range (IQR) = 21-38 minutes); STA: median = 49 minutes (IQR 37-77 minutes); p < 0.0001) and FT (DT: median = 12 minutes (IQR 7-18 minutes); STA: median = 26 minutes (IQR 14-43 minutes); p < 0.0001) were shorter in patients who received MT using DT. RE (DT: median = 62.6 Gy·cm2 (IQR 41.7-89.4 Gy·cm2); STA: median = 89.8 Gy·cm2 (IQR 53.7-131.7 Gy·cm2); p = 0.034) was significantly lower in patients who received MT using DT. This represents a relative increase of RE, FT and PT by 43.6%, 116.6% and 88.5%, respectively, in patients who received MT using STA. CONCLUSION MT using DT is associated with shorter FT and PT and lower RE compared to matched patients treated with STA.
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Affiliation(s)
| | - Ulf Neuberger
- Department of Neuroradiology, Heidelberg University Hospital, Germany
| | - Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Germany
| | | | | | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Germany
| | - Johannes Ar Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Germany
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Greffier J, Ferretti G, Rousseau J, Andreani O, Alonso E, Rauch A, Gillet R, Le Roy J, Cabrol-Faivre L, Douane F, David A, Henry S, Jacques T, Stefanovic X, Decoux E, Lafay F, Pilleul F, Couzon F, Boutet C, Woerly B, Baur P, Sans N, Faruch M, Moussier-Lherm A, Tselikas L, Jacquier A, Bigand E, Pessis E, Teriitehau C, Magnier F, Cassagnes L, Haberlay M, Boutteau D, De Kerviler E, Majorel-Gouthain C, Defez D, Vuillod A, Rouviere O, Hennequin L, Fohlen A, Alwan R, Malakhia A, Aubry S, Dohan A, Eresue-Bony M, Gautier R, Dal R, Dabli D, Hebert T, Kovacs R, Hadid-Beurrier L, Bousson V, Potel M, Barbotteau Y, Michel C, Habib-Geryes B, André M, Arnaud T, Bestion N, Ernst O, Monfraix S, Brillet PY, Guiu B, Boussel L, Demonchy M, Beregi JP, Frandon J. National dose reference levels in computed tomography–guided interventional procedures—a proposal. Eur Radiol 2020; 30:5690-5701. [DOI: 10.1007/s00330-020-06903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
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Tzanis E, Ioannou CV, Tsetis D, Lioudaki S, Matthaiou N, Damilakis J. Complexity-based local diagnostic reference levels (DRLs) for standard endovascular aneurysm repair (EVAR) procedures. Phys Med 2020; 73:89-94. [DOI: 10.1016/j.ejmp.2020.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/24/2020] [Accepted: 04/15/2020] [Indexed: 01/29/2023] Open
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Forbrig R, Ozpeynirci Y, Grasser M, Dorn F, Liebig T, Trumm CG. Radiation dose and fluoroscopy time of modern endovascular treatment techniques in patients with saccular unruptured intracranial aneurysms. Eur Radiol 2020; 30:4504-4513. [PMID: 32193640 PMCID: PMC8093177 DOI: 10.1007/s00330-020-06777-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Objectives Modern endovascular treatment of unruptured intracranial aneurysms (UIAs) demands for observance of diagnostic reference levels (DRLs). The national DRL (250 Gy cm2) is only defined for coiling. We provide dosimetric data for the following procedures: coiling, flow diverter (FD), Woven EndoBridge (WEB), combined techniques. Methods A retrospective single-centre study of saccular UIAs treated between 2015 and 2019. Regarding dosimetric analysis, the parameters dose area product (DAP) and fluoroscopy time were investigated for the following variables: endovascular technique, aneurysm location, DSA protocol, aneurysm size, and patient age. Results Eighty-seven patients (59 females, mean age 54 years) were included. Total mean and median DAP (Gy cm2) were 119 ± 73 (89–149) and 94 (73; 130) for coiling, 128 ± 53 (106–151) and 134 (80; 176) for FD, 128 ± 56 (102–153) and 118 (90; 176) for WEB, and 165 ± 102 (110–219) and 131 (98; 209) for combined techniques (p > .05). Regarding the aneurysm location, neither DAP nor fluoroscopy time was significantly different (p > .05). The lowest and highest fluoroscopy times were recorded for WEB and combined techniques, respectively (median 26 and 94 min; p < .001). A low-dose protocol yielded a 43% reduction of DAP (p < .001). Significantly positive correlations were found between DAP and both aneurysm size (r = .320, p = .003) and patient age (r = .214, p = .046). Conclusions This UIA study establishes novel local DRLs for modern endovascular techniques such as FD and WEB. A low-dose protocol yielded a significant reduction of radiation dose. Key Points • This paper establishes local diagnostic reference levels for modern endovascular treatment techniques of unruptured intracranial aneurysms, including flow diverter stenting and Woven EndoBridge device. • Dose area product was not significantly different between endovascular techniques and aneurysm locations, but associated with aneurysm size and patient age. • A low-dose protocol yielded a significant reduction of dose area product and is particularly useful when applying materials with a high radiopacity (e.g. platinum coils).
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Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Franziska Dorn
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christoph G Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma. Radiol Med 2020; 125:609-617. [DOI: 10.1007/s11547-020-01155-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/06/2020] [Indexed: 02/07/2023]
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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Effective Dose Assessment for Patients Undergoing Contemporary Fluoroscopically Guided Interventional Procedures. AJR Am J Roentgenol 2020; 214:158-170. [DOI: 10.2214/ajr.19.21804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Borstelmann SM. Machine Learning Principles for Radiology Investigators. Acad Radiol 2020; 27:13-25. [PMID: 31818379 DOI: 10.1016/j.acra.2019.07.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/04/2019] [Accepted: 07/11/2019] [Indexed: 12/16/2022]
Abstract
Artificial intelligence and deep learning are areas of high interest for radiology investigators at present. However, the field of machine learning encompasses multiple statistics-based techniques useful for investigators, which may be complementary to deep learning approaches. After a refresher in basic statistical concepts, relevant considerations for machine learning practitioners are reviewed: regression, classification, decision boundaries, and bias-variance tradeoff. Regularization, ground truth, and populations are discussed along with compute and data management principles. Advanced statistical machine learning techniques including bootstrapping, bagging, boosting, decision trees, random forest, XGboost, and support vector machines are reviewed along with relevant examples from the radiology literature.
