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Moorthy G, Bush L, Zimmerman A, Jha S. Laws That Have Shaped Radiology: Part I. Acad Radiol 2024:S1076-6332(24)00617-2. [PMID: 39294056 DOI: 10.1016/j.acra.2024.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/20/2024]
Abstract
Radiology began as a translation of quantum physics to clinical medicine. Advances in computing and engineering enabled the differentiation of the field into diagnostic radiology, interventional radiology, and radiation oncology as practical responses to rapidly proliferating medical knowledge. Radiology has itself transformed modern medicine, helping clinicians identify, track, and intervene on multiple once deadly diseases. It is practiced in academic departments and hospital based, outpatient center based, or fully remote private groups of varying sizes, often with direct physicist support to optimize the use of complicated equipment. Importantly, radiology was guided to its current form not just by scientific advances, but by the interplay of cultural and governmental forces, as well as hard lessons, the results of constantly shifting balances of competing interests as follows: insurance, pharmaceutical, medical device, hospital, physician, physician extender, and patient. The purpose of this review is to describe the historical legal landscape of diagnostic radiology in the context of ethics, public health initiatives, and patient protections. For clarity, the review is divided into two parts.
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Affiliation(s)
- Gyan Moorthy
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA (G.M., L.B.).
| | - Leah Bush
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA (G.M., L.B.)
| | - Anne Zimmerman
- Program in Bioethics, Columbia University School of Professional Studies, New York, New York 10027, USA (A.Z.)
| | - Saurabh Jha
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA (S.J.)
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Fitton I, Tsapaki V, Zerbib J, Decoux A, Kumar A, Stembert A, Malchair F, Van Ngoc Ty C, Fournier L. Two-Dimensional Mammography Imaging Techniques for Screening Women with Silicone Breast Implants: A Pilot Phantom Study. Bioengineering (Basel) 2024; 11:884. [PMID: 39329625 PMCID: PMC11429089 DOI: 10.3390/bioengineering11090884] [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: 07/10/2024] [Revised: 08/19/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
This study aimed to evaluate the impact of three two-dimensional (2D) mammographic acquisition techniques on image quality and radiation dose in the presence of silicone breast implants (BIs). Then, we propose and validate a new International Atomic Energy Agency (IAEA) phantom to reproduce these techniques. Images were acquired on a single Hologic Selenia Dimensions® unit. The mammography of the left breast of a single clinical case was included. Three methods of image acquisition were identified. They were based on misused, recommended, and reference settings. In the clinical case, image criteria scoring and the signal-to-noise ratio on breast tissue (SNRBT) were determined for two 2D projections and compared between the three techniques. The phantom study first compared the reference and misused settings by varying the AEC sensor position and, second, the recommended settings with a reduced current-time product (mAs) setting that was 13% lower. The signal-difference-to-noise ratio (SDNR) and detectability indexes at 0.1 mm (d' 0.1 mm) and 0.25 mm (d' 0.25 mm) were automatically quantified using ATIA software. Average glandular dose (AGD) values were collected for each acquisition. A statistical analysis was performed using Kruskal-Wallis and corrected Dunn tests (p < 0.05). The SNRBT was 2.6 times lower and the AGD was -18% lower with the reference settings compared to the recommended settings. The SNRBT values increased by +98% with the misused compared to the recommended settings. The AGD increased by +79% with the misused settings versus the recommended settings. The median values of the reference settings were 5.8 (IQR 5.7-5.9), 1.2 (IQR 0.0), 7.0 (IQR 6.8-7.2) and 1.2 (IQR 0.0) mGy and were significantly lower than those of the misused settings (p < 0.03): 7.9 (IQR 6.1-9.7), 1.6 (IQR 1.3-1.9), 9.2 (IQR 7.5-10.9) and 2.2 (IQR 1.4-3.0) mGy for the SDNR, d' 0.1 mm, d' 0.25 mm and the AGD, respectively. A comparison of the recommended and reduced settings showed a reduction of -6.1 ± 0.6% (p = 0.83), -7.7 ± 0.0% (p = 0.18), -6.4 ± 0.6% (p = 0.19) and -13.3 ± 1.1% (p = 0.53) for the SDNR, d' 0.1 mm, d' 0.25 mm and the AGD, respectively. This study showed that the IAEA phantom could be used to reproduce the three techniques for acquiring 2D mammography images in the presence of breast implants for raising awareness and for educational purposes. It could also be used to evaluate and optimize the manufacturer's recommended settings.
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Affiliation(s)
- Isabelle Fitton
- Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France; (J.Z.); (C.V.N.T.)
| | - Virginia Tsapaki
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, 1220 Vienna, Austria;
| | - Jonathan Zerbib
- Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France; (J.Z.); (C.V.N.T.)
| | - Antoine Decoux
- Paris Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale Unité 970, 75015 Paris, France
| | - Amit Kumar
- OKOMERA, iPEPS, The Healthtech Hub, 75013 Paris, CEDEX 13, France;
| | | | | | - Claire Van Ngoc Ty
- Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France; (J.Z.); (C.V.N.T.)
| | - Laure Fournier
- Department of Radiology, PARCC UMRS 970, INSERM, Hôpital Européen Georges Pompidou, Université Paris Cité, AP-HP, 75015 Paris, France;
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Kleefeld C, Castillo Lopez JP, Costa PR, Fitton I, Mohamed A, Pesznyak C, Ruggeri R, Tsalafoutas I, Tsougos I, Wong JHD, Zdesar U, Ciraj-Bjelac O, Tsapaki V. Automated Quality Control Solution for Radiographic Imaging of Lung Diseases. J Clin Med 2024; 13:4967. [PMID: 39201109 PMCID: PMC11355187 DOI: 10.3390/jcm13164967] [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: 07/09/2024] [Revised: 08/07/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Radiography is an essential and low-cost diagnostic method in pulmonary medicine that is used for the early detection and monitoring of lung diseases. An adequate and consistent image quality (IQ) is crucial to ensure accurate diagnosis and effective patient management. This pilot study evaluates the feasibility and effectiveness of the International Atomic Energy Agency (IAEA)'s remote and automated quality control (QC) methodology, which has been tested in multiple imaging centers. Methods: The data, collected between April and December 2022, included 47 longitudinal data sets from 22 digital radiographic units. Participants submitted metadata on the radiography setup, exposure parameters, and imaging modes. The database comprised 968 exposures, each representing multiple image quality parameters and metadata of image acquisition parameters. Python scripts were developed to collate, analyze, and visualize image quality data. Results: The pilot survey identified several critical issues affecting the future implementation of the IAEA method, as follows: (1) difficulty in accessing raw images due to manufacturer restrictions, (2) variability in IQ parameters even among identical X-ray systems and image acquisitions, (3) inconsistencies in phantom construction affecting IQ values, (4) vendor-dependent DICOM tag reporting, and (5) large variability in SNR values compared to other IQ metrics, making SNR less reliable for image quality assessment. Conclusions: Cross-comparisons among radiography systems must be taken with cautious because of the dependence on phantom construction and acquisition mode variations. Awareness of these factors will generate reliable and standardized quality control programs, which are crucial for accurate and fair evaluations, especially in high-frequency chest imaging.
