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Nasr B, Villa M, Benoit D, Visvikis D, Bert J. Monte Carlo Dosimetry Validation for X-Ray Guided Endovascular Procedures. Ann Vasc Surg 2024; 99:186-192. [PMID: 37717818 DOI: 10.1016/j.avsg.2023.07.104] [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: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Endovascular treatment is continuously gaining ground in vascular surgery procedures. However, current patient radiation dose estimation does not take into account the exact patient morphology and organs' composition. Monte Carlo (MC) simulation can accurately estimate the dose by recreating the irradiation process generated during X-ray-guided interventions. This study aimed to validate the MC simulation models by comparing simulated and measured dose distributions in endovascular aortic aneurysm repair (EVAR) procedures. METHODS We conducted a clinical study in patients treated for EVAR. Patient dose measurements were taken with passive dosimeters using Optically Stimulated Luminescence technology in 4 specific anatomical points on the skin: xiphoid process, pubic symphysis, right and left iliac crest. Dose measurements were compared to the corresponding simulated doses with the Geant4 Application for Emission Tomography (GATE) and GPU Geant4-based Monte Carlo Simulations (GGEMS) MC simulations softwares. The MC simulation took as input the computed tomography scan of the patient and the parameters of the imaging system (orientation angles, tube voltage, and aluminum filtration) and gives as output the three-dimensional (3D) dose map for each patient and angulation. RESULTS A good agreement with real doses was found for doses simulated by the MC GATE method (P < 0.0001; r = 0.97; 95% confidence interval [CI] [0.96-0.98]), as well as for doses simulated by the GGEMS method (P < 0.0001; r = 0.96; 95% CI [0.94-0.97]). The mean relative error for all measurements was 5 ± 5% in the MC GATE group and 6 ± 5% in the GGEMS group. Process execution on GGEMS (6 sec) was faster than the GATE MC simulation (5 hr). CONCLUSION Considering the current imaging settings, this study shows the potential of using the GATE and GGEMS MC simulations platforms to model the 3D dose distributions during EVAR procedures.
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Affiliation(s)
- Bahaa Nasr
- Univ Brest, INSERM, IMT-Atlantique, UMR 1011 LaTIM, Brest, France; CHU Cavale Blanche Brest, Vascular and Endovascular Surgery Department, Brest, France.
| | - Mateo Villa
- Univ Brest, INSERM, IMT-Atlantique, UMR 1011 LaTIM, Brest, France
| | - Didier Benoit
- Univ Brest, INSERM, IMT-Atlantique, UMR 1011 LaTIM, Brest, France
| | | | - Julien Bert
- Univ Brest, INSERM, IMT-Atlantique, UMR 1011 LaTIM, Brest, France
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Healy GM, Ahrari A, Alkhalifah F, Oreopoulos G, Tan KT, Jaberi A, Mafeld S. Typology, Severity, and Outcomes of Adverse Events Related to Angiographic Equipment-A Ten-Year Analysis of the FDA MAUDE Database. Can Assoc Radiol J 2023; 74:737-744. [PMID: 37023704 DOI: 10.1177/08465371231167990] [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] [Indexed: 04/08/2023] Open
Abstract
Purpose: Angiographic equipment is a key component of healthcare infrastructure, used for endovascular procedures throughout the body. The literature on adverse events related to this technology is limited. The purpose of this study was to analyze adverse events related to angiographic devices from the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. Methods: MAUDE data on angiographic imaging equipment from July 2011 to July 2021 were extracted. Qualitative content analysis was performed, a typology of adverse events was derived, and this was used to classify the data. Outcomes were assessed using the Healthcare Performance Improvement (HPI) and Society of Interventional Radiology (SIR) adverse event classifications. Results: There were 651 adverse events reported. Most were near misses (67%), followed by precursor safety events (20.5%), serious safety events (11.2%), and unclassifiable (1.2%). Events impacted patients (42.1%), staff (3.2%), both (1.2%), or neither (53.5%). The most common events associated with patient harm were intra-procedure system shut down, foot pedal malfunction, table movement malfunction, image quality deterioration, patient falls, and fluid damage to system. Overall, 34 (5.2%) events were associated with patient death; 18 during the procedure and 5 during patient transport to another angiographic suite/hospital due to critical failure of equipment. Conclusion: Adverse events related to angiographic equipment are rare; however, serious adverse events and deaths have been reported. This study has defined a typology of the most common adverse events associated with patient and staff harm. Increased understanding of these failures may lead to improved product design, user training, and departmental contingency planning.
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Affiliation(s)
- Gerard M Healy
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Networkand Sinai Health System, Toronto, ON, CA
- Department of Medical Imaging, University of Toronto, Toronto, ON, CA
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Ireland
| | - Aida Ahrari
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Networkand Sinai Health System, Toronto, ON, CA
- Department of Medical Imaging, University of Toronto, Toronto, ON, CA
| | - Fahd Alkhalifah
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Networkand Sinai Health System, Toronto, ON, CA
- Department of Medical Imaging, University of Toronto, Toronto, ON, CA
| | - George Oreopoulos
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Networkand Sinai Health System, Toronto, ON, CA
- Department of Medical Imaging, University of Toronto, Toronto, ON, CA
- Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, ON, CA
| | - Kong Teng Tan
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Networkand Sinai Health System, Toronto, ON, CA
- Department of Medical Imaging, University of Toronto, Toronto, ON, CA
| | - Arash Jaberi
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Networkand Sinai Health System, Toronto, ON, CA
- Department of Medical Imaging, University of Toronto, Toronto, ON, CA
| | - Sebastian Mafeld
- Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Networkand Sinai Health System, Toronto, ON, CA
- Department of Medical Imaging, University of Toronto, Toronto, ON, CA
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Villa M, Nasr B, Benoit D, Padoy N, Visvikis D, Bert J. Fast dose calculation in x-ray guided interventions by using deep learning. Phys Med Biol 2023; 68:164001. [PMID: 37433326 DOI: 10.1088/1361-6560/ace678] [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: 01/12/2023] [Accepted: 07/11/2023] [Indexed: 07/13/2023]
Abstract
Objective.Patient dose estimation in x-ray-guided interventions is essential to prevent radiation-induced biological side effects. Current dose monitoring systems estimate the skin dose based in dose metrics such as the reference air kerma. However, these approximations do not take into account the exact patient morphology and organs composition. Furthermore, accurate organ dose estimation has not been proposed for these procedures. Monte Carlo simulation can accurately estimate the dose by recreating the irradiation process generated during the x-ray imaging, but at a high computation time, limiting an intra-operative application. This work presents a fast deep convolutional neural network trained with MC simulations for patient dose estimation during x-ray-guided interventions.Approach.We introduced a modified 3D U-Net that utilizes a patient's CT scan and the numerical values of imaging settings as input to produce a Monte Carlo dose map. To create a dataset of dose maps, we simulated the x-ray irradiation process for the abdominal region using a publicly available dataset of 82 patient CT scans. The simulation involved varying the angulation, position, and tube voltage of the x-ray source for each scan. We additionally conducted a clinical study during endovascular abdominal aortic repairs to validate the reliability of our Monte Carlo simulation dose maps. Dose measurements were taken at four specific anatomical points on the skin and compared to the corresponding simulated doses. The proposed network was trained using a 4-fold cross-validation approach with 65 patients, and evaluating the performance on the remaining 17 patients during testing.Main results.The clinical validation demonstrated a average error within the anatomical points of 5.1%. The network yielded test errors of 11.5 ± 4.6% and 6.2 ± 1.5% for peak and average skin doses, respectively. Furthermore, the mean errors for the abdominal region and pancreas doses were 5.0 ± 1.4% and 13.1 ± 2.7%, respectively.Significance.Our network can accurately predict a personalized 3D dose map considering the current imaging settings. A short computation time was achieved, making our approach a potential solution for dose monitoring and reporting commercial systems.
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Affiliation(s)
| | - Bahaa Nasr
- LaTIM, INSERM UMR1101, Brest, France
- Brest University Hospital, France
| | | | - Nicolas Padoy
- ICube, Strasbourg University, CNRS, Strasbourg, France
- IHU Strasbourg, France
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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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Digital Subtraction Angiography (DSA) Technical and Diagnostic Aspects in the Study of Lower Limb Arteries. RADIATION 2022. [DOI: 10.3390/radiation2040028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cardiovascular diseases represent one of the most frequent diseases worldwide; among these, lower limb ischemia is a threatening condition, which can lead to permanent disability if not promptly and correctly diagnosed and treated. A patient’s clinical evaluation and diagnostic imaging (e.g., color-Doppler ultrasound, computed tomography angiography (CTA), and magnetic resonance imaging (MRI)) are mandatory to carefully assess arterial lesion extension and severity. Digital subtraction angiography (DSA) is a minimally invasive technique that represents the gold standard for percutaneous revascularization treatment of symptomatic patients who are refractory to medical management. However, when dealing with patients with lower limb terminal ischemia, the correct interpretation of diagnostic DSA findings is mandatory for treatment re-planning and to effectively evaluate post-treatment results and complications. The purpose of this review is to provide interventional radiologists and endovascular practitioners with an up-to-date practical guide to diagnostic angiography of the lower limbs, which is mandatory to address correct treatment decisions and post-treatment evaluation.
