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Forbes A, Geryes BH, Hornbeck A, Kien N, Quelquejay C, Adamsbaum C, Farah J, le Pointe HD. Harmonisation of imaging protocols, radiation doses and image quality in gastrointestinal fluoroscopy examinations - multicentre study. Pediatr Radiol 2022; 52:50-57. [PMID: 34657168 DOI: 10.1007/s00247-021-05194-6] [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: 02/08/2021] [Revised: 06/24/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Paediatric gastrointestinal fluoroscopy examinations can impart varying amounts of radiation for the same patient size and exam type. OBJECTIVE To investigate the variability of imaging protocol, radiation dose and image quality in paediatric fluoroscopy examinations in order to provide recommendations for the harmonisation and optimisation of local practices. MATERIALS AND METHODS Five paediatric radiology departments performing fluoroscopically-guided contrast enema, micturating cystourethrography and upper gastrointestinal tract examinations participated in this study. Information on imaging protocols and radiation doses was retrospectively collected for more than 2,400 examinations. Image quality was analysed on clinical and phantom images. RESULTS Patient doses showed great variability among centers with up to a factor of 5 for similar fluoroscopy times. The five departments had imaging protocols with major differences in fluoroscopy dose regulation curves and additional filtration. Image quality analysis on phantoms and patients images showed no major improvement in contrast, spatial resolution or noise when increasing the radiation dose. Age-based diagnostic reference levels using both dose area product and fluoroscopy time were proposed per procedure type. CONCLUSION Disparities between centers and no correlation of radiation dose with image quality criteria create margins for optimisation. These results highlight the need for guidelines on fluoroscopy image quality and dose reference levels in paediatric gastrointestinal examinations to harmonise practices and optimise patient dose.
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Affiliation(s)
- Aurélie Forbes
- Radiology Department, Public Assistance - Paris Hospitals Antoine Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France.
| | - Bouchra Habib Geryes
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Necker-Enfants Malades University Hospital, Paris, France
| | - Amaury Hornbeck
- Radiology Department, Public Assistance - Paris Hospitals Armand-Trousseau Paediatric Hospital, Paris, France
- ALARA Expertise, Entzheim, France
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
| | - Nicolas Kien
- ALARA Expertise, Entzheim, France
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
| | - Caroline Quelquejay
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Necker-Enfants Malades University Hospital, Paris, France
| | - Catherine Adamsbaum
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Jad Farah
- Paediatric Radiology Department, Public Assistance - Paris Hospitals Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Hubert Ducou le Pointe
- Radiology Department, Public Assistance - Paris Hospitals Robert-Debré Paediatric Hospital, Paris, France
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Schmidt VF, Masthoff M, Czihal M, Cucuruz B, Häberle B, Brill R, Wohlgemuth WA, Wildgruber M. Imaging of peripheral vascular malformations - current concepts and future perspectives. Mol Cell Pediatr 2021; 8:19. [PMID: 34874510 PMCID: PMC8651875 DOI: 10.1186/s40348-021-00132-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Czihal
- Angiology Division, Department for Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Dr. von Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany. .,Clinic for Radiology, University Hospital Muenster, Muenster, Germany.
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Werncke T, Kemling M, Tashenov S, Hinrichs JB, Meine TC, Maschke SK, Kyriakou Y, Wacker FK, Meyer BC. Comparison of a contrast-to-noise ratio-driven exposure control and a regular detector dose-driven exposure control in abdominal imaging in a clinical angiography system. Med Phys 2021; 48:7641-7656. [PMID: 34651705 DOI: 10.1002/mp.15288] [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: 06/09/2021] [Revised: 05/28/2021] [Accepted: 09/20/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The first purpose of this phantom study was to verify whether a contrast-to-noise ratio (CNR)-driven exposure control (CEC) can maintain target CNR in angiography more precisely compared to a conventional detector dose-driven exposure control (DEC). The second purpose was to estimate the difference between incident air kerma produced by CEC and DEC when both exposure controls reach the same CNR. METHODS A standardized 3D-printed phantom with an iron foil and a cavity, filled with iodinated contrast material, was developed to measure CNR using different image acquisition settings. This phantom was placed into a stack of polymethylmethacrylate and aluminum plates, simulating a patient equivalent thickness (PET) of 2.5-40 cm. Images were acquired using fluoroscopy and digital radiography modes with CEC using one image quality level and four image quality gradients and DEC having three different detector dose levels. The spatial frequency weighted CNR and incident air kerma were determined. The differences in incident air kerma between DEC and CEC were estimated. RESULTS When using DEC, CNR decreased continuously with increasing attenuation, while CEC within physical limits maintained a predefined CNR level. Furthermore, CEC could be parameterized to deliver the CNR as a predefined function of PET. To provide a given CNR level, CEC used equal or lower air kerma than DEC. The mean estimated incident air kerma of CEC compared to DEC was between 3% (PET 20 cm) and 40% (PET 27.5 cm) lower in fluoroscopy and between 1% (PET 20 cm) and 55% (PET 2.5 cm) lower in digital radiography while maintaining CNR. CONCLUSION Within physical and legislative limits, the CEC allows for a flexible adjustment of the CNR as a function of PET. Thus, the CEC enables task-dependent examination protocols with predefined image quality in order to easier achieve the as low as reasonably achievable principle. CEC required equal or lower incident air kerma than DEC to provide similar CNR, which allows for a substantial reduction of skin radiation dose in these situations.
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Affiliation(s)
- Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Marius Kemling
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Stanislav Tashenov
- Advanced Therapies, Cancer Therapy, Define, Siemens Healthcare GmbH, Forchheim, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Timo C Meine
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Yiannis Kyriakou
- Customer Services, Education, Education Architecture & Design, Siemens Healthcare GmbH, Forchheim, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Song Y, Han S, Kim BJ, Oh SH, Kim JS, Kim TI, Lee DH. Low-Dose Fluoroscopy Protocol for Diagnostic Cerebral Angiography. Neurointervention 2020; 15:67-73. [PMID: 32450675 PMCID: PMC7412660 DOI: 10.5469/neuroint.2020.00129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We applied a low-dose fluoroscopic protocol in routine diagnostic cerebral angiography and evaluated the feasibility of the protocol. MATERIALS AND METHODS We retrospectively reviewed a total of 60 patients who underwent diagnostic cerebral angiography for various neurovascular diseases from September to November 2019. Routine protocols were used for patients in the first phase and low-dose protocols in the second phase. We compared radiation dose, fluoroscopy time, and complications between groups. RESULTS Age, diseases, and operators were not significantly different between the two groups. The mean fluoroscopy dose significantly decreased by 52% in the low-dose group (3.09 vs. 6.38 Gy·cm2 ); however, the total dose was not significantly different between the two groups (34.07 vs. 33.70 Gy·cm2 ). The total fluoroscopic time was slightly longer in the low-dose group, but the difference was not statistically significant (12.2. vs. 12.5 minutes). In all patients, angiography was successfully performed without complications. CONCLUSION The low-dose fluoroscopy protocol is feasible to apply for diagnostic cerebral angiography in that this protocol could significantly reduce the fluoroscopic dose.
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Affiliation(s)
- Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongsik Han
- Department of Radiologic Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Jun Kim
- Advanced Therapies, Siemens Healthineers Ltd., Seoul, Korea
| | - Seong Heum Oh
- Department of Radiologic Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Su Kim
- Department of Radiologic Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Department of Radiologic Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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