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Affiliation(s)
- Christoph Kleefeld
- Department of Medical Physics and Clinical Engineering, University Hospital Galway and Physics, School of Natural Sciences, University of Galway, H91 TK33 Galway, Ireland;
| | | | - Paulo R. Costa
- Instituto de Física, Universidade de Sao Paulo (USP), R. do Matao, 1371-Butanta, São Paulo 05508-090, Brazil;
| | | | - Ahmed Mohamed
- National Cancer Institute, University of Gezira, Wad Madani 11111, Sudan;
| | | | - Ricardo Ruggeri
- Fundación Médica de Río Negro y Neuquén-Leben Salud, Cipolleti R8324, Argentina;
| | | | - Ioannis Tsougos
- University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece;
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Urban Zdesar
- Institute of Occupational Safety, 1000 Ljubljana, Slovenia;
| | - Olivera Ciraj-Bjelac
- Division of Human Health, International Atomic Energy Agency, 1220 Vienna, Austria;
| | - Virginia Tsapaki
- Division of Human Health, International Atomic Energy Agency, 1220 Vienna, Austria;
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Grosser OS, Volk M, Georgiades M, Punzet D, Alsawalhi B, Kupitz D, Omari J, Wissel H, Kreissl MC, Rose G, Pech M. Effect of Spectral Filtering and Segmental X-ray Tube Current Switch-Off on Interventionalist's Scatter Exposure during CT Fluoroscopy. Bioengineering (Basel) 2024; 11:838. [PMID: 39199796 PMCID: PMC11351108 DOI: 10.3390/bioengineering11080838] [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: 06/29/2024] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024] Open
Abstract
Dose optimization in computed tomography (CT) is crucial, especially in CT fluoroscopy (fluoro-CT) used for real-time navigation, affecting both patient and operator safety. This study evaluated the impact of spectral X-ray filtering using a tin filter (Sn filter), and a method called partial-angle computed tomography (PACT), which involves segmentally switching off the X-ray tube current at the ambient dose rate H˙*(10) at the interventional radiologist's (IR) position. Measurements were taken at two body regions (upper body: head/neck; lower body: lower legs/feet) using a 120 kV X-ray tube voltage, 3 × 5.0 mm CT collimation, 0.5 s rotation speed, and X-ray tube currents of 43 Eff.mAs (without Sn filter) and 165 Eff.mAs (with Sn filter). The study found significant dose reductions in both body regions when using the Sn filter and PACT together. For instance, in the upper body region, the combination protocol reduced H˙*(10) from 11.8 µSv/s to 6.1 µSv/s (p < 0.0001) compared to the protocol without using these features. Around 8% of the reduction (about 0.5 µSv/s) is attributed to the Sn filter (p = 0.0005). This approach demonstrates that using the Sn filter along with PACT effectively minimizes radiation exposure for the IR, particularly protecting areas like the head/neck, which can only be insufficiently covered by (standard) radiation protection material.
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Affiliation(s)
- Oliver S. Grosser
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany; (D.P.)
| | - Martin Volk
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany; (D.P.)
| | - Marilena Georgiades
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany; (D.P.)
| | - Daniel Punzet
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany; (D.P.)
- Chair of Medical Telematics and Medical Technics, Institute of Medical Engineering, Faculty of Electrical Engineering and Information Technology, Otto-von-Guericke University, 39106 Magdeburg, Germany
| | - Bahaa Alsawalhi
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
| | - Dennis Kupitz
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany; (D.P.)
| | - Heiko Wissel
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
| | - Michael C. Kreissl
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany; (D.P.)
| | - Georg Rose
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany; (D.P.)
- Chair of Medical Telematics and Medical Technics, Institute of Medical Engineering, Faculty of Electrical Engineering and Information Technology, Otto-von-Guericke University, 39106 Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.V.); (M.G.); (B.A.); (D.K.); (M.P.)
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany; (D.P.)
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Maruyama S, Watanabe H, Shimosegawa M. An image quality assessment index based on image features and keypoints for X-ray CT images. PLoS One 2024; 19:e0304860. [PMID: 38990930 PMCID: PMC11238976 DOI: 10.1371/journal.pone.0304860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/21/2024] [Indexed: 07/13/2024] Open
Abstract
Optimization tasks in diagnostic radiological imaging require objective quantitative metrics that correlate with the subjective perception of observers. However, although one such metric, the structural similarity index (SSIM), is popular, it has limitations across various aspects in its application to medical images. In this study, we introduce a novel image quality evaluation approach based on keypoints and their associated unique image feature values, focusing on developing a framework to address the need for robustness and interpretability that are lacking in conventional methodologies. The proposed index quantifies and visualizes the distance between feature vectors associated with keypoints, which varies depending on changes in the image quality. This metric was validated on images with varying noise levels and resolution characteristics, and its applicability and effectiveness were examined by evaluating images subjected to various affine transformations. In the verification of X-ray computed tomography imaging using a head phantom, the distances between feature descriptors for each keypoint increased as the image quality degraded, exhibiting a strong correlation with the changes in the SSIM. Notably, the proposed index outperformed conventional full-reference metrics in terms of robustness to various transformations which are without changes in the image quality. Overall, the results suggested that image analysis performed using the proposed framework could effectively visualize the corresponding feature points, potentially harnessing lost feature information owing to changes in the image quality. These findings demonstrate the feasibility of applying the novel index to analyze changes in the image quality. This method may overcome limitations inherent in conventional evaluation methodologies and contribute to medical image analysis in the broader domain.