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Rizk C, Farah J, Vanhavere F, Fares G. NATIONAL DIAGNOSTIC REFERENCE LEVELS IN INTERVENTIONAL RADIOLOGY SUITES IN LEBANON: A MULTICENTER SURVEY. RADIATION PROTECTION DOSIMETRY 2019; 187:50-60. [PMID: 31111937 DOI: 10.1093/rpd/ncz137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Abstract
Air kerma-area product (PKA), cumulative air kerma at patient entrance reference point, fluoroscopy time and number of images were retrospectively collected from 15 hospitals in Lebanon for 11282 fluoroscopically-guided interventional (FGI) procedures between March 2016 and November 2018. National diagnostic reference levels (NDRLs) were established based on the third quartile of the distribution of median values of exposure parameters per department for 27 types of FGI procedures. NDRLs were in line with international DRLs except for coronary angiography (CA), percutaneous coronary interventions (PCI) and transcatheter aortic valve implantation (TAVI) which require optimisation. Additionally, following the National Council on Radiation Protection and Measurements report 168, PCI, TAVI, triple chamber pacemaker implantation, endovascular aortic repair, nephrostomy, kyphoplasty and percutaneous transhepatic biliary drainage were classified as potentially high-dose procedures with >5% of the patients with PKA exceeding 300 Gycm2. The established NDRLs will promote dose optimisation and patient radiation protection.
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Affiliation(s)
- C Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research, PO Box, Riad El Solh, Beirut, Lebanon
- Faculty of Sciences, Saint-Joseph University, PO Box, Riad El Solh, Beirut, Lebanon
| | - J Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France
| | - F Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang, BE-2400 Mol, Belgium
| | - G Fares
- Faculty of Sciences, Saint-Joseph University, PO Box, Riad El Solh, Beirut, Lebanon
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66
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Chivot C, Bouzerar R, Yzet T. Transitioning to Transradial Access for Cerebral Aneurysm Embolization. AJNR Am J Neuroradiol 2019; 40:1947-1953. [PMID: 31582386 PMCID: PMC6975100 DOI: 10.3174/ajnr.a6234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about implementing TRA for neurointerventions. This reluctance is mainly due to anatomic factors, technical factors, and a long learning curve (relative to transfemoral access). We present here our experience of TRA transition for cerebral aneurysm embolization. Our aim was to demonstrate the feasibility and safety of radial access for consecutive embolizations of ruptured and unruptured cerebral aneurysms. MATERIALS AND METHODS We performed a retrospective review of a prospective data base on cerebral aneurysm embolizations. Between April and December 2018, radial access was considered for all consecutive patients referred to our institution for cerebral aneurysm embolization. Technical success was defined as radial access with insertion of the sheath and completion of the intervention without a crossover to conventional femoral access. The primary safety end point was the in-hospital plus 30-day incidence of radial artery occlusion. Secondary end points included intraoperative complications and neurologic complications at discharge and in the following 30 days. RESULTS Seventy-one patients with a cerebral aneurysm underwent 73 embolization procedures at our institution. The first-choice access route was the radial artery in 62 patients (87.3%) and the femoral artery in 9 (12.6%). Thirty-four embolizations were performed using coils, 22 used a balloon-assisted coil technique, 6 used a stent-assisted coil technique, and 2 used a flow diverter. Crossover to femoral access was observed in 2 patients (3.1%). Four patients developed coil-induced thrombi requiring intra-arterial tirofiban injections. In 1 case, an aneurysm ruptured during the operation but did not have a clinical impact. No cases of radial artery occlusion or hand ischemia were observed. CONCLUSIONS A transition to radial access for cerebral aneurysm embolization is feasible and does not increase the level of risk associated with the procedure.
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Affiliation(s)
- C Chivot
- From the Departments of Radiology (C.C., T.Y.)
| | - R Bouzerar
- Image Processing (R.B.), Amiens University Hospital, Amiens, France
| | - T Yzet
- From the Departments of Radiology (C.C., T.Y.)
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67
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A Guided Survey Approach for Joint Commission Preparedness in Radiology. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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68
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Patient dose in angiographic interventional procedures: A multicentre study in Italy. Phys Med 2019; 64:273-292. [DOI: 10.1016/j.ejmp.2019.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 06/04/2019] [Accepted: 06/15/2019] [Indexed: 01/04/2023] Open
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69
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Radiation Exposure During Transarterial Chemoembolization: Angio-CT Versus Cone-Beam CT. Cardiovasc Intervent Radiol 2019; 42:1609-1618. [PMID: 31222382 DOI: 10.1007/s00270-019-02269-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/13/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cone-beam computed tomography (CBCT) has been developed to improve reliability of many interventional radiology (IR) procedures performed with Angio system, such as transarterial chemoembolization (TACE). Angio-CT has emerged as a new imaging technology that combines a CT scanner with an Angio system in the same IR suite. The purpose of our study was to compare Angio system with CBCT capability and Angio-CT in terms of patient radiation exposure during TACE procedures. MATERIALS AND METHODS Consecutive TACE procedures performed between January 2016 and September 2017 with the two imaging modalities (Artis Zeego defining the CBCT group and Infinix-i 4D-CT defining the Angio-CT group) were reviewed. TACE and patient's characteristics and patient radiation exposure parameters were collected. Dose-area products (DAP) and dose-length products (DLP) were converted into effective doses (ED) using conversion factors. Accuracy of tumor targeting and response was retrospectively assessed. RESULTS A total of 114 TACE procedures in 96 patients were included with 57 procedures in each group. The total ED in the Angio-CT group was 2.5 times lower than that in the CBCT group (median 15.4 vs. 39.2 mSv, p < 0.001). Both 2D ED and 3D ED were lower in the Angio-CT group than in the CBCT group (5.1 vs. 20 mSv, p < 0.001, and 7.4 vs. 17.9 mSv, p < 0.001, respectively). There was no significant difference neither in terms of classes of tumor targeting (p = 0.509) nor in terms of classes of tumor response (p = 0.070) between both groups. CONCLUSION Angio-CT provides significant decrease in patient effective dose during TACE procedures compared to Angio system with CBCT.
