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D'Alessio A, Strocchi S, Dalmasso F, Cannillo B, Matheoud R, Ponzetti A, Aimonetto S, Cernigliaro M, Azzalin G, Giorgianni A, Natrella M, Carriero A, Guzzardi G, Brambilla M. Effective and organ doses in patient undergoing interventional neuroradiology procedures: A multicentre study. Phys Med 2024; 122:103383. [PMID: 38810393 DOI: 10.1016/j.ejmp.2024.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/22/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Radiation doses to adult patients submitted to cerebral angiography and intracranial aneurysms treatments were assessed by using DICOM Radiation Dose Structured Reports (RDSR) and Monte Carlo simulations. Conversion factors to estimate effective and organ doses from Kerma-Area Product (PKA) values were determined. METHODS 77 cerebral procedures performed with five angiographic equipment installed in three Italian centres were analyzed. Local settings and acquisition protocols were considered. The geometrical, technical and dosimetric data of 16,244 irradiation events (13305 fluoroscopy, 2811 digital subtraction angiography, 128 cone-beam CT) were extracted from RDSRs by local dose monitoring systems and were input in MonteCarlo PCXMC software to calculate effective and organ doses. Finally, conversion factors to determine effective and organ doses from PKA were determined. Differences between centres were assessed through statistical analysis and accuracy of dose calculation method based on conversion factors was assessed through Bland-Altman analysis. RESULTS Large variations in PKA (14-561 Gycm2) and effective dose (1.2-73.5 mSv) were observed due to different degrees of complexity in the procedures and angiographic system technology. The most exposed organs were brain, salivary glands, oral mucosa, thyroid and skeleton. The study highlights the importance of recent technology in reducing patient exposure (about fourfold, even more in DSA). No statistically significant difference was observed in conversion factors between centres, except for some organs. A conversion factor of 0.09 ± 0.02 mSv/Gycm2 was obtained for effective dose. CONCLUSIONS Organ and effective doses were assessed for neuro-interventional procedures. Conversion factors for calculating effective and organ doses from PKA were provided.
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Affiliation(s)
- Andrea D'Alessio
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
| | - Sabina Strocchi
- Medical Physics Department, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federico Dalmasso
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | - Barbara Cannillo
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Roberta Matheoud
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Alex Ponzetti
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy; Medical Physics Postgraduate School, University of Turin, Turin, Italy
| | - Stefania Aimonetto
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | | | - Giulia Azzalin
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Andrea Giorgianni
- Neuroradiology Department, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Massimiliano Natrella
- Radiology Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | - Alessandro Carriero
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
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Gizewski ER, Verius M, Rehani MM, Jaschke W. Cumulative Effective Dose During Fluoroscopically Guided Interventions (FGI): Analysis of More Than 5000 FGIs in a Single European Center. Cardiovasc Intervent Radiol 2024; 47:101-108. [PMID: 38110753 DOI: 10.1007/s00270-023-03604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/23/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The number of fluoroscopically guided interventions (FGI) has increased significantly over time. However, little attention has been paid to possible stochastic radiation effects. The aim of this retrospective study was to investigate the number of patients who received cumulative effective doses over 100 mSv during FGI procedures. MATERIAL AND METHODS Five thousand five hundred and fifty four classified FGI procedures were included. Radiation dose data, retrieved from an in-house-dose-management system, was analysed. Effective doses and cumulative effective doses (CED) were calculated. Patients who received a CED > 100 mSv were identified. Radiology reports, patient age, imaging and clinical data of these patients were used to identify reasons for CED ≥ 100 mSv. RESULTS One Hundred and thirty two (41.1% female) of 3981 patients received a CED > 100 mSy, with a mean CED of 173.5 ± 84.5 mSv. Mean age at first intervention was 66.1 ± 11.7 years. 81 (61.4%) of 132 were older than 64 years, one patient was < 30 years. 110 patients received ≥ 100 mSv within one year (83.4%), through FGIs: EVAR, pelvic/mesenteric interventions (stent or embolization), hepatic interventions (chemoembolization, TIPSS), embolization of cerebral aneurysms or arterio-venous-malformations. CONCLUSIONS Substantial CED may occur in a small but not ignorable fraction of patients (~ 3%) undergoing FGIs. Approximately 2/3rd of patients may most likely not encounter radiation-related stochastic effects due to life-threatening diseases and age at first treatment > 65 years but 1/3rd may. Patients undergoing more than one FGI (77%) carry a higher risk of accumulating effective doses > 100 mSv. Remarkably, 23% received a mean CED 162.2 ± 72.3 mSv in a single procedure.
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Affiliation(s)
- Elke R Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
- Department of Radiology, Medical University Innsbruck, Anichstrasse. 35, 6020, Innsbruck, Austria
| | - Michael Verius
- Department of Radiology, Medical University Innsbruck, Anichstrasse. 35, 6020, Innsbruck, Austria.