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Affiliation(s)
- Sho Maruyama
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, Japan
| | - Haruyuki Watanabe
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, Japan
| | - Masayuki Shimosegawa
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Gunma, Japan
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Kundu S, Nayak K, Kadavigere R, Pendem S, Priyanka. Evaluation of positioning accuracy, radiation dose and image quality: artificial intelligence based automatic versus manual positioning for CT KUB. F1000Res 2024; 13:683. [PMID: 38962690 PMCID: PMC11221346 DOI: 10.12688/f1000research.150779.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/05/2024] Open
Abstract
Background Recent innovations are making radiology more advanced for patient and patient services. Under the immense burden of radiology practice, Artificial Intelligence (AI) assists in obtaining Computed Tomography (CT) images with less scan time, proper patient placement, low radiation dose (RD), and improved image quality (IQ). Hence, the aim of this study was to evaluate and compare the positioning accuracy, RD, and IQ of AI-based automatic and manual positioning techniques for CT kidney ureters and bladder (CT KUB). Methods This prospective study included 143 patients in each group who were referred for computed tomography (CT) KUB examination. Group 1 patients underwent manual positioning (MP), and group 2 patients underwent AI-based automatic positioning (AP) for CT KUB examination. The scanning protocol was kept constant for both the groups. The off-center distance, RD, and quantitative and qualitative IQ of each group were evaluated and compared. Results The AP group (9.66±6.361 mm) had significantly less patient off-center distance than the MP group (15.12±9.55 mm). There was a significant reduction in RD in the AP group compared with that in the MP group. The quantitative image noise (IN) was lower, with a higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the AP group than in the MP group (p<0.05). Qualitative IQ parameters such as IN, sharpness, and overall IQ also showed significant differences (p< 0.05), with higher scores in the AP group than in the MP group. Conclusions The AI-based AP showed higher positioning accuracy with less off-center distance (44%), which resulted in 12% reduction in RD and improved IQ for CT KUB imaging compared with MP.
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Affiliation(s)
- Souradip Kundu
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kaushik Nayak
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Rajagopal Kadavigere
- Department of Radio Diagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Saikiran Pendem
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Priyanka
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Aly A, Tsapaki V, Ahmed AZ, Own A, Patro S, Al Naemi H, Kharita MH. Clinical diagnostic reference levels in neuroradiology based on clinical indication. RADIATION PROTECTION DOSIMETRY 2024; 200:755-762. [PMID: 38702851 PMCID: PMC11148473 DOI: 10.1093/rpd/ncae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/27/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
This study focuses on patient radiation exposure in interventional neuroradiology (INR) procedures, a field that has advanced significantly since its inception in the 1980s. INR employs minimally invasive techniques to treat complex cerebrovascular diseases in the head, neck, and spine. The study establishes diagnostic reference levels (DRLs) for three clinical indications (CIs): stroke (S), brain aneurysms (ANs), and brain arteriovenous malformation (AVM). Data from 209 adult patients were analyzed, and DRLs were determined in terms of various dosimetric and technical quantities. For stroke, the established DRLs median values were found to be 78 Gy cm2, 378 mGy, 118 mGy, 12 min, 442 images, and 15 runs. Similarly, DRLs for brain AN are 85 Gy cm2, 611 mGy, 95.5 mGy, 19.5, 717 images, and 26 runs. For brain AVM, the DRL's are 180 Gy cm2, 1144 mGy, 537 mGy, 36 min, 1375 images, and 31 runs. Notably, this study is unique in reporting DRLs for specific CIs within INR procedures, providing valuable insights for optimizing patient safety and radiation exposure management.
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Affiliation(s)
- Antar Aly
- Medical Physics Section, Hamad Medical Corporation, Doha 3050, Qatar
- Radiology Department, Weill Cornell Medicine, Doha 24144, Qatar
| | - Virginia Tsapaki
- Medical Physics Department, Konstantopoulio Hospital, 142 33 Nea Ionia, Athens, Greece
| | | | - Ahmed Own
- Neurosurgery Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Satya Patro
- Neurosurgery Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Huda Al Naemi
- Radiology Department, Weill Cornell Medicine, Doha 24144, Qatar
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Hulthén M, Tsapaki V, Karambatsakidou A. Estimating brain and eye lens dose for the cardiologist in interventional cardiology-are the dose levels of concern? Br J Radiol 2024; 97:1191-1201. [PMID: 38711194 DOI: 10.1093/bjr/tqae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/06/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To establish conversion coefficients (CCs), between mean absorbed dose to the brain and eye lens of the cardiologist and the air kerma-area product, PKA, for a set of projections in cardiac interventional procedures. Furthermore, by taking clinical data into account, a method to estimate the doses per procedure, or annual dose, is presented. METHODS Thermoluminescence dosimeters were used together with anthropomorphic phantoms, simulating a cardiologist performing an interventional cardiac procedure, to estimate the CCs for the brain and eye lens dose for nine standard projections, and change in patient size and x-ray spectrum. Additionally, a single CC has been estimated, accounting for each projections fraction of use in the clinic and associated PKA using clinical data from the dose monitoring system in our hospital. RESULTS The maximum CCs for the eye lens and segment of the brain, is 5.47 μGy/Gycm2 (left eye lens) and 1.71 μGy/Gycm2 (left brain segment). The corresponding weighted CCs: are 3.39 μGy/Gycm2 and 0.89 μGy/Gycm2, respectively. CONCLUSIONS Conversion coefficients have been established under actual scatter conditions, showing higher doses on the left side of the operator. Using modern interventional x-ray equipment, interventional cardiac procedures will not cause high radiation dose levels to the operator when a ceiling mounted shield is used, otherwise there is a risk that the threshold dose values for cataract will be reached. ADVANCE IN KNOWLEDGE In addition to the CCs for the different projections, methods for deriving a single CC per cardiac interventional procedure and dose per year were introduced.
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Affiliation(s)
- Markus Hulthén
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Virginia Tsapaki
- Dosimetry and Medical Radiation Physics Section, Human Health Division, IAEA, Vienna, Austria
| | - Angeliki Karambatsakidou
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
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9
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Dudhe SS, Mishra G, Parihar P, Nimodia D, Kumari A. Radiation Dose Optimization in Radiology: A Comprehensive Review of Safeguarding Patients and Preserving Image Fidelity. Cureus 2024; 16:e60846. [PMID: 38910606 PMCID: PMC11191847 DOI: 10.7759/cureus.60846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Radiation dose optimization in radiology is a critical aspect of modern healthcare, aimed at balancing the necessity of diagnostic imaging with the imperative of patient safety. This comprehensive review explores the fundamental principles, techniques, and considerations in optimizing radiation dose to safeguard patients while preserving image fidelity. Beginning with acknowledging the inherent risks associated with medical radiation exposure, the review highlights strategies such as the As Low as Reasonably Achievable (ALARA) principle, technological advancements, and quality assurance measures to minimize radiation dose without compromising diagnostic accuracy. Regulatory guidelines and the importance of patient education and informed consent are also discussed. Through a synthesis of current knowledge and emerging trends, the review underscores the pivotal role of radiation dose optimization in radiology practice. Furthermore, it emphasizes the need for ongoing research and collaboration to advance dose reduction strategies, establish standards for radiation safety, and explore personalized dose optimization approaches. By prioritizing radiation dose optimization, healthcare providers can ensure the highest standards of patient care while minimizing potential risks associated with medical radiation exposure.
