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Choi TW, Chung JW. Radiation dose during transarterial chemoembolization and associated factors. Abdom Radiol (NY) 2024:10.1007/s00261-024-04370-0. [PMID: 38831076 DOI: 10.1007/s00261-024-04370-0] [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: 10/28/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE To provide detailed reports on radiation doses during transarterial chemoembolization (TACE) in the cone-beam computed tomography (CBCT) era and to identify the associated factors. METHODS This retrospective study included 385 consecutive patients who underwent initial conventional TACE for hepatocellular carcinoma (HCC) between January 2016 and December 2017. In most cases, CBCT was performed at the common hepatic artery or celiac axis to confirm the location of the tumor and the three-dimensional hepatic artery anatomy. Superselective TACE was performed for all technically feasible cases. Information on total dose area product (DAP), total cumulative air kerma (CAK), fluoroscopy time, and DAP and CAK of each digital subtraction angiography (DSA) and CBCT scan was recorded. Multiple linear regression analysis was performed to identify the factors associated with increased DAP during TACE. RESULTS The mean values of total DAP and CAK were 165.2 ± 81.2 (Gy·cm²) and 837.1 ± 571.0 (mGy), respectively. The mean fluoroscopy time was 19.1 ± 10.3 min. The mean DAP caused by fluoroscopy, DSA, and CBCT was 51.8 ± 43.9, 28.0 ± 24.1, and 83.9 ± 42.1 Gy·cm², respectively. Male sex, a high body mass index, largest tumor size > 3 cm, presence of aberrant right and left hepatic arteries, and superselective TACE were identified as independent predictors of increased total DAP during TACE. CONCLUSION We were able to provide detailed reports on radiation doses during TACE and associated factors.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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Pizano A, Khurram A, Chamseddin K, Timaran CH, Baig S, Shih M, Xi Y, Guild J, Kirkwood ML. New imaging technology system reduces patient radiation dose during peripheral arterial endovascular interventions. J Vasc Surg 2022; 76:500-504. [PMID: 35367567 DOI: 10.1016/j.jvs.2022.03.865] [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: 02/03/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Radiation exposure and imaging quality are among the main concerns in endovascular procedures. The Clear VD11 PURE platform technology system (Siemens Healthineers, Erlangen, Germany) has been reported to lower the radiation dose and improve image quality. In the present study, we evaluated whether the radiation dose during peripheral arterial endovascular procedures had decreased after implementation of this new imaging system. METHODS The patient characteristics (age, gender, body mass index [BMI]), procedure type (diagnostic, balloon angioplasty, atherectomy, stenting), body location (aortoiliac, superficial femoral artery, tibial artery), reference air kerma (RAK), kerma area product (KAP), and fluoroscopy time (FT) were recorded during peripheral artery interventions performed 1 year before (group A) and 1 year after (group B) the CLEAR system upgrade. The procedures were performed in an Artis zeego hybrid room (Siemens Healthineers) with the same providers. A general linear model was used to estimate the average difference between groups adjusted by procedure type and patient age, gender, and BMI. Additionally, to control for variations in case complexity, groups A and B were matched by age, gender, BMI, lesion location, and intervention type. Propensity score matching and a paired t test were used to compare the KAP, RAK, and FT stratified by single intervention procedures. RESULTS A total of 487 endovascular procedures were performed: 209 in group A and 278 in group B. A total of 111 single intervention procedures from each group were matched (1:1), with a mean age of 61 ± 8 years and a BMI of 26.5 ± 4 kg/m2. The median KAP, RAK, and FT for group A were 28.8 Gy · cm2 (interquartile range [IQR], 24-34 Gy · cm2), 146 mGy (IQR, 123-173 mGy), and 12 minutes (IQR, 10-14 minutes), respectively. The median KAP, RAK, and FT for group B were 18.3 Gy · cm2 (IQR, 16-22 Gy · cm2), 71.2 mGy (IQR, 60-85 mGy), and 10.4 minutes (IQR, 9-12 minutes), respectively. The KAP, RAK, and FT were significantly decreased in group B by 24% (P = .005), 41% (P < .001), and 22% (P = .002), respectively, compared with the values for group A. Stratified by single intervention procedures, the KAP and RAK had decreased significantly in group B (36% [P = .002] and 51% [P < .001], respectively) compared with group A. The FT decrease of 13% in group B was not statistically significant (P = .20). CONCLUSIONS Use of the Clear VD11 PURE platform system (Siemens Healthineers) reduced the patient radiation dose by 51% during endovascular peripheral interventions. The similar FTs for the matched single intervention procedures before and after the upgrade indicated consistent case complexity and surgeon practice. This platform appears to be an effective system for lowering the radiation dose.