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Lefèvre T, Mangiameli A, Hovasse T, Louvard Y, Benamer H, Garot P, Unterseeh T, Champagne S, Tavolaro O, Amelot S, Chevalier B. On-line estimated peak skin dose during percutaneous coronary intervention for chronic total occlusion using new patient dose mapping technology. Arch Cardiovasc Dis 2022; 115:436-447. [PMID: 35840491 DOI: 10.1016/j.acvd.2022.04.010] [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: 12/09/2021] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND X-ray exposure during complex percutaneous coronary intervention is a very important issue. AIM To reduce patient peak skin dose during percutaneous coronary intervention procedures for chronic total occlusion using on-line estimated peak skin dose software (Dose Map). METHODS Throughout the procedure, Dose Map provided a map of local cumulative peak skin dose. This map was displayed in-room from 1Gy cumulative air kerma, and was updated every 0.5Gy. The operator's actions to minimize deterministic risks following map notification were collected. Skin reaction was evaluated 3 months after the procedure. A comparison with our historical X-ray exposure data (207 patients from January 2013 to July 2014) was performed. RESULTS From November 2015 to October 2016, 97 patients (Japanese chronic total occlusion score 2.1±1.1; 100 percutaneous coronary intervention procedures for chronic total occlusion) were prospectively enrolled. Fluoroscopy time was 40.8 (21.6-60.3) minutes, cumulative air kerma 1884 (1144-3231) mGy, estimated peak skin dose 962 (604-1474) mGy and kerma area product 115.8 (71.5-206.7) Gy.cm2. Cumulative air kerma was>3Gy in 28% of cases, and>5Gy in 11% of cases. In 68% of cases, at least one action was taken by the operator after map notification to optimize skin dose distribution. Main changes included: gantry angulation (52%); field of view (25%); and collimation (13%). No skin injuries were observed at follow-up. In comparison with our chronic total occlusion historical radiation data, median cumulative air kerma and kerma area product were reduced by 31% and 33%, respectively (P<0.005. CONCLUSION Online skin dose mapping software allows the distribution of patient skin dose during complex percutaneous coronary intervention procedures, and may minimize X-ray exposure.
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Affiliation(s)
- Thierry Lefèvre
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France.
| | - Andrea Mangiameli
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Thomas Hovasse
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Yves Louvard
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Hakim Benamer
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Philippe Garot
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Thierry Unterseeh
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Stéphane Champagne
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Oscar Tavolaro
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | | | - Bernard Chevalier
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
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Balter S, Patel A. Radiation Management in Interventional Cardiology. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Fisher RF, Applegate KE, Berkowitz LK, Christianson O, Dave JK, DeWeese L, Harris N, Jafari ME, Jones AK, Kobistek RJ, Loughran B, Marous L, Miller DL, Schueler B, Schwarz BC, Springer A, Wunderle KA. AAPM Medical Physics Practice Guideline 12.a: Fluoroscopy dose management. J Appl Clin Med Phys 2022; 23:e13526. [PMID: 35174964 PMCID: PMC8906204 DOI: 10.1002/acm2.13526] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ryan F Fisher
- Department of Radiology, The Metro Health System, Cleveland, Ohio, USA
| | - Kimberly E Applegate
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | | | - Olav Christianson
- Clinical Dose Optimization Service, LANDAUER Medical Physics, Glenwood, Illinois, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lindsay DeWeese
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nichole Harris
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mary Ellen Jafari
- Department of Radiation Physics & Safety, Atlantic Medical System Morristown, Morristown, New Jersey, USA
| | - A Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Brendan Loughran
- Clinical Dose Optimization Service™/OPTIMIZE™ Division, LANDAUER Medical Physics, Glenwood, Illinois, USA
| | - Loren Marous
- Upstate Medical Physics, P.C., Victor, New York, USA
| | - Donald L Miller
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Beth Schueler
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, USA
| | - Bryan C Schwarz
- Department of Radiology, University of Florida, Gainesville, Florida, USA
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Abstract
There has been a rapid development in the field of interventional radiology over recent years, and this has led to a rapid increase in the number of interventional radiology procedures being performed. There is, however, a growing concern regarding radiation exposure to the patients and the operators during these procedures. In this article, we review the basics of radiation exposure, radiation protection techniques, radiation protection tools available to interventional radiologists, and radiation protection during pregnancy.
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Affiliation(s)
- Tushar Garg
- Department of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Apurva Shrigiriwar
- Department of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Trunz LM, Eschelman DJ, Gonsalves CF, Adamo RD, Dave JK. Investigation of Radiation Dose Estimates and Image Quality Between Commercially Available Interventional Fluoroscopy Systems for Fluoroscopically Guided Interventional Procedures. Acad Radiol 2021; 28:1559-1569. [PMID: 32224035 DOI: 10.1016/j.acra.2020.02.024] [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: 12/16/2019] [Revised: 02/12/2020] [Accepted: 02/23/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate differences in radiation dose and image quality for single-plane flat-panel-detector based interventional fluoroscopy systems from two vendors using phantom study and clinical procedures. MATERIALS AND METHODS AlluraClarityIQ (Philips) and Artis Q (Siemens-Healthineers) interventional fluoroscopy systems were evaluated. Phantom study included comparison of system-reported air-kerma rates (AKR) for clinical protocols with simulated patient thicknesses (20-40 cm). Differences in system-reported radiation dose estimates, cumulative-air-kerma (CAK) and kerma-area-product (KAP), for different clinical procedures were investigated. Subset analysis investigated differences in CAK, KAP and other factors affecting radiation dose when the same patients underwent repeat embolization procedures performed by the same physician on the two different fluoroscopy systems. Two blinded interventional radiologists reviewed image-quality for these procedures using a five-point scale (1-5; 5-best) for five parameters. RESULTS Phantom study revealed that air-kerma rates was significantly higher for Artis Q system for 30-40cm of simulated patient thicknesses (p < 0.05). Overall data analysis from 4381 clinical cases revealed significant differences in CAK and KAP for certain procedures (p < 0.05); with significantly lower values for AlluraClarityIQ systems (median CAK lower by: 29%-58%). Subset analysis with 40 patients undergoing repeat embolization procedures on both systems revealed that median CAK and KAP were significantly lower for AlluraClarityIQ systems (p < 0.02) by 45% and 31%, respectively. Image quality scores for AlluraClarityIQ systems were significantly greater (mean difference range for five parameters: 1.3-1.6; p < 0.005). CONCLUSION Radiation dose and image quality differences were observed between AlluraClarityIQ and Artis Q systems. AlluraClarityIQ systems showed lower radiation utilization and an increase in subjective perception of image quality.
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Stanev S, Kostova-Lefterova D, Dineva S. Patient doses in endovascular and hybrid revascularization of aortoiliac segment. Br J Radiol 2021; 94:20210439. [PMID: 34591595 DOI: 10.1259/bjr.20210439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Constantly increasing number of procedures performed - endovascular or hybrid in patients with aortoiliac occlusive disease during the last decades finds its explanation in the lower morbidity and mortality rates, compared to bypass surgery. The purpose of the current survey was to estimate patients' radiation exposure in aortoiliac segment after endovascular or hybrid revascularization and to study the main factors which have direct contribution. METHODS A retrospective study of 285 procedures conducted with the help of a mobile C-arm system in 223 patients was performed. Procedures were grouped according to criteria such as: type of intervention, vascular access, level of complexity and operating team. Different analyses were performed within the groups and dose values. RESULTS The median values of kerma-air product (KAP), the number of series and the peak skin dose (PSD) significantly increase with the increasing number of vascular accesses: for one access (16.68 Gy.cm2, 6 and 336 mGy), for two (56.93 Gy.cm2, 11 and 545 mGy), and for three (102.28 Gy.cm2, 15 and 781 mGy). Significant dependence was observed in the case of single access site between the type of access and the dose values: hybrid and retrograde common femoral artery/superficial femoral artery (CFA/SFA) endovascular accesses, 10.06 Gy.cm2/301 mGy and 13.23 Gy.cm2/318 mGy respectively, in contrast with the contralateral CFA and left brachial access, 33 Gy.cm2/421 mGy and 38.33 Gy.cm2/448 mGy respectively. CONCLUSION The results demonstrate that the most important factors increasing the dose values are number and type of vascular accesses, followed by the combination and number of implanted stents with the complexity of the procedure. The PSD values for a single procedure were between 2 and 12 times lower than those IAEA proposed as trigger levels for radiation-induced erythema. This study shows that trigger levels were not reached even for patients with repeated procedures in the same segment in 1-year period. ADVANCES IN KNOWLEDGE The study gives important understanding and clarity on the growing awareness for dose-modifying factors during endovascular and hybrid revascularization of aortoiliac segment.
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Affiliation(s)
| | - Desislava Kostova-Lefterova
- National Cardiology Hospital, Sofia, Bulgaria.,Medical University - Pleven, Pleven, Bulgaria.,Aleksandrovska University Hospital, Sofia, Bulgaria
| | - Svetla Dineva
- National Cardiology Hospital, Sofia, Bulgaria.,Aleksandrovska University Hospital, Sofia, Bulgaria.,Medical University - Sofia, Sofia, Bulgaria
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Zanardo M, Gerasia R, Giovannelli L, Scurto G, Cornacchione P, Cozzi A, Durante S, Schiaffino S, Monfardini L, Sardanelli F. A critical appraisal of the quality of guidelines for radiation protection in interventional radiology using the AGREE II tool: A EuroAIM initiative. Eur J Radiol 2021; 143:109906. [PMID: 34479125 DOI: 10.1016/j.ejrad.2021.109906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To systematically review and assess the methodological quality of guidelines for radiation protection in interventional radiology. MATERIALS AND METHODS On April 15th, 2021, a systematic search for guidelines on radiation protection in interventional radiology was performed using MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence databases. Among retrieved guidelines, we then excluded those not primarily focused on radiation protection or on interventional radiology. Authors' professional role and year of publication were recorded for each included guideline. Guideline quality evaluation was performed independently by three authors using the six-domain tool "AGREE II", with an overall guideline quality score divided into three classes: low (<60%), acceptable (60-80%), and good quality (>80%). RESULTS Our literature search identified 106 citations: after applying exclusion criteria, 11 guidelines published between 2009 and 2018 were included, most of their authors being interventional radiologists (168/224, 75%). Overall quality of included guidelines was acceptable (median 72%, interquartile range 64-83%), with only one guideline (9%) with overall low quality and four guidelines (36%) with overall good quality. Among AGREE II domains, "Scope and Purpose", "Clarity of Presentations", and "Editorial Independence" had the best results (87%, 76%, and 75% respectively), while "Applicability", "Rigor of Development", and "Stakeholder Involvement" the worst (46%, 49%, and 52% respectively). CONCLUSION Considering all guidelines, the overall methodological quality was acceptable with one third of them reaching the highest score class. The "Applicability" domain had the lowest median score, highlighting a practical implementation gap to be addressed by future guidelines.
