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Mizunuma K. Review of personal radiation exposure dose and history of the interventional procedure records for 40 years. Jpn J Radiol 2021; 39:1000-1008. [PMID: 34117984 PMCID: PMC8490249 DOI: 10.1007/s11604-021-01147-z] [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: 02/08/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
Objective To inspect personal dose as an interventional radiologist for 40 years, to assess the enforcement number of interventional radiology (IR), and to check for radiation cataract. Materials and methods I evaluated my own effective dose, an equivalent dose to the lens of the eye (EDL), and the number of IR procedures between March 2019 and June 1979. I examined the lens in June 2019 as a radiologist for 40 years. Results The accumulation dose was 0 mSv in 1979–88. During 1989–93, the right crystalline lens equivalence of the value dose was measured. During 1993–96, two badge items for the head, neck, and abdomen were present. Both were distributed, but attaching to the same part and reversing occurred frequently. The EDL of the recent 5 years has exceeded 100 mSv. No association with the number of IR procedures was recognized. Posterior subcapsular vacuoles (PSV) as the early changes of the radiation cataract were recognized as four on the left and one on the right. Conclusion It is important to get accustomed to film badge wearing, and the cancelation of making a mistake in the wearing part. Radiologists should check the PSV at a stage beyond a certain constant dose.
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Affiliation(s)
- Kimiyoshi Mizunuma
- Department of the Diagnostic and Interventional Radiology, Nasu Red Cross Hospital, 1081-4, Nakadawara, Ohtawara, Tochigi, 324-8686, Japan.
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Della Vecchia E, Modenese A, Loney T, Muscatello M, Silva Paulo M, Rossi G, Gobba F. Risk of cataract in health care workers exposed to ionizing radiation: a systematic review. LA MEDICINA DEL LAVORO 2020; 111:269-284. [PMID: 32869764 PMCID: PMC7809955 DOI: 10.23749/mdl.v111i4.9045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 06/22/2020] [Indexed: 12/17/2022]
Abstract
Background: The eye is an important sensory organ occupationally exposed to ionizing radiation (IR) in healthcare workers (HCWs) engaged in medical imaging (MI). New evidence highlights the possible induction of cataract at IR exposure levels to be much lower than expected in the past. Objective: Conduct an updated review on the current evidence on cataract risk in healthcare workers exposed to IR. Methods: Published scientific studies on cataract risk in IR exposed healthcare workers were collected through a systematic search of two biomedical databases (MEDLINE and Scopus). Data from included studies was extracted and summarized. Study quality was also assessed. Results: All 21 eligible studies reported an increased prevalence of cataract, especially posterior subcapsular cataract, in IR exposed HCWs with a higher prevalence in interventional cardiology staff. Discussion: Our review synthesizes the latest evidence to support the hypothesis of a significantly increased risk of occupational cataract in healthcare workers operating MI and exposed to IR, especially in interventional cardiologists. Data also support a dose-response relationship between IR exposure and the prevalence of opacities, especially posterior subcapsular opacities. Conclusions: Findings highlight the need for effective control measures including appropriate training, adherence to protective procedures, and a constant use of shields and eye personal protective equipment in healthcare workers with optical exposure to IR. Periodic health surveillance programs, possibly including lens evaluation, are also important to monitor cataract risk in these MI operators.
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Affiliation(s)
- Elena Della Vecchia
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena (IT) .
| | - Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Martina Muscatello
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena (IT) .
| | - Marilia Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| | - Giorgia Rossi
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena (IT) .
| | - Fabriziomaria Gobba
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena (IT) .
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Abstract
Cataract, the clinical correlate of opacity or light scattering in the eye lens, is usually caused by the presence of high-molecular-weight (HMW) protein aggregates or disruption of the lens microarchitecture. In general, genes involved in inherited cataracts reflect important processes and pathways in the lens including lens crystallins, connexins, growth factors, membrane proteins, intermediate filament proteins, and chaperones. Usually, mutations causing severe damage to proteins cause congenital cataracts, while milder variants increasing susceptibility to environmental insults are associated with age-related cataracts. These may have different pathogenic mechanisms: Congenital cataracts induce the unfolded protein response and apoptosis. By contrast, denatured crystallins in age-related cataracts are bound by α-crystallin and form light-scattering HMW aggregates. New therapeutic approaches to age-related cataracts use chemical chaperones to solubilize HMW aggregates, while attempts are being made to regenerate lenses using endogenous stem cells to treat congenital cataracts.
