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Nocetti D, Villalobos K, Wunderle K. Physical Image Quality Metrics for the Characterization of X-ray Systems Used in Fluoroscopy-Guided Pediatric Cardiac Interventional Procedures: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1784. [PMID: 38002875 PMCID: PMC10670102 DOI: 10.3390/children10111784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Pediatric interventional cardiology procedures are essential in diagnosing and treating congenital heart disease in children; however, they raise concerns about potential radiation exposure. Managing radiation doses and assessing image quality in angiographs becomes imperative for safe and effective interventions. This systematic review aims to comprehensively analyze the current understanding of physical image quality metrics relevant for characterizing X-ray systems used in fluoroscopy-guided pediatric cardiac interventional procedures, considering the main factors reported in the literature that influence this outcome. A search in Scopus and Web of Science, using relevant keywords and inclusion/exclusion criteria, yielded 14 relevant articles published between 2000 and 2022. The physical image quality metrics reported were noise, signal-to-noise ratio, contrast, contrast-to-noise ratio, and high-contrast spatial resolution. Various factors influencing image quality were investigated, such as polymethyl methacrylate thickness (often used to simulate water equivalent tissue thickness), operation mode, anti-scatter grid presence, and tube voltage. Objective evaluations using these metrics ensured impartial assessments for main factors affecting image quality, improving the characterization of fluoroscopic X-ray systems, and aiding informed decision making to safeguard pediatric patients during procedures.
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Affiliation(s)
- Diego Nocetti
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica 1010069, Chile
| | - Kathia Villalobos
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica 1010069, Chile
| | - Kevin Wunderle
- Department of Radiology, Cleveland Clinic, Cleveland, OH 44195, USA
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PAN LUNGFA, WU KENGYI, CHEN KELIN, KITTIPAYAK SAMRIT, PAN LUNGKWANG. TAGUCHI METHOD-BASED OPTIMIZATION OF THE MINIMUM DETECTABLE DIFFERENCE OF A CARDIAC X-RAY IMAGING SYSTEM USING A PRECISE LINE PAIR GAUGE. J MECH MED BIOL 2019. [DOI: 10.1142/s021951941940030x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To optimize the minimum detectable difference (MDD) of a cardiac X-ray imaging system using the Taguchi L8(27) analysis and a precise line pair (LP) gauge. Methods: The optimal combination of the four critical factors of the cardiac X-ray imaging system, namely X-ray focus, kilovoltage (kVp), milliamper-seconds (mAs) and source image distance (SID), providing the MDD was calculated via the Taguchi analysis and experimentally verified. Two (low and high) levels were assigned for each factor, and eight combinations of four factors were used to acquire instant X-ray images using an NDT commercial LP gauge (with a gauge length of 64[Formula: see text]mm and a width of [Formula: see text][Formula: see text]mm). The latter had five lines and was split gradually from top to bottom for the inspection of X-ray images, whose quality was ranked by three well-trained radiologists according to the double-blind criterion. The ranking grade was given by sharp contrast, low noise and precision to distinguish the LP. Accordingly, the MDD was derived to represent the spatial resolution of instant X-ray images by the revised Student’s [Formula: see text]-test analysis. The optimal combination of factors was experimentally identified and clinically verified in the follow-up inspections. Results: For the conventional setting, Group No. 7 (which obtained the highest grade among eight groups) and the optimal setting, the obtained MDD values were [Formula: see text], [Formula: see text] and [Formula: see text][Formula: see text]mm, respectively, while the LP (line pair/mm) interpolated from the gauge scale amounted to [Formula: see text], [Formula: see text] and [Formula: see text][Formula: see text]LP/mm, respectively. Conclusion: The Taguchi L8 analysis was proved to be instrumental in optimizing the cardiac X-ray imaging system MDD and is recommended to be used jointly with the revised Student’s [Formula: see text]-test analysis for improving the spatial resolution of instant X-ray images.