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Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Roberta Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; AITRI, Italian Association of Interventional Radiographers, Milan, Italy.
| | - Lorenzo Giovannelli
- Radiology Department, Ospedale Santa Maria del Carmine, Azienda Provinciale per i Servizi Sanitari di Trento, Viale Verona 4, 38068 Rovereto (TN), Italy; HTA team, FNO TSRM e PSTRP, Via Magna Grecia 30/A, 00183 Rome, Italy.
| | - Giuseppe Scurto
- HTA team, FNO TSRM e PSTRP, Via Magna Grecia 30/A, 00183 Rome, Italy; Radiology Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Viale Strasburgo 233, 90146 Palermo, Italy.
| | - Patrizia Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy.
| | - Lorenzo Monfardini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy.
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy.
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Bocian S, Granato A, Cain M, Friis CM, Loyola M, Robertson L. RADIATION SAFETY IN THE GASTROENTEROLOGY SETTING. Gastroenterol Nurs 2021; 44:368-371. [PMID: 34417405 DOI: 10.1097/sga.0000000000000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Susan Bocian
- Society of Gastroenterology Nurses and Associates, Inc, 330 N Wabash Ave., Suite 2000, Chicago, IL 60611, Tel: 312-321-5165, Fax: 312-673-6694, Online:
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Augustin AM, Dalla Torre G, Fuss CT, Fassnacht M, Bley TA, Kickuth R. Reduction of Radiation Exposure in Adrenal Vein Sampling: Impact of the Rapid Cortisol Assay. ROFO-FORTSCHR RONTG 2021; 193:1392-1402. [PMID: 34384111 DOI: 10.1055/a-1535-2566] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine radiation exposure associated with adrenal vein sampling and its reduction by implementing the rapid cortisol assay and modification of the sampling protocol. MATERIALS AND METHODS A single-center retrospective study of adrenal vein sampling performed between August 2009 and March 2020 revealed data from 151 procedures. Three subgroups were determined. In group I, a sampling protocol including sampling from the renal veins without the rapid cortisol assay was applied. In group II, blood was sampled using the same protocol but applying the rapid cortisol assay. In group III, a modified sampling protocol was used, in which the additional sampling from the renal veins was dispensed with, while the rapid cortisol assay was retained. Primary endpoints were radiation exposure parameters with dose area product, fluoroscopy time, and effective dose. As secondary endpoints, procedural data including technical success, lateralization, the correlation between patient BMI and radiation exposure, and concordance of lateralization with cross-sectional imaging were investigated. Furthermore, the correlation of aldosterone-cortisol ratios between the adrenal and ipsilateral renal vein was calculated to assess the benefit of sampling from the renal veins. RESULTS For all procedures performed in the study collective, the median dose area product was 60.01 Gy*cm2 (5.71-789.31), the median fluoroscopy time was 14.90 min (3.27-80.90), and the calculated median effective dose was 12.60 mSv (1.20-165.76). Significant differences in radiation exposure parameters between the study subgroups could be revealed. Dose area product resulted in reductions of 57.94 % after implementation of the rapid cortisol assay and a further 40.44 % after revision of the sampling protocol. Fluoroscopy time was reduced by 40.48 % after integration of the rapid cortisol assay and a further 40.47 % after protocol refinement. Radiation doses were increased in cases of resampling (dose area product 51.31 vs. 118.11 Gy*cm2, fluoroscopy time of 12.48 vs. 28.70 min). A strong correlation between patient BMI and procedural dose area product could be found. After the introduction of the rapid cortisol assay, successive improvement of the technical success rate could be found (33.33 % in group I, 90.22 % in group II and 92.11 % in group III). The correlation of aldosterone-cortisol ratios between adrenal and renal veins was poor. CONCLUSION The introduction of the rapid cortisol assay significantly decreased the radiation exposure and increased the technical success rate. Renal vein sampling did not provide further benefit in the evaluation of primary aldosteronism subtype and its omission resulted in a further reduction of radiation dose. KEY POINTS · The rapid cortisol assay significantly reduces the procedure-related radiation dose in adrenal vein sampling and increases the procedural technical success.. · Since additional sampling from the renal veins offers no further diagnostic benefit, a refinement of the sampling protocol can enable a further reduction of radiation dose.. · Resampling, technical unsuccessful procedures, and higher patients' BMI are associated with higher radiation exposures.. CITATION FORMAT · Augustin A, Dalla Torre G, Fuss CT et al. Reduction of Radiation Exposure in Adrenal Vein Sampling: Impact of the Rapid Cortisol Assay. Fortschr Röntgenstr 2021; 193: 1392 - 1402.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Giulia Dalla Torre
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Carmina Teresa Fuss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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Ploussi A, Brountzos E, Rammos S, Apostolopoulou S, Efstathopoulos EP. Radiation Exposure in Pediatric Interventional Procedures. Cardiovasc Intervent Radiol 2021; 44:857-865. [PMID: 34009422 DOI: 10.1007/s00270-020-02752-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023]
Abstract
The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. The expanding applications of interventional procedures coupled with the potential harmful effects of ionizing radiation highlight the need to assess the delivered radiation dose and establish an effective radiation protection program, particularly in the radiosensitive pediatric population. Given the complexity and heterogeneity of interventional procedures as well as the unique characteristics of children, the management of radiation dose is proving to be quite challenging. The aim of the current article is to provide an overview of the radiation exposure in pediatric patients during interventional procedures focusing on the importance of radiation protection in the pediatric population, the reported radiation doses and the techniques of minimizing radiation dose.
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Affiliation(s)
- Agapi Ploussi
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Andrea Siggrou 356 Av., 17674, Kallithea, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Andrea Siggrou 356 Av., 17674, Kallithea, Greece
| | - Efstathios P Efstathopoulos
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece.
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Khattab M, Howard B, Al-Rifai S, Torgerson T, Vassar M. Adherence to the RIGHT statement in Society of Interventional Radiology guidelines. J Osteopath Med 2021; 121:11-24. [DOI: 10.1515/jom-2020-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Context
The Reporting Items for Practice Guidelines in Health Care (RIGHT) Statement was developed by a multidisciplinary team of experts to improve reporting quality and transparency in clinical practice guideline development.
Objective
To assess the quality of reporting in clinical practice guidelines put forth by the Society of Interventional Radiology (SIR) and their adherence to the RIGHT statement checklist.
Methods
In March 2018, using the 22 criteria listed in the RIGHT statement, two researchers independently documented adherence to each item for all eligible guidelines listed by the SIR by reading through each guideline and using the RIGHT statement elaboration and explanation document as a guide to determine if each item was appropriately addressed as listed in the checklist. To qualify for inclusion in this study, each guideline must have met the strict definition for a clinical practice guideline as set forth by the National Institute of Health and the Institute of Medicine, meaning they were informed by a systematic review of evidence and intended to direct patient care and physician decisions. Guidelines were excluded if they were identified as consensus statements, position statements, reporting standards, and training standards or guidelines. After exclusion criteria were applied, the two researchers scored each of the remaining clinical practice guidelines (CPGs) using a prespecified abstraction Google form that reflected the RIGHT statement checklist (22 criteria; 35 items inclusive of subset questions). Each item on the abstraction form consisted of a “yes/no” option; each item on the RIGHT checklist was recorded as “yes” if it was included in the guideline and “no” if it was not. Each checklist item was weighed equally. Partial adherence to checklist items was recorded as “no.” Data were extracted into Microsoft Excel (Microsoft Corporation) for statistical analysis.
Results
The initial search results yielded 129 CPGs in the following areas: 13 of the guidelines were in the field of interventional oncology; 16 in neurovascular disorders; five in nonvascular interventions; four in pediatrics; 25 in peripheral, arterial, and aortic disease; one in cardiac; one in portal and mesenteric vascular disease; 37 in practice development and safety; three in spine and musculoskeletal disorders; 14 in venous disease; five in renal failure/hemodialysis; and five in women’s health. Of the 46 guidelines deemed eligible for evaluation by the RIGHT checklist, 12 of the checklist items showed less than 25% adherence and 13 showed more than 75% adherence. Of 35 individual RIGHT statement checklist items, adherence was found for a mean (SD) of 22.9 items (16.3). The median number of items with adherence was 21 (interquartile range, 7.5–38).
Conclusion
The quality of reporting in interventional radiology guidelines is lacking in several key areas, including whether patient preferences were considered, whether costs and resources were considered, the strength of the recommendations, and the certainty of the body of evidence. Poor adherence to the RIGHT statement checklist in these guidelines reveals many areas for improvement in guideline reporting.
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Affiliation(s)
- Mostafa Khattab
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Benjamin Howard
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Shafiq Al-Rifai
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Trevor Torgerson
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
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17
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Radiation dose during fluoroscopically guided central venous access device insertion: Retrospective observational study. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ionizing Radiation and Translation Control: A Link to Radiation Hormesis? Int J Mol Sci 2020; 21:ijms21186650. [PMID: 32932812 PMCID: PMC7555331 DOI: 10.3390/ijms21186650] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023] Open
Abstract
Protein synthesis, or mRNA translation, is one of the most energy-consuming functions in cells. Translation of mRNA into proteins is thus highly regulated by and integrated with upstream and downstream signaling pathways, dependent on various transacting proteins and cis-acting elements within the substrate mRNAs. Under conditions of stress, such as exposure to ionizing radiation, regulatory mechanisms reprogram protein synthesis to translate mRNAs encoding proteins that ensure proper cellular responses. Interestingly, beneficial responses to low-dose radiation exposure, known as radiation hormesis, have been described in several models, but the molecular mechanisms behind this phenomenon are largely unknown. In this review, we explore how differences in cellular responses to high- vs. low-dose ionizing radiation are realized through the modulation of molecular pathways with a particular emphasis on the regulation of mRNA translation control.