| | - Madan M Rehani
- Global Outreach for Radiation Protection Program; Chair, Radiation Safety Committee, Massachusetts General Hospital, 175 Cambridge Street, Suite 244, Boston, MA, 02114, USA
| | - Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Anichstrasse. 35, 6020, Innsbruck, Austria
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Forbrig R, Ozpeynirci Y, Fischer TD, Trumm CG, Liebig T, Stahl R. Radiation Dose and Fluoroscopy Time of Extracranial Carotid Artery Stenting : Elective vs. Emergency Treatment Including Combined Mechanical Thrombectomy in Tandem Occlusion. Clin Neuroradiol 2023; 33:843-853. [PMID: 37261451 PMCID: PMC10449680 DOI: 10.1007/s00062-023-01288-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/24/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Fluoroscopically guided endovascular carotid artery stenting (CAS) of extracranial carotid stenosis (ECS) is a reasonable alternative to carotid endarterectomy in selected patients. Diagnostic reference levels (DRL) for this common neurointervention have not yet been defined and respective literature data are sparse. We provide detailed dosimetrics for useful expansion of the DRL catalogue. METHODS A retrospective single-center study of patients undergoing CAS between 2013 and 2021. We analyzed dose area product (DAP) and fluoroscopy time considering the following parameters: indications for CAS, semielective/elective versus emergency including additional mechanical thrombectomy (MT) in extracranial/intracranial tandem occlusion, etiology of ECS (atherosclerotic vs. radiation-induced), periprocedural features, e.g., number of applied stents, percutaneous transluminal angioplasty (PTA) and MT maneuvers, and dose protocol. Local DRL was defined as 75% percentile of the DAP distribution. RESULTS A total of 102 patients were included (semielective/elective CAS n = 75, emergency CAS n = 8, CAS + MT n = 19). Total median DAP was 78.2 Gy cm2 (DRL 117 Gy cm2). Lowest and highest median dosimetry values were documented for semielective/elective CAS and CAS + MT (DAP 49.1 vs. 146.8 Gy cm2, fluoroscopy time 27.1 vs. 43.8 min; p < 0.005), respectively. Dosimetrics were significantly lower in patients undergoing 0-1 PTA maneuvers compared to ≥ 2 maneuvers (p < 0.05). Etiology of ECS, number of stents and MT maneuvers had no significant impact on dosimetry values (p > 0.05). A low-dose protocol yielded a 33% reduction of DAP. CONCLUSION This CAS study suggests novel local DRLs for both elective and emergency cases with or without intracranial MT. A dedicated low-dose protocol was suitable for substantial reduction of radiation dose.
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Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas David Fischer
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph G. Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Stahl
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Kirisattayakul W, Pattum P, Munkong W, Prabsattroo T, Khottapat C, Chomkhunthod T, Pungkun V. Comparing Radiation Dose of Cerebral Angiography Using Conventional and High kV Techniques: A Retrospective Study on Intracranial Aneurysm Patients and a Phantom Study. Tomography 2023; 9:621-632. [PMID: 36961009 PMCID: PMC10037658 DOI: 10.3390/tomography9020050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
Evaluation of patient radiation dose after the implementation of a high kV technique during a cerebral angiographic procedure is an important issue. This study aimed to determine and compare the patient radiation dose of intracranial aneurysm patients undergoing cerebral angiography using the conventional and high kV techniques in a retrospective study and a phantom study. A total of 122 cases (61 cases with conventional technique and 61 cases with high kV technique) of intracranial aneurysm patients, who underwent cerebral angiographic procedure and met the inclusion criteria, were recruited. The radiation dose and the angiographic exposure parameters were reviewed retrospectively. The radiation dose in the phantom study was conducted using nanoDotTM optically stimulating luminescence (OSLD), which were placed on the scalp of the head phantom, the back of the neck, and the phantom skin at the position of the eyes. The standard cerebral angiographic procedure using the conventional and high kV techniques was performed following the standard protocol. The results showed that the high kV technique significantly reduced patient radiation dose and phantom skin dose. This study confirms that the implementation of a high kV technique in routine cerebral angiography for aneurysm diagnosis provides an effective reduction in radiation dose. Further investigation of radiation dose in other interventional neuroradiology procedures, particularly embolization procedure, should be performed.
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Affiliation(s)
- Woranan Kirisattayakul
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Panuwat Pattum
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Waranon Munkong
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Thawatchai Prabsattroo
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Chonnatcha Khottapat
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Tanyalak Chomkhunthod
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Vithit Pungkun
- Office of Atoms for Peace, Ministry of Higher Education, Science, Research and Innovation, Bangkok 10900, Thailand
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Opitz M, Zenk C, Zensen S, Bos D, Li Y, Styczen H, Oppong MD, Jabbarli R, Hagenacker T, Forsting M, Wanke I, Deuschl C. Radiation dose and fluoroscopy time of aneurysm coiling in patients with unruptured and ruptured intracranial aneurysms as a function of aneurysm size, location, and patient age. Neuroradiology 2023; 65:637-644. [PMID: 36418556 PMCID: PMC9905176 DOI: 10.1007/s00234-022-03092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Endovascular treatment of unruptured intracranial aneurysms (UIAs) requires a risk-benefit analysis and adherence to diagnostic reference levels (DRLs). The national DRL (250 Gy·cm2) is only determined for intracranial aneurysm coiling in general, including ruptured intracranial aneurysms (RIAs). This study aims to investigate the dose in the treatment of UIAs and RIAs separately. METHODS In a retrospective study design, dose area product (DAP) and fluoroscopy time (FT) were assessed for all patients undergoing intracranial aneurysm coiling between 2010 and 2021. DRL was set as the 75th percentile of the dose distribution. A multivariable linear regression analysis was performed to investigate DAP and FT for the two groups, UIA and RIA adjusted for patient age, aneurysm size, and location. RESULTS 583 (414 females, mean age 56.5 years, 311 UIAs) are included. In the overall population, DAP (median (IQR)) is 157 Gy·cm2 (108-217) with a median FT of 32.7 min (IQR 24.0-47.0). Local DRL is 183 Gy·cm2 for UIAs and 246 Gy·cm2 for RIAs. After adjustment for the other variables, the UIA and RIA groups have a significant effect on both DAP (p < 0.001; 95% CI - 68.432 - - 38.040) and FT (p < 0.001; 95% CI - 628.279 - - 291.254). In general, both DAP and FT increase significantly with patient age and aneurysm size, whereas the location of the aneurysm did not significantly change neither DAP (p = 0.171; 95% CI - 5.537-31.065) nor FT (p = 0.136; 95% CI - 357.391-48.508). CONCLUSION Both aneurysm size and patient age were associated with increased DAP, whereas aneurysm location did not significantly change DAP or FT. The increased dose in patients with RIAs is likely equivalent to additional diagnostic cerebral four-vessel angiography performed in this group.
