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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024:10.1007/s00261-024-04381-x. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Knott EA, Rose SD, Wagner MG, Lee FT, Radtke J, Anderson DR, Zlevor AM, Lubner MG, Hinshaw JL, Szczykutowicz TP. CT Fluoroscopy for Image-Guided Procedures: Physician Radiation Dose During Full-Rotation and Partial-Angle CT Scanning. J Vasc Interv Radiol 2021; 32:439-446. [PMID: 33414069 DOI: 10.1016/j.jvir.2020.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/29/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine physician radiation exposure when using partial-angle computed tomography (CT) fluoroscopy (PACT) vs conventional full-rotation CT and whether there is an optimal tube/detector position at which physician dose is minimized. MATERIALS AND METHODS Physician radiation dose (entrance air kerma) was measured for full-rotation CT (360°) and PACT (240°) at all tube/detector positions using a human-mimicking phantom placed in a 64-channel multidetector CT. Parameters included 120 kV, 20- and 40-mm collimation, and 100 mA. The mean, standard deviation, and increase/decrease in physician dose compared with a full-rotation scan were reported. RESULTS Physician radiation exposure during CT fluoroscopy with PACT was highly dependent on the position of the tube/detector during scanning. The lowest PACT physician dose was when the physician was on the detector side (center view angle 116°; -35% decreased dose vs full-angle CT). The highest PACT physician dose was with the physician on the tube side (center view angle 298°; +34% increased dose vs full-angle CT), all doses P <.05 vs full-rotation CT. CONCLUSIONS Partial-angle CT has the potential to both significantly increase or decrease physician radiation dose during CT fluoroscopy-guided procedures. The detector/tube position has a profound effect on physician dose. The lowest dose during PACT was achieved when the physician was located on the detector side (ie, distant from the tube). This data could be used to optimize CT fluoroscopy parameters to reduce physician radiation exposure for PACT-capable scanners.
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Affiliation(s)
- Emily A Knott
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Sean D Rose
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Martin G Wagner
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Jeff Radtke
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Daniel R Anderson
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705
| | - Timothy P Szczykutowicz
- Department of Radiology, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705; Department of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705; Department of Biomedical Engineering, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705.
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Maingard J, Kok HK, Ranatunga D, Brooks DM, Chandra RV, Lee MJ, Asadi H. The future of interventional and neurointerventional radiology: learning lessons from the past. Br J Radiol 2017; 90:20170473. [PMID: 28972807 DOI: 10.1259/bjr.20170473] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The rapid progression of medical imaging technology and the ability to leverage knowledge from non-invasive imaging means that Interventional Radiologists (IRs) and Interventional Neuroradiologists are optimally placed to incorporate minimally invasive interventional paradigms into clinical management to advance patient care. There is ample opportunity to radically change the management options for patients with a variety of diseases through the use of minimally invasive interventional procedures. However, this will need to be accompanied by an increased clinical role of IRs to become active partners in the clinical management of patients. Unfortunately, the development of IR clinical presence has lagged behind and is reflected by declining rates of IR involvement in certain areas of practice such as vascular interventions. Current and future IRs must be willing to take on clinical responsibilities; reviewing patients in clinic to determine suitability for a procedure and potential contraindications, rounding on hospital inpatients and be willing to manage procedure related complications, which are all important parts of a successful IR practice. Increasing our clinical presence has several advantages over the procedure-driven model including enhanced patient knowledge and informed consent for IR procedures, improved rapport with patients and other clinical colleagues through active participation and engagement in patient care, visibility as a means to facilitate referrals and consistency of follow-up with opportunities for further learning. Many of the solutions to these problems are already in progress and the use of IR as a "hired gun" or "technician" is a concept that should be relegated to the past, and replaced with recognition of IRs as clinicians and partners in delivering modern high quality multidisciplinary team-based patient care. The following article will review the history of IR, the challenges facing this rapidly evolving profession and discuss recent developments occurring globally that are essential in maintaining expertise, securing future growth and improving patient outcomes in the modern multidisciplinary practice of medicine.