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Patient dosimetry in neurointerventional procedures. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Doyen B, Gordon L, Soenens G, Bacher K, Vlerick P, Vermassen F, Grantcharov T, Van Herzeele I. Introduction of a surgical Black Box system in a hybrid angiosuite: Challenges and opportunities. Phys Med 2020; 76:77-84. [DOI: 10.1016/j.ejmp.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022] Open
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Krajinović M, Dobrić M, Ciraj-Bjelac O. SKIN DOSE MAPPING IN INTERVENTIONAL CARDIOLOGY: A PRACTICAL SOLUTION. RADIATION PROTECTION DOSIMETRY 2020; 188:508-515. [PMID: 32614065 DOI: 10.1093/rpd/ncaa002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/25/2019] [Accepted: 01/06/2020] [Indexed: 06/11/2023]
Abstract
Numerous cases of radiation-induced tissue reactions following interventional cardiology (IC) procedures have been reported, resulting in the need for an optimized and personalized dosimetry. At present, there are many fluoroscopy units without Digital Imaging and Communications in Medicine (DICOM) Radiation Dose Structured Report globally installed. Many of these have not been updated yet, and may never be, therefore, the main objectives of this paper are to develop an offline skin dose mapping application, which uses DICOM headers for the peak skin dose (PSD) assessment and to compare the PSD assessment results to XR-RV3 Gafchromic film for common IC procedures. The mean deviation between the measured and the calculated PSD was 8.7 ± 26.3%. Simulated skin dose map showed good matching with XR-RV3 Gafchromic film. The skin dose mapping application presented in this paper is an elegant solution and a suitable alternative to XR-RV3 Gafchromic film.
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Affiliation(s)
- M Krajinović
- School of Electrical Engineering, University of Belgrade, Studentski trg 1, 11000 Belgrade, Serbia
- Vinča Institute of Nuclear Sciences, University of Belgrade, Studentski trg 1, 11000 Belgrade, Serbia
| | - M Dobrić
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade 11000, Serbia
| | - O Ciraj-Bjelac
- School of Electrical Engineering, University of Belgrade, Studentski trg 1, 11000 Belgrade, Serbia
- Vinča Institute of Nuclear Sciences, University of Belgrade, Studentski trg 1, 11000 Belgrade, Serbia
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22
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Uflacker AB, Haskal ZJ, Baerlocher MO, Bhatia SS, Carnevale FC, Dariushnia SR, Faintuch S, Gaba RC, Golzarian J, Midia M, Nikolic B, Sapoval MR, Walker TG. Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization. J Vasc Interv Radiol 2020; 31:891-898.e1. [PMID: 32340862 DOI: 10.1016/j.jvir.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andre B Uflacker
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ziv J Haskal
- Department of Radiology and Medical Imaging/Interventional Radiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Mark O Baerlocher
- Department of Radiology, Royal Victoria Hospital, Barrie, Ontario, Canada
| | - Shivank S Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Francisco C Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Salomao Faintuch
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ron C Gaba
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota
| | - Mehran Midia
- Department of Radiology, McMaster University, Joseph Brant Hospital, Burlington, Ontario, Canada
| | - Boris Nikolic
- Department of Interventional Radiology, Cooley Dickinson Hospital, Massachusetts General Hospital Affiliate, Northampton, Massachusetts
| | - Marc R Sapoval
- Department of Interventional Vascular and Oncologic Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - T Gregory Walker
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
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23
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Badawy MK, Witkowski CJ, Baldoni R, Carrion D, Yildirim E. Radiation dose during fluoroscopically guided central venous access device insertion: retrospective observational study. RADIOLOGIA 2020; 63:5-12. [PMID: 32279868 DOI: 10.1016/j.rx.2020.01.011] [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: 05/09/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Central venous access devices (CVAD) are used to deliver intravenous therapy to the bloodstream. CVAD insertion is sometimes fluoroscopically guided and thus associated with radiation dose to both the patient and the staff members within the room. The objective of this study is to assess the radiation dose to the patient through a retrospective audit and directly measure the exposure to staff members in simulated procedures. A secondary objective is to evaluate the radiation exposure to the staff and patients when utilising fluoroscopic pulse rate of 7.5 pps and 4 pps. MATERIAL AND METHODS A retrospective audit of patients undergoing Permcath and Hickman line insertions was conducted. The patients were grouped by the pulse rate used for the duration of the study; 4 pulses per second (pps) (n=24) and 7.5 pps (n=33). A STEP OD-2 monitor and PMMA was used in a simulated environment to estimate the radiation exposure to locations that a Radiologist, Nurse and Radiographer would be standing during the procedures using the average procedure details collected in the retrospective audit. Measurements were conducted at heights to reflect a whole body estimate and an estimate to the lens of the eye. RESULTS The results show that the median dose area product (DAP) for CVAD insertion is 0.7Gy.cm2 and 0.3Gy.cm2 for procedures done at 7.5 pps and 4 pps, respectively. This corresponded to an effective dose of 0.22 mSv and 0.1 mSv. The radiologist, nurse and radiographer were exposed to a whole-body shielded dose of 0.36μSv, 0.1μSv and 0.05μSv when 7.5 pps was utilised and 0.13μSv, 0.03μSv and 0.02μSv when 4 pps was used. The exposure to the head of radiologist, nurse and radiographer was 2.1μSv, 1.4μSv, and 0.6μSv in the 7.5 pps studies and 0.7μSv, 0.5μSv, and 0.2μSv when 4pps was used. CONCLUSION The patient effective dose was estimated to be 0.1-0.22 mSv depending on the fluoroscopic pulse rate utilised during CVAD insertions. Additionally, The radiologist, nurse and radiographer whole body and lens exposure was estimated in a simulated setting. In all cases, there was a statistically significant dose reduction when the lower fluoroscopic pulse rate was used. Thus, where possible, consideration should be given to utilising a lower pulse rate during CVAD insertions to reduce the exposure to both staff and patients.
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Affiliation(s)
- M K Badawy
- Monash Imaging, Monash Health, Clayton, VIC 3168, Australia
| | - C J Witkowski
- Departamento de Cirugía, Monash Health, Clayton, VIC 3168, Australia
| | - R Baldoni
- Monash Imaging, Monash Health, Clayton, VIC 3168, Australia.
| | - D Carrion
- Departamento de Física Médica, Austin Health, Heidelberg, VIC 3084, Australia
| | - E Yildirim
- Departamento de Radiología, Austin Health, Heidelberg, VIC 3084, Australia
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24
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Serna Santos J, Uusi-Simola J, Kaasalainen T, Aho P, Venermo M. Radiation Doses to Staff in a Hybrid Operating Room: An Anthropomorphic Phantom Study with Active Electronic Dosimeters. Eur J Vasc Endovasc Surg 2020; 59:654-660. [DOI: 10.1016/j.ejvs.2020.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/15/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
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Villecourt A, Faroux L, Blanpain T, Kinnel M, Mora C, Tassan-Mangina S, Heroguelle V, Nazeyrollas P, Metz D. Exposure to Ionizing Radiation in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:114-119. [PMID: 31699362 DOI: 10.1016/j.amjcard.2019.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is currently becoming an alternative to surgical valve replacement for patients at low risk, a population that is likely to experience an increase in the radiation-induced cancer risk following TAVI. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent transfemoral TAVI, including the procedure itself as well as the procedures performed in the preintervention work-up and the post-TAVI interventions. All patients who underwent transfemoral TAVI for symptomatic aortic stenosis in our center over a 26 months period were included. Dosimetric indicators from preprocedural coronary angiography and computed tomography (CT), the TAVI procedure, and any postprocedural interventions (electrophysiology study and/or pacemaker implantation) were collected and converted into an effective dose. A total of 119 transfemoral TAVI procedures were included. The mean cumulative effective dose (ED) was 37.3 mSv. Three irradiating procedures were necessary for 84 patients (71% of the population, i.e., coronary angiography, CT scan and the TAVI procedure itself), whereas 30 patients (25%) required a fourth procedure, and 5 required a fifth (4%). The majority of the dose was from the CT, while only 11% of the dose derived from the TAVI procedure itself. In conclusion, overall exposure to ionizing radiation for patients who underwent transfemoral TAVI seems acceptable, and the majority of the overall ED comes from the CT scan.
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Affiliation(s)
| | - Laurent Faroux
- Department of Cardiology, Reims University Hospital, Reims, France.
| | - Thierry Blanpain
- Department of Cardiology, Reims University Hospital, Reims, France; Department of Radiation Protection, Reims University Hospital, Reims, France
| | - Marine Kinnel
- Department of Cardiology, Reims University Hospital, Reims, France
| | - Caroline Mora
- Department of Radiology, Reims University Hospital, Reims, France
| | | | | | | | - Damien Metz
- Department of Cardiology, Reims University Hospital, Reims, France
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Hersh-Boyle RA, Culp WTN, Brown DC, Luskin AC, Kapatkin AS, Chou PY, Agnello KA, Reetz JA, Oyama MA, Visser LC, Palm CA, Clarke DL. Radiation exposure of dogs and cats undergoing fluoroscopic procedures and for operators performing those procedures. Am J Vet Res 2019; 80:558-564. [PMID: 31140847 DOI: 10.2460/ajvr.80.6.558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate radiation exposure of dogs and cats undergoing procedures requiring intraoperative fluoroscopy and for operators performing those procedures. SAMPLE 360 fluoroscopic procedures performed at 2 academic institutions between 2012 and 2015. PROCEDURES Fluoroscopic procedures were classified as vascular, urinary, respiratory, cardiac, gastrointestinal, and orthopedic. Fluoroscopy operators were classified as interventional radiology-trained clinicians, orthopedic surgeons, soft tissue surgeons, internists, and cardiologists. Total radiation exposure in milligrays and total fluoroscopy time in minutes were obtained from dose reports for 4 C-arm units. Kruskal-Wallis equality of populations rank tests and Dunn pairwise comparisons were used to compare differences in time and exposure among procedures and operators. RESULTS Fluoroscopy time (median, 35.80 minutes; range, 0.60 to 84.70 minutes) was significantly greater and radiation exposure (median, 137.00 mGy; range, 3.00 to 617.51 mGy) was significantly higher for vascular procedures than for other procedures. Median total radiation exposure was significantly higher for procedures performed by interventional radiology-trained clinicians (16.10 mGy; range, 0.44 to 617.50 mGy), cardiologists (25.82 mGy; range, 0.33 to 287.45 mGy), and internists (25.24 mGy; range, 3.58 to 185.79 mGy). CONCLUSIONS AND CLINICAL RELEVANCE Vascular fluoroscopic procedures were associated with significantly longer fluoroscopy time and higher radiation exposure than were other evaluated fluoroscopic procedures. Future studies should focus on quantitative radiation monitoring for patients and operators, importance of operator training, intraoperative safety measures, and protocols for postoperative monitoring of patients.