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Jibiri N, Olowookere C. Patient dose audit of the most frequent radiographic examinations and the proposed local diagnostic reference levels in southwestern Nigeria: Imperative for dose optimisation. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1016/j.jrras.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- N.N. Jibiri
- Health Physics Laboratory, Department of Physics, University of Ibadan, Nigeria
| | - C.J. Olowookere
- Department of Physical Sciences, Ajayi Crowther University, Oyo Town, Nigeria
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71
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Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients. Eur Radiol 2019; 29:3506-3515. [DOI: 10.1007/s00330-019-06062-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/08/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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Hitomi G, Matsubara S, Moritake T, Sun L, Mura M, Matsumoto H, Kusachi F, Matsumaru Y, Uno M. [The First Step in the Optimization of Radiation Protection of Patients in Cerebral Angiography: Investigate the Possibility of Constructing the Diagnostic Reference Level by Imaging Objective/Disease Group Using Display Value of the Blood Vessel Imaging Apparatus]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:263-269. [PMID: 30890674 DOI: 10.6009/jjrt.2019_jsrt_75.3.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To optimize the radiation protection of patients, we investigated the possibility of constructing the diagnostic reference levels (DRLs) by imaging objective/disease group using display value of the blood vessel imaging apparatus (air kerma-area product: PKA, air kerma at the patient entrance reference point: Ka, r) in cerebral angiography. We used PKA and Ka, r recorded during surgery of 997 patients at our hospital, and classified them according to the purpose of imaging (diagnostic cerebral angiography or neuro interventional radiology) and disease group. Neuro interventional radiology (PKA: 268±155 Gy・cm2, Ka, r: 2420±1462 mGy) was significantly higher than that of diagnostic cerebral angiography (PKA: 161±70 Gy・cm2, Ka, r: 1112±485 mGy), (Mann-Whitney test, P<0.01). Significant difference was found between PKA and Ka, r for imaging purpose and disease group (Kruskal-Wallis test, P<0.05). It is highly probable that the DRL for cerebral angiography can be constructed by imaging purpose/disease group using display value (PKA, Ka, r) of the blood vessel imaging apparatus.
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Affiliation(s)
- Go Hitomi
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | | | - Takashi Moritake
- Department of Radiological Health Science, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Lue Sun
- Department of Radiation Biology, Faculty of Medicine, University of Tsukuba
| | - Masakatsu Mura
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Hiroki Matsumoto
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Fumiko Kusachi
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School Hospital
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73
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Rana BS, Kumar S, Ahuja CK, Singh NP, Yadav MK, Sandhu IS. ESTIMATION OF RADIATION EXPOSURE TO THE PATIENTS IN DIAGNOSTIC AND THERAPEUTIC INTERVENTIONAL PROCEDURES. RADIATION PROTECTION DOSIMETRY 2018; 181:290-300. [PMID: 29462376 DOI: 10.1093/rpd/ncy025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
The present work reports data of the radiation exposure to the patient in various diagnostic and therapeutic interventional radiological (IR) procedures. The study includes 260 diagnostic and 195 therapeutic exposure data in 455 IR procedures. All the IR procedures were performed on a biplane angiographic machine in a tertiary care hospital. The radiation exposure was estimated from dose-area product (DAP), fluoroscopy time (FT), number of fluoroscopic runs, number of images and cumulative dose (CD) value recorded during the procedure. The data reported in the present study show significant variability in DAP values in diagnostic and therapeutic IR procedures. In diagnostic procedures, the minimum median DAP value is 8.93 Gy cm2 for upper limb angiography with mean FT of 2.7 min and maximum DAP value is 108.8 Gy cm2 for inferior vena cava angiography with mean FT of 12.55 min. For therapeutic procedures, the median value of DAP ranges from 2.43 Gy cm2 for sclerotherapy with mean FT 0.65 min to 267.23 Gy cm2 for coiling of cerebral aneurysm with mean FT of 60.52 min. The DAP value for each procedure was also correlated with FT, number of fluoroscopic runs, number of images and CD. The reported DAP values in this study are within the range of earlier published results which suggest that our finding provides at least approximate applicability to other hospitals. The third quartile DAP values of the procedures having significant number of patient data (n ≥ 10) serves as provisional reference values for the optimization of procedure protocols.
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Affiliation(s)
| | - Sanjeev Kumar
- Department of Physics, G.G.D.S.D. College, Chandigarh, India
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74
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Assessment of automated cone-beam CT vessel identification software during transarterial hepatic embolisation: radiation dose, contrast medium volume, processing time, and operator perspectives compared to digital subtraction angiography. Clin Radiol 2018; 73:1057.e1-1057.e6. [PMID: 30220595 DOI: 10.1016/j.crad.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022]
Abstract
AIM To evaluate arterial cone-beam computed tomography (A-CBCT) automated analysis software for identification of vessels supplying tumours during transarterial hepatic embolisation (TAE). MATERIALS AND METHODS This study was approved by the institutional review board, with waiver of consent. Consecutive TAE procedures using arterial mapping software (AMS), and performed between February 2014 and August 2014, were reviewed. Hepatic arteries were imaged using digital subtraction angiography (DSA) as well as A-CBCT processed with AMS. Interventional radiologists reported1 potential embolisation target vessels computed using AMS versus DSA alone,2 modification of the embolisation plan based on AMS, and3 operator confidence related to technical success. Imaging set-up, processing time, radiation dose, and contrast media volume were recorded. RESULTS Thirty of 34 consecutive procedures were evaluated retrospectively. At least one additional embolisation target vessel was identified using AMS in 13 procedures (43%, 95% confidence interval [CI]: 26-61%) and embolisation plan modified in 11 (37%, 95% CI: 19-54%). Radiologists reported AMS increased operator confidence and reduced the number of DSA acquisitions in 25 (83%, 95% CI: 70-97%) and 15 cases (50%, 95% CI: 32-68%), respectively. The average A-CBCT acquisition and processing time was 4 minutes 53 seconds and 3 minutes 45 seconds, respectively. A-CBCT contributed to 11% of the radiation dose and 18% of the contrast media volume. CONCLUSION Physicians report increased tumour supplying vessel detection and intraprocedural confidence using AMS during TAE without substantial impact on radiation dose, contrast media volume, and procedure time.