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Affiliation(s)
- Sakshi S Dudhe
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav Mishra
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Devyansh Nimodia
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjali Kumari
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Makoba A, Jusabani A, Muhogora W, Kileo A, Ndukeki M, Makungu H, Maro H, Onoka E, Ngulimi M, Mammba H, Muhulo A, Masoud A, Balobegwa V, Ngoye W, Nakembetwa A. Entrance surface air kerma to patients during digital radiographic examinations in Tanzania. RADIATION PROTECTION DOSIMETRY 2024; 200:229-239. [PMID: 38069535 DOI: 10.1093/rpd/ncad294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 03/05/2024]
Abstract
The aim of this study was to determine the entrance surface air kerma (ESAK) in adult patients during digital radiography and to evaluate the optimisation potential in five common X-ray examinations in Tanzania. Based on a sample of 240-610 patients, ESAK was estimated using X-ray tube output measurements, patient information and backscatter factors. The results show that the mean ESAK values were higher or comparable to data from the literature. The diagnostic reference values of ESAK for digital radiography were 0.31 mGy (chest PA), 4 mGy (lumbar spine AP), 5.4 mGy (lumbar spine LAT), 3.8 mGy (abdomen AP) and 2.4 mGy (pelvis AP). For computed radiography, the mean ESAK ranges were 0.44-0.57 mGy (thoracic AP), 3.59-3.72 mGy (lumbar spine AP), 6.16-6.35 mGy (lumbar spine LAT), 3.89-3.44 mGy (abdominal AP) and 2.92-3.47 mGy (pelvic AP). In conclusion, high ESAK variations show the potential for optimising protection in digital radiology.
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Affiliation(s)
- Atumaini Makoba
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Ahmed Jusabani
- Aga Khan Medical Centre, Baraka Obama Drive, 11102 Dar es Salaam, Tanzania
| | - Wilbroad Muhogora
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Abdallah Kileo
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Musa Ndukeki
- Muhimbili National Hospital, Kalenga Road, 11103 Dar es Salaam, Tanzania
| | - Hilda Makungu
- Muhimbili National Hospital, Kalenga Road, 11103 Dar es Salaam, Tanzania
| | - Haika Maro
- Mbeya Zonal Referral Hospital, Hospital Hill Road, Mbeya, Tanzania
| | - Erick Onoka
- Arusha Lutheran Medical Centre, Fr. Babu Road, Block No.54 Levolosi, Arusha, Tanzania
| | - Miguta Ngulimi
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Huruma Mammba
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Alex Muhulo
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Ali Masoud
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Vitus Balobegwa
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Wilson Ngoye
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
| | - Adam Nakembetwa
- Tanzania Atomic Energy Commission, Block J, Njiro, 23114 Arusha, Tanzania
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11
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Tsalafoutas IA, Arlany L, Titovich E, Pynda Y, Ruggeri R, Sánchez RM, Reiser I, Tsapaki V. Technical specifications of dose management systems: An international atomic energy agency survey. J Appl Clin Med Phys 2024; 25:e14219. [PMID: 38060709 PMCID: PMC10795438 DOI: 10.1002/acm2.14219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 01/19/2024] Open
Abstract
PURPOSE Dose management systems (DMS) have been introduced in radiological services to facilitate patient radiation dose management and optimization in medical imaging. The purpose of this study was to gather as much information as possible on the technical characteristics of DMS currently available, regarding features that may be considered essential for simply ensuring regulatory compliance or desirable to fully utilize the potential role of DMS in optimization of many aspects of radiological examinations. METHODS A technical survey was carried out and all DMS developers currently available (both commercial and open source) were contacted and were asked to participate. An extensive questionnaire was prepared and uploaded in the IAEA International Research Integration System (IRIS) online platform which was used for data collection process. Most of the questions (93%) required a "Yes/No" answer, to facilitate an objective analysis of the survey results. Some free text questions and comments' slots were also included, to allow participants to give additional information and clarifications where necessary. Depending on the answer, they were considered either as "Yes" or "No." RESULTS Given the way that the questions were posed, every positive response indicated that a feature was offered. Thus, the percentage of positive responses was used as a measure of adherence. The percentages of positive answers per section (and sub-section) are presented in graphs and limitations of this type of analysis are discussed in detail. CONCLUSIONS The results of this survey clearly exhibit that large differences exist between the various DMS developers. Consequently, potential end users of a DMS should carefully determine which of the features available are essential for their needs, prioritize desirable features, but also consider their infrastructure, the level of support required and the budget available before selecting a DMS.