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Affiliation(s)
- Julian Maingard
- 1 Interventional Radiology Service-Department of Radiologyz, Austin Hospital , Melbourne, VIC , Australia.,2 Interventional Neuroradiology Service-Radiology Departmentz, Austin Hospital , Melbourne, VIC , Australia.,3 School of Medicine-Faculty of Healthz, Deakin University , Waurn Ponds, VIC , Australia
| | - Hong Kuan Kok
- 4 Department of Interventional Radiologyz, Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Dinesh Ranatunga
- 1 Interventional Radiology Service-Department of Radiologyz, Austin Hospital , Melbourne, VIC , Australia
| | - Duncan Mark Brooks
- 1 Interventional Radiology Service-Department of Radiologyz, Austin Hospital , Melbourne, VIC , Australia.,2 Interventional Neuroradiology Service-Radiology Departmentz, Austin Hospital , Melbourne, VIC , Australia.,5 The Florey Institute of Neuroscience and Mental Health, University of Melbourne , Melbourne , Australia
| | - Ronil V Chandra
- 6 Department of Imagingz, Monash University , Melbourne, VIC , Australia.,7 Interventional Neuroradiology Unit-Monash Imagingz, Monash Health , Melbourne, VIC , Australia
| | - Michael J Lee
- 8 Interventional Radiology Service-Department of Radiologyz, Beaumont Hospital , Dublin , Ireland.,9 Department of Radiologyz, Royal College of Surgeons , Dublin , Ireland
| | - Hamed Asadi
- 1 Interventional Radiology Service-Department of Radiologyz, Austin Hospital , Melbourne, VIC , Australia.,2 Interventional Neuroradiology Service-Radiology Departmentz, Austin Hospital , Melbourne, VIC , Australia.,3 School of Medicine-Faculty of Healthz, Deakin University , Waurn Ponds, VIC , Australia.,4 Department of Interventional Radiologyz, Guy's and St Thomas' NHS Foundation Trust , London , UK.,5 The Florey Institute of Neuroscience and Mental Health, University of Melbourne , Melbourne , Australia.,7 Interventional Neuroradiology Unit-Monash Imagingz, Monash Health , Melbourne, VIC , Australia
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Guimaraes AR, Siqueira L, Uppal R, Alford J, Fuchs BC, Yamada S, Tanabe K, Chung RT, Lauwers G, Chew ML, Boland GW, Sahani DV, Vangel M, Hahn PF, Caravan P. T2 relaxation time is related to liver fibrosis severity. Quant Imaging Med Surg 2016; 6:103-14. [PMID: 27190762 DOI: 10.21037/qims.2016.03.02] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The grading of liver fibrosis relies on liver biopsy. Imaging techniques, including elastography and relaxometric, techniques have had varying success in diagnosing moderate fibrosis. The goal of this study was to determine if there is a relationship between the T2-relaxation time of hepatic parenchyma and the histologic grade of liver fibrosis in patients with hepatitis C undergoing both routine, liver MRI and liver biopsy, and to validate our methodology with phantoms and in a rat model of liver fibrosis. METHODS This study is composed of three parts: (I) 123 patients who underwent both routine, clinical liver MRI and biopsy within a 6-month period, between July 1999 and January 2010 were enrolled in a retrospective study. MR imaging was performed at 1.5 T using dual-echo turbo-spin echo equivalent pulse sequence. T2 relaxation time of liver parenchyma in patients was calculated by mono-exponential fit of a region of interest (ROI) within the right lobe correlating to histopathologic grading (Ishak 0-6) and routine serum liver inflammation [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)]. Statistical comparison was performed using ordinary logistic and ordinal logistic regression and ANOVA comparing T2 to Ishak fibrosis without and using AST and ALT as covariates; (II) a phantom was prepared using serial dilutions of dextran coated magnetic iron oxide nanoparticles. T2 weighed imaging was performed by comparing a dual echo fast spin echo sequence to a Carr-Purcell-Meigboom-Gill (CPMG) multi-echo sequence at 1.5 T. Statistical comparison was performed using a paired t-test; (III) male Wistar rats receiving weekly intraperitoneal injections of phosphate buffer solution (PBS) control (n=4 rats); diethylnitrosamine (DEN) for either 5 (n=5 rats) or 8 weeks (n=4 rats) were MR imaged on a Bruker Pharmascan 4.7 T magnet with a home-built bird-cage coil. T2 was quantified by using a mono-exponential fitting algorithm on multi-slice multi echo T2 weighted data. Statistical comparison was performed using ANOVA. RESULTS (I) Histopathologic evaluation of both rat and human livers demonstrated no evidence of steatosis or hemochromatosis There was a monotonic increase in mean T2 value with increasing degree of fibrosis (control 65.4±2.9 ms, n=6 patients); mild (Ishak 1-2) 66.7±1.9 ms (n=30); moderate (Ishak 3-4) 71.6±1.7 ms (n=26); severe (Ishak 5-6) 72.4±1.4 ms (n=61); with relatively low standard error (~2.9 ms). There was a statistically significant difference between degrees of mild (Ishak <4) vs. moderate to severe fibrosis (Ishak >4) (P=0.03) based on logistic regression of T2 and Ishak, which became insignificant (P=0.07) when using inflammatory markers as covariates. Expanding on this model using ordinal logistic regression, there was significance amongst all 4 groups comparing T2 to Ishak (P=0.01), with significance using inflammation as a covariate (P=0.03) and approaching statistical significance amongst all groups by ANOVA (P=0.07); (II) there was a monotonic increase in T2 and statistical significance (ANOVA P<0.0001) between each rat subgroup [phosphate buffer solution (PBS) 25.2±0.8, DEN 5-week (31.1±1.5), and DEN 9-week (49.4±0.4) ms]; (III) the phantoms that had T2 values within the relevant range for the human liver (e.g., 20-100 ms), demonstrated no statistical difference between two point fits on turbo spin echo (TSE) data and multi-echo CPMG data (P=0.9). CONCLUSIONS The finding of increased T2 with liver fibrosis may relate to inflammation that may be an alternative or adjunct to other noninvasive MR imaging based approaches for assessing liver fibrosis.
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Affiliation(s)
- Alexander R Guimaraes
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Luiz Siqueira
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ritika Uppal
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jamu Alford
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bryan C Fuchs
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Suguru Yamada
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kenneth Tanabe
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Raymond T Chung
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gregory Lauwers
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Michael L Chew
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Giles W Boland
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Duhyant V Sahani
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mark Vangel
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter F Hahn
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter Caravan
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
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Andrabi Y, Saadeh TS, Uppot RN, Arellano RS, Sahani DV. Impact of Dose-Modified Protocols on Radiation Doses in Patients Undergoing CT Examinations following Image-Guided Catheter Placement. J Vasc Interv Radiol 2015; 26:1339-46.e1. [PMID: 26190187 DOI: 10.1016/j.jvir.2015.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the impact of dose-modified (DM) scan protocols on decreasing radiation exposure from computed tomography (CT) scans obtained following image-guided catheter procedures. MATERIALS AND METHODS In this retrospective analysis, between December 2012 and June 2014, 192 patients (mean age, 60.7 y; 102 men) who underwent abdomen/pelvis CT examinations for catheter placement follow-up were included. The standard-dose (SD) baseline CT parameters included tube potential of 120 kVp, tube current of 75-550 mA, and noise index (NI) of 18-22. Weight-based scan parameters applied for follow-up CT were based on two reconstruction algorithms: filtered back projection (FBP; 120 kVp, 75-350 mA, NI = 30) and iterative reconstruction technique (IRT; 100/120 kVp, 75-250/350 mA, NI = 35). Two readers reviewed image quality (IQ) of follow-up and baseline CT examinations for 22 randomly sampled patients. Radiation doses were retrieved by dose monitoring software. RESULTS Compared with baseline, DM follow-up CT protocols enabled substantial (62.4%) dose reductions (mean CT dose indexes: 4.1 mGy at follow-up, 10.9 mGy at baseline; P < .0001). Doses were significantly lower for IRT follow-up CT examinations compared with FBP (mean CT dose indexes: IRT, 3.6 mGy; FBP, 4.6 mGy; P < .05). In 47 patients with more than one follow-up CT examination (mean, 3.1 examinations per patient; range, 2-6), the observed cumulative radiation dose (CRD) was 42.1% lower than the expected CRD (observed, 1,437.9 mGy·cm; expected, 2,483.6 mGy·cm; P < .0001). Subjective IQ scores were acceptable for follow-up CT examinations (follow-up, 3.6; baseline, 4; P < .05). CONCLUSIONS DM CT examinations enable substantial dose reduction (62.4%) for each follow-up examination compared with SD baseline scans, without any IQ concerns. Use of IRT decreases dose by an additional 22%. The CRD is lowered by 42% in patients undergoing multiple DM follow-up CT examinations.
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Affiliation(s)
- Yasir Andrabi
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA 02114
| | - Thomas S Saadeh
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA 02114
| | - Raul N Uppot
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA 02114
| | - Ronald S Arellano
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA 02114
| | - Dushyant V Sahani
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA 02114..
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