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75
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3D C-Arm cone beam CT for targeting the portal vein during TIPS: Initial clinical experience. Eur J Radiol 2018; 106:20-25. [DOI: 10.1016/j.ejrad.2018.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 05/05/2018] [Accepted: 06/29/2018] [Indexed: 02/07/2023]
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Contemporary Interventional Radiology Dosimetry: Analysis of 4,784 Discrete Procedures at a Single Institution. J Am Coll Radiol 2018; 15:1214-1221. [PMID: 29980351 DOI: 10.1016/j.jacr.2018.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/20/2022]
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77
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McCarthy CJ, Kilcoyne A, Li X, Cahalane AM, Liu B, Arellano RS, Uppot RN, Gee MS. Radiation Dose and Risk Estimates of CT-Guided Percutaneous Liver Ablations and Factors Associated with Dose Reduction. Cardiovasc Intervent Radiol 2018; 41:1935-1942. [PMID: 30132100 DOI: 10.1007/s00270-018-2066-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/17/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine the radiation dose associated with CT-guided percutaneous liver ablations and identify potential risk factors that result in higher radiation doses. MATERIALS AND METHODS Between June 2011 and June 2015, 245 consecutive patients underwent 304 CT-guided liver ablation treatments. Patient demographics, tumor characteristics and procedural parameters were identified and analyzed. The peak skin dose and effective dose were assessed for each procedure. Excess relative risk related to radiation effects was calculated. A logistic regression model was prepared by means of stepwise logistic regression to identify variables predictive of increased radiation exposure. RESULTS Tumor ablations were performed with microwave (n = 220), radiofrequency (n = 74) or irreversible electroporation (IRE) (n = 10). The mean peak skin dose for ablations was 239.2 ± 136.4 mGy, and the mean effective dose was 36.6 ± 22.3 mSv. Of the patient and procedural parameters that were analyzed, increasing weight, use of intravenous contrast and/or hydrodissection during the procedure, together with treatment of multiple lesions in the same sitting were all associated with higher radiation exposure. The mean increase in the absolute risk of fatal malignancy from a single procedure was 0.18% (range 0.02-0.9%). No deterministic skin changes were identified in the patient cohort. CONCLUSION The overall risk of stochastic and deterministic effects from radiation associated with CT-guided ablations is low compared with other inherent procedural complications. This study identifies several factors that are associated with higher radiation dose in percutaneous liver ablation procedures.
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Affiliation(s)
- Colin J McCarthy
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Xinhua Li
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Alexis M Cahalane
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Bob Liu
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Raul N Uppot
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
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78
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Patient dose reference levels in surgery: a multicenter study. Eur Radiol 2018; 29:674-681. [DOI: 10.1007/s00330-018-5600-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/11/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
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79
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Farah J, Rouchaud A, Henry T, Regen C, Mihalea C, Moret J, Spelle L. Dose reference levels and clinical determinants in stroke neuroradiology interventions. Eur Radiol 2018; 29:645-653. [DOI: 10.1007/s00330-018-5593-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 12/17/2022]
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80
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Giordano C, Marcello G, Barbattini L, Gobbi R. LOCAL LEVELS OF PATIENT RADIATION EXPOSURE IN A UROLOGY OPERATING ROOM IN ITALY. RADIATION PROTECTION DOSIMETRY 2018; 179:327-332. [PMID: 29315415 DOI: 10.1093/rpd/ncx288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
The data analysed came from 545 patients and were related to five types of procedures performed in the urology operating room: percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureteropyeloscopy (UPS), ureteral catheterisation and nephrostomy. Local reference levels (75th percentiles) were determined for the various procedures. The peak entrance skin dose for a patient 20 cm thick was highest for PCNL, being 82 mGy, followed by 43 mGy for nephrostomy, 23 mGy for RIRS, 23 mGy for UPS and 17 mGy for stenting. Even taking into account the maximum values measured (296 mGy for UPS), the doses reached at the skin were not such as to cause deterministic effects. However, the threshold dose for male temporary sterility could be reached (150 mGy).
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Affiliation(s)
- C Giordano
- Medical Physics Unit, AUSL, Piacenza, Italy
| | | | | | - R Gobbi
- Medical Physics Unit, AUSL, Piacenza, Italy
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81
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Loewenstern J, Welch C, Lekperic S, Bishay V, Ranade M, Patel RS, Kim E, Nowakowski FS, Lookstein RA, Fischman AM. Patient Radiation Exposure in Transradial versus Transfemoral Yttrium-90 Radioembolization: A Retrospective Propensity Score-Matched Analysis. J Vasc Interv Radiol 2018; 29:936-942. [PMID: 29753675 DOI: 10.1016/j.jvir.2018.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/10/2018] [Accepted: 02/11/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare differences in patient radiation exposure (PRE) during transarterial yttrium-90 (90Y) radioembolization (TARE) between transradial access (TRA) and transfemoral access (TFA). MATERIALS AND METHODS A total of 810 consecutive first-time TARE procedures in patients from 2013 to 2017 were retrospectively reviewed. A propensity score-matching (PSM) analysis matched TRA and TFA groups on the basis of patient age, sex, weight, height, cancer type, 90Y microsphere type, and number of previous procedures from the same and opposite approaches. Matched groups were then compared by PRE measures fluoroscopy time (FT), dose-area product (DAP), and cumulative air kerma (AK). Effect size for each PRE measure was calculated. RESULTS Before PSM, TRA and TFA groups differed significantly in mean age, weight, and number of previous procedures from the same and opposite approach (all P < .05). After PSM, each group consisted of 302 procedures (overall, n = 604) and no longer differed in any procedure performed before surgery measure. TRA did not differ from the matched TFA group regarding median FT (9.50 vs 9.40 minutes, P = .095), median DAP (67,066 vs 67,219 mGy·cm2; P = .19), or median AK (323.63 vs 248.46 mGy; P = .16). Effect sizes were 0.068, 0.054, and 0.110 for FT, DAP, and AK, respectively. CONCLUSIONS No statistical differences were found for PRE measures between the matched TRA and TFA approach groups. Furthermore, practical effect sizes were considered to be small for AK and less than small for FT and DAP, and therefore, any differences in PRE between the radial and femoral approaches for TARE are minor and unlikely to be noticeable in everyday clinical practice.