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Affiliation(s)
- Ioannis A. Tsalafoutas
- Hamad Medical Corporation, Occupational Health and SafetyMedical Physics SectionDohaQatar
| | | | - Egor Titovich
- Dosimetry and Medical Radiation Physics SectionInternational Atomic Energy AgencyViennaAustria
| | - Yaroslav Pynda
- Division of Human HealthInternational Atomic Energy AgencyViennaAustria
| | - Ricardo Ruggeri
- Fundación Médica de Río Negro y Neuquén‐Leben SaludRio NegroArgentina
| | | | - Ingrid Reiser
- Department of RadiologyThe University of ChicagoChicagoIllinoisUSA
| | - Virginia Tsapaki
- Dosimetry and Medical Radiation Physics SectionInternational Atomic Energy AgencyViennaAustria
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12
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Pearce B, Nguyên VNB, Cowling C, Pinson JA, Sim J. Australian radiographer roles in the emergency department; evidence of regulatory compliance to improve patient safety - A narrative review. Radiography (Lond) 2024; 30:319-331. [PMID: 38128248 DOI: 10.1016/j.radi.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Using a narrative approach, this paper aims to determine the extent of Australian radiographers' regulatory compliance to improve patient safety when performing appendicular X-ray and non-contrast brain computed tomography (CT) in the Emergency Department (ED). KEY FINDINGS A narrative review explored relevant literature and key regulatory policy. Ten documents were identified, three main themes were developed related to the radiographer roles in X-ray request justification, dose optimisation and preliminary image evaluation (PIE). Radiographers were equally aware of justification and optimisation pre and post the introduction of a Medical Code of Practice. The collective PIE accuracy of radiographers remained unaffected by changes in mode of PIE delivery and regulatory factors but varied based on the anatomical region. CONCLUSION While current Australian regulations mandate radiographer request justification, dose optimisation and PIE, the degree of compliance by Australian radiographers remains uncertain. Current literature provides evidence that radiographers can improve patient care and safety through justification, optimisation, and PIE delivery. Change in workplace practice, supported by key stakeholders including radiologists, is essential to integrate radiographers' functions into routine ED clinical practice. Further research is required to audit radiographers' regulatory compliance to improve patient safety. IMPLICATIONS FOR PRACTICE Patient safety in ED can be improved with timely and accurate diagnosis provided by radiographers. Radiographers have a professional obligation to adhere to the capabilities and standards for safe medical radiation practice defined by Australian regulations. Therefore, radiographers must justify the X-ray request, optimise the radiation dose where appropriate and communicate urgent or unexpected findings to the referrer.
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Affiliation(s)
- B Pearce
- Peninsula Health: Frankston Hospital, Frankston, Victoria, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia.
| | - Van N B Nguyên
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - C Cowling
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - J-A Pinson
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - J Sim
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
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13
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Li Q, Zhao Z, Yang C, Zhu F, Sun C, Zhao Z. An organ-effective modulation for non-contrast chest computed tomography imaging: effect on image quality and thyroid exposure reduction. RADIATION PROTECTION DOSIMETRY 2023; 200:84-90. [PMID: 37861270 DOI: 10.1093/rpd/ncad270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/23/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
We investigate the efficacy of organ-effective modulation (OEM) technique for thyroid dose reduction among various body habitus and its impact on image quality in chest non-contrast computed tomography (CT). We prospectively enrolled 64 patients who underwent non-contrast chest CT from January to May 2022. The skin-absorbed radiation dose over the thyroid (Dthyroid) was obtained using a thermoluminescence dosemeter. Signal-to-noise ratio and image noise was also quantitatively assessed. In subjective analyses, two radiologists independently evaluated images based on a 5-point scale. The OEM group showed a markedly decrease in Dthyroid when compared with the non-OEM group (p < 0.05). No significant difference was observed regarding the image noise (p < 0.05), except for the ventral air space. The subjective scores of two radiologists showed no significant differences between the non-OEM and OEM groups. OEM can effectively reduce the radiation exposure of thyroid without compromising on image quality in non-contrast chest CT.
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Affiliation(s)
- Qianling Li
- Department of Radiology, Zhejiang University School of Medicine, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Hangzhou 310000, China
| | - Zicheng Zhao
- CT Scientific Collaboration Department, CT Business Unit, Canon Medical Systems (China) CO., LTD., Beijing 100015, China
| | - Chen Yang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, China
| | - Fandong Zhu
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, China
| | - Chenweng Sun
- Department of Radiology, Zhejiang University School of Medicine, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Hangzhou 310000, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, China
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14
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Abdulwahid Noor K, Mohd Norsuddin N, Abdul Karim MK, Che Isa IN, Alshamsi W. Estimating Local Diagnostic Reference Levels for Mammography in Dubai. Diagnostics (Basel) 2023; 14:8. [PMID: 38201317 PMCID: PMC10804395 DOI: 10.3390/diagnostics14010008] [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: 09/26/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024] Open
Abstract
As the total volume of mammograms in Dubai is increasing consistently, it is crucial to focus on the process of dose optimization by determining dose reference levels for such sensitive radiographic examinations as mammography. This work aimed to determine local diagnostic reference levels (DRLs) for mammography procedures in Dubai at different ranges of breast thickness. A total of 2599 anonymized mammograms were randomly retrieved from a central dose survey database. Mammographic cases for screening women aged from 40 to 69 years were included, while cases of breast implants and breast thickness outside the range of 20-100 mm were excluded. Mean, median, and 75 percentiles were obtained for the mean glandular dose (MGD) distribution of each mammography projection for all compressed breast thickness (CBT) ranges. The local DRLs for mammography in Dubai were found to be between 0.80 mGy and 0.82 mGy for the craniocaudal (CC) projection and between 0.89 mGy and 0.971.8 mGy for the mediolateral oblique (MLO) projection. Local DRLs were proposed according to different breast thicknesses, starting from 20 to 100 mm. All groups of CBT showed a slight difference in MGD values, with higher values in MLO views rather than CC views. The local DRLs in this study were lower than some other Middle Eastern countries and lower than the standard reference levels reported by the International Atomic Energy Agency (IAEA) at 3 mGy/view.
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Affiliation(s)
- Kaltham Abdulwahid Noor
- Dubai Health Academic Corporate, Radiology Department, Rashid Hospital, Dubai 00971, United Arab Emirates;
- Center of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Norhashimah Mohd Norsuddin
- Center of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | | | - Iza Nurzawani Che Isa
- Center of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Wadha Alshamsi
- SEHA, Medical Physics Department, Al Ain Hospital, Abu Dhabi 80050, United Arab Emirates;
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Sulieman A, Mahgoub O, Salah H, Tamam N, Taha A, Dawood S, Bradley DA. Assessment of patient and occupational exposure and radiation risk from cath-lab procedure. Appl Radiat Isot 2023; 202:111071. [PMID: 37871398 DOI: 10.1016/j.apradiso.2023.111071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/22/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
Due to the extended localized fluoroscopy, many radiographic exposures, and multiple procedures that might result in tissue reaction, patients and personnel received a significant radiation dose during interventional cardiology (IR) procedures. This study aims to calculate the radiation risk and assess patient and staff effective doses during IC procedures. Thirty-two patients underwent a Cath lab treatment in total. Ten Cath lab personnel, including six nurses, two cardiologists, and two X-ray technologists. Optical stimulating-luminescent dosimeters (OSL) (Al2O3:C) calibrated for this purpose were used to monitor both occupational and ambient doses. Using an automated OSL reader, these badges were scanned. The Air Kerma (mGy) and Kerma Area Products (KAP, mGy.cm2) have a mean and standard deviation (SD) of 371 ± 132 and 26052, respectively. The average personal dose equivalent (mSv) and its range for cardiologists, nurses and X ray technologists were 1.11 ± 0.21 (0.96-1.26), 0.84 ± 0.11 (0.68-1.16), and 0.68 ± 0.014 (0.12-0.13), respectively. The current study findings showed that the annual effective dose for cardiologists, nurses, and X-ray technologists was lesser than the yearly occupational dose limit of 20 mSv recommended by national and international guidelines. The patients' doses are comparable with some previously published studies and below the tissue reaction limits.