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Affiliation(s)
- Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Celina Zenk
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Hanna Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery and Center for Translational Neuro- and Behavioral Science (C-TNBS), University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery and Center for Translational Neuro- and Behavioral Science (C-TNBS), University Hospital Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Science (C-TNBS), University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Department of Neuroradiology, Clinic Hirslanden, Zurich, Switzerland
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Tristram J, Steuwe A, Kröpil F, Thomas C, Rubbert C, Antoch G, Boos J. Typical doses and typical values for fluoroscopic diagnostic and interventional procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021510. [PMID: 35130526 DOI: 10.1088/1361-6498/ac5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
To implement typical doses (TD) and typical values (TV) for fluoroscopic diagnostic and interventional procedures. A total of 3811 fluoroscopic procedures performed within 34 months on three devices were included in this retrospective study. Dose-, patient- and procedure-related information were extracted using the institutional dose management system (DMS). TD/TV were defined as median dose and calculated for the five most frequent procedures per device for dose area product (DAP), cumulative air kerma (CAK) and fluoroscopy time (FT). National diagnostic reference levels and other single facility studies were compared to our results. Additionally, the five procedures with the highest doses of each device were analysed. To evaluate the data coverage of the DMS compared to the picture archiving and communication system (PACS), procedure lists were extracted from the PACS and compared to the procedure information extracted from the DMS. TD/TV for 15 procedures were implemented. Among all devices, TD for DAP ranged between 0.6 Gycm2for port catheter control (n= 64) and 145.9 Gycm2for transarterial chemoembolisation (n= 84). TD for CAK ranged between 5 mGy for port catheter control and 1397 mGy for aneurysm treatment (n= 129) and TV for FT ranged between 0.3 min for upper cavography (n= 67) and 51.4 min for aneurysm treatment. TD for DAP and CAK were lower or within the range of other single facility studies. The five procedures with the highest median DAP per device were identified, 6 of 15 procedures were also found to be among the most frequent procedures. Data coverage of the DMS compared to the PACS ranged between 71% (device 2, stroke treatment) and 78% (device 1, lower limb angiography) for the most common procedure per device. Thus, in 22%-29% of cases dose data of the performed procedure was not transferred into the DMS. We implemented TD/TV for fluoroscopic diagnostic and interventional procedures which enable a comprehensive dose analysis and comparison with previously published values.
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Affiliation(s)
- Juliana Tristram
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Andrea Steuwe
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Feride Kröpil
- Medical Faculty, Department of Surgery, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Christoph Thomas
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Christian Rubbert
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Johannes Boos
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
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Ki HJ, Kim BS, Kim JK, Choi JH, Shin YS, Choi Y, Shin NY, Jang J, Ahn KJ. Low-Dose Three-Dimensional Rotational Angiography for Evaluating Intracranial Aneurysms: Analysis of Image Quality and Radiation Dose. Korean J Radiol 2022; 23:256-263. [PMID: 35029071 PMCID: PMC8814704 DOI: 10.3348/kjr.2021.0162] [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] [Received: 07/17/2020] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to evaluate the image quality and dose reduction of low-dose three-dimensional (3D) rotational angiography (RA) for evaluating intracranial aneurysms. Materials and Methods We retrospectively evaluated the clinical data and 3D RA datasets obtained from 146 prospectively registered patients (male:female, 46:100; median age, 58 years; range, 19–81 years). The subjective image quality of 79 examinations obtained from a conventional method and 67 examinations obtained from a low-dose (5-seconds and 0.10-µGy/frame) method was assessed by two neurointerventionists using a 3-point scale for four evaluation criteria. The total image quality score was then obtained as the average of the four scores. The image quality scores were compared between the two methods using a noninferiority statistical testing, with a margin of -0.2 (i.e., score of low-dose group – score of conventional group). For the evaluation of dose reduction, dose-area product (DAP) and air kerma (AK) were analyzed and compared between the two groups. Results The mean total image quality score ± standard deviation of the 3D RA was 2.97 ± 0.17 by reader 1 and 2.95 ± 0.20 by reader 2 for conventional group and 2.92 ± 0.30 and 2.95 ± 0.22, respectively, for low-dose group. The image quality of the 3D RA in the low-dose group was not inferior to that of the conventional group according to the total image quality score as well as individual scores for the four criteria in both readers. The mean DAP and AK per rotation were 5.87 Gy-cm2 and 0.56 Gy, respectively, in the conventional group, and 1.32 Gy-cm2 (p < 0.001) and 0.17 Gy (p < 0.001), respectively, in the low-dose group. Conclusion Low-dose 3D RA was not inferior in image quality and reduced the radiation dose by 70%–77% compared to the conventional 3D RA in evaluating intracranial aneurysms.
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Affiliation(s)
- Hee Jong Ki
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Jun-Ki Kim
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jai Ho Choi
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yangsean Choi
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Na-Young Shin
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jinhee Jang
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kook-Jin Ahn
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Malan L, Pitcher RD, da Silva M, Breuninger S, Groenewald W. Diagnostic reference levels for fluoroscopically guided procedures in a South African tertiary hospital. Acta Radiol 2021; 62:807-814. [PMID: 32640888 DOI: 10.1177/0284185120938371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burgeoning usage and complexity of fluoroscopically guided procedures (FGPs) contribute to extended examination times and increased risk of adverse radiation effects. Diagnostic reference levels (DRLs) play a pivotal role in dose optimization. There are limited DRL data for FGPs in low- and middle-income countries (LMICs). PURPOSE To determine local DRLs (LDRLs) for common FGPs in the South African (SA) context and compare these with published international data. MATERIAL AND METHODS A three-year, retrospective study of the 15 most frequently performed FGPs at a SA institution. For each procedure, the 50th and 75th percentiles of kerma area product (KAP), reference point air kerma (Ka,r), and fluoroscopy time data were derived. Published international FGP DRL data were collated and compared with the 75th percentiles of local institutional dosage parameters. RESULTS The commonest FGPs were aorto-bifemoral diagnostic angiography (n = 590), aorto-bifemoral interventional angiography (n = 287), nephrostomy (n = 265), and bronchial arterial embolization (BAE) (n = 208). Selective abdominal vessel interventional angiography (KAP = 170 Gy . cm2; Ka,r = 877 mGy) recorded the highest LDRL dosages; BAE was the longest procedure (LDRL = 38 min). Nephrostomies achieved the lowest LDRLs across all parameters (KAP = 10 Gy . cm2; Ka,r = 63 mGy, fluoroscopy time = 4.3 min). All Tygerberg Hospital LDRLs with comprehensive comparable data were within or below published ranges. CONCLUSION This study advances international radiation protection initiatives, addresses the paucity of LMIC DRL data, demonstrates broad alignment of Tygerberg Hospital FGP practice with international norms and highlights areas for optimization of institutional practice.
