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Lantz AG, O'Malley P, Ordon M, Lee JY. Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy. Can Urol Assoc J 2014; 8:347-51. [PMID: 25408802 DOI: 10.5489/cuaj.2037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room staff. Endoscopic-guided PCNL (ePCNL) is a technique that may be associated with less radiation exposure. This study examines ePCNL-related radiation exposure (fluoroscopy time, effective dose) and investigates variables that may predict increased exposure. METHODS A retrospective review of all consecutive ePCNLs performed at our institution, by a single surgeon, was conducted between November 2011 and November 2013. Patient demographics, stone characteristics and perioperative details were recorded, including radiation exposure. Pearson and Spearman correlation were used to assess variables correlated with radiation exposure. RESULTS In total, 55 ePCNL cases were included in the study. The mean age was 60 ± 15 years, mean body mass index (BMI) 30.0 ± 6.4 kg/m(2) and mean stone size 3.2 × 2.1 cm. Seven cases (13%) involved complete staghorn stones, and 69% involved supracostal punctures. The mean fluoroscopy time was 3.4 ± 2.3 minutes, mean ED 2.4 ± 1.9 mSv. The treatment success rate, assessed 1-week postoperatively, was 87.3% and 7.3% of cases required ancillary procedures. The overall complication rate was 29%, but only 3 cases (5.5%) were Clavien ≥3. Longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); higher effective dose correlated with longer fluoroscopy time (p < 0.01) and increased skin-to-stone distance (p < 0.01). BMI did not correlate with fluoroscopy time or effective dose. CONCLUSIONS Outcomes of ePCNL are comparable to traditional PCNL techniques and may be associated with lower radiation exposure, particularly beneficial for patients with higher BMI.
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Affiliation(s)
- Andrea G Lantz
- Department of Urology, Dalhousie University, Halifax, NS
| | - Padraic O'Malley
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Jason Y Lee
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON
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Abstract
SUMMARY The primary purpose of diagnostic imaging is to enable clinicians to make correct decisions about a patient's diagnosis and severity of its condition and, thereby, to contribute to effective and efficient treatment. Advanced imaging modalities are inherently better detectors of morphological lesions than radiography; hence, they offer the possibility of more accurate diagnosis and staging, with correspondingly better patient outcomes. However, there is a lack of evidence that better outcomes are being realised for veterinary patients. Furthermore, increased use of advanced imaging carries the possibility of increased misuse, primarily through unnecessary studies that contribute little to patient management other than increased costs. SCOPE This article is intended to be relevant to all veterinary species. Advanced imaging of cats is not sufficiently developed as a specific discipline that a balanced review could be based purely on feline examples or references.
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Affiliation(s)
- Christopher R Lamb
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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Kim YJ, Cho KB, Kim ES, Park KS, Jang BK, Chung WJ, Hwang JS. Efficacy of a Self-designed Protective Lead Shield in Reduction of Radiation Exposure Dose During Endoscopic Retrograde Cholangiopancreatography. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 57:28-33. [DOI: 10.4166/kjg.2011.57.1.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Yun Jung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Eun Soo Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Sik Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byoung Kuk Jang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Woo Jin Chung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Seok Hwang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Knowledge and Attitudes of Emergency Department Patients Regarding Radiation Risk of CT: Effects of Age, Sex, Race, Education, Insurance, Body Mass Index, Pain, and Seriousness of Illness. AJR Am J Roentgenol 2010; 195:1151-8. [DOI: 10.2214/ajr.09.3847] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Linet MS, Kim KP, Miller DL, Kleinerman RA, Simon SL, Berrington de Gonzalez A. Historical review of occupational exposures and cancer risks in medical radiation workers. Radiat Res 2010; 174:793-808. [PMID: 21128805 DOI: 10.1667/rr2014.1] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Epidemiological studies of medical radiation workers have found excess risks of leukemia, skin and female breast cancer in those employed before 1950 but little consistent evidence of cancer risk increases subsequently. Occupational radiation-related dose-response data and recent and lifetime cancer risk data are limited for radiologists and radiologic technologists and lacking for physicians and technologists performing fluoroscopically guided procedures. Survey data demonstrate that occupational doses to radiologists and radiologic technologists have declined over time. Eighty mostly small studies of cardiologists and fewer studies of other physicians reveal that effective doses to physicians per interventional procedure vary by more than an order of magnitude. For medical radiation workers, there is an urgent need to expand the limited information on average annual, time-trend and organ doses from occupational radiation exposures and to assess lifetime cancer risks of these workers. For physicians and technologists performing interventional procedures, more information about occupational doses should be collected and long-term follow-up studies of cancer and other serious disease risks should be initiated. Such studies will help optimize standardized protocols for radiologic procedures, determine whether current radiation protection measures for medical radiation workers are adequate, provide guidance on cancer screening needs, and yield valuable insights on cancer risks associated with chronic radiation exposure.