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Affiliation(s)
- Joshua Loewenstern
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Colton Welch
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Safet Lekperic
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Vivian Bishay
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Mona Ranade
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Rahul S Patel
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Edward Kim
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - F Scott Nowakowski
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Robert A Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Aaron M Fischman
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029.
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Greffier J, Goupil J, Larbi A, Stefanovic X, Pereira F, Moliner G, Ovtchinnikoff S, Beregi J, Frandon J. Assessment of patient's peak skin dose during abdominopelvic embolization using radiochromic (Gafchromic) films. Diagn Interv Imaging 2018; 99:321-329. [DOI: 10.1016/j.diii.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
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83
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Acton H, James K, Kavanagh RG, O'Tuathaigh C, Moloney D, Wyse G, Fanning N, Maher M, O'Connor OJ. Monitoring neurointerventional radiation doses using dose-tracking software: implications for the establishment of local diagnostic reference levels. Eur Radiol 2018; 28:3669-3675. [PMID: 29651772 DOI: 10.1007/s00330-018-5405-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/10/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is potential for high radiation exposure during neurointerventional procedures. Increasing regulatory requirements mandate dose monitoring of patients and staff, and justification of high levels of radiation exposure. This paper demonstrates the potential to use radiation dose-tracking software to establish local diagnostic reference levels. METHODS Consecutive neurointerventional procedures, performed in a single institution within a one-year period, were retrospectively studied. Dose area product (DAP) data were collected using dose-tracking software and clinical data obtained from a prospectively generated patient treatment database. RESULTS Two hundred and sixty-four procedures met the selection criteria. Median DAP was 100 Gy.cm2 for aneurysm coiling procedures, 259 Gy.cm2 for arteriovenous malformation (AVM) embolisation procedures, 87 Gy.cm2 for stroke thrombolysis/thrombectomy, and 74 Gy.cm2 for four-vessel angiography. One hundred and nine aneurysm coiling procedures were further studied. Six significant variables were assessed using stepwise regression analysis to determine effect on DAP. Aneurysm location (anterior vs posterior circulation) had the single biggest effect (p = 0.004). CONCLUSIONS This paper confirms variable radiation exposures during neurointerventional procedures. The 75th percentile (used to define diagnostic reference levels) of DAP measurements represents a reasonable guidance metric for monitoring purposes. Results indicate that aneurysm location has the greatest impact on dose during coiling procedures and that anterior and posterior circulation coiling procedures should have separate diagnostic reference levels. KEY POINTS • Dose-tracking software is useful for monitoring patient radiation dose during neurointerventional procedures • This paper provides a template for methodology applicable to any interventional suite • Local diagnostic reference levels were defined by using the 75th percentile of DAP as per International Commission on Radiological Protection recommendations • Aneurysm location is the biggest determinant of radiation dose during coiling procedures. • Anterior and posterior circulation coiling procedures should have separate diagnostic reference levels.
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Affiliation(s)
- Holly Acton
- School of Medicine, University College Cork, Cork, Ireland
| | - Karl James
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Richard G Kavanagh
- School of Medicine, University College Cork, Cork, Ireland. .,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | | | - Deirdre Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael Maher
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Owen J O'Connor
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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84
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Falco MD, Masala S, Stefanini M, Bagalà P, Morosetti D, Calabria E, Tonnetti A, Verona-Rinati G. Effective-dose estimation in interventional radiological procedures. Radiol Phys Technol 2018. [DOI: 10.1007/s12194-018-0446-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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85
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Computed Tomography-Assisted Thoracoscopic Surgery: A Novel, Innovative Approach in Patients With Deep Intrapulmonary Lesions of Unknown Malignant Status. Invest Radiol 2018; 52:374-380. [PMID: 28141614 DOI: 10.1097/rli.0000000000000353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Minimally invasive resection of small, deep intrapulmonary lesions can be challenging due to the difficulty of localizing them during video-assisted thoracoscopic surgery (VATS). We report our preliminary results evaluating the feasibility of an image-guided, minimally invasive, 1-stop-shop approach for the resection of small, deep intrapulmonary lesions in a hybrid operating room (OR). MATERIALS AND METHODS Fifteen patients (5 men, 10 women; mean age, 63 years) with a total of 16 solitary, deep intrapulmonary nodules of unknown malignant status were identified for intraoperative wire marking. Patients were placed on the operating table for resection by VATS. A marking wire was placed within the lesion under 3D laser and fluoroscopic guidance using a cone beam computed tomography system. Then, wedge resection by VATS was performed in the same setting without repositioning the patient. RESULTS Complete resection with adequate safety margins was confirmed for all lesions. Marking wire placement facilitated resection in 15 of 16 lesions. Eleven lesions proved to be malignant, either primary or secondary; 5 were benign. Mean lesion size was 7.7 mm; mean distance to the pleural surface was 15.1 mm (mean lesion depth-diameter ratio, 2.2). Mean procedural time for marking wire placement was 35 minutes; mean VATS duration was 36 minutes. CONCLUSIONS Computed tomography-assisted thoracoscopic surgery is a new, safe, and effective procedure for minimally invasive resection of small, deeply localized intrapulmonary lesions. The benefits of computed tomography-assisted thoracoscopic surgery are 1. One-stop-shop procedure, 2. Lower risk for the patient (no patient relocation, no marking wire loss), and 3. No need to coordinate scheduling between the CT room and OR.