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Affiliation(s)
- LUNG-FA PAN
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung 411, Taiwan, ROC
| | - KENG-YI WU
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Cardiology, Taichung Armed Forces General Hospital, Taichung 411, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, ROC
| | - KE-LIN CHEN
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Radiology, Ningbo First Hospital, Ningbo 315012, Zhejiang, P. R. China
| | - SAMRIT KITTIPAYAK
- Department of Radiological Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - LUNG-KWANG PAN
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
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Metaxas VI, Messaris GA, Gatzounis GD, Panayiotakis GS. OPTIMISATION OF PATIENT DOSE AND IMAGE QUALITY IN FLUOROSCOPICALLY GUIDED CERVICAL SPINE SURGERY: A PHANTOM-BASED STUDY. RADIATION PROTECTION DOSIMETRY 2019; 184:237-247. [PMID: 30508126 DOI: 10.1093/rpd/ncy205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/28/2018] [Accepted: 10/31/2018] [Indexed: 06/09/2023]
Abstract
The purpose of the current study was to provide useful data, which may help neurosurgeons to manage the patient dose and image quality in spinal surgery procedures, utilising a phantom and a test object. The kerma area product, cumulative dose (CD) and entrance surface dose (ESD) rate on the phantom and image intensifier were measured, for selectable fields of view (FOVs), fluoroscopy modes, two geometric magnifications and various phantom thicknesses. The images were subjectively evaluated regarding low-contrast detectability and high-contrast resolution. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), high-contrast spatial resolution (HCSR) and figure of merit (FOM) values were also estimated. The ESD rates increased with increasing phantom thickness, when using electronic or geometric magnification, continuous or high-definition fluoroscopy (HDF). The observers' evaluation showed relatively slight changes in image quality when pulsed fluoroscopy was used. SNR, CNR and HCSR values decreased with increasing phantom thicknesses, while remained almost constant when using pulsed fluoroscopy. SNR and HCSR improved in HDF, while the CNR remained almost constant only for the FOVs 23 and 17 cm. By applying electronic magnification, this resulted in improved HCSR. FOM values decreased in HDF, with increasing phantom thickness and using electronic magnification. For the 'thinnest' patients, CD may overestimate skin dose by 25% than the actual values. Geometric magnification resulted in improved FOM, especially for low-dose fluoroscopy and FOV 23 cm. The knowledge of the increments in dose values, image quality and FOM indices concerning phantom thickness may help neurosurgeons to optimise spinal surgery procedures by selecting the appropriate operational parameters, which could contribute toward the establishment of a radiation protection culture.
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Affiliation(s)
- Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Gerasimos A Messaris
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - George D Gatzounis
- Department of Neurosurgery, School of Medicine, University of Patras, Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
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Hadjiconstanti AC, Messaris GAT, Thomopoulos KC, Solomou AG, Panayiotakis GS. OPTIMISATION OF PATIENT DOSE AND IMAGE QUALITY IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A PHANTOM-BASED EVALUATION. RADIATION PROTECTION DOSIMETRY 2017; 175:118-123. [PMID: 27664432 DOI: 10.1093/rpd/ncw276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/03/2016] [Indexed: 06/06/2023]
Abstract
A phantom-based study is presented aiming to optimise patient dose and image quality (IQ) in endoscopic retrograde cholangiopancreatography procedures, utilising a fluoroscopy system equipped with a flat panel detector. The patient thickness was simulated with various polymethyl methacrylate slabs, whilst IQ was evaluated using the Leeds test object. The main factors evaluated were phantom thickness, distance between phantom and detector, field of view and pulse rate. For all these factors, the dosemetric indices, entrance surface air kerma (ESAK) rate and ESAK per pulse, as well as the IQ parameters, signal-to-noise ratio and high contrast spatial resolution, were measured. Based on these measurements, the figure of merit (FOM) was estimated. The FOM and ESAK rate values indicated the optimum combination of the factors evaluated which could provide adequate clinical information, assuring minimum patient dose.
