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Reeg A, Braun Y, Sunderbrink D, Hakimi M. Lowest reported dose area product of 2.4 Gy∗cm 2 for ultra-low-dose endovascular aortic aneurysm repair of a standard infrarenal aortic aneurysm. J Vasc Surg Cases Innov Tech 2024; 10:101496. [PMID: 38764464 PMCID: PMC11099303 DOI: 10.1016/j.jvscit.2024.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/21/2024] [Indexed: 05/21/2024] Open
Abstract
This is a report of successful treatment of an abdominal aortic aneurysm via standard endovascular aortic repair with an ultra-low dose (ULD) of 2.4 Gy∗cm2 using the latest imaging software in a hybrid operating room. To the best of our knowledge, no case has yet been reported achieving a successful outcome with such ULD values to date. The key factors to achieving an ULD regarding the dose area product comprise the right technology, procedural standardization, and team education and training. This case highlights the potential for reducing the radiation dose routinely for patients and staff alike, especially for operating room staff with daily radiation exposure.
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Affiliation(s)
- Alina Reeg
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Yvonne Braun
- Global Clinical Marketing Surgery, Siemens Healthineers, Forchheim, Germany
| | - Dirk Sunderbrink
- Global Clinical Marketing, Siemens Healthineers, Forchheim, Germany
| | - Maani Hakimi
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Ehrengut C, Vogt J, Leonhardi J, Carabenciov E, Teske F, van Boemmel F, Berg T, Seehofer D, Lincke T, Sabri O, Gößmann H, Denecke T, Ebel S. Analysis of Periprocedural X-ray Exposure in Transarterial Radioembolization with Glass or Resin Microspheres. Diagnostics (Basel) 2023; 13:3609. [PMID: 38132193 PMCID: PMC10742723 DOI: 10.3390/diagnostics13243609] [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: 11/14/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
Background: Transarterial Radioembolization (TARE) is an effective treatment option for both primary and secondary liver malignancies. However, challenging anatomical conditions can lead to prolonged fluoroscopy times (FT), elevated doses of periprocedural X-radiation (DAP), and increased use of contrast agents (CAs). In this study, we examined the influence of our radiologists' experience and the choice of microspheres on X-ray exposure and CA doses in TARE. Material and Methods: Datasets comprising 161 TARE and 164 preprocedural evaluation angiographies (TARE-EVA) were analyzed. Our study focused on assessing DAP, FT, and CA concerning both microsphere types, the radiologist's experience, and whether the same radiologist performed both the TARE-EVA and the actual TARE. Results: In TARE, the use of resin microspheres resulted in significantly higher FT and CA compared to glass microspheres (14.3 ± 1.6 min vs. 10.6 ± 1.1 min and 43 ± 2.2 mL vs. 33.6 ± 2.1 mL, p < 0.05), with no notable differences in DAP (p = 0.13). Experienced radiologists demonstrated reduced FT/DAP, with a 19% decrease in DAP and 53% in FT during the evaluation angiography (p < 0.05) and a 49% reduction in DAP during the actual TARE (p < 0.05), with no statistical differences in FT. Performing TARE and TARE-EVA under the same radiologist led to a 43% reduction in DAP and a 25% decrease in FT (p < 0.05, respectively). Conclusions: To mitigate X-radiation exposure, it is advisable for radiologists to undergo thorough training, and, ideally, the same radiologist should conduct both the TARE and the TARE-EVA. While the use of glass spheres may decrease intraarterial CA, it does not significantly impact periprocedural X-ray exposure.