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Affiliation(s)
- Abdelmoneim Sulieman
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Alkharj, Saudi Arabia.
| | - Omer Mahgoub
- College of Medical Radiologic Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - H Salah
- College of Medical Radiologic Science, Sudan University of Science and Technology, Khartoum, Sudan; INAYA Medical Collage, Nuclear Medicine Department, Riyadh, Saudi Arabia
| | - Nissren Tamam
- Department of Physics, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428 Riyadh 1167, Saudi Arabia
| | - Afaf Taha
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Alkharj, Saudi Arabia
| | - Sali Dawood
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Alkharj, Saudi Arabia
| | - D A Bradley
- Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, Bandar Sunway, 47500, Selangor, Malaysia; Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, UK
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16
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Nocetti D, Villalobos K, Marín N, Monardes M, Tapia B, Toledo MI, Villegas C. Radiation dose reduction and image quality evaluation for lateral lumbar spine projection. Heliyon 2023; 9:e19509. [PMID: 37681134 PMCID: PMC10481289 DOI: 10.1016/j.heliyon.2023.e19509] [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: 04/03/2023] [Revised: 07/29/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose Optimization studies in digital radiology help to reduce the radiological risk to patients and maximize the benefits associated with their clinical purpose. The aim of this study was to assess the optimization of lateral lumbar spine projection via a combination of exposure parameters adjustments and additional filtration using a sectional anthropomorphic phantom. Materials and methods We evaluated the effects of peak voltage, tube loading, and low-cost filters made of copper, titanium, brass, and nickel on both the perceived and physical quality of 125 radiographs obtained in a computer radiography system. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) with their Figure of Merit (FOM), based on the entrance surface air kerma with backscatter (ESAK), was used to assess physical image quality. Results The standard image had a perceived image quality, SNR, FOMSNR, CNR, FOMCNR and ESAK of 3.4, 22.3, 386.4, 23.6, 433.7 and 1.28 mGy, respectively. Copper (90.3% purity) and titanium (95.0% purity) filters reduced ESAK by an average of 60% without compromising diagnostic quality, while brass and nickel filters increased dose under the conditions of the study. Conclusions Our findings show that optimizing lumbar spine projection can reduce radiation dose without compromising image quality. Low-cost copper and titanium filters can be valuable in resource-limited settings. Further research can explore additional strategies for radiological optimization.
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Affiliation(s)
- Diego Nocetti
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Kathia Villalobos
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Nelson Marín
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Martina Monardes
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Benjamín Tapia
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - María Ignacia Toledo
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
| | - Camila Villegas
- Carrera de Tecnología Médica en Imagenología y Física Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Avenida 18 de septiembre N°2222, 1010069, Arica, Chile
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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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Kumsa MJ, Nguse TM, Ambessa HB, Gele TT, Fantaye WG, Dellie ST. Establishment of local diagnostic reference levels for common adult CT examinations: a multicenter survey in Addis Ababa. BMC Med Imaging 2023; 23:6. [PMID: 36624411 PMCID: PMC9830915 DOI: 10.1186/s12880-023-00963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In medical imaging, a computed tomography (CT) scanner is a major source of ionizing radiation. All medical radiation exposures should be justified and optimized to meet the clinical diagnosis. Thus, to avoid unnecessary radiation doses for patients, diagnostic reference levels (DRLs) have been used. The DRLs are used to identify unusually high radiation doses during CT procedures, which are not appropriate for the clinical diagnosis. It has been successfully implemented in Europe, Canada, Australia, the United States, several industrialized countries, and a few underdeveloped countries. The present study aimed to establish DRLs for the head, chest, and abdominopelvic (AP) CT procedures in Addis Ababa, Ethiopia. METHODS A pilot study identified the most frequent CT examinations in the city. At the time of the pilot, eighteen CT scan facilities were identified as having functioning CT scanners. Then, on nine CT facilities (50% of functional CT scanners), a prospective analysis of volume CT dose index (CTDIvol) and dose length product (DLP) was performed. We collected data for 838 adult patients' head, chest, and AP CT examinations. SPSS version 25 was used to compute the median values of the DLP and CTDIvol dose indicators. The rounded 75th percentile of CTDIvol and DLP median values were used to define the DRLs. The results are compared to DRL data from the local, regional, and international levels. RESULT The proposed DRLs using CTDIvol (mGy) are 53, 13, and 16 for the head, chest, and AP examinations respectively, while the DLP (mGy.cm) for the respective examinations were 1210, 635, and 822 mGy.cm. CONCLUSION Baseline CT DRLs figures for the most frequently performed in Addis Ababa were provided. The discrepancies in dose between CT facilities and as well as between identical scanners suggests a large potential for dose optimization of examinations. This can be actually achieved through appropriate training of CT technologists and continuous dose audits.
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Affiliation(s)
- Marema Jebessa Kumsa
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teklehaimanot Mezgebe Nguse
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Haleluya Biredaw Ambessa
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Tefera Gele
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondemu Geteye Fantaye
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seife Teferi Dellie
- grid.7123.70000 0001 1250 5688Department of Radiology, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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CIRSE Standards of Practice on Varicocele Embolisation. Cardiovasc Intervent Radiol 2023; 46:19-34. [PMID: 36380154 DOI: 10.1007/s00270-022-03293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous embolisation is an effective, minimally invasive means of treating a variety of benign and malignant lesions and has been successfully used to treat varicoceles since the late 1970s, with refined and expanded techniques and tools currently offering excellent outcomes for varicocele embolisation. PURPOSE This document will presume that the indication for treatment is clear and approved by the multidisciplinary team (MDT) and will define the standards required for the performance of each modality, as well as their advantages and limitations. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of percutaneous varicocele embolisation. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in embolisation of male varicoceles. The writing group reviewed the existing literature on varicocele embolisation, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects published from 2006 to 2021. The final recommendations were formulated through consensus. CONCLUSION Embolisation has an established role in the successful management of male varicoceles. This Standards of Practice document provides up-to-date recommendations for the safe performance of varicocele embolisation.