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Affiliation(s)
- Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892-7238, USA.
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Single-centre experience of radiation exposure in acute surgical patients: assessment of therapeutic impact and future recommendations. World J Surg 2010; 34:2009-16. [PMID: 20499066 DOI: 10.1007/s00268-010-0608-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Radiological investigations have become a key adjunct in patient management and consequently radiation exposure to patients is increasing. The study objectives were to examine the use of radiological investigations in the management of acute surgical patients and to assess whether a guideline-based radiation exposure risk/benefit analysis can aid in the choice of radiological investigation used. METHODS A prospective observational study was completed over a 12-week period from April to July 2008 for all acute surgical admissions. Data recorded included demographics, clinical presentation, differential diagnosis, investigations, surgical interventions, and final clinical outcome. The use of radiological investigative modalities as an adjunct to clinical assessment was then evaluated against The Royal College of Radiologists (RCR) guidelines. RESULTS A total of 380 acute surgical admissions (M = 174, F = 185, children = 21) were assessed during the study period. Seven hundred thirty-four radiological investigations were performed with a mean of 1.93 investigations per patient. Based on the RCR guidelines, 680 (92.6%) radiological investigations were warranted and included 142 CT scans (19.3%), 129 chest X-rays (17.6%), and 85 abdominal X-rays (11.6%). Clinically, radiological imaging complemented surgical management in 326 patients (85.8%) and the management plan remained unchanged for the remaining 54 patients (14.2%). This accounted for an average radiation dose of 4.18 millisievert (mSv) per patient or 626 days of background radiation exposure. CT imaging was responsible for the majority of the radiation exposure, with a total of 1310 mSv (82.6%) of the total radiation exposure being attributed to CT imaging in 20.8% of acute admissions. Subgroup analysis demonstrated that 92.8% of the CT scans performed were appropriate. CONCLUSION Radiation exposure was generally low for the majority of acute surgical admissions. However, it is recommended that CT imaging requests be evaluated carefully, particularly for patients with clinically confirmed pathologies and in younger women.