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Affiliation(s)
| | - Gerasimos A T Messaris
- Department of Medical Physics, School of Medicine, University of Patras, 265 04Patras, Greece
| | | | - Aikaterini G Solomou
- Department of Radiology, School of Medicine, University of Patras, 265 04Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 265 04Patras, Greece
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Abstract
Antiscatter grids improve the X-ray image contrast at a cost of patient radiation doses. The choice of appropriate grid or its removal requires a good knowledge of grid characteristics, especially for pediatric digital imaging. The aim of this work is to understand the relation between grid performance parameters and some numerical image quality metrics for digital radiological examinations. The grid parameters such as bucky factor (BF), selectivity (Σ), Contrast improvement factor (CIF), and signal-to-noise improvement factor (SIF) were determined following the measurements of primary, scatter, and total radiations with a digital fluoroscopic system for the thicknesses of 5, 10, 15, 20, and 25 cm polymethyl methacrylate blocks at the tube voltages of 70, 90, and 120 kVp. Image contrast for low- and high-contrast objects and high-contrast spatial resolution were measured with simple phantoms using the same scatter thicknesses and tube voltages. BF and SIF values were also calculated from the images obtained with and without grids. The correlation coefficients between BF values obtained using two approaches (grid parameters and image quality metrics) were in good agreement. Proposed approach provides a quick and practical way of estimating grid performance for different digital fluoroscopic examinations.
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Affiliation(s)
- Dogan Bor
- Department of Physics Engineering, Faculty of Engineering, Ankara University, 06100 Ankara, Turkey
| | - Ozlem Birgul
- Department of Medical Physics, Institute of Nuclear Sciences, Ankara University, 06100 Ankara, Turkey
| | - Umran Onal
- Department of Medical Physics, Institute of Nuclear Sciences, Ankara University, 06100 Ankara, Turkey
| | - Turan Olgar
- Department of Physics Engineering, Faculty of Engineering, Ankara University, 06100 Ankara, Turkey
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Nocetti D, Ubeda C, Calcagno S, Acevedo J, Pardo D. Comparison of image quality among three X-ray systems for chest radiography: first step in optimisation. RADIATION PROTECTION DOSIMETRY 2015; 165:386-391. [PMID: 25821212 DOI: 10.1093/rpd/ncv081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to compare the performance of three digital X-ray systems [one flat-panel (DR) and two computed radiography (CR)] for chest radiography in terms of the entrance surface air kerma (ESAK) delivered to a polymethyl methacrylate phantom of 20 cm (equivalent to an adult patient) and image quality through of numerical evaluations using a test object (TO). The tube charge applied was ranged from 0.6 to 32 mAs, to a fixed tension of 125 kVp. The DR system presented the highest mean values of ESAK (615.9 µGy) along with the highest signal-to-noise ratio values, whereas CR systems showed a better high-contrast spatial resolution. Differences were statistically significant in both cases regarding the tube charge used. Thus, this parameter should be mainly considered to optimise the radiological protection through exposure settings selected. This survey represents the first effort to achieve optimisation in digital radiology for Chile.
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Affiliation(s)
- D Nocetti
- Medical Technology Department, Faculty of Health Sciences, Tarapaca University, Arica, Chile
| | - C Ubeda
- Medical Technology Department, Faculty of Health Sciences, Tarapaca University, Arica, Chile
| | - S Calcagno
- Medical Image Service, Ernesto Torres Galdames Regional Hospital, Iquique, Chile
| | - J Acevedo
- Medical Image Service, Ernesto Torres Galdames Regional Hospital, Iquique, Chile
| | - D Pardo
- Field Service Engineer DXR-IXR-CT-MR Service, Philips HealthCare, Latam, Chile
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Eloot L, Thierens H, Taeymans Y, Drieghe B, De Pooter J, Van Peteghem S, Buytaert D, Gijs T, Lapere R, Bacher K. Novel X-ray imaging technology enables significant patient dose reduction in interventional cardiology while maintaining diagnostic image quality. Catheter Cardiovasc Interv 2015; 86:E205-12. [PMID: 25754018 PMCID: PMC6680340 DOI: 10.1002/ccd.25913] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/26/2015] [Indexed: 12/31/2022]
Abstract