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Affiliation(s)
- Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ali Khurram
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Division of Medical Physics, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Guild
- Division of Medical Physics, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Nocum DJ, Robinson J, Halaki M, Båth M, Thompson JD, Thompson N, Moscova M, Liang E, Mekiš N, Reed W. Predictors of radiation dose for uterine artery embolisation are angiography system-dependent. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:011502. [PMID: 34985415 DOI: 10.1088/1361-6498/ac480b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre's practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura,n= 95) and Group II (Azurion,n= 95) demonstrated a significant reduction in kerma-area product (KAP) and Ka, r (reference air kerma) by 63% (143.2 Gy cm2vs 52.9 Gy cm2;P< 0.001,d= 0.8) and 67% (0.6 Gy vs 0.2 Gy;P< 0.001,d= 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy cm2and the limits of agreement were +28.49 and -27.71 Gy cm2, and thus illustrated no proportional bias. The resultant MLR model was considered system-dependent and validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose. Interventional radiologist and interventional radiographer familiarisation of the system's features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.
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Affiliation(s)
- Don J Nocum
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John Robinson
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Magnus Båth
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - John D Thompson
- Department of Radiography, School of Health and Society, University of Salford, Salford M6 6PU, United Kingdom
| | - Nadine Thompson
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Moscova
- Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Eisen Liang
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Sydney Fibroid Clinic, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Nejc Mekiš
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Warren Reed
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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El-Diasty MT, Olfat AA, Mufti AS, Alqurashi AR, Alghamdi MJ. Patients' Radiation Shielding in Interventional Radiology Settings: A Systematic Review. Cureus 2021; 13:e16870. [PMID: 34513445 PMCID: PMC8412000 DOI: 10.7759/cureus.16870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
As a result of the increasing risk of developing radiation-related complications, many approaches aimed at reducing this risk and enhancing the outcomes of the patient, doctor or device operator have been developed. In this systematic review, we aim to discuss previous investigations that studied patient shielding or protection within the context of selected interventional radiology procedures. We included original studies that used Ka,r, and PKA for the assessment of the outcomes of two procedures: transjugular intrahepatic portosystemic shunt creation (TIPS) and hepatic arterial chemoembolization (HAE). A thorough search strategy was conducted on relevant databases to identify all relevant studies. We included 13 investigations, including 12 cross-sectional studies and one randomized controlled trial. Significant diversity was found among all these studies in terms of the used modalities, which made them hard to compare. However, almost all studies agreed that using novel imaging and interventional modalities is useful when obtaining better outcomes and reducing patient radiation exposure. The use of ultrasound-guided procedures and providing adequate lead curtains has also been recommended by the identified studies in order to minimize the frequency of radiation exposure. The reported Ka,r, and PKA were also variable between studies and were discussed within this study. Our findings indicate that unified guidelines for patient radiation shielding should be urgently investigated.
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Affiliation(s)
| | - Ahmed A Olfat
- Department of Radiology, King Abdullah Medical City, Mecca, SAU
| | - Ahmad S Mufti
- Department of Radiology, King Abdullah Medical City, Mecca, SAU
| | - Ahmed R Alqurashi
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, SAU
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Jiang X, Han X, Zhang T, Huang Z, Shen J, Bo Y, Chen G, Chen M, Huang J. Transcatheter arterial chemoembolization combined with simultaneous cone beam computed tomography-guided multipolar microwave ablation for massive hepatocellular carcinoma (≥10 cm): Safety and primary clinical results. J Interv Med 2019; 2:65-68. [PMID: 34805875 PMCID: PMC8562256 DOI: 10.1016/j.jimed.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose To explore the safety and clinical efficacy of transcatheter arterial chemoembolization (TACE)combined with simultaneous cone beam computed tomography (CBCT)-guided multipolar microwave ablation (MWA)in the treatment of massive hepatocellular carcinoma (HCC). Materials and methods Records of nine patients who underwent TACE combined with simultaneous CBCT-guided multipolar MWA for massive HCC, between January and June 2015, were retrospectively reviewed. Technical success rate, blood levels of liver function indicators, complications, and tumor response one month after treatmentwere investigated. Results The technical success rate of TACE combined with simultaneous MWA was 100%. The mean procedure time was 195.0 min (range, 125–350 min), the mean hospital stay after the treatment was 4.0 ± 1.0 days (range, 3–7 days), and no serious complications occurred. Minor complications were experienced by some patients but were relieved after conservative treatment. One month after treatment, enhanced CT revealed a complete response rate of 66.7% (6/9), a partial response rate of 22.2% (2/9), and a stable disease rate of 11.1% (1/9). Mild and reversible injury of liver function occurred in these patients. Conclusion TACE combined with simultaneous CBCT-guided MWA for massive HCC was feasible and safe, and yielded a high response rate.