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Affiliation(s)
- Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Johanna Vogt
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Emma Carabenciov
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Felix Teske
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Florian van Boemmel
- Division of Hepatology, Department of Medicine II, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Thomas Lincke
- Department of Nuclear Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Holger Gößmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
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Efthymiou FO, Metaxas VI, Dimitroukas CP, Kakkos SK, Panayiotakis GS. KERMA-AREA PRODUCT, ENTRANCE SURFACE DOSE AND EFFECTIVE DOSE IN ABDOMINAL ENDOVASCULAR ANEURYSM REPAIR. RADIATION PROTECTION DOSIMETRY 2021; 194:121-134. [PMID: 34227656 DOI: 10.1093/rpd/ncab082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/15/2021] [Accepted: 05/09/2021] [Indexed: 06/13/2023]
Abstract
This study aims to evaluate patient radiation dose during fluoroscopically guided endovascular aneurysm repair (EVAR) procedures. Fluoroscopy time (FT) and kerma-area product (KAP) were recorded from 87 patients that underwent EVAR procedures with a mobile C-arm fluoroscopy system. Effective dose (ED) and organs' doses were calculated utilising appropriate conversion coefficients based on the recorded KAP values. Entrance surface dose (ESD) was calculated based on KAP values and technical parameters. The mean FT was 22.7 min (range 6.4-76.8 min), resulting in a mean KAP of 36.6 Gy cm2 (range 2.0-167.8 Gy cm2), a mean ED of 6.2 mSv (range 0.3-28.5 mSv) and a mean ESD of 458 mGy (range 26-2098 mGy). The corresponding median values were 17.4 min, 25.6 Gy cm2, 4.4 mSv and 320 mGy. The threshold of 2 Gy for skin erythema was exceeded in two procedures for a focus-to-skin distance (FSD) of 40 cm and six procedures when an FSD of 30 cm was considered. The highest doses absorbed by the adrenals, kidneys, spleen and pancreas and ranged between 3.7 and 313.3 mGy (average 66.8 mGy), 3.3 and 285.1 mGy (average 60.8 mGy), 1.3 and 111.1 mGy (average 23.7 mGy), 1.1 and 92.1 mGy (average 19.6 mGy), respectively. A wide range of patient doses was reported in the literature. The radiation dose received by the patients was comparative or lower than most of the previously reported values. However, higher doses can be revealed due to the X-ray system's non-optimum use and extended FTs, mainly affected by complex clinical conditions, patients' body habitus and vascular surgeon experience. The large variation of patient doses highlights the potential to optimise the EVAR procedure by considering the balance between the radiation dose and the required image quality. Additional studies need to be conducted in increasing the vascular surgeons' awareness regarding patient dose and radiation protection issues during EVAR procedures.
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Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Christos P Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Vascular Surgery, University Hospital of Patras, 26504 Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
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Wilson-Stewart K, Fontanarosa D, Malacova E, Gett S, Kruger A, Trapp JV. Occupational and Patient Radiation Dose and Quality Implications of Femoral Access Imaging During Coronary Angiography. J Multidiscip Healthc 2021; 14:1807-1818. [PMID: 34285499 PMCID: PMC8286066 DOI: 10.2147/jmdh.s316135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/16/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Cardiologists often perform angiography of the common femoral artery (CFA) access site to evaluate whether the anatomy is suitable for deployment of a vascular closure device or to assess whether iatrogenic vessel damage has occurred. The choice of acquisition mode has radiation dose implications. The objective of this study was to investigate the influence of the selected type of CFA x-ray imaging mode (fluoro save, cine acquisition and digital subtraction angiography (DSA)) and tube angle on patient and staff dose during coronary angiography. Materials and Methods Assessment of image quality for the different modes was performed to determine whether lower dose modes provide images of sufficient clinical quality to be routinely employed. Radiation dose levels for the patients (n=782), cardiologists (n=17), scrub nurses (n=27) and scout nurses (n=32) were measured in a prospective single-centre study between February 2017 