Objectives The purpose of this study was to quantify the reduction in patient radiation dose during coronary angiography (CA) by a new X‐ray technology, and to assess its impact on diagnostic image quality. Background Recently, a novel X‐ray imaging technology has become available for interventional cardiology, using advanced image processing and an optimized acquisition chain for radiation dose reduction. Methods 70 adult patients were randomly assigned to a reference X‐ray system or the novel X‐ray system. Patient demographics were registered and exposure parameters were recorded for each radiation event. Clinical image quality was assessed for both patient groups. Results With the same angiographic technique and a comparable patient population, the new imaging technology was associated with a 75% reduction in total kerma‐area product (KAP) value (decrease from 47 Gycm2 to 12 Gycm2, P < 0.001). Clinical image quality showed an equivalent detail and contrast for both imaging systems. On the other hand, the subjective appreciation of noise was more apparent in images of the new image processing system, acquired at lower doses, compared to the reference system. However, the higher noise content did not affect the overall image quality score, which was adequate for diagnosis in both systems. Conclusions For the first time, we present a new X‐ray imaging technology, combining advanced noise reduction algorithms and an optimized acquisition chain, which reduces patient radiation dose in CA drastically (75%), while maintaining diagnostic image quality. Use of this technology may further improve the radiation safety of cardiac angiography and interventions. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Liesbeth Eloot
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Hubert Thierens
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Yves Taeymans
- Heart Centre, Ghent University Hospital, Ghent, Belgium
| | - Benny Drieghe
- Heart Centre, Ghent University Hospital, Ghent, Belgium
| | - Jan De Pooter
- Heart Centre, Ghent University Hospital, Ghent, Belgium
| | | | - Dimitri Buytaert
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Thomas Gijs
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Régine Lapere
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Klaus Bacher
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
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Ubeda C, Vano E, Gonzalez L, Miranda P, Valenzuela E, Vergara F, Guarda E. Evaluation of patient doses and lens radiation doses to interventional cardiologists in a nationwide survey in Chile. RADIATION PROTECTION DOSIMETRY 2013; 157:36-43. [PMID: 23740814 DOI: 10.1093/rpd/nct118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of this study was to perform a nationwide survey in Chile to determine dose levels to patients and staff in four risk scenarios during cardiac catheterisation procedures. Different phantom thicknesses of polymethyl methacrylate (PMMA) were used to simulate adult patients. Scenario 1: 10-min fluoroscopy and 800 cine frames for 20 cm of PMMA; Scenario 2: 10-min fluoroscopy and 800 cine frames for 28 cm of PMMA; Scenario 3: 30-min fluoroscopy and 2400 cine frames for 20 cm of PMMA; Scenario 4: 30-min fluoroscopy and 2400 cine frames for 28 cm of PMMA. The average values regarding dose-area product and scattered doses at the cardiologist eye lens achieved for the four scenarios were 94, 249, 281, 747 Gy cm(2) and 0.3, 0.8, 0.9 and 2.5 mSv, respectively. Large variations in radiation doses received by both patients and staff for the same type of procedure suggest that optimising procedure protocols and using the most effective types of protective devices may substantially reduce the dose values found here.
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Affiliation(s)
- Carlos Ubeda
- Medical Technology Department, Study Center in Radiological Sciences (CECRAD), Health Sciences Faculty and CHIDE, Tarapaca University, Arica, Chile
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Vassileva J, Vano E, Ubeda C, Rehani M, Zotova R. Impact of the X-ray system setting on patient dose and image quality; a case study with two interventional cardiology systems. RADIATION PROTECTION DOSIMETRY 2013; 155:329-334. [PMID: 23396881 DOI: 10.1093/rpd/nct011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study investigates the influence of the initial X-ray system setting on patient doses and image quality in interventional cardiology procedures. Two dedicated interventional cardiology systems were studied: a system with image intensifier (II) and a flat detector (FD) system. Entrance surface air kerma (ESAK) rates in fluoroscopy and ESAK per frame in the acquisition mode were measured on the surface of a PMMA phantom for the field of views (FOV) of 23 and 17 cm (II system) and 25 and 20 cm (FD system). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were estimated using DICOM images obtained during the measurements. System performances were compared using a figure of merit combining SNR and ESAK. The influence of system setting on patient doses was investigated analysing the information for air kerma area product (KAP) and cumulative dose (CD) at the patient entrance reference point, for a sample of coronary angiography examinations. ESAK rates in fluoroscopy modes were a factor of 2 higher in the FD system for the similar FOVs, resulting in a factor of 1.9 higher median values of KAP and CD for patients with FD system than for the II system. SNR and CNR for the FD system were better than the equivalent FOVs with II. The resulting FOM was better for the FD system in both FOVs. Potential for optimisation was suggested by adjusting system settings.