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Affiliation(s)
- Leon Malan
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Richard D Pitcher
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Michelle da Silva
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Sharlene Breuninger
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Wilhelm Groenewald
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
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Peter Y, Speelman A, Daries V. Measurement of the average radiation dose to the local skin and thyroid gland during intracranial aneurysm coil embolization. Radiography (Lond) 2021; 27:255-259. [DOI: 10.1016/j.radi.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/07/2023]
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Forbrig R, Stahl R, Geyer LL, Ozpeynirci Y, Liebig T, Trumm CG. Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae. Clin Neuroradiol 2020; 31:1149-1157. [PMID: 33313974 PMCID: PMC8648699 DOI: 10.1007/s00062-020-00982-3] [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: 09/30/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022]
Abstract
Purpose Intracranial lateral dural arteriovenous fistula (LDAVF) represents a specific subtype of cerebrovascular fistulae, harboring a potentially life-threatening risk of brain hemorrhage. Fluoroscopically guided endovascular embolization is the therapeutic gold standard. We provide detailed dosimetry data to suggest novel diagnostic reference levels (DRL). Methods Retrospective single-center study of LDAVFs treated between January 2014 and December 2019. Regarding dosimetry, the dose area product (DAP) and fluoroscopy time were analyzed for the following variables: Cognard scale grade, endovascular technique, angiographic outcome, and digital subtraction angiography (DSA) protocol. Results A total of 70 patients (19 female, median age 65 years) were included. Total median values for DAP and fluoroscopy time were 325 Gy cm2 (25%/75% percentile: 245/414 Gy cm2) and 110 min (68/142min), respectively. Neither median DAP nor fluoroscopy time were significantly different when comparing low-grade with high-grade LDAVF (Cognard I + IIa versus IIb–V; p > 0.05, each). Transvenous coil embolization yielded the lowest dosimetry values, with significantly lower median values when compared to a combined transarterial/transvenous technique (DAP 290 Gy cm2 versus 388 Gy cm2, p = 0.031; fluoroscopy time 85 min versus 170 min, p = 0.016). A significant positive correlation was found between number of arterial feeders treated by liquid embolization and both DAP (rs = 0.367; p = 0.010) and fluoroscopy time (rs = 0.295; p = 0.040). Complete LDAVF occlusion was associated with transvenous coiling (p = 0.001). A low-dose DSA protocol yielded a 20% reduction of DAP (p = 0.021). Conclusion This LDAVF study suggests several local DRLs which varied substantially dependent on the endovascular technique and DSA protocol.
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Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Robert Stahl
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Lucas L. Geyer
- 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
| | - 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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High-Dose Fluoroscopically Guided Procedures in Patients: Radiation Management Recommendations for Interventionalists. Cardiovasc Intervent Radiol 2020; 44:849-856. [PMID: 33184693 DOI: 10.1007/s00270-020-02703-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/31/2020] [Indexed: 12/19/2022]
Abstract
The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. In addition to the risks from fluoroscopic-guided interventional procedures of tissue injuries, recent studies have drawn attention to the risk of stochastic effects. Guidelines exist for preprocedural planning and radiation management during the procedure. The concept of a substantial radiation dose level (SRDL) is helpful for patient follow-up for tissue injury. The uncommon nature of tissue injuries requires the interventionalist to be responsible for follow-up of patients who receive substantial radiation doses. Dose management systems for recognizing and avoiding higher patient exposures have been introduced. The European Directive provides a legal framework and requirements for equipment, training, dose monitoring, recording and optimization that are helpful in radiation risk management.
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Investigating the parameters that affect the radiation exposure and establishing typical values based on procedure complexity for cerebral angiography and brain aneurysm embolization. Neuroradiology 2020; 63:787-794. [PMID: 33057746 DOI: 10.1007/s00234-020-02580-z] [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: 06/17/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to investigate the parameters that affect the radiation exposure and to establish typical values (TV) based on procedure complexity for cerebral angiography (CA) and brain aneurysm embolization (BAE). METHODS Clinical parameters and exposure data were retrospectively reviewed for 348 examinations performed between March 2016 and December 2019 at a single specialized neuroradiology center. TV were derived as the median value of the distribution of exposure parameters such as total air kerma area product (PKA,T), air kerma at the patient entrance reference point, fluoroscopy time, and number of frames. A statistical analysis was conducted to investigate the exposure variability with patient's gender, number of treated vessels during CA and patient gender, aneurysm location and dimension, and treatment strategies during BAE. RESULTS Patient gender was associated with a significant increase in the exposure level for both CA and BAE. For CA, TV were in term of PKA,T of 52 Gycm2 for male vs. 28 Gycm2 for female patients. For BAE, these were 113 Gycm2 for male vs. 75 Gycm2 for female patients. Exposure levels increased significantly with the number of treated vessels in CA. TV were 20 Gycm2 for one vessel vs. 77 Gycm2 for 5-6 vessels CA. For BAE, aneurysm location was also a key factor that affects the patient exposure. TV were 55 Gycm2 for aneurysms grouped in location 1 vs. 105 Gycm2 for those grouped in location 2. CONCLUSION Male gender, number of treated vessels, and aneurysm location are key parameters affecting patient exposure during CA and BAE procedures.