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Affiliation(s)
- Alan Shiels
- Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - J Fielding Hejtmancik
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892-1860, USA;
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4
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Yokoyama S, Hamada N, Tsujimura N. Recent discussions toward regulatory implementation of the new occupational equivalent dose limit for the lens of the eye and related studies in Japan. Int J Radiat Biol 2019; 95:1103-1112. [PMID: 30964367 DOI: 10.1080/09553002.2019.1605464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose: In 2011, the International Commission on Radiological Protection (ICRP) recommended an equivalent dose limit for the lens of the eye of 20 mSv/year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv for occupational exposure in planned exposure situations. Since then, there have been extensive discussions toward regulatory implementation of such a new occupational lens dose limit. This paper provides an overview of the recent discussions toward regulatory implementation and the current status of the studies related to radiation exposure of the lens and its effect in Japan. Conclusions: In Japan, the Radiation Council established a Subcommittee in July 2017 to discuss the feasibility of implementing the new occupational lens dose limit. In March 2018, the Radiation Council requested all relevant government ministries and agencies to take necessary actions toward implementation of the new occupational lens dose limit, considering a series of discussions made by the Subcommittee. According to the currently available information, the new occupational lens dose limit (20 mSv/year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv) will be implemented into regulations in Japan, most likely in April 2021, albeit subject to change. In particular, there were extensive discussions about reduction of a dose limit and radiation control for workers who may exceed 20 mSv per year, such as the Fukushima Daiichi Nuclear Power Plant decommissioning workers and medical staff, and measurement of 3 mm dose equivalent. In order to underpin regulatory practice, epidemiological and biological studies on radiation effects on the lens and studies on lens dose measurements have been conducted in Japan, some of which have been funded by the Japanese Nuclear Regulation Authority.
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Affiliation(s)
- Sumi Yokoyama
- a Faculty of Radiological Technology, School of Medical Sciences, Fujita Health University , Aichi , Japan
| | - Nobuyuki Hamada
- b Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI) , Tokyo , Japan
| | - Norio Tsujimura
- c Radiation Protection Department, Nuclear Fuel Cycle Engineering Laboratories, Japan Atomic Energy Agency , Ibaraki , Japan
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5
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Dalke C, Neff F, Bains SK, Bright S, Lord D, Reitmeir P, Rößler U, Samaga D, Unger K, Braselmann H, Wagner F, Greiter M, Gomolka M, Hornhardt S, Kunze S, Kempf SJ, Garrett L, Hölter SM, Wurst W, Rosemann M, Azimzadeh O, Tapio S, Aubele M, Theis F, Hoeschen C, Slijepcevic P, Kadhim M, Atkinson M, Zitzelsberger H, Kulka U, Graw J. Lifetime study in mice after acute low-dose ionizing radiation: a multifactorial study with special focus on cataract risk. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2018; 57:99-113. [PMID: 29327260 PMCID: PMC5902533 DOI: 10.1007/s00411-017-0728-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/21/2017] [Indexed: 05/28/2023]
Abstract
Because of the increasing application of ionizing radiation in medicine, quantitative data on effects of low-dose radiation are needed to optimize radiation protection, particularly with respect to cataract development. Using mice as mammalian animal model, we applied a single dose of 0, 0.063, 0.125 and 0.5 Gy at 10 weeks of age, determined lens opacities for up to 2 years and compared it with overall survival, cytogenetic alterations and cancer development. The highest dose was significantly associated with increased body weight and reduced survival rate. Chromosomal aberrations in bone marrow cells showed a dose-dependent increase 12 months after irradiation. Pathological screening indicated a dose-dependent risk for several types of tumors. Scheimpflug imaging of the lens revealed a significant dose-dependent effect of 1% of lens opacity. Comparison of different biological end points demonstrated long-term effects of low-dose irradiation for several biological end points.