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Bosowska J, Modlińska S, Pękala T, Szydło F, Cebula M. Impact of monoplane to biplane angiography upgrade on diagnostic angiography procedures: A retrospective cross-sectional study. Phys Med 2022; 98:40-44. [PMID: 35489130 DOI: 10.1016/j.ejmp.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/25/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
The radiation dose during digital subtraction angiography (DSA) examination is determined on the basis of many factors. The aim of this study was to evaluate the dose-area product, air kerma, and fluoroscopy time on monoplane and biplane DSA of the cerebral arteries. Our results show that biplane angiography offered lower DAP, cumulative air kerma at the reference point and fluoroscopy time despite comparable procedure time.. Further research in this area and personnel training warrant the improvement of the radiosafety of angiographic interventional procedures and further development of angiographic technology.
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Affiliation(s)
- Joanna Bosowska
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Sandra Modlińska
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Tomasz Pękala
- Department of Radiodiagnostics and Invasive Radiology, Central Clinical Hospital of Prof. K. Gibiński, Medical University of Silesia, Katowice, Poland
| | - Filip Szydło
- Department of Radiodiagnostics and Invasive Radiology, Central Clinical Hospital of Prof. K. Gibiński, Medical University of Silesia, Katowice, Poland
| | - Maciej Cebula
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, School of Medicine, Medical University of Silesia, Katowice, Poland.
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21
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McCaughey C, Healy GM, Al Balushi H, Maher P, McCavana J, Lucey J, Cantwell CP. Patient radiation dose during angiography and embolization for abdominal hemorrhage: the influence of CT angiography, fluoroscopy system, patient and procedural variables. CVIR Endovasc 2022; 5:12. [PMID: 35171363 PMCID: PMC8850522 DOI: 10.1186/s42155-022-00284-4] [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: 10/03/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Angiography and embolization (AE) is a lifesaving, high radiation dose procedure for treatment of abdominal arterial hemorrhage (AAH). Interventional radiologists have utilized pre-procedure CT angiography (CTA) and newer fluoroscopic systems in an attempt to reduce radiation dose and procedure time. Purpose To study the factors contributing to the radiation dose of AE for AAH and to compare to the reference standard. Materials and methods This retrospective single-centre observational cohort study identified 154 consecutive AE procedures in 138 patients (median age 65 years; interquartile range 54–77; 103 men) performed with a C-arm fluoroscopic system (Axiom Artis DTA or Axiom Artis Q (Siemens Healthineers)), between January 2010 and December 2017. Parameters analysed included: demographics, fluoroscopy system, bleeding location, body mass index (BMI), preprocedural CT, air kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of digital subtraction angiography (DSA) runs. Factors affecting dose were assessed using Mann–Whitney U, Kruskal–Wallis one-way ANOVA and linear regression. Results Patients treated with the new angiographic system (NS) had a median PKA, median Ka,r, Q3 PKA and Q3 Ka,r that were 74% (p < 0.0005), 66%(p < 0.0005), 55% and 52% lower respectively than those treated with the old system (OS). This dose reduction was consistent for each bleeding location (upper GI, Lower GI and extraluminal). There was no difference in PKA (p = 0.452), Ka,r (p = 0.974) or FT (p = 0.179), between those who did (n = 137) or did not (n = 17) undergo pre-procedure CTA. Other factors significantly influencing radiation dose were: patient BMI and number of DSA runs. A multivariate model containing these variables accounts for 15.2% of the variance in Ka,r (p < 0.005) and 45.9% of the variance of PKA (p < 0.005). Conclusion Radiation dose for AE in AAH is significantly reduced by new fluoroscopic technology. Higher patient body mass index is an independent key parameter affecting patient dose. Radiation dose was not influenced by haemorrhage site or performance of pre-procedure CTA.
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Affiliation(s)
| | - Gerard M Healy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Patrice Maher
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Jackie McCavana
- Department of Medical Physics and Clinical Engineering, St Vincent's University Hospital, Dublin, Ireland
| | - Julie Lucey
- Department of Medical Physics and Clinical Engineering, St Vincent's University Hospital, Dublin, Ireland
| | - Colin P Cantwell
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Amalaraj T, Satharasinghe D, Pallewatte A, Jeyasugiththan J. Establishment of national diagnostic reference levels for computed tomography procedures in Sri Lanka: first nationwide dose survey. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021504. [PMID: 34875641 DOI: 10.1088/1361-6498/ac40e8] [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: 10/30/2021] [Accepted: 12/06/2021] [Indexed: 06/13/2023]
Abstract
The main purpose of this study was to establish for the first time national diagnostic reference levels (NDRLs) for common computed tomography (CT) procedures in Sri Lanka. Patient morphometric data, exposure parameters and dose data such as volume CT dose index (CTDIvol) and dose-length product (DLP) were collected from 5666 patients who underwent 22 types of procedure. The extreme dose values were filtered before analysis to ensure that the data come from standard size patients. The median of the dose distribution was calculated for each institution, and the third quartile value of the median distribution was considered as the NDRL. Based on the inclusion and exclusion criteria, data from 4592 patients and 17 procedure types were considered for establishment of a NDRL, covering 41% of the country's CT machines. The proposed NDRLs based on CTDIvoland DLP were: non-contrast-enhanced (NC) head, 82.2 mGy/1556 mGy cm; contrast-enhanced (CE) head, 82.2 mGy/1546 mGy cm; chest NC, 7.4 mGy/350 mGy cm; chest CE, 8.3 mGy/464 mGy cm; abdomen NC, 10.5 mGy/721 mGy cm; abdomen arterial (A) phase, 13.4 mGy/398 mGy cm; abdomen venous (V) phase, 10.8 mGy/460 mGy cm; abdomen delay (D) phase, 12.6 mGy/487 mGy cm; sinus NC, 30.2 mGy/452 mGy cm; lumbar spine NC, 24.1 mGy/1123 mGy cm; neck NC, 27.5 mGy/670 mGy cm; high-resolution CT of chest, 10.3 mGy/341 mGy cm; kidneys ureters and bladder NC, 19.4 mGy/929 mGy cm; chest to pelvis (CAP) NC, 10.8 mGy/801 mGy cm; CAP A, 10.4 mGy/384 mGy cm; CAP V, 10.5 mGy/534 mGy cm; CAP D, 16.8 mGy/652 mGy cm. Although the proposed NDRLs are comparable with those of other countries, the observed broad dose distributions between the CT machines within Sri Lanka indicate that dose optimisation strategies for the country should be implemented for most of the CT facilities.