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86
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Hwang J, Shin J, Lee Y, Yoon H, Cho Y, Kim K. Percutaneous nephrostomy placement in infants and young children. Diagn Interv Imaging 2018; 99:157-162. [DOI: 10.1016/j.diii.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 12/15/2022]
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87
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Tavare AN, Wigham A, Hadjivassilou A, Alvi A, Papadopoulou A, Goode A, Woodward N, Patch D, Yu D, Davies N. Use of transabdominal ultrasound-guided transjugular portal vein puncture on radiation dose in transjugular intrahepatic portosystemic shunt formation. Diagn Interv Radiol 2018; 23:206-210. [PMID: 28223261 DOI: 10.5152/dir.2016.15601] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Transjugular intrahepatic portosystemic shunt (TIPS) creation is used to treat portal hypertension complications. Often the most challenging and time-consuming step in the procedure is the portal vein (PV) puncture. TIPS procedures are associated with prolonged fluoroscopy time and high patient radiation exposures. We measured the impact of transabdominal ultrasound guidance for PV puncture on duration of fluoroscopy time and dose. METHODS We retrospectively analyzed the radiation dose for all TIPS performed over a four-year period with transabdominal ultrasound guidance for PV puncture (n=212, with 210 performed successfully and data available for 206); fluoroscopy time, dose area product (DAP) and skin dose were recorded. RESULTS Mean fluoroscopy time was 12 min 9 s (SD, ±14 min 38 s), mean DAP was 40.3±73.1 Gy·cm2, and mean skin dose was 404.3±464.8 mGy. CONCLUSION Our results demonstrate that ultrasound-guided PV puncture results in low fluoroscopy times and radiation doses, which are markedly lower than the only published dose reference levels.
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Affiliation(s)
- Aniket N Tavare
- Departments of Radiology, Royal Free London NHS Foundation Trust, London, UK.
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88
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Summary of the Italian inter-society recommendations for radiation protection optimization in interventional radiology. LA RADIOLOGIA MEDICA 2018; 123:378-384. [PMID: 29307078 DOI: 10.1007/s11547-017-0849-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES A Working Group coordinated by the Italian National Institute of Health (Istituto Superiore di Sanità) and the National Workers Compensation Authority (Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, INAIL) and consisting of 11 Italian scientific/professional societies involved in the fluoroscopically guided interventional practices has been established to define recommendations for the optimization of patients and staff radiation protection in interventional radiology. A summary of these recommendations is here reported. MATERIALS AND METHODS A multidisciplinary approach was used to establish the Working Group by involving radiologists, interventional radiologists, neuroradiologists, interventional cardiologists, occupational health specialists, medical physicists, radiation protection experts, radiographers and nurses. The Group operated as a "Consensus Conference". Three main topics have been addressed: patient radiation protection (summarized in ten "golden rules"); staff radiation protection (summarized in ten "golden rules"); and education/training of interventional radiology professionals. RESULTS In the "golden rules", practical and operational recommendations were provided to help the professionals in optimizing dose delivered to patients and reducing their own exposure. Operative indications dealt also with continuing education and training, and recommendations on professional accreditation and certification. CONCLUSIONS The "Consensus Conference" was the methodology adopted for the development of these recommendations. Involvement of all professionals is a winning approach to improve practical implementation of the recommendations, thus getting a real impact on the optimization of the interventional radiology practices.
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89
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Hadjiconstanti AC, Messaris GAT, Thomopoulos KC, Panayiotakis GS. Patient Radiation Doses in Therapeutic Endoscopic Retrograde Cholangiopancreatography in Patras and the Key Role of the Operator. RADIATION PROTECTION DOSIMETRY 2017; 177:243-249. [PMID: 28419374 DOI: 10.1093/rpd/ncx037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
The patient radiation doses, in conjunction with the operator experience, in therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, performed in our hospital, were obtained. Ninety-six patients participated in the study and were divided into 3 groups, based on the operator experience. The dosemetric indices, fluoroscopy time (FT), cumulative dose (Ka,r) and air kerma-area product (PKA), were collected. For the total and weight banding group the third quartile values of the distribution of FT, Ka,r and PKA were 2.90 and 2.92 min, 6.89 and 6.93 mGy and 1.84 and 1.85 Gycm2, respectively, and were comparative or significantly lower than the corresponding values previously reported. Taking as a criterion the operator, the differences in the patient radiation doses were statistically significant, with the highest dose recorded for the operator of the lowest experience degree. The values obtained could contribute in establishing local and national diagnostic reference levels and in optimising ERCP procedure.
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Affiliation(s)
| | - Gerasimos A T Messaris
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
| | | | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
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90
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Subhashree M, Venkateswarlu R, Karthik K, Shangamithra V, Venkatachalam P. DNA damage and the bystander response in tumor and normal cells exposed to X-rays. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2017; 821:20-27. [PMID: 28735740 DOI: 10.1016/j.mrgentox.2017.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/31/2022]
Abstract
Monolayer and suspension cultures of tumor (BMG-1, CCRF-CEM), normal (AG1522, HADF, lymphocytes) and ATM-mutant (GM4405) human cells were exposed to X-rays at doses used in radiotherapy (high dose and high dose-rate) or radiological imaging (low dose and low dose-rate). Radiation-induced DNA damage, its persistence, and possible bystander effects were evaluated, based on DNA damage markers (γ-H2AX, p53ser15) and cell-cycle-specific cyclins (cyclin B1 and cyclin D1). Dose-dependent DNA damage and a dose-independent bystander response were seen after exposure to high dose and high dose-rate radiation. The level of induced damage (expression of p53ser15, γ-H2AX) depended on ATM status. However, low dose and dose-rate exposures neither increased expression of marker proteins nor induced a bystander response, except in the CCRF-CEM cells. Bystander effects after high-dose irradiation may contribute to stochastic and deterministic effects. Precautions to protect unexposed regions or to inhibit transmission of DNA damage signaling might reduce radiation risks.