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Affiliation(s)
- Claudia Dalke
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Developmental Genetics, 85764 Neuherberg, Germany
| | - Frauke Neff
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Pathology, Neuherberg, Germany
- Present Address: Municipal Clinical Center Munich, Munich, Germany
| | - Savneet Kaur Bains
- Department of Life Sciences, Brunel University London, Uxbridge, UK
- Present Address: Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, UK
| | - Scott Bright
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, UK
- Present Address: University of Texas, MD Anderson, Houston, TX USA
| | - Deborah Lord
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, UK
| | - Peter Reitmeir
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Ute Rößler
- Department Radiation Protection and Health, Federal Office for Radiation Protection, Oberschleissheim, Germany
| | - Daniel Samaga
- Department Radiation Protection and Health, Federal Office for Radiation Protection, Oberschleissheim, Germany
- Present Address: Helmholtz Center Munich, German Research Center for Environmental Health, Research Unit of Radiation Cytogenetics, Neuherberg, Germany
| | - Kristian Unger
- Helmholtz Center Munich, German Research Center for Environmental Health, Research Unit of Radiation Cytogenetics, Neuherberg, Germany
| | - Herbert Braselmann
- Helmholtz Center Munich, German Research Center for Environmental Health, Research Unit of Radiation Cytogenetics, Neuherberg, Germany
| | - Florian Wagner
- Helmholtz Center Munich, German Research Center for Environmental Health, Research Unit Medical Radiation Physics and Diagnostics, Neuherberg, Germany
- Present Address: Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Radiation Protection, Neuherberg, Germany
| | - Matthias Greiter
- Helmholtz Center Munich, German Research Center for Environmental Health, Research Unit Medical Radiation Physics and Diagnostics, Neuherberg, Germany
- Present Address: Helmholtz Center Munich, German Research Center for Environmental Health, Individual Monitoring Service, Neuherberg, Germany
| | - Maria Gomolka
- Department Radiation Protection and Health, Federal Office for Radiation Protection, Oberschleissheim, Germany
| | - Sabine Hornhardt
- Department Radiation Protection and Health, Federal Office for Radiation Protection, Oberschleissheim, Germany
| | - Sarah Kunze
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Developmental Genetics, 85764 Neuherberg, Germany
| | - Stefan J. Kempf
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Radiation Biology, Neuherberg, Germany
- Present Address: Department of Bioanalytical Sciences, CSL Behring GmbH, Marburg, Germany
| | - Lillian Garrett
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Developmental Genetics, 85764 Neuherberg, Germany
| | - Sabine M. Hölter
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Developmental Genetics, 85764 Neuherberg, Germany
| | - Wolfgang Wurst
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Developmental Genetics, 85764 Neuherberg, Germany
| | - Michael Rosemann
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Radiation Biology, Neuherberg, Germany
| | - Omid Azimzadeh
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Radiation Biology, Neuherberg, Germany
| | - Soile Tapio
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Radiation Biology, Neuherberg, Germany
| | - Michaela Aubele
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Pathology, Neuherberg, Germany
| | - Fabian Theis
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Computational Biology, Neuherberg, Germany
| | - Christoph Hoeschen
- Helmholtz Center Munich, German Research Center for Environmental Health, Research Unit Medical Radiation Physics and Diagnostics, Neuherberg, Germany
- Present Address: Chair of Medical Systems Technology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | | | - Munira Kadhim
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, UK
| | - Michael Atkinson
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Radiation Biology, Neuherberg, Germany
| | - Horst Zitzelsberger
- Helmholtz Center Munich, German Research Center for Environmental Health, Research Unit of Radiation Cytogenetics, Neuherberg, Germany
| | - Ulrike Kulka
- Department Radiation Protection and Health, Federal Office for Radiation Protection, Oberschleissheim, Germany
| | - Jochen Graw
- Helmholtz Center Munich, German Research Center for Environmental Health, Institute of Developmental Genetics, 85764 Neuherberg, Germany
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Ko S, Kang S, Ha M, Kim J, Jun JK, Kong KA, Lee WJ. Health Effects from Occupational Radiation Exposure among Fluoroscopy-Guided Interventional Medical Workers: A Systematic Review. J Vasc Interv Radiol 2018; 29:353-366. [PMID: 29306599 DOI: 10.1016/j.jvir.2017.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/30/2017] [Accepted: 10/09/2017] [Indexed: 01/06/2023] Open
Abstract
A systematic review was conducted to provide an overview of the health effects of occupational radiation exposure from interventional fluoroscopy procedures on medical radiation workers. Among the 34 studies that met the inclusion criteria, most studies were cross-sectional (76%) and published after 2011 (65%) in a handful of countries. Although diverse outcomes were reported, most studies focused on cataracts. Radiation health effects were rarely assessed by risk per unit dose. Interventional radiation medical workers represent a small subset of the population studied worldwide. Further epidemiologic studies should be conducted to evaluate health outcomes among interventional radiation medical workers.