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Schott P, Katoh M, Fischer N, Freyhardt P. Radiation Dose in Prostatic Artery Embolization Using Cone-Beam CT and 3D Roadmap Software. J Vasc Interv Radiol 2019; 30:1452-1458. [PMID: 31371137 DOI: 10.1016/j.jvir.2019.04.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the radiation dose in patients undergoing prostatic artery embolization (PAE) using cone-beam CT and 3-dimensional (3D) guidance software. MATERIALS AND METHODS In this single-center retrospective study, 100 patients with benign prostatic hyperplasia (mean prostate volume, 83.6 mL ± 44.2; 69.4 ± 9.6 years of age; body mass index, 26.5 ± 4.2) were treated using PAE between October 2016 and April 2018. Informed consent was obtained from all participants included in the study. All patients received at least 1 intraprocedural cone-beam CT per side for evaluation of the vessel anatomy and software rendering of 3D guidance for catheter guidance. Digital subtraction angiography (DSA) was performed in the distal branches only. The total dose area product (DAP), along with the DAP attributed to fluoroscopy, DSA, and cone-beam CT, were assessed. RESULTS Bilateral embolization was achieved in 83 patients (83%). The average total DAP was 134.4 Gy ⋅ cm2 ± 69.5 (range, 44.7-410.9 Gy ⋅ cm2). Fluoroscopy, DSA, and cone-beam CT accounted for 35.5 Gy ⋅ cm2 ± 21.3 (range, 8.6-148.6 Gy ⋅ cm2) or 26.4% (percentage of total DAP), 58.2 Gy ⋅ cm2 ± 48.3 (range, 10.3-309.3 Gy ⋅ cm2) or 43.3%, and 40.7 Gy ⋅ cm2 ± 14.5 (range, 15.9-86.3 Gy ⋅ cm2) or 30.3%, respectively. Average procedure time was 89.4 ± 27.0 minutes, and the average fluoroscopy time was 30.9 ± 12.2 minutes. CONCLUSIONS Intraprocedural cone-beam CT in combination with 3D guidance software allows for identification and catheterization of the prostatic artery in PAE. Furthermore, the results of this trial indicate that this study protocol may lead to a low overall radiation dose.
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Affiliation(s)
- Peter Schott
- Institut für Diagnostische und Interventionelle Radiologie, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany.
| | - Marcus Katoh
- Institut für Diagnostische und Interventionelle Radiologie, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Nicolas Fischer
- Klinik für Urologie und Kinderurologie, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Patrick Freyhardt
- Institut für Diagnostische und Interventionelle Radiologie, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
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Schmitz D, Vogl T, Nour-Eldin NEA, Radeleff B, Kröger JC, Mahnken AH, Ittrich H, Gehl HB, Plessow B, Böttcher J, Tacke J, Wispler M, Rosien U, Schorr W, Joerdens M, Glaser N, Fuchs ES, Tal A, Friesenhahn-Ochs B, Leimbach T, Höpner L, Weber M, Gölder S, Böhmig M, Hetjens S, Rudi J, Schegerer A. Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study. Eur Radiol 2019; 29:3390-3400. [PMID: 31016441 DOI: 10.1007/s00330-019-06208-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs. METHODS A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs. RESULTS Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4-21,510 cGy·cm2) and FTs (range 0.07-180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm2) than those of follow-up PBIs (median 464 cGy·cm2). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm2) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm2) (p = 0.85). FT varied substantially (0.07-180.33 min). CONCLUSIONS DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm2 for initial PBIs and 1400 cGy·cm2 for follow-up PBIs are recommended. KEY POINTS • DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. • PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture. • DRLs of 4300 cGy·cm2for initial PBIs (establishing a transhepatic tract) and 1400 cGy·cm2for follow-up PBIs (transhepatic tract already established) are recommended.
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Affiliation(s)
- Daniel Schmitz
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany.
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Boris Radeleff
- Department for Diagnostic and Interventional Radiology, Sana Municipal Hospital Hof, Hof, Germany
| | - Jens-Christian Kröger
- Institute for Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
| | - Andreas H Mahnken
- Institute for Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany
| | - Harald Ittrich
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg, Hamburg, Germany
| | - Hans-Björn Gehl
- Institute for Diagnostic Radiology, Municipal Hospital Bielefeld, Bielefeld, Germany
| | - Bernd Plessow
- Radiological Institute, University Medicine Greifswald, Greifswald, Germany
| | - Joachim Böttcher
- Institute for Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Josef Tacke
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, Municipal Hospital Passau, Passau, Germany
| | - Markus Wispler
- Community Hospital Havelhöhe, Gastroenterology, Berlin, Germany
| | - Ulrich Rosien
- Medical Clinic, Israelite Hospital Hamburg, Hamburg, Germany
| | - Wolfgang Schorr
- Department of Gastroenterology and Interventional Endoscopy, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany
| | - Markus Joerdens
- Department of Gastroenterology, Oncology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicolas Glaser
- Clinic for Internal Medicine II: Gastroenterology, Oncology, Endocrinology and Infectiology, University Hospital Freiburg, Freiburg, Germany
| | - Erik-Sebastian Fuchs
- Department of Gastroenterology, Infectiology, Diabetology and Gastrointestinal Oncology (Medical Clinic C), Ludwigshafen Municipal Hospital, Ludwigshafen, Germany
| | - Andrea Tal
- Medical Clinic I: Gastroenterology and Hepatology, Pneumology and Allergology, Endocrinology and Diabetology as Nutritional Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Bettina Friesenhahn-Ochs
- Clinic for Internal Medicine II: Gastroenterology, Hepatology, Endocrinology, Diabetology and Nutritional Medicine, Saarland University Hospital, Homburg, Germany
| | - Thomas Leimbach
- Clinic for Gastroenterology, Hepatology, Gastrointestinal Oncology, Municipal Hospital Bogenhausen Munich, Munich, Germany
| | - Lars Höpner
- Clinic for Gastrointestinal Diseases/Medical Clinic I, Municipal Clinic of Braunschweig, Braunschweig, Germany
| | - Marko Weber
- Clinic for Internal Medicine IV: Gastroenterology, Hepatology, Infectiology, Interdisciplinary Endoscopy, University Hospital Jena, Jena, Germany
| | - Stefan Gölder
- Medical Clinic III - Gastroenterology, Municipal Hospital Augsburg, Augsburg, Germany
| | - Michael Böhmig
- Medical Clinic I (Gastroenterology, Hepatology, Oncology, Infectiology), Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics and Biomathematics of Mannheim University Hospital, Heidelberg University-Hospital, Heidelberg, Germany
| | - Jochen Rudi
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany
| | - Alexander Schegerer
- Department for Radiation Protection and Health, Federal Office of Radiation Protection, Salzgitter, Germany
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Lee B, Kim MS, Eum D, Min KT. The radiation environment of anaesthesiologists in the endoscopic retrograde cholangiopancreatography room. Sci Rep 2019; 9:9124. [PMID: 31235744 PMCID: PMC6591287 DOI: 10.1038/s41598-019-45610-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022] Open
Abstract
Anaesthesiologists are increasingly involved in nonoperating room anaesthesia (NORA) for fluoroscopic procedures. However, the radiation exposure of medical staff differs among NORA settings. Therefore, we aimed to investigate the radiation environment generated by fluoroscopic endoscopic retrograde cholangiopancreatography (ERCP) and the radiation exposure of anaesthesiologists. The dose area product (DAP), radiation entrance dose (RED), and fluoroscopy time (FT) according to the procedures and monthly cumulative radiation exposure were analysed at two sites (neck and wrist) from 363 procedures in 316 patients performed within 3 months. The total RED and DAP were 43643.1 mGy and 13681.1 Gy cm2, respectively. DAP and RED (r = 0.924) were strongly correlated and DAP and FT (r = 0.701) and RED and FT (r = 0.749) were moderately correlated. The radiation environment per procedure varied widely, DAP and RED per FT were the highest during stent insertion with esophagogastroduodenoscopy. Monthly cumulative deep dose equivalents at the wrist and neck ranged between 0.31-1.27 mSv and 0.33-0.59 mSv, respectively, but they were related to jaw thrust manipulation (r = 0.997, P = 0.047) and not to the radiation environment. The anaesthesiologists may be exposed to high dose of radiation in the ERCP room, which depends on the volume of procedures performed and perhaps the anaesthesiologists' practice patterns.