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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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Hashimoto Y, Matsushige T, Ogawa T, Sakuragouchi H, Shimonaga K, Takahashi H, Yoshiyama M, Ono C, Sakamoto S. Impact of Cone-Beam Computed Tomography Angiography on Visualization of Sylvian Veins. World Neurosurg 2020; 143:e206-e214. [PMID: 32712404 DOI: 10.1016/j.wneu.2020.07.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND A detailed understanding of the anatomy of Sylvian veins preoperatively is needed for venous-preserving Sylvian dissection. Better visualization of the venous architecture will facilitate surgical strategies for Sylvian dissection. This study evaluated and compared the image quality of the Sylvian veins and their tributaries using high-resolution cone-beam computed tomography angiography (CBCT-A) and three-dimensional computed tomography angiography (3D-CTA). METHODS Twenty-four patients who underwent 3D-CTA and CBCT-A as a preoperative simulation for clipping of unruptured intracranial aneurysms were retrospectively reviewed. In comparisons with intraoperative inspections, 3 raters evaluated the image quality of the Sylvian veins by 3D-CTA and CBCT-A with a 5-point scale. Visualization of the Sylvian veins and their tributaries by the 2 imaging modalities was compared using Wilcoxon signed rank test. RESULTS CBCT-A showed superior image quality to 3D-CTA in evaluations of the discrimination of adjacent superficial Sylvian veins (2.8 ± 0.80 vs. 4.6 ± 0.37, P < 0.0001), adjacent Sylvian veins at the sphenoid wing (3.1 ± 0.71 vs. 4.1 ± 0.56, P = 0.0001), and visualization of the tributaries of the Sylvian veins (2.5 ± 0.70 vs. 4.4 ± 0.37, P < 0.0001). CONCLUSIONS CBCT-A was superior to 3D-CTA for visualizing the Sylvian veins and their tributaries. CBCT-A will provide important information on the anatomy of the Sylvian veins preoperatively.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Taichi Ogawa
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hiroki Takahashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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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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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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17
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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: 13] [Impact Index Per Article: 2.6] [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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18
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Choi DH, Yoo CJ, Park CW, Kim MJ. Practical Dose Parameter Values for the Prediction of the Adverse Effect of Neurointerventional Radiation: Relationship Between the Dose Parameters and Temporary Alopecia After Intracranial Coil Embolization. World Neurosurg 2019; 130:e222-e229. [PMID: 31203064 DOI: 10.1016/j.wneu.2019.06.039] [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: 04/26/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To present values for the dose parameters predictive of alopecia as an adverse effect induced by neuroembolization using a biplane fluoroscopy. METHODS This study included a total of 151 patients (52 men, mean age of 55.1 ± 12.2 years) treated for intracranial neuroembolization between 2014 to 2018 with the following criteria: 1) obtainable dose report with digital subtraction angiographic image records, 2) no history of radiation exposure 6 months prior to the first procedure, and 3) and clinical follow-up performed through 12 months following the procedure. Patients were divided into 2 groups according to their presentation of alopecia during the follow-up period. RESULTS Eighteen (11.9%) patients developed alopecia 10 to 30 days after the procedure (average: 18.5 ± 5.3 days). Sixteen (88.9%) patients in the alopecia group were affected by projection of the A-plane fluoroscopy. Area under the receiver operating characteristic analysis curves of 0.865 (P = 0.000) and 0.831 (P = 0.000) were used to compute the optimal A-plane dose area product (255.4 Gy-cm2; sensitivity: 0.875; specificity: 0.805; Youden J = 0.682) and cumulative dose (4437.5 mGy; sensitivity, 0.750; specificity, 0.805; Youden J = 0.556) cutoff values, respectively, capable of distinguishing patients with alopecia (n = 16) from subtotal patients (n = 149). CONCLUSIONS The dose area product and the cumulative dose may be useful, intuitive factors for predicting the adverse effects of the neurointerventional radiation. Further multicenter research should be performed to confirm the efficacy and utility of the reference values of dose area product and cumulative dose for preventing excessive irradiation during neurointerventional procedures.
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Affiliation(s)
- Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chan Jong Yoo
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Cheol Wan Park
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Myeong Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
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Choi J, Kim B, Choi Y, Shin NY, Jang J, Choi HS, Jung SL, Ahn KJ. Image Quality of Low-Dose Cerebral Angiography and Effectiveness of Clinical Implementation on Diagnostic and Neurointerventional Procedures for Intracranial Aneurysms. AJNR Am J Neuroradiol 2019; 40:827-833. [PMID: 30948380 DOI: 10.3174/ajnr.a6029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Awareness of the potential for exposure to high doses of radiation from interventional radiologic procedures has increased. The purpose of this study was to evaluate image quality and dose reduction of low-dose cerebral angiography during diagnostic and therapeutic procedures for intracranial aneurysms. MATERIALS AND METHODS A retrospective review of 1137 prospectively collected patients between January 2012 and June 2014 was performed. Beginning in April 2013, a dose-reduction strategy was implemented. Subjective image-quality assessment of 506 standard and 540 low-dose cerebral angiography images was performed by 2 neuroradiologists using a 5-point scale and was tested using noninferiority statistics. Radiation dose-area product and air kerma of 1046 diagnostic and 317 therapeutic procedures for intracranial aneurysms were analyzed and compared between groups before (group 1) and after (group 2) clinical implementation of a dose-reduction strategy. RESULTS The image quality of the low-dose cerebral angiography was not inferior on the basis of results from the 2 readers. For diagnostic cerebral angiography, the mean dose-area product and air kerma were 140.8 Gy×cm2 and 1.0 Gy, respectively, in group 1 and 82.0 Gy×cm2 and 0.6 Gy in group 2 (P < .001, P < .001). For the neurointerventional procedure, the mean dose-area product and air kerma were 246.0 Gy×cm2 and 3.7 Gy, respectively, in group 1 and 169.8 Gy×cm2 and 3.3 Gy in group 2 (P < .001, P = .291). CONCLUSIONS With low-dose cerebral angiography, image quality was maintained, and implementation of dose-reduction strategies reduced radiation doses in patients undergoing diagnostic and neurointerventional procedures for intracranial aneurysms.