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Affiliation(s)
- T Amalaraj
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
| | | | - Aruna Pallewatte
- Department of Radiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Kaatsch HL, Schneider J, Brockmann C, Brockmann MA, Overhoff D, Becker BV, Waldeck S. Radiation exposure during angiographic interventions in interventional radiology - risk and fate of advanced procedures. Int J Radiat Biol 2022; 98:865-872. [PMID: 34982640 DOI: 10.1080/09553002.2021.2020362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Advanced angiographic procedures in interventional radiology are becoming more important and are more frequently used, especially in the treatment of several acute life-threatening diseases like stroke or aortic injury. In recent years, technical advancement has led to a broader spectrum of interventions and complex procedures with longer fluoroscopy times. This involves the risk of higher dose exposures, which, in rare cases, may cause deterministic radiation effects, e.g. erythema in patients undergoing angiographic procedures. Against this background, these procedures recently also became subject to national and international regulations regarding radiation protection. At the same time, individual risk assessment of possible stochastic radiation effects for each patient must be weighed up against the anticipated benefits of the therapy itself. Harmful effects of the administered dose are not limited to the patient but can also affect the radiologist and the medical staff. In particular, the development of cataracts in interventionalists is a rising matter of concern. Furthermore, long-term effects of repeated and prolonged x-ray exposure have long been neglected by radiologists but have come into focus in the past years. CONCLUSIONS With all this in mind, this review discusses different efforts to reduce radiation exposition levels for patients and medical staff by means of technical, personal as well as organizational measures.
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Affiliation(s)
| | - Julian Schneider
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
| | - Carolin Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Daniel Overhoff
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
| | | | - Stephan Waldeck
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
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Rivera-López R, García-López C, Sánchez-Moreno JM, Rivera-López RA, Almansa-López J, Rivera-Fernández R, Molina-Navarro E, Jiménez-Fernández M, Ortiz-Pérez S, Ramírez-Hernández JA. High Incidence of Cataracts in the Follow-Up of Patients Undergoing Percutaneous Coronary Intervention for Chronic Coronary Total Occlusion. J Clin Med 2021; 10:jcm10215002. [PMID: 34768525 PMCID: PMC8584919 DOI: 10.3390/jcm10215002] [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: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Development of cataracts is a well-known adverse effect of ionizing radiation, but little information is available on their incidence in patients after other medical procedures, such as cardiac catheterizations. The study objective was to determine the incidence of cataracts in a cohort of patients undergoing percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) and its association with radiation dose. The study analyzed the incidence of cataracts during the follow-up of 126 patients who underwent chronic total coronary PCI, using Cox regression to identify predictive factors of cataract development. The study included 126 patients, 86.9% male, with a mean age of 60.5 years (range, 55.0-68.0 years). Twenty-three (18.2% n = 23) developed cataracts during a mean follow-up of 49.5 months (range 37.3-64.5 months). A higher incidence was observed in patients who received more than 5 Gy (29.0% vs. 14.7%, Hazard ratio (HR = 2.84 [1.19-6.77]). Multivariate analysis revealed a relationship between cataract development during the follow-up and a receipt of radiation dose >5 Gy (HR = 2.60, 95% confidence interval [CI 1.03-6.61]; p = 0.03), presence or history of predisposing eye disease (HR = 4.42, CI:1.57-12.40), diabetes (HR = 3.33 [1.22-9.24]), and older age, as in >57 (HR, 6.40 [1.81-22.61]). An elevated incidence of cataracts was observed in patients after PCI for CTO. The onset of cataracts is related to the radiation dose during catheterization, which is a potentially avoidable effect of which operators should be aware.
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Affiliation(s)
- Ricardo Rivera-López
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
| | - Celia García-López
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- Correspondence: ; Tel.: +34-958020009
| | - José M. Sánchez-Moreno
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | | | - Julio Almansa-López
- Radiophysics Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | | | - Eduardo Molina-Navarro
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Miriam Jiménez-Fernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Santiago Ortiz-Pérez
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- University of Granada (UGR), 18016 Granada, Spain;
| | - José A. Ramírez-Hernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Medicine Department, University of Granada (UGR), 18016 Granada, Spain
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Pazinato LV, Leite TFDO, Bortolini E, Pereira OI, Nomura CH, Motta-Leal-Filho JMD. Percutaneous retrieval of intravascular foreign body in children: a case series and review. Acta Radiol 2021; 63:684-691. [PMID: 33832338 DOI: 10.1177/02841851211006904] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous retrieval of intravascular foreign bodies has recently increased as a treatment option. PURPOSE To report our single-center experience of the percutaneous retrieval of 14 intravascular embolized catheter fragments in children and to conduct a literature review. MATERIAL AND METHODS MEDLINE databases were searched for case reports and series including children and iatrogenic catheter fragments or guidewires retrieved through percutaneous techniques. We also conducted a retrospective analysis of 14 cases from our institution over a 14-year period. A total of 27 studies were selected comprising 74 children, plus our 14 unpublished cases. Statistical analyses were performed using Microsoft Excel version 2016. RESULTS Port catheter fragments and peripherally inserted central catheters (PICCs) were the most embolized foreign bodies and the pulmonary artery was the most common site of embolization in 44.1% of cases. Analysis of the retrieval technique demonstrated a preference for extraction through the femoral vein (81.7%) and using snare techniques (93.5%). The success rate of percutaneous retrieval was 96.6% with only 1.1% of procedure-related complications. Patients were asymptomatic in 77.2% of cases, presented septic complications in 2.3%, and no deaths were reported. Median fluoroscopy time was 10 min (range = 1.7-80 min) and median procedure length was 60 min (range = 35-208 min). CONCLUSION Percutaneous retrieval of intravascular foreign bodies is a feasible, safe, and efficient technique in children and should be considered the preferred treatment option.
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Affiliation(s)
- Lucas Vatanabe Pazinato
- Interventional Radiology, Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Edgar Bortolini
- Interventional Radiology, Department of Radiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | | | - Cesar Higa Nomura
- Interventional Radiology, Department of Radiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
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Colombo P, Felisi M, Riga S, Torresin A. On skin dose estimation software in interventional radiology. Phys Med 2021; 81:182-184. [DOI: 10.1016/j.ejmp.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/29/2022] Open
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Editorial. Phys Med 2020; 79:ii-v. [DOI: 10.1016/j.ejmp.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/20/2022] Open
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