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Affiliation(s)
- M Subhashree
- Department of Human Genetics, Sri Ramachandra University, Porur, Chennai, 600 116, India
| | - R Venkateswarlu
- Department of Human Genetics, Sri Ramachandra University, Porur, Chennai, 600 116, India
| | - K Karthik
- Department of Human Genetics, Sri Ramachandra University, Porur, Chennai, 600 116, India
| | - V Shangamithra
- Department of Human Genetics, Sri Ramachandra University, Porur, Chennai, 600 116, India
| | - P Venkatachalam
- Department of Human Genetics, Sri Ramachandra University, Porur, Chennai, 600 116, India.
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91
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Basheerudeen SAS, Kanagaraj K, Jose M, Ozhimuthu A, Paneerselvam S, Pattan S, Joseph S, Raavi V, Perumal V. Entrance surface dose and induced DNA damage in blood lymphocytes of patients exposed to low-dose and low-dose-rate X-irradiation during diagnostic and therapeutic interventional radiology procedures. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2017; 818:1-6. [DOI: 10.1016/j.mrgentox.2017.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 01/03/2023]
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92
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Three-dimensional Image Fusion Guidance for Transjugular Intrahepatic Portosystemic Shunt Placement. Cardiovasc Intervent Radiol 2017; 40:1732-1739. [DOI: 10.1007/s00270-017-1699-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/09/2017] [Indexed: 12/14/2022]
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93
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Kohlbrenner R, Kolli KP, Taylor AG, Kohi MP, Lehrman ED, Fidelman N, Conrad M, LaBerge JM, Kerlan RK, Gould R. Radiation Dose Reduction during Uterine Fibroid Embolization Using an Optimized Imaging Platform. J Vasc Interv Radiol 2017; 28:1129-1135.e1. [PMID: 28457758 DOI: 10.1016/j.jvir.2017.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To assess radiation dose reduction during uterine fibroid embolization (UFE) using an optimized angiographic processing and acquisition platform. MATERIALS AND METHODS Radiation dose data for 70 women (mean age, 46 y; range, 34-67 y) who underwent UFE were retrospectively analyzed. Twenty-one patients underwent UFE using the baseline fluoroscopic and angiographic image acquisition platform, and 49 underwent UFE after implementing an optimized imaging platform in otherwise identical angiography suites. Cumulative kerma-area product (CKAP), cumulative air kerma (CAK), total fluoroscopy time, and image exposure number were collected for each procedure. Image quality was assessed by 3 interventional radiologists blinded to the platform used for image acquisition and processing. RESULTS Patients undergoing UFE using the new x-ray fluoroscopy platform had significantly lower CKAP and CAK indicators than patients for whom baseline settings were used. Mean CKAP decreased by 60% from 438.5 Gy · cm2 (range, 180.3-1,081.1 Gy · cm2) to 175.2 Gy · cm2 (range, 47.1-757.0 Gy · cm2; P < .0001). Mean CAK decreased by 45% from 2,034.2 mGy (range, 699.3-5,056.0 mGy) to 1,109.8 mGy (range, 256.6-4,513.6 mGy; P = .001). No degradation of image quality was identified through qualitative evaluation. CONCLUSIONS Significant reduction in patient radiation dose indicators can be achieved with use of an optimized image acquisition and processing platform.
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Affiliation(s)
- Ryan Kohlbrenner
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143.
| | - K Pallav Kolli
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Andrew G Taylor
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Maureen P Kohi
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Evan D Lehrman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Nicholas Fidelman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Miles Conrad
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Jeanne M LaBerge
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Robert K Kerlan
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Robert Gould
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
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94
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Metaxas VI, Messaris GA, Gatzounis GD, Tzortzidis FN, Konstantinou DT, Panayiotakis GS. Institutional (local) diagnostic reference levels in fluoroscopically guided spine surgery. Eur J Radiol 2017; 90:50-59. [DOI: 10.1016/j.ejrad.2017.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
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95
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Han SC, Kim KB, Jung H, Ji Y, Park S. ASSESSMENT OF DIAGNOSTIC MULTILEAF COLLIMATOR FOR CEPHALOMETRIC EXPOSURE REDUCTION USING OPTICALLY STIMULATED LUMINESCENT DOSEMETERS. RADIATION PROTECTION DOSIMETRY 2017; 174:102-108. [PMID: 27056147 DOI: 10.1093/rpd/ncw080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
A diagnostic multileaf collimator (MLC) was developed for diagnostic radiography dose reduction. Optically stimulated luminescent dosemeters (OSLDs) were used to evaluate the efficacy of this device for dental radiography cephalometric exposure reduction. The OSLD dosimetric characteristics for 80 kVp cephalometric exposure were first obtained. The batch homogeneity and reproducibility were 1.67 % and 0.18-1.58, respectively. Good linearity was obtained between the OSLD dose and response, and the angular dependence was within ±4 %. The equivalent organ doses for the left eye, right eye and thyroid were 41.20±6.58, 178.86±1.71 and 171.12±8.78 μSv and 36.80±0.33, 156.63±0.22 and 22.04±0.13 μSv for the open and MLC fields, respectively. The MLC-induced dose reductions for the left and right eyes of in field were 10.67±16.78 and 12.42±8.84 %, respectively, and that of the thyroid gland of out of field was 87±8.82 %, considering combined uncertainty. Therefore, use of diagnostic MLC for dose reduction during dental radiography cephalometric exposure is both feasible and effective.