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Affiliation(s)
- J Vassileva
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria.
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Comparative performance evaluation of a flat detector and an image intensifier angiographic system both used for interventional cardiology procedures in adult and pediatric patients. Phys Med 2013; 29:178-87. [DOI: 10.1016/j.ejmp.2012.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 12/10/2011] [Accepted: 02/01/2012] [Indexed: 11/16/2022] Open
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Messaris GAT, Abatzis I, Kagadis GC, Samartzis AP, Athanasopoulou P, Christeas N, Katsanos K, Karnabatidis D, Nikiforidis GC. Hysterosalpingography using a flat panel unit: evaluation and optimization of ovarian radiation dose. Med Phys 2012; 39:4404-13. [PMID: 22830773 DOI: 10.1118/1.4729715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The aim of the present study was the evaluation and optimization of radiation dose to the ovaries (D) in hysterosalpingography (HSG). METHODS The study included a phantom study and a clinical one. In the phantom study, we evaluated imaging results for different geometrical setups and irradiation conditions. In the clinical study, 34 women were assigned into three different fluoroscopy modes and D was estimated with direct cervical TLD measurements. RESULTS In the phantom study, we used a source-to-image-distance (SID) of 110 cm and a field diagonal of 48 cm, and thus decreased air KERMA rate (KR) by 19% and 70%, respectively, for beam filtration: 4 mm Al and 0.9 mm Cu (Low dose). The least radiation exposure was accomplished by using the 3.75 pps fluoroscopy mode in conjunction with beam filtration: Low dose. In the clinical study, D normalized to 50 s of fluoroscopy time with a 3.75 pps fluoroscopy mode reached a value of 0.45 ± 0.04 mGy. Observers' evaluation of diagnostic image quality did not significantly differ for the three different modes of acquisition that were compared. CONCLUSIONS Digital spot radiographs could be omitted in modern flat panel systems during HSG. Fluoroscopy image acquisitions in a modern flat panel unit at 3.75 pps and a beam filtration of 4 mm Al and 0.9 mm Cu demonstrate acceptable image quality with an average D equal to 0.45 mGy. This value is lower compared to the studied literature. For these reasons, the proposed method may be recommended for routine HSG examination in order to limit radiation exposure to the ovaries.
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Magrassi L, Bongetta D, D'Ercole L, Lisciandro F, Arienta C, Thyrion FZ. Neuroembolization may expose patients to radiation doses previously linked to tumor induction. Acta Neurochir (Wien) 2012; 154:33-41. [PMID: 22052473 DOI: 10.1007/s00701-011-1209-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/12/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Epidemiological studies indicate a link between low-dose irradiation (<10,000 mGy) to the head and the local occurrence of tumors after decades of delay. Comparable radiation doses can be reached during neuro-endovascular procedures (NEP), but the incidence of similar exposures has not been completely delineated. We compared the levels of radiation to the head measured during NEP to those reported for patients developing radiation-induced cancers. METHODS In our prospective study we determined the cumulative maximum entrance skin doses (MESD) and the incidence of epilation in 107 consecutive patients submitted to NEP between 2003 and 2007. We also extensively searched the literature and compared our results with the data we found. RESULTS The cumulative MESD due to NEP was above 3,000 mGy (range 3,101-5,421 mGy) in 18 patients. In 22 we observed partial epilation within 10 weeks from the initial NEP. Sixty cases of epilation after NEP have been previously reported in the literature. The average of the reported MESD was 4,241 mGy (range 2,000-6,640 mGy). CONCLUSION Physical dosimetry and the incidence of partial epilation indicate that about one fifth of the patients submitted to NEP received radiation doses comparable to those linked to the occurrence of tumors. The potential risks of developing tumors after a long delay, when compared to the immediate benefits of endovascular treatment of aneurysm and arteriovenous malformations (AVM) of the brain, do not counterindicate NEP, but increased awareness of the risk should help physicians and patients to make a fully informed decision when other treatments are available.
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Affiliation(s)
- Lorenzo Magrassi
- Department of Surgical Sciences, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Italy.
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