and August 2019. Three Philips angiographic units and DoseAware dose monitoring systems were used. Results Among the acquisition modes, fluoro save provided acceptable diagnostic quality for visualizing femoral access points and diagnosing pathology in 99% of cases. Average patient dose area product (DAP) was 83.95, 742.50, and 3363.41mGy2 and average patient air kerma (AK) was 0.87, 8.44, and 18.61mGy for fluoro save, cine, and DSA acquisitions, respectively. The use of higher dose imaging modes, imaging in the contralateral view and utilizing steeper TA was associated with a higher patient dose. Due to staff dose being highly correlated with DAP and AK, it was difficult to observe any association between staff dose and CFA imaging mode. However, this does not discount a potential increase in occupational dose due to the use of cine angiography or digital subtraction angiography during CFA imaging. Conclusion DSA of the CFA should be avoided during transfemoral coronary angiography unless critical to diagnostic analysis. It is recommended that fluoroscopic operators consider utilizing lower dose modes in the ipsilateral orientation ≤32° TA to reduce the risk of patient and staff radiation exposure. ![]()
Point your SmartPhone at the code above. If you have a QR code reader, the video abstract will appear. Or use: https://youtu.be/fkaiBXXpPsE
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Affiliation(s)
- Kelly Wilson-Stewart
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Cardiiovascular Suites, Greenslopes Private Hospital, Brisbane, QLD, 4120, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies (CBT), Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,QMIR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - Steven Gett
- Cardiiovascular Suites, Greenslopes Private Hospital, Brisbane, QLD, 4120, Australia
| | - Allan Kruger
- Cardiiovascular Suites, Greenslopes Private Hospital, Brisbane, QLD, 4120, Australia.,Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia
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Nadjiri J, Geith T, Waggershauser T, Heuser L, Morhard D, Bücker A, Paprottka PM. [Comparison of radiation exposure in common hepatic interventions : A retrospective analysis of DeGIR registry data]. Radiologe 2021; 61:80-86. [PMID: 32816049 PMCID: PMC7810650 DOI: 10.1007/s00117-020-00737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Hintergrund Die transarterielle Chemoembolisation (TACE) oder auch Gallenganginterventionen stellen häufige Leberinterventionen dar. Ziel der Arbeit In dieser retrospektiven Studie soll die Strahlenexposition der Patienten mit einem hepatischen Eingriff in Abhängigkeit von Art und Feinziel der Intervention analysiert und verglichen werden. Material und Methoden Dies ist eine Analyse von 7003 DeGIR-Registerdatensätzen aus den Jahren 2016 bis 2018 für TACE und Gallenganginterventionen. Das Dosisflächenprodukt (DFP) und die Durchleuchtungszeit (DL) sowie die Interventionsart und das anatomisch definierte Feinziel der Interventionen wurden erfasst. Ergebnisse Insgesamt lagen Dosiswerte für 4985 durchgeführte TACE und 2018 Gallenganginterventionen vor. Bei Gallenganginterventionen lag der Median des DFP bei 2594 (Interquartilbereich [IQR] = 1174–5858) cGy*cm2. Bei der TACE betrug der Median des DFP 11.632 [IQR = 5530–22.800] cGy*cm2 und lag damit signifikant höher als bei Gallenganginterventionen (p < 0,0001). Gallengangeingriffe mit dem höchsten DFP sind Interventionen am Ductus hepaticus, während Eingriffe mit der längsten DL an der Hepatikusgabel stattfinden. Diskussion Die individuelle Strahlendosis für einen Patienten bei einer Leberintervention hängt weniger von der Komplexität des Eingriffs bzw. Durchleuchtungszeit ab, sondern von der Art des Eingriffs und vom Feinziel der Intervention. Die vorliegenden Dosisdaten können eine Hilfe sein, die Strahlenexposition bei einer Leberintervention bereits vor dem Eingriff grob abzuschätzen.
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Affiliation(s)
- Jonathan Nadjiri
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland.
| | - Tobias Geith
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
| | - Tobias Waggershauser
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
| | | | - Dominik Morhard
- Radiologie und Neuroradiologie, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Deutschland
| | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum der Universität des Saarlandes, Homburg /Saar, Deutschland
| | - Philipp M Paprottka
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
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