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Affiliation(s)
- Su Chul Han
- Research Center for Radiography, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
- Radiological Cancer Medicine, University of Science and Technology, Daejeon, Korea
| | - Kum Bae Kim
- Research Center for Radiography, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
- Radiological Cancer Medicine, University of Science and Technology, Daejeon, Korea
| | - Haijo Jung
- Research Center for Radiography, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
- Radiological Cancer Medicine, University of Science and Technology, Daejeon, Korea
| | - YoungHoon Ji
- Research Center for Radiography, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
- Radiological Cancer Medicine, University of Science and Technology, Daejeon, Korea
| | - Seungwoo Park
- Research Center for Radiography, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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96
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Cone-beam computed tomography with automated bone subtraction in preoperative embolization for pelvic bone tumors. PLoS One 2017; 12:e0175907. [PMID: 28419147 PMCID: PMC5395210 DOI: 10.1371/journal.pone.0175907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/02/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the usefulness of cone-beam computed tomography with automated bone subtraction (CBCT-ABS) in the preoperative embolization of hypervascular tumors located in the pelvic bone. MATERIALS AND METHODS This retrospective study included 26 patients with pelvic bone tumors who underwent preoperative embolization between January 2014 and October 2016. A CBCT-ABS scan was taken in a total of 17 patients (CBCT-ABS group), and only a series of digital subtraction angiographies (DSAs) was taken in the remaining 9 patients (DSA group). The percent devascularization, number of angiographic runs, total dose-area product (DAP), fluoroscopy time, interventional procedure time, operative time, and estimated blood loss were compared between the two groups using Mann-Whitney test. RESULTS The percent devascularization, interventional procedure time, fluoroscopy time, operative time, and estimated blood loss were not statistically different between the two groups (p > 0.05). On the other hand, the number of angiographic runs in the CBCT-ABS group was significantly lower than that in the DSA group (p = 0.029). The total DAP of the CBCT-ABS group (mean, 17700.7 μGym2) was higher than that of the DSA group (mean, 8939.4 μGym2) (p = 0.002). CONCLUSIONS The use of CBCT-ABS during the preoperative embolization of pelvic bone tumors significantly reduces the number of angiographic runs at the cost of an increased radiation dose.
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97
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Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France. Eur Radiol 2017; 27:4281-4290. [DOI: 10.1007/s00330-017-4780-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 10/20/2022]
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98
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Establishing Local Diagnostic Reference Levels in IR Procedures with Dose Management Software. J Vasc Interv Radiol 2017; 28:429-441. [DOI: 10.1016/j.jvir.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/01/2016] [Accepted: 10/12/2016] [Indexed: 11/21/2022] Open
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99
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Habib Geryes B, Bak A, Lachaux J, Ozanne A, Boddaert N, Brunelle F, Naggara O, Saliou G. Patient radiation doses and reference levels in pediatric interventional radiology. Eur Radiol 2017; 27:3983-3990. [PMID: 28210801 DOI: 10.1007/s00330-017-4769-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/20/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe, in a multicentric paediatric population, reference levels (RLs) for three interventional radiological procedures. METHODS From January 2012 to March 2015, children scheduled for an interventional radiological procedure in two French tertiary centres were retrospectively included and divided into four groups according to age: children younger than 2 years (A1), aged 2-7 years (A5), 8-12 years (A10) and 13-18 years (A15). Three procedures were identified: cerebral digital subtraction angiography (DSA), brain arteriovenous malformation (bAVM) embolization, and head and neck superficial vascular malformation (SVM) percutaneous sclerotherapy. Demographic and dosimetric data, including dose area product (DAP), were collected. RESULTS 550 procedures were included. For DSA (162 procedures), the proposed RL values in DAP were 4, 18, 12 and 32 Gy∙cm2 in groups A1, A5, A10 and A15, respectively. For bAVM embolization (258 procedures), values were 33, 70, 105 and 88 Gy∙cm2 in groups A1, A5, A10 and A15, respectively. For SVM sclerotherapy (130 procedures), values were 350, 790, 490 and 248 mGy∙cm2 in groups A1, A5, A10 and A15, respectively. CONCLUSION Consecutive data were available to permit a proposal of reference levels for three major paediatric interventional radiology procedures. KEY POINTS • We determined reference levels (RLs) for bAVM embolization, DSA and SVM sclerotherapy. • The proposed RLs will permit benchmarking practice with an external standard. • The proposed RLs by age may help to develop paediatric dose guidelines.
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Affiliation(s)
- Bouchra Habib Geryes
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Adeline Bak
- Department of Neuroradiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - Julie Lachaux
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Augustin Ozanne
- Department of Neuroradiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - Nathalie Boddaert
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Francis Brunelle
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Olivier Naggara
- Department of Paediatric Radiology, Hôpital Universitaire Necker Enfants Malades, Paris, France. .,Université Paris Descartes Sorbonne Paris Cité, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasculaire, Centre Hospitalier Sainte-Anne, Paris, France. .,Department of Neuroradiology, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR894, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75014, Paris, France.
| | - Guillaume Saliou
- Department of Neuroradiology, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
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100
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Hassan AE, Amelot S. Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site Experience. INTERVENTIONAL NEUROLOGY 2017; 6:105-116. [PMID: 29118787 DOI: 10.1159/000456622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background and Purpose Per the ALARA principle, reducing the dose delivered to both patients and staff must be a priority for endovascular therapists, who should monitor their own practice. We evaluated patient exposure to radiation during common neurointerventions performed with a recent flat-panel detector angiographic system and compared our results with those of recently published studies. Methods All consecutive patients who underwent a diagnostic cerebral angiography or intervention on 2 modern flat-panel detector angiographic biplane systems (Innova IGS 630, GE Healthcare, Chalfont St Giles, UK) from February to November 2015 were retrospectively analyzed. Dose-area product (DAP), cumulative air kerma (CAK) per plane, fluoroscopy time (FT), and total number of digital subtraction angiography (DSA) frames were collected, reported as median (interquartile range), and compared with the previously published literature. Results A total of 755 consecutive cases were assessed in our institution during the study period, including 398 diagnostic cerebral angiographies and 357 interventions. The DAP (Gy × cm2), fontal and lateral CAK (Gy), FT (min), and total number of DSA frames were as follows: 43 (33-60), 0.26 (0.19-0.33), 0.09 (0.07-0.13), 5.6 (4.2-7.5), and 245 (193-314) for diagnostic cerebral angiographies, and 66 (41-110), 0.46 (0.25-0.80), 0.18 (0.10-0.30), 18.3 (9.1-30.2), and 281 (184-427) for interventions. Conclusion Our diagnostic cerebral angiography group had a lower median and was in the 75th percentile of DAP and FT when compared with the published literature. For interventions, both DAP and number of DSA frames were significantly lower than the values reported in the literature, despite a higher FT. Subgroup analysis by procedure type also revealed a lower or comparable DAP.
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