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Affiliation(s)
- J Choi
- From the Department of Radiology (J.C.), St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - B Kim
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Y Choi
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - N Y Shin
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - J Jang
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H S Choi
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S L Jung
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K J Ahn
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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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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Borota L, Jangland L, Åslund PE, Ronne-Engström E, Nyberg C, Mahmoud E, Sakaguchi T, Patz A. Spot fluoroscopy: a novel innovative approach to reduce radiation dose in neurointerventional procedures. Acta Radiol 2017; 58:600-608. [PMID: 27522095 PMCID: PMC5347367 DOI: 10.1177/0284185116658682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Increased interest in radiation dose reduction in neurointerventional procedures has led to the development of a method called “spot fluoroscopy” (SF), which enables the operator to collimate a rectangular or square region of interest anywhere within the general field of view. This has potential advantages over conventional collimation, which is limited to symmetric collimation centered over the field of view. Purpose To evaluate the effect of SF on the radiation dose. Material and Methods Thirty-five patients with intracranial aneurysms were treated with endovascular coiling. SF was used in 16 patients and conventional fluoroscopy in 19. The following parameters were analyzed: the total fluoroscopic time, the total air kerma, the total fluoroscopic dose-area product, and the fluoroscopic dose-area product rate. Statistical differences were determined using the Welch’s t-test. Results The use of SF led to a reduction of 50% of the total fluoroscopic dose-area product (CF = 106.21 Gycm2, SD = 99.06 Gycm2 versus SF = 51.80 Gycm2, SD = 21.03 Gycm2, p = 0.003884) and significant reduction of the total fluoroscopic dose-area product rate (CF = 1.42 Gycm2/min, SD = 0.57 Gycm2/s versus SF = 0.83 Gycm2/min, SD = 0.37 Gycm2/min, p = 0.00106). The use of SF did not lead to an increase in fluoroscopy time or an increase in total fluoroscopic cumulative air kerma, regardless of collimation. Conclusion The SF function is a new and promising tool for reduction of the radiation dose during neurointerventional procedures.
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Affiliation(s)
- Ljubisa Borota
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Jangland
- Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Per-Erik Åslund
- Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | | | | | - Ehab Mahmoud
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Andreas Patz
- Toshiba Medical systems Europe, BV, Zoetermeer, the Netherlands
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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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van der Marel K, Vedantham S, van der Bom IMJ, Howk M, Narain T, Ty K, Karellas A, Gounis MJ, Puri AS, Wakhloo AK. Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform. AJNR Am J Neuroradiol 2017; 38:442-449. [PMID: 28104643 DOI: 10.3174/ajnr.a5049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose-reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings. MATERIALS AND METHODS In this single-center, retrospective study, cumulative dose-area product inclusive of fluoroscopy, angiography, and 3D acquisitions for all neurovascular procedures performed during a 2-year period on the dose-reduction platform were compared with a reference platform. Key study features were the following: The neurointerventional radiologist could select the targeted dose reduction for each patient with the dose-reduction platform, and the statistical analyses included patient characteristics and the neurointerventional radiologist as covariates. The analyzed outcome measures were cumulative dose (kerma)-area product, fluoroscopy duration, and administered contrast volume. RESULTS A total of 1238 neurointerventional cases were included, of which 914 and 324 were performed on the reference and dose-reduction platforms, respectively. Over all diagnostic and neurointerventional procedures, the cumulative dose-area product was significantly reduced by 53.2% (mean reduction, 160.3 Gy × cm2; P < .0001), fluoroscopy duration was marginally significantly increased (mean increase, 5.2 minutes; P = .0491), and contrast volume was nonsignificantly increased (mean increase, 15.3 mL; P = .1616) with the dose-reduction platform. CONCLUSIONS A significant reduction in patient radiation dose is achievable during neurovascular procedures by using dose-reduction technology with a minimal impact on workflow.
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Affiliation(s)
- K van der Marel
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - S Vedantham
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - M Howk
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - T Narain
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - K Ty
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A Karellas
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - M J Gounis
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A S Puri
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A K Wakhloo
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
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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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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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Ihn YK, Kim BS, Byun JS, Suh SH, Won YD, Lee DH, Kim BM, Kim YS, Jeon P, Ryu CW, Suh SI, Choi DS, Choi SS, Choi JW, Chang HW, Lee JW, Kim SH, Lee YJ, Shin SH, Lim SM, Yoon W, Jeong HW, Han MH. Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study. Neurointervention 2016; 11:78-85. [PMID: 27621943 PMCID: PMC5018552 DOI: 10.5469/neuroint.2016.11.2.78] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL). MATERIALS AND METHODS We studied a sample of 490 diagnostic and 371 therapeutic procedures for intracranial aneurysms, which were performed at 23 hospitals in Korea in 2015. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time and total angiographic image frames were obtained and analyzed. RESULTS Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were 106.2 ± 66.4 Gy-cm(2), 697.1 ± 473.7 mGy, 9.7 ± 6.5 minutes, 241.5 ± 116.6 frames for diagnostic procedures, 218.8 ± 164.3 Gy-cm(2), 3365.7 ± 2205.8 mGy, 51.5 ± 31.1 minutes, 443.5 ± 270.7 frames for therapeutic procedures, respectively. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm(2) for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm(2) for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively. On average, rotational angiography was used 1.5 ± 0.7 times/session (range, 0-4; n=490) for diagnostic procedures and 1.6 ± 1.2 times/session (range, 0-4; n=368) for therapeutic procedures, respectively. CONCLUSION Radiation dose as measured by DAP, fluoroscopy time and image frames were lower in our patients compared to another study regarding cerebral angiography, and DAP was lower with fewer angiographic image frames for therapeutic procedures. Proposed DRLs can be used for quality assurance and patient safety in diagnostic and therapeutic procedures.