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Affiliation(s)
- Bora Lee
- Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Min-Soo Kim
- Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Darhae Eum
- Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyeong Tae Min
- Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Choi DH, Yoo CJ, Park CW, Kim MJ. Practical Dose Parameter Values for the Prediction of the Adverse Effect of Neurointerventional Radiation: Relationship Between the Dose Parameters and Temporary Alopecia After Intracranial Coil Embolization. World Neurosurg 2019; 130:e222-e229. [PMID: 31203064 DOI: 10.1016/j.wneu.2019.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To present values for the dose parameters predictive of alopecia as an adverse effect induced by neuroembolization using a biplane fluoroscopy. METHODS This study included a total of 151 patients (52 men, mean age of 55.1 ± 12.2 years) treated for intracranial neuroembolization between 2014 to 2018 with the following criteria: 1) obtainable dose report with digital subtraction angiographic image records, 2) no history of radiation exposure 6 months prior to the first procedure, and 3) and clinical follow-up performed through 12 months following the procedure. Patients were divided into 2 groups according to their presentation of alopecia during the follow-up period. RESULTS Eighteen (11.9%) patients developed alopecia 10 to 30 days after the procedure (average: 18.5 ± 5.3 days). Sixteen (88.9%) patients in the alopecia group were affected by projection of the A-plane fluoroscopy. Area under the receiver operating characteristic analysis curves of 0.865 (P = 0.000) and 0.831 (P = 0.000) were used to compute the optimal A-plane dose area product (255.4 Gy-cm2; sensitivity: 0.875; specificity: 0.805; Youden J = 0.682) and cumulative dose (4437.5 mGy; sensitivity, 0.750; specificity, 0.805; Youden J = 0.556) cutoff values, respectively, capable of distinguishing patients with alopecia (n = 16) from subtotal patients (n = 149). CONCLUSIONS The dose area product and the cumulative dose may be useful, intuitive factors for predicting the adverse effects of the neurointerventional radiation. Further multicenter research should be performed to confirm the efficacy and utility of the reference values of dose area product and cumulative dose for preventing excessive irradiation during neurointerventional procedures.
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Affiliation(s)
- Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chan Jong Yoo
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Cheol Wan Park
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Myeong Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
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Al-Jabri AJ, Alzimami K, Alsafi K, Alaamer AS, Al-Rajhi MA, Suliman II. RETROSPECTIVE ANALYSIS OF PATIENT RADIATION DOSES IN DIGITAL CORONARY ANGIOGRAPHY AND INTERVENTIONS. RADIATION PROTECTION DOSIMETRY 2019; 183:496-501. [PMID: 30260437 DOI: 10.1093/rpd/ncy168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/19/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
This study sought to assess patient and operator eye lens doses in diagnostic coronary angiography (DCA) and percutaneous coronary interventions (PCI) in a University hospital in Oman. Kerma area product (PkA), cumulative air kerma (CAK) and fluoroscopic time (FT) were retrospectively recorded from the DICOM header for 264 patients. The median (interquartile range) of FT, PKA and CAK were: 5.3 min (2.6-10.5), 60.9 Gy cm2 (41.3-91.4) and 0.86 Gy (0.61-1.29), respectively, for DCA procedures, and they were 20.2 min (13.3-30.1), 174.0 Gy cm2 (113.7-253.3) and 2.6 Gy (1.8-3.9), respectively, for PCI procedures. The results revealed wide variability in patient doses among individual patients. Monitoring and recording patient dose data can be valuable for quality assurance and patient safety purposes. Feedback to the operator may help optimize radiation doses to patients and prompt further action, as needed.
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Affiliation(s)
- Amna J Al-Jabri
- Department of Radiology and Molecular Imaging, Medical Physics Section, College of Medicine & Health Sciences, Sultan Qaboos University, Al-Khod 123, Oman
| | - Khalid Alzimami
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - K Alsafi
- Department of Radiology, Medical Physics Unit, King Abdul Aziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz S Alaamer
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
| | - M A Al-Rajhi
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
| | - I I Suliman
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
- Sudan Atomic Energy Commission, Institute of Nuclear and Radiological Safety, Khartoum, Sudan
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Maghbool M, Hosseini MA. AN ASSESSMENT OF RADIATION EXPOSURE DOSES IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION BASED ON ANGIOGRAPHIC RECORDS. RADIATION PROTECTION DOSIMETRY 2019; 183:474-481. [PMID: 30289545 DOI: 10.1093/rpd/ncy180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
The stochastic and non-stochastic (deterministic) effects of radiation dose in patients undergoing primary percutaneous coronary intervention (PPCI) have been investigated using data recorded by an angiographic monitoring system. A total of 132 patients with acute myocardial infarction referred to the angiography department of Vali-Asr hospital, Fasa, Iran, during the second half of 2016 were recruited. Quantities like dose-area product (DAP), total air kerma (Ka,r) and fluoroscopy time (FT) were calculated and converted into effective dose (ED) and peak skin dose (PSD). The values for Ka,r, DAP and FT equaled 80 399.20 ± 63 312 mGy cm2, 1392.80 ± 1155.373 mGy and 524.11 ± 423.057 s, respectively, which were within the ranges reported in previous studies. After considering standard dose thresholds for Ka,r and PSD, it was revealed that only a small portion of patients had reached these thresholds and exceeded them (<3%). Moreover, ED < 20 mSv for the majority of patients was fairly consistent with results from a recent research in eight Belgian hospitals. It was shown that angiographic records are reliable for assessing radiation dose in patients.
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Affiliation(s)
- M Maghbool
- Nuclear Engineering Department, Islamic Azad University, Arsanjan Branch, Arsanjan, Iran
| | - M A Hosseini
- Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran
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Kato M, Chida K, Nakamura M, Toyoshima H, Terata K, Abe Y. New real-time patient radiation dosimeter for use in radiofrequency catheter ablation. JOURNAL OF RADIATION RESEARCH 2019; 60:215-220. [PMID: 30624747 PMCID: PMC6430253 DOI: 10.1093/jrr/rry110] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 05/17/2023]
Abstract
In a previous study, we reported on a novel (prototype) real-time patient dosimeter with non-toxic phosphor sensors. In this study, we developed new types of sensors that were smaller than in the previous prototype, and clarified the clinical feasibility of our newly proposed dosimeter. Patient dose measurements obtained with the newly proposed real-time dosimeter were compared with measurements obtained using a calibrated radiophotoluminescence glass reference dosimeter (RPLD). The reference dosimeters were set at almost the same positions as the new real-time dosimeter sensors. We found excellent correlations between the reference RPLD measurements and those obtained using our new real-time dosimeter (r2 = 0.967). However, the new type of dosimeter was found to underestimate radiation skin dose measurements when compared with an RPLD. The most probable reason for this was the size reduction in the phosphor sensor of the new type of dosimeter. We believe that, as a result of reducing the phosphor sensor size, the backscattered X-ray irradiation was underestimated. However, the new dosimeter can accurately determine the absorbed dose by correcting the measured value with calibration factors. The calibration factor for the new type dosimeter was determined (by linear regression) to be ~1.15. New real-time patient dosimeter design would be an effective tool for the real-time measurement of patient skin doses during interventional radiology treatments.
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Affiliation(s)
- Mamoru Kato
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels – Akita, 6–10 Senshu-Kubota Machi, Akita, Akita, Japan
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Sendai, Miyagi, Japan
| | - Koichi Chida
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Sendai, Miyagi, Japan
| | - Masaaki Nakamura
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Sendai, Miyagi, Japan
| | - Hideto Toyoshima
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels – Akita, 6–10 Senshu-Kubota Machi, Akita, Akita, Japan
| | - Ken Terata
- Department of Cardiology, Division of Internal Medicine, Research Institute for Brain and Blood Vessels – Akita, 6–10 Senshu-Kubota Machi, Akita, Akita, Japan
| | - Yoshihisa Abe
- Department of Cardiology, Division of Internal Medicine, Research Institute for Brain and Blood Vessels – Akita, 6–10 Senshu-Kubota Machi, Akita, Akita, Japan
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Nielsen CJ. Radiation Safety Certification: A Review. J Nucl Med Technol 2018; 46:321-325. [PMID: 30413600 DOI: 10.2967/jnmt.118.209528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022] Open
Abstract
It has become common for nuclear medicine technologists to assume the responsibilities, or even the role, of the radiation safety officer or associate radiation safety officer. Their responsibilities are primarily related to the radioactive materials license but increasingly can include additional safety responsibilities within the hospital. These include CT, MRI, and fluoroscopy safety. Many technologists reading this article may be interested in sitting for the radiation safety advanced certification examination by the Nuclear Medicine Technology Certification Board. A consultation of the content outline for that examination (found on the Nuclear Medicine Technology Certification Board website) is a good place to start. The content outline is quite extensive and cannot be covered within a single article.
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Affiliation(s)
- Cybil J Nielsen
- Nuclear Medicine Technology Program, Department of Radiologic and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
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Nguyen Q, Sarwar A, Luo M, Berkowitz S, Ahmed M, Brook OR. Structured Reporting of IR Procedures: Effect on Report Compliance, Accuracy, and Satisfaction. J Vasc Interv Radiol 2018; 29:345-352. [PMID: 29373245 DOI: 10.1016/j.jvir.2017.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/03/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare effect of free-text versus structured reporting of IR procedures on report quality and report coding and value. MATERIALS AND METHODS In this retrospective study, 432 common consecutive free-text IR reports created during 4 months (from September 2013 to December 2013) before implementation of structured reporting (February 2014) and 415 structured IR reports created after implementation (from September 2014 to December 2014) were reviewed to assess ease of use and compliance with reporting requirements for regulatory requirements and coding. IR staff and trainees and referring physicians to IR were surveyed on procedure report attributes, such as detail, quality, and clarity. RESULTS Structured reporting increased compliance with reporting fluoroscopy time, radiation dose, and contrast administration compared with free-text reports (402/432 [93.1%] vs 251/415 [60.5%], P < .001; 402/432 [93.1%] vs 242/415 [58.3%], P < .001; and 395/432 [91.4%] vs 257/415 [61.9%], P < .001). Structured reporting decreased addendum requests for insufficient documentation from 43% (121/435 [28%] to 50/415 [12%], P = .01). Most IR physicians found structured reports to require less time to complete (21/26 [81%]), to be easier to complete (23/26 [89%]), and to have a similar or higher level of detail (19/26 [73%]) compared with free-text reports. Referring physicians were more satisfied with structured reports compared with free-text reports (6.9/10 vs 5.6/10, P = .03). CONCLUSIONS Structured IR reporting compared with free-text reporting improves compliance with radiation dose and contrast reporting, reporting and coding efficiency, and satisfaction among IR and referring physicians.