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Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization. Invest Radiol 2019; 54:153-159. [DOI: 10.1097/rli.0000000000000519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Jonczyk M, Collettini F, Geisel D, Schnapauff D, Böning G, Wieners G, Gebauer G. Radiation exposure during TACE procedures using additional cone-beam CT (CBCT) for guidance: safety and precautions. Acta Radiol 2018; 59:1277-1284. [PMID: 29490465 DOI: 10.1177/0284185118761203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background During transarterial chemoembolization (TACE), cone-beam computed tomography (CBCT) can be used for tumor and feeding vessel detection as well as postembolization CT imaging. However, there will be additional radiation exposure from CBCT. Purpose To evaluate the additional dose raised through CBCT-assisted guidance in comparison to TACE procedures guided with pulsed digital subtraction angiography (DSA) alone. Material and Methods In 70 of 140 consecutive patients undergoing TACE for liver cancer, CBCT was used to facilitate the TACE. Cumulative dose area product (DAP), cumulative kerma(air), DAP values of DSA, total and cine specific fluoroscopy times (FT) of 1375 DSA runs, and DAP of 91 CBCTs were recorded and analyzed using Spearman's correlation, Mann-Whitney U-test, and Kruskal-Wallis test. P values < 0.05 were considered significant. Results Additional CBCT increased DAP by 2% ( P = 0.737), kerma(air) by 24.6% ( P = 0.206), and FT by 0.02% ( P = 0.453). Subgroup analysis revealed that postembolization CBCT for detection of ethiodized oil deposits added more DAP to the procedure. Performing CBCT-assisted TACE, DSA until first CBCT contributed about 38% to the total DAP. Guidance CBCT acquisitions conduced to 6% of the procedure's DAP. Additional DSA for guidance after CBCT acquisition required approximately 46% of the mean DAP. The last DSA run for documentation purposes contributed about 10% of the DAP. Conclusion CBCT adds radiation exposure in TACE. However, the capability of CBCT to detect vessels and overlay in real-time during fluoroscopy facilitates TACE with resultant reduction of DAPs up to 46%.
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Affiliation(s)
- M Jonczyk
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - F Collettini
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - D Geisel
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - D Schnapauff
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Böning
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Wieners
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Gebauer
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
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Panick C, Wunderle K, Sands M, Martin C. Patient Radiation Dose Reduction Considerations in a Contemporary Interventional Radiology Suite. Cardiovasc Intervent Radiol 2018; 41:1925-1934. [PMID: 30132101 DOI: 10.1007/s00270-018-2052-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/01/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE We sought to evaluate patient radiation exposure during complex liver interventional procedures performed with newer angiography equipment. MATERIALS AND METHODS We conducted a retrospective study of transjugular intrahepatic portosystemic shunt (TIPS) creations and liver tumor embolizations performed in our new angiography suite (Discovery IGS740, GE Healthcare). T tests were used to compare air kerma-area product (PKA) and reference plane air kerma (Ka,r) in the new room versus data from historical rooms and previous studies (including the RAD IR study). Results were expressed as medians [interquartile ranges (Q1, Q3)]. RESULTS From February 2015 to June 2016, 134 complex liver interventional procedures were performed in the new room, including 14 TIPS creations, 60 hepatic tumor arterial embolizations (HAEs), 26 Y90 mappings (Y90m), and 34 Y90 radioembolizations (Y90). Ka,r (Gy) values were as follows: TIPS, 0.65 (0.24, 1.15); HAE, 0.89 (0.49, 1.49); Y90m, 0.54 (0.38, 0.94); Y90, 0.46 (0.21, 1.06). PKA (Gy·cm2) values were as follows: TIPS, 148.2 (66.7, 326.5); HAE, 142.6 (88, 217.8); Y90m, 148.3 (98.2, 247); Y90, 90.8 (43.9, 161.5). Ka,r and PKA were lower in the new room than in historical rooms [Ka,r and PKA reductions: TIPS, 58 and 49%; HAE, 31 and 39%; Y90m, 58 and 52%; Y90, 49 and 56% (p < 0.05)] and versus the RAD IR study [Ka,r and PKA reductions: TIPS, 64 and 43%; HAE, 26 and 40% (p < 0.05)]. CONCLUSIONS Using the latest technology and image processing tools enables significant reduction in radiation exposure during complex liver interventional procedures.
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Affiliation(s)
- Catherine Panick
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Kevin Wunderle
- Diagnostic Radiology, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mark Sands
- Diagnostic Radiology, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Charles Martin
- Diagnostic Radiology, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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