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Affiliation(s)
- Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02855, South Korea; Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea
| | - Seonghoon Kang
- Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea; Department of Occupational and Environmental Medicine, Korea University Ansan Hospital, Gyeonggi-do, South Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea
| | - Jaeyoung Kim
- Department of Preventive Medicine, Keimyung University College of Medicine, Daegu, South Korea
| | - Jae Kwan Jun
- National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do, South Korea
| | - Kyoung Ae Kong
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02855, South Korea; Graduate School of Public Health, Korea University, Seongbuk-gu, Seoul, South Korea.
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7
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Wang ML, Hoffler CE, Ilyas AM, Kirkpatrick WH, Beredjiklian PK, Leinberry CF. Hand Surgery and Fluoroscopic Eye Radiation Dosage: A Prospective Pilot Comparison of Large Versus Mini C-Arm Fluoroscopy Use. Hand (N Y) 2017; 12:21-25. [PMID: 28082838 PMCID: PMC5207279 DOI: 10.1177/1558944716643279] [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] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study is to (1) perform a prospective pilot comparison of the impact of large versus mini C-arm fluoroscopy on resultant eye radiation exposure and (2) test the hypothesis that the use of either modality during routine hand surgery does not exceed the current recommended limits to critical eye radiation dosage. Methods: Over a 12-month period, eye radiation exposure was prospectively measured by a board-certified hand surgeon using both large and mini C-arm fluoroscopy. For each modality, accumulated eye radiation dosage was measured monthly, while fluoroscopic radiation output was recorded, including total exposure time and dose rate. Results: A total of 58 cases were recorded using large C-arm and 25 cases using mini C-arm. Between the 2 groups, there was not a significant difference with total exposure time (P = .88) and average dose rate per case (P = .10). With the use of either modality, average monthly eye radiation exposure fell within the undetectable range (<30 mrem), significantly less than the current recommended limit of critical eye radiation (167 mrem/month). Conclusions: The impact of various fluoroscopic sources on eye radiation exposure remains relatively unexplored. In this study, the minimal detectable eye radiation dosages observed in both groups were reliably consistent. Our findings suggest that accumulated eye radiation dosage, from the use of either fluoroscopic modality, does not approach previously reported levels of critical radiation loads.
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Affiliation(s)
- Mark L. Wang
- Thomas Jefferson University, Philadelphia, PA, USA,Mark L. Wang, Department of Orthopedic Surgery, The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107-1216, USA.
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Kahn EN, Gemmete JJ, Chaudhary N, Thompson BG, Chen K, Christodoulou EG, Pandey AS. Radiation dose reduction during neurointerventional procedures by modification of default settings on biplane angiography equipment. J Neurointerv Surg 2015; 8:819-23. [PMID: 26245735 DOI: 10.1136/neurintsurg-2015-011891] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/13/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Neurointerventional procedures represent a significant source of ionizing radiation. We sought to assess the effect during neurointerventional procedures of varying default rates of radiation dose in fluoroscopy (F) and image acquisition (IA) modes, and frame rates during cine acquisition (CINE) on total X-ray dose, acquisition exposures, fluoroscopy time, and complications. METHODS We retrospectively reviewed procedures performed with two radiation dose and CINE settings: a factory setting dose cohort (30 patients, F 45 nGy/pulse, IA 3.6 μGy/pulse, factory CINE frame rate) and a reduced dose cohort (30 patients, F 32 nGy/pulse, IA 1.2 μGy/pulse, with a decreased CINE frame rate). Total radiation dose, dose area product, number of acquisition exposures, fluoroscopy time, and complications were compared between the groups. Means comparisons (t tests) were employed to evaluate differences in the outcome variables between the two groups. p Value <0.05 was considered significant. RESULTS The reduced dose cohort had a significant reduction in mean radiation dose (factory, 3650 mGy; reduced, 1650 mGy; p=0.005) and dose area product (factory, 34 700 μGy×m(2); reduced, 15 000 μGy×m(2); p=0.02). There were no significant differences between cohorts in acquisition exposure (p=0.73), fluoroscopy time (p=0.45), or complications. CONCLUSIONS Significant reductions in radiation dose delivered by neurointerventional procedures can be achieved through simple modifications of default radiation dose in F and IA and frame rate during CINE without an increase in procedural complexity (fluoroscopy time) or rate of complications.
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Affiliation(s)
- Elyne N Kahn
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Byron Gregory Thompson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin Chen
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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