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Affiliation(s)
- Yon Kwon Ihn
- Department of Radiology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Yoo Dong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei Unviersity College of Medicine, Seoul, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Korea
| | - Pyong Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Gyeonggi-do, Korea
| | - Hyuk Won Chang
- Department of Radiology, Keimyung University College of Medicine, Dongsan Medical Center, Daegu, Korea
| | - Jae-Wook Lee
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea
| | - Sang Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Korea
| | - Young Jun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Shang Hun Shin
- Department of Radiology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Hernández-Girón I, Mourik JEM, Overvelde ML, Veldkamp WJH, Zweers D, Geleijns J. MULTICENTRE COMPARISON OF IMAGE QUALITY FOR LOW-CONTRAST OBJECTS AND MICROCATHETER TIPS IN X-RAY-GUIDED TREATMENT OF ARTERIOVENOUS MALFORMATION IN THE BRAIN. RADIATION PROTECTION DOSIMETRY 2016; 169:325-330. [PMID: 26622041 DOI: 10.1093/rpd/ncv481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The treatment of brain arteriovenous malformations (AVMs) can be performed as a minimally invasive X-ray-guided procedure using a microcatheter for navigation to reach the target site. The performance of the interventional vascular surgery devices used for AVM was compared in four hospitals. The relation between image quality and the entrance surface air kerma (ESAK) was assessed for the default protocols for digital subtraction angiography (DSA) and fluoroscopy. A custom phantom, built with PMMA and aluminium plates was used to mimic the attenuation properties of the patient head. Image quality was assessed using low-contrast objects and catheters embedded in two phantoms. Differences were found in the ESAK values, especially for the fluoroscopy, whereas for DSA, the ESAK values were similar. The differences in image quality can be related to acquisition parameters, such as kV and filtration, and post-processing. The proposed method can be used to optimise the existing AVM protocols.
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Affiliation(s)
- I Hernández-Girón
- Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - J E M Mourik
- Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands Radiology Department and Nuclear Medicine, Sint Franciscus Vlietland Group, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
| | - M L Overvelde
- Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands
| | - W J H Veldkamp
- Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - D Zweers
- Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - J Geleijns
- Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Sánchez RM, Vañó E, Fernández JM, Rosati S, López-Ibor L. Radiation Doses in Patient Eye Lenses during Interventional Neuroradiology Procedures. AJNR Am J Neuroradiol 2016; 37:402-7. [PMID: 26542238 PMCID: PMC7960141 DOI: 10.3174/ajnr.a4549] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/06/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Eye lenses are among the most sensitive organs to x-ray radiation and may be considered at risk during neurointerventional radiology procedures. The threshold dose to produce eye lens opacities has been recently reduced to 500 mGy by the International Commission on Radiologic Protection. In this article, the authors investigated the radiation doses delivered to patients' eyes during interventional neuroradiology procedures at a university hospital. MATERIALS AND METHODS Small optically stimulated luminescence dosimeters were located over patients' eyes during 5 diagnostic and 31 therapeutic procedures performed in a biplane x-ray system. Phantom measurements were also made to determine the level of radiation to the eye during imaging runs with conebeam CT. RESULTS The left eye (located toward the lateral C-arm x-ray source) received a 4.5 times greater dose than the right one. The average dose during embolization in the left eye was 300 mGy, with a maximum of 2000 mGy in a single procedure. The patient who received this maximum eye dose needed 6 embolization procedures to treat his high-volume AVM. If one took into account those 6 embolizations, the eye dose could be 2-fold. Sixteen percent of the embolizations resulted in eye doses of >500 mGy. CONCLUSIONS A relevant fraction of patients received eye doses exceeding the threshold of 500 mGy. A careful optimization of the procedures and follow-up of these patients to evaluate potential lens opacities should be considered.
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Affiliation(s)
- R M Sánchez
- From the Departments of Physics (R.M.S., E.V., J.M.F.)
| | - E Vañó
- From the Departments of Physics (R.M.S., E.V., J.M.F.) Department of Radiology (E.V., J.M.F.), Universidad Complutense de Madrid, Madrid, Spain
| | - J M Fernández
- From the Departments of Physics (R.M.S., E.V., J.M.F.) Department of Radiology (E.V., J.M.F.), Universidad Complutense de Madrid, Madrid, Spain
| | - S Rosati
- Neuroradiology (S.R., L.L.-I.), Hospital Clínico San Carlos, Madrid, Spain
| | - L López-Ibor
- Neuroradiology (S.R., L.L.-I.), Hospital Clínico San Carlos, Madrid, Spain
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Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures. AJR Am J Roentgenol 2015; 204:W713-9. [PMID: 26001261 DOI: 10.2214/ajr.14.13630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of our study was to survey radiation dose indexes of pediatric peripheral and abdominal fluoroscopically guided procedures from which estimates of diagnostic reference levels (DRLs) can be proposed for both a standard fluoroscope and a novel fluoroscope with advanced image processing and lower radiation dose rates. MATERIALS AND METHODS Radiation dose structured reports were retrospectively collected for 408 clinical pediatric cases: Half of the procedures were performed with a standard imaging technology and half with a novel x-ray technology. Dose-area product (DAP), air Kerma (AK), fluoroscopy time, number of digital subtraction angiography images, and patient mass were collected to calculate and normalize radiation dose indexes for procedures completed with the standard and novel fluoroscopes. RESULTS The study population was composed of 180 and 175 patients who underwent procedures with the standard and novel technology, respectively. The 21 different types of pediatric peripheral and abdominal interventional procedures produced 408 total studies. Median ages, mass and body mass index, fluoroscopy time per procedure, and total number of recorded images for the standard and novel technologies were not statistically different. The area of the x-ray beams was square at the level of the patient with a dimension of 10-13 cm. The dose reduction achieved with the novel fluoroscope ranged from 18% to 51% of the dose required with the standard fluoroscope. The median DAP and AK patient dose indexes were 0.38 Gy · cm(2) and 4.00 mGy, respectively, for the novel fluoroscope. CONCLUSION Estimates of dose indexes of pediatric peripheral and abdominal fluoroscopically guided, clinical procedures should assist in the development of DRLs to foster management of radiation doses of pediatric patients.