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Johnson CD. Computed tomography colonography: a current appraisal. Gastroenterology 2009; 137:792-4. [PMID: 19619549 DOI: 10.1053/j.gastro.2009.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- C Daniel Johnson
- Department of Radiology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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Hayes A, Alspaugh JM, Bartelt D, Campion MB, Eng J, Gayler BW, Henkel SE, Jones B, Lingaraj A, Mahesh M, Rostkowski M, Smith CP, Haynos J. Radiation Safety for the Speech-Language Pathologist. Dysphagia 2009; 24:274-9. [DOI: 10.1007/s00455-008-9201-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
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Harolds JA, Smith GT, Baker SR. Trends and different educational pathways for training physicians in nuclear medicine. Acad Radiol 2008; 15:1596-603. [PMID: 19000877 DOI: 10.1016/j.acra.2008.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 07/20/2008] [Accepted: 08/09/2008] [Indexed: 10/21/2022]
Abstract
The introduction of positron emission tomography/computed tomography (CT), single photon-emission CT/CT, and software packages for multimodality imaging has accelerated the need for nuclear medicine physicians to obtain more training in cross-sectional imaging, especially in CT. In recent years, the Nuclear Regulatory Commission, the Accreditation Council for Graduate Medical Education, the American Board of Radiology, and the American Board of Nuclear Medicine have promulgated new rules and regulations. In addition, the Society of Nuclear Medicine, the American College of Radiology, and the American College of Cardiology Foundation have crafted new guidelines and training requirements. All these changes have consequences for the education of physicians in nuclear medicine. Self-referral and concerns about radiation exposure from nuclear medicine examinations and CT are also affecting the education of physicians practicing nuclear medicine. The authors examine the impact of these developments on training and certification in nuclear medicine and suggest another pathway to train some nuclear medicine physicians.
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Cacace AT, Silver SM. Applications of magnetic resonance spectroscopy to tinnitus research: initial data, current issues, and future perspectives. PROGRESS IN BRAIN RESEARCH 2008; 166:71-81. [PMID: 17956773 DOI: 10.1016/s0079-6123(07)66007-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Conducting tinnitus research on humans poses challenges for investigators because of its subjective nature, the complexities involved in establishing underlying generator sites, the diversity of potential causes, and the inherent difficulties in dissociating reactive changes in the central nervous system (CNS), secondary to peripheral hearing loss, from those effects that may be due to tinnitus. One area of considerable interest concerns biomarker development, particularly in the areas of metabolism and biochemistry. Establishing a biomarker or a profile of metabolic and neurobiochemical constituents of tinnitus-related activity within the CNS could be of considerable importance for understanding the fundamental properties of this disorder. Therefore, in an effort to gain greater insight into mechanisms of tinnitus, magnetic resonance spectroscopy (MRS) is being proposed as one of the several tools that can address pertinent issues. Apart from its long-standing use in analytical chemistry and physics, MRS is also being applied with greater frequency in the neurosciences to gain insight into human brain function under normal and pathological states. By considering the history of this method and advances made to date, MRS has the potential to: (1) identify unique in vivo metabolic and neurobiochemical biomarkers associated with tinnitus in specific regions of the CNS, (2) clarify and track disease pathogenesis, (3) monitor short and long-term treatment effects, and (4) serve as a tool in testing of drugs that may be used in treatment of tinnitus.
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Affiliation(s)
- Anthony T Cacace
- The Neurosciences Institute and Advanced Imaging Research Center, Department of Neurology, Albany Medical College, Albany, NY, USA.
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Otero HJ, Weissman BN, Rybicki FJ. System-based practice: proposal for a comprehensive curriculum. Acad Radiol 2008; 15:119-26. [PMID: 18078915 DOI: 10.1016/j.acra.2007.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Revised: 07/11/2007] [Accepted: 07/13/2007] [Indexed: 12/01/2022]
Affiliation(s)
- Hansel J Otero
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Cohen M. Are we doing enough to minimize fluoroscopic radiation exposure in children? Pediatr Radiol 2007; 37:1020-4. [PMID: 17673995 DOI: 10.1007/s00247-007-0547-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 05/21/2007] [Accepted: 05/30/2007] [Indexed: 10/23/2022]
Affiliation(s)
- Mervyn Cohen
- Department of Radiology, Riley Hospital, Indiana University, 702 Barnhill Drive, Indianapolis, IN 46202, USA.
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Detorie N, Mahesh M, Schueler BA. Reducing occupational exposure from fluoroscopy. J Am Coll Radiol 2007; 4:335-7. [PMID: 17467618 DOI: 10.1016/j.jacr.2007.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Indexed: 11/18/2022]
Affiliation(s)
- Nicholas Detorie
- Mayo Clinic Rochester, Department of Radiology, Rochester, MN 55905, USA
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