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Affiliation(s)
- Quang Nguyen
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Ammar Sarwar
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Michael Luo
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Seth Berkowitz
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Olga R Brook
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; Department of Radiology, Harvard Medical School, Boston, Massachusetts.
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Kostova-Lefterova DD, Nikolov NN, Stanev SS, Stoyanova BB. Patient doses in endovascular and hybrid revascularization of the lower extremities. Br J Radiol 2018; 91:20180176. [PMID: 30028182 DOI: 10.1259/bjr.20180176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Hybrid surgical methods such as remote endarterectomy and endovascular revascularization are fluoroscopy-guided procedures successfully replacing conventional open surgery for treatment of peripheral artery disease (PAD). The aim of this study was to: (1) evaluate the dose parameters describing exposure of patients undergoing endovascular or hybrid revascularization of the lower limb (below the inguinal ligament); (2) compare the data available in the literature with the evaluations of patients' dose values and related factors for patients undergoing such procedures; (3) examine the correlation of doses with certain parameters; (4) estimate the peak skin dose and assess the potential for radiation-induced skin injuries during the procedures. METHODS: Data for 259 patients were extracted retrospectively and analyzed. The procedures were grouped by type of intervention, vascular approach, and level of complexity. The analyses included the correlation of dose values with the operating team. RESULTS: The air kerma-area product (KAP) and fluoroscopy time (FT) values greatly varied depending on the procedure type but also among patients undergoing the same procedure. The type of vascular access has the largest impact on patients' doses. The KAP and FT values for brachial artery were: 347 Gy.cm2 and FT: NA; for contralateral common femoral artery (CFA) approach: 207 Gy.cm2 and 153 s; e.g. significantly higher than for ipsilateral CFA: 96 Gy.cm2 and 78 s; for hybrid surgery: 77 Gy.cm2 and 41 s; and for ipsilateral retrograde popliteal approach: 61 Gy.cm2 and 53 s. The same tendency is observed for the peak skin dose (PSD) values: the highest are for brachial artery (2053 mGy) and contralateral CFA (1325 mGy) approach, followed by the ipsilateral CFA (748 mGy), hybrid surgery (649 mGy), and ipsilateral retrograde popliteal approach (566 mGy). CONCLUSION: Registered dose values and FT for the different procedures do not exceed the International Atomic Energy Agency (IAEA) proposed trigger values for patients' follow-up for radiation-induced skin injuries. The type of vascular access has the highest negative impact on radiation dose levels and resultant KAP, PSD, and FT values. There is a significant increase of the dose values with increase of the number of inserted stents and the level of complexity. This should be considered in planning, especially for patients who undergo multiple diagnostic and therapeutic procedures. ADVANCES IN KNOWLEDGE: This study gives a systematic understanding for patient radiation exposure in endovascular and hybrid revascularization of the lower extremities, thus far absent in the literature.
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Affiliation(s)
- Desislava D Kostova-Lefterova
- 1 Clinic of Vascular Surgery, National Cardiology Hospital , Sofia , Bulgaria.,2 Medical College, Medical University - Pleven , Pleven , Bulgaria
| | - Nadelin N Nikolov
- 1 Clinic of Vascular Surgery, National Cardiology Hospital , Sofia , Bulgaria
| | - Stefan S Stanev
- 1 Clinic of Vascular Surgery, National Cardiology Hospital , Sofia , Bulgaria
| | - Boyka B Stoyanova
- 1 Clinic of Vascular Surgery, National Cardiology Hospital , Sofia , Bulgaria
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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Loewenstern J, Welch C, Lekperic S, Bishay V, Ranade M, Patel RS, Kim E, Nowakowski FS, Lookstein RA, Fischman AM. Patient Radiation Exposure in Transradial versus Transfemoral Yttrium-90 Radioembolization: A Retrospective Propensity Score-Matched Analysis. J Vasc Interv Radiol 2018; 29:936-942. [PMID: 29753675 DOI: 10.1016/j.jvir.2018.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/10/2018] [Accepted: 02/11/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare differences in patient radiation exposure (PRE) during transarterial yttrium-90 (90Y) radioembolization (TARE) between transradial access (TRA) and transfemoral access (TFA). MATERIALS AND METHODS A total of 810 consecutive first-time TARE procedures in patients from 2013 to 2017 were retrospectively reviewed. A propensity score-matching (PSM) analysis matched TRA and TFA groups on the basis of patient age, sex, weight, height, cancer type, 90Y microsphere type, and number of previous procedures from the same and opposite approaches. Matched groups were then compared by PRE measures fluoroscopy time (FT), dose-area product (DAP), and cumulative air kerma (AK). Effect size for each PRE measure was calculated. RESULTS Before PSM, TRA and TFA groups differed significantly in mean age, weight, and number of previous procedures from the same and opposite approach (all P < .05). After PSM, each group consisted of 302 procedures (overall, n = 604) and no longer differed in any procedure performed before surgery measure. TRA did not differ from the matched TFA group regarding median FT (9.50 vs 9.40 minutes, P = .095), median DAP (67,066 vs 67,219 mGy·cm2; P = .19), or median AK (323.63 vs 248.46 mGy; P = .16). Effect sizes were 0.068, 0.054, and 0.110 for FT, DAP, and AK, respectively. CONCLUSIONS No statistical differences were found for PRE measures between the matched TRA and TFA approach groups. Furthermore, practical effect sizes were considered to be small for AK and less than small for FT and DAP, and therefore, any differences in PRE between the radial and femoral approaches for TARE are minor and unlikely to be noticeable in everyday clinical practice.
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Affiliation(s)
- Joshua Loewenstern
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Colton Welch
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Safet Lekperic
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Vivian Bishay
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Mona Ranade
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Rahul S Patel
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Edward Kim
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - F Scott Nowakowski
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Robert A Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029
| | - Aaron M Fischman
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level, New York, New York 10029.
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Reduction in exposure of interventional cardiologists to ionising radiation over a 10-year period. Int J Cardiol 2018; 259:57-59. [DOI: 10.1016/j.ijcard.2018.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/25/2017] [Accepted: 02/07/2018] [Indexed: 11/20/2022]
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40
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Kostova-Lefterova D, Vassileva J, Rehani MM. Lessons from two cases of radiation induced skin injuries in fluoroscopic procedures in Bulgaria. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:938-946. [PMID: 28914233 DOI: 10.1088/1361-6498/aa8ce7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Radiation-induced injuries to patient skin as a result of fluoroscopy guided interventional procedures are infrequently reported, often misdiagnosed and there is a need to learn lessons from every injury. METHODS This paper describes two cases of radiation induced skin injuries that are, to the best of our knowledge, the first ever reported cases from Bulgaria and possibly from Eastern Europe, and would thus have educational value. RESULTS The important messages from the skin injuries reported here are: lack of awareness among part of the interventional specialists about the potential for radiation induced skin injury, misdiagnosis after injury happened because of lack of awareness and knowledge among general physicians, dermatologists and surgeons who followed up cases of skin injuries; the lack of system to monitor patients with relatively high exposure; the important role played by the medical physicist in diagnosing the injury and overall in initiating actions; the role of training and informational material displayed in interventional facilities. CONCLUSIONS For avoidance of skin injuries from interventional procedures it is of utmost importance to implement a system that includes (a) regular monitoring of radiation dose parameters of the procedure; (b) established trigger values for reporting;
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Affiliation(s)
- D Kostova-Lefterova
- National Cardiology Hospital, Sofia, Bulgaria. Alexandrovska Hospital, Sofia, Bulgaria
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Faroux L, Blanpain T, Nazeyrollas P, Tassan-Mangina S, Herce B, Tourneux C, Metz D. Trends in Patient Exposure to Radiation in Percutaneous Coronary Interventions Over a 10-Year Period. Am J Cardiol 2017; 120:927-930. [PMID: 28739037 DOI: 10.1016/j.amjcard.2017.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/20/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
Technological progress has made it possible to reduce the dose of radiation delivered by medical x-ray systems. In parallel, interventional coronary procedures have become increasingly complex and consequently, last longer. This study aimed to compare the estimated dose of radiation received by patients in interventional cardiology at 10 years interval (2006 vs 2016). The study population included all patients who underwent interventional coronary procedures in one of the catheterization laboratories of our institution during 2 periods, namely, period 1 from October 2005 to March 2006, and period 2 from November 2015 to October 2016. The primary end point was the estimated dose of radiation received by the patient as assessed by dose area product. In 2016, the estimated dose of radiation received by patients who underwent interventional coronary procedures was on average 78% lower than that received in 2006 (p <0.0001), whereas the fluoroscopy time increased by 54% on average over the same period (p <0.0001). By multivariate analysis, including age, approach, body mass index, fluoroscopy time, and performance of angioplasty, the reduction in radiation remained significant. The radial approach was significantly associated with an increased estimated dose of radiation received (p <0.0001). In conclusion, the estimated dose of radiation received by patients who underwent interventional cardiology procedures has been reduced by 78% over the last decade.