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Chun CW, Kim BS, Lee CH, Ihn YK, Shin YS. Patient radiation dose in diagnostic and interventional procedures for intracranial aneurysms: experience at a single center. Korean J Radiol 2014; 15:844-9. [PMID: 25469098 PMCID: PMC4248642 DOI: 10.3348/kjr.2014.15.6.844] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/05/2014] [Indexed: 11/15/2022] Open
Abstract
Objective To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms in a large sample size from a single center. Materials and Methods We studied a sample of 439 diagnostic and 149 therapeutic procedures for intracranial aneurysms in 480 patients (331 females, 149 males; median age, 57 years; range, 21-88 years), which were performed in 2012 with a biplane unit. Parameters including fluoroscopic time, dose-area product (DAP), and total angiographic image frames were obtained and analyzed. Results Mean fluoroscopic time, total mean DAP, and total image frames were 12.6 minutes, 136.6 ± 44.8 Gy-cm2, and 251 ± 49 frames for diagnostic procedures, 52.9 minutes, 226.0 ± 129.2 Gy-cm2, and 241 frames for therapeutic procedures, and 52.2 minutes, 334.5 ± 184.6 Gy-cm2, and 408 frames for when both procedures were performed during the same session. The third quartiles for diagnostic reference levels (DRLs) were 14.0, 61.1, and 66.1 minutes for fluoroscopy time, 154.2, 272.8, and 393.8 Gy-cm2 for DAP, and 272, 276, and 535 for numbers of image frames in diagnostic, therapeutic, and both procedures in the same session, respectively. The proportions of fluoroscopy in DAP for the procedures were 11.4%, 50.5%, and 36.1%, respectively, for the three groups. The mean DAP for each 3-dimensional rotational angiographic acquisition was 19.2 ± 3.2 Gy-cm2. On average, rotational angiography was used 1.4 ± 0.6 times/session (range, 1-4; n = 580). Conclusion Radiation dose in our study as measured by DAP, fluoroscopy time and image frames did not differ significantly from other reported DRL studies for cerebral angiography, and DAP was lower with fewer angiographic image frames for embolization. A national registry of radiation-dose data is a necessary next step to refine the dose reference level.
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Affiliation(s)
- Chang Woo Chun
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Cheol Hyoun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Yon Kwon Ihn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
| | - Yong-Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea
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Local diagnostic reference levels for angiographic and fluoroscopic procedures: Australian practice. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2014; 37:75-82. [DOI: 10.1007/s13246-014-0244-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
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Söderman M, Holmin S, Andersson T, Palmgren C, Babić D, Hoornaert B. Image Noise Reduction Algorithm for Digital Subtraction Angiography: Clinical Results. Radiology 2013; 269:553-60. [DOI: 10.1148/radiol.13121262] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Söderman M, Mauti M, Boon S, Omar A, Marteinsdóttir M, Andersson T, Holmin S, Hoornaert B. Radiation dose in neuroangiography using image noise reduction technology: a population study based on 614 patients. Neuroradiology 2013; 55:1365-72. [PMID: 24005833 PMCID: PMC3825538 DOI: 10.1007/s00234-013-1276-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/15/2013] [Indexed: 11/04/2022]
Abstract
Introduction The purpose of this study was to quantify the reduction in patient radiation dose by X-ray imaging technology using image noise reduction and system settings for neuroangiography and to assess its impact on the working habits of the physician. Methods Radiation dose data from 190 neuroangiographies and 112 interventional neuroprocedures performed with state-of-the-art image processing and reference system settings were collected for the period January–June 2010. The system was then configured with extra image noise reduction algorithms and system settings, which enabled radiation dose reduction without loss of image quality. Radiation dose data from 174 neuroangiographies and 138 interventional neuroprocedures were collected for the period January–June 2012. Procedures were classified as diagnostic or interventional. Patient radiation exposure was quantified using cumulative dose area product and cumulative air kerma. Impact on working habits of the physician was quantified using fluoroscopy time and number of digital subtraction angiography (DSA) images. Results The optimized system settings provided significant reduction in dose indicators versus reference system settings (p<0.001): from 124 to 47 Gy cm2 and from 0.78 to 0.27 Gy for neuroangiography, and from 328 to 109 Gy cm2 and from 2.71 to 0.89 Gy for interventional neuroradiology. Differences were not significant between the two systems with regard to fluoroscopy time or number of DSA images. Conclusion X-ray imaging technology using an image noise reduction algorithm and system settings provided approximately 60% radiation dose reduction in neuroangiography and interventional neuroradiology, without affecting the working habits of the physician.
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Affiliation(s)
- Michael Söderman
- Department of Clinical Neuroscience, Karolinska Institute and Department of Neuroradiology, Karolinska University Hospital - Solna, Stockholm, 17176, Sweden,
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Vano E, Fernandez JM, Sanchez RM, Martinez D, Ibor LL, Gil A, Serna-Candel C. Patient radiation dose management in the follow-up of potential skin injuries in neuroradiology. AJNR Am J Neuroradiol 2013; 34:277-82. [PMID: 22859286 PMCID: PMC7965086 DOI: 10.3174/ajnr.a3211] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 04/29/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiation exposure from neurointerventional procedures can be substantial, with risk of radiation injuries. We present the results of a follow-up program applied to potential skin injuries in interventional neuroradiology based on North American and European guidelines. MATERIALS AND METHODS The following guidelines approved in 2009 by SIR and CIRSE have been used over the last 2 years to identify patients with potential skin injuries requiring clinical follow-up: peak skin dose >3 Gy, air kerma at the patient entrance reference point >5 Gy, kerma area product >500 Gy · cm(2), or fluoroscopy time >60 minutes. RESULTS A total of 708 procedures (325 in 2009 and 383 in 2010) were included in the study. After analyzing each dose report, 19 patients (5.9%) were included in a follow-up program for potential skin injuries in 2009, while in 2010, after introducing several optimizing actions and refining the selection criteria, only 4 patients (1.0%) needed follow-up. Over the last 2 years, only 3 patients required referral to a dermatology service. CONCLUSIONS The application of the guidelines to patient radiation dose management helped standardize the selection criteria for including patients in the clinical follow-up program of potential skin radiation injuries. The peak skin dose resulted in the most relevant parameter. The refinement of selection criteria and the introduction of a low-dose protocol in the x-ray system, combined with a training program focused on radiation protection, reduced the number of patients requiring clinical follow-up.
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Affiliation(s)
- E Vano
- Medical Physics Service and Radiology Department, Instituto de Investigación Sanitaria Hospital Clinico San Carlos and Complutense University, Madrid, Spain.
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