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Minimizing exposure to radiation in invasive cardiology using modern dose-reduction technology: Evaluation of the real-life effects. Catheter Cardiovasc Interv 2017; 91:1194-1199. [DOI: 10.1002/ccd.27245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 01/28/2023]
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43
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DeSimone AK, Post A, Duszak R, Duong PAT. Radiology Trainee vs Faculty Radiologist Fluoroscopy Time for Imaging-Guided Procedures: A Retrospective Study of 17,966 Reports Over a 5.5-Year Period. Curr Probl Diagn Radiol 2017; 47:233-237. [PMID: 28797716 DOI: 10.1067/j.cpradiol.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/26/2017] [Accepted: 07/05/2017] [Indexed: 12/18/2022]
Abstract
To evaluate differences in fluoroscopy time (FT) for common vascular access and gastrointestinal procedures performed by radiology trainees vs faculty radiologists. Report information was extracted for all 17,966 index fluoroscopy services performed by trainees or faculty, or both from 2 university hospitals over 66 months. Various vascular access procedures (eg, peripherally inserted central catheters [PICCs] and ports) and gastrointestinal fluoroscopy procedures (eg, upper gastrointestinal and contrast enema studies) were specifically targeted. Statistical analysis was performed. FT was recorded in 17,549 of 17,966 reports (98%) The 1393 procedures performed by nonphysician providers or transitional year interns were excluded. Residents, fellows, and faculty were primary operators in 5066, 6489, and 4601 procedures, respectively. Average FT (in seconds) for resident and fellow services, respectively, was less than that of faculty only for PICCs (75 and 101 vs 148, P < 0.01). For all other procedures, average FT of trainee services was greater than that for faculty. This was statistically significant (P < 0.05) for fellows vs faculty port placement (121 vs 87), resident vs faculty small bowel series (130 vs 96), and both resident and fellow vs faculty esophagram procedures (143 and 183 vs 126 ). FT for residents was significantly less than that for fellows only for PICCs (75 vs 101, P < 0.01). For most, but not all, fluoroscopy procedures commonly performed by radiology trainees, FT is greater than that for procedures performed by faculty radiologists. Better awareness and understanding of such differences may aid training programs in developing benchmarks, protocols, and focused teaching in the safe use of fluoroscopy for patients and operators.
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Affiliation(s)
- Ariadne K DeSimone
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Andrew Post
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA; Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Phuong-Anh T Duong
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
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Gress DA, Dickinson RL, Erwin WD, Jordan DW, Kobistek RJ, Stevens DM, Supanich MP, Wang J, Fairobent LA. AAPM medical physics practice guideline 6.a.: Performance characteristics of radiation dose index monitoring systems. J Appl Clin Med Phys 2017; 18:12-22. [PMID: 28497529 PMCID: PMC5875816 DOI: 10.1002/acm2.12089] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 11/30/2016] [Accepted: 01/20/2017] [Indexed: 11/08/2022] Open
Abstract
The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: •Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. •Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.
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Affiliation(s)
- Dustin A. Gress
- Department of Imaging PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
| | | | - William D. Erwin
- Department of Imaging PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - David W. Jordan
- Department of RadiologyUniversity Hospitals Cleveland Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | | | - Donna M. Stevens
- Northwest Permanente, PCKaiser Sunnyside Medical CenterClackamasORUSA
| | - Mark P. Supanich
- Department of Diagnostic Radiology and Nuclear MedicineRush University Medical CenterChicagoILUSA
| | - Jia Wang
- Environmental Health and SafetyStanford UniversityStanfordCAUSA
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Baumann F, Peña C, Kloeckner R, Katzen BT, Gandhi R, Benenati JB. The Effect of a New Angiographic Imaging Technology on Radiation Dose in Visceral Embolization Procedures. Vasc Endovascular Surg 2017; 51:183-187. [PMID: 28424042 DOI: 10.1177/1538574417698903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the impact of a new angiographic imaging technology on radiation dose during visceral embolization procedures involving both fluoroscopy and digital subtraction angiography. MATERIAL AND METHODS A retrospective analysis from a single-center consecutive series of patients was performed comparing 2 angiographic imaging systems. The AlluraClarity (CIQ; Philips Healthcare, Best, the Netherlands) was used in 100 patients (n = 59 male, mean age: 70.6 years) from July 2013 to April 2014 and compared to the former AlluraXper (AX) technology used in 139 patients (n = 71 male, mean age: 70.1 years) from May 2011 to June 2013. Patients were categorized according to body mass index (BMI [kg/m2])-group 1: BMI <25, group 2: BMI ≥25 and <30, and group 3: BMI ≥30. Fluoroscopy time, the total dose of iodinated contrast administered, and procedural AirKerma (Ka, r [mGy]) were obtained. RESULTS Mean BMI was 26.4 ± 5.0 kg/m2 in the CIQ and 26.4 ± 7.1 kg/m2 in the AX group ( P = .93). Fluoroscopy time and the amount of contrast media were equally distributed. Ka, r was 1342.9 mGy versus 2214.8 mGy ( P < .001, t test) when comparing CIQ to AX. Comparing CIQ to AX, BMI subgroup analysis revealed a mean Ka, r of 970.1 to 1586.1 mGy ( P = .003, t test), 1484.7 to 2170.1 mGy ( P = .02, t test), and 1848.8 to 3348.9 mGy ( P = .001, t test) in BMI groups 1, 2, and 3, respectively. CONCLUSION The CIQ technology significantly reduced mean radiation dose by 39.4% for visceral embolization procedures when compared to fluoroscopy time and contrast media dose. This dose relationship was consistent across all BMI groups.
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Affiliation(s)
- Frederic Baumann
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA.,2 Clinical and Interventional Angiology, University Hospital of Zurich, Zurich, Switzerland
| | - Constantino Peña
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - Roman Kloeckner
- 2 Clinical and Interventional Angiology, University Hospital of Zurich, Zurich, Switzerland.,3 Clinic for Interventional Radiology, University Hospital of Mainz, Mainz, Germany
| | - Barry T Katzen
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - Ripal Gandhi
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - James B Benenati
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
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Establishing Local Diagnostic Reference Levels in IR Procedures with Dose Management Software. J Vasc Interv Radiol 2017; 28:429-441. [DOI: 10.1016/j.jvir.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/01/2016] [Accepted: 10/12/2016] [Indexed: 11/21/2022] Open
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Hari A, Nair HK, De Gottardi A, Baumgartner I, Dufour JF, Berzigotti A. Diagnostic hepatic haemodynamic techniques: safety and radiation exposure. Liver Int 2017; 37:148-154. [PMID: 27495217 DOI: 10.1111/liv.13215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/27/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Hepatic venous pressure gradient (HVPG) and transjugular liver biopsy (TJLB) are increasingly used in the management of patients with liver disease. We aimed to describe the safety profile of these procedures, providing data on the intra- and periprocedure complications, radiation exposure and amount of iodinated contrast material used. METHODS In 106 consecutive patients undergoing HVPG and TJLB data on fluoroscopy time (FT), absorbed radiation dose, equivalent effective dose (mSv) and volume of iodinated contrast material (ICM) were prospectively collected and reviewed, together with clinical and laboratory data. Incidence and severity of procedure-related complications were assessed. In 28 hospitalised patients, creatinine values after 72 hours of the procedure were reviewed to identify contrast-induced nephropathy (CIN). RESULTS Median effective radiation dose was 5.4 mSv (IQR 10 mSv). A total 28.3% of patients exceeded an effective exposure of 10 mSv and 9.4% exceeded 20 mSv. Only age and BMI correlated with radiation dose (R = .327, P=.001 and R = .410, P<.0001 respectively), and only BMI remained independently associated with an exposure over 20 mSv. Procedure-related complications occurred in eight patients (7.5%), and were minor in six cases. Median ICM volume was 12.5 mL. 6/28 patients met the diagnostic criteria for CIN. CONCLUSIONS Hepatic venous pressure gradient and Transjugular liver biopsy show a good safety profile and radiation exposure associated with these procedures is in most of the cases low. In hepatic haemodynamic procedures, efforts should be made to reduce the radiation dose in patients with overweight/obesity and to use the minimal possible ICM volume in patients with acute-on-chronic liver failure.
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Affiliation(s)
- Andrej Hari
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland
| | - Hari Kumar Nair
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland
| | - Andrea De Gottardi
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland
| | - Iris Baumgartner
- Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Berne, Berne, Switzerland
| | - Jean-François Dufour
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland
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48
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Balter S, Chambers CE. Radiation Management in Interventional Cardiology. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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49
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Chida K, Kato M, Inaba Y, Kobayashi R, Nakamura M, Abe Y, Zuguchi M. Real-time patient radiation dosimeter for use in interventional radiology. Phys Med 2016; 32:1475-1478. [DOI: 10.1016/j.ejmp.2016.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/09/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022] Open
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de Ruiter QMB, Reitsma JB, Moll FL, van Herwaarden JA. Meta-analysis of Cumulative Radiation Duration and Dose During EVAR Using Mobile, Fixed, or Fixed/3D Fusion C-Arms. J Endovasc Ther 2016; 23:944-956. [DOI: 10.1177/1526602816668305] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose: To investigate the total fluoroscopy time and radiation exposure dose during endovascular aortic repairs using mobile, fixed, or fixed C-arms with 3-dimensional image fusion (3D-IF). Methods: A systematic search was performed to identify original articles reporting fluoroscopy time (FT) and the kerma area product (KAP) during endovascular aortic repairs. Data were grouped by noncomplex or complex (fenestrated, branched, or chimney) repairs and stratified by type of C-arm. The search identified 27 articles containing 51 study groups (35 noncomplex and 16 complex) that included 3444 patients. Random-effects meta-analysis and meta-regression models were used to calculate the pooled mean estimates of KAP and FT, as well as any effect of equipment or type of intervention. Results are presented with the 95% confidence interval and the statistical heterogeneity ( I2). Results: Within the noncomplex procedure studies, a significant (p<0.001) increase was found in the pooled mean KAP estimate in the fixed C-arm group (181 Gy·cm2, 95% CI 129 to 233; I2=99.7) compared with the mobile C-arm (78 Gy·cm2, 95% CI 59.6 to 97.3; I2=99.6). For complex cases, use of 3D-IF showed a significantly (p<0.001) lower mean KAP (139 Gy·cm2, 95% CI 85 to 191; I2=94%) compared to using fixed C-arms without 3D-IF (487 Gy·cm2, 95% CI 331 to 643; I2=94%). Conclusion: For equivalent fluoroscopy times, the use of a fixed C-arm in noncomplex procedures leads to higher patient radiation doses compared to a mobile C-arm. Complex procedures, which are predominantly performed using fixed C-arms, are associated with the highest radiation dose per intervention. Using fixed C-arms combined with 3D-IF techniques during complex cases might seem an adequate method to compensate for the higher radiation doses measured when a fixed C-arm is used.
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Affiliation(s)
| | - Johannes B. Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
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