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Werncke T, Becker LS, Maschke SK, Hinrichs JB, Meine TCH, Dewald CLA, Brüsch I, Rumpel R, Wacker FK, Meyer BC. Image Quality and Radiation Exposure in Abdominal Angiography: A Head-to-Head Comparison of Conventional Detector-Dose-Driven Versus Contrast-to-Noise Ratio-Driven Exposure Control at Various Source-to-Image Receptor Distances and Collimations in a Pilot Phantom and Animal Study. Invest Radiol 2024; 59:711-718. [PMID: 38529924 DOI: 10.1097/rli.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVES This phantom and animal pilot study aimed to compare image quality and radiation exposure between detector-dose-driven exposure control (DEC) and contrast-to-noise ratio (CNR)-driven exposure control (CEC) as functions of source-to-image receptor distance (SID) and collimation. MATERIALS AND METHODS First, an iron foil simulated a guide wire in a stack of polymethyl methacrylate and aluminum plates representing patient thicknesses of 15, 25, and 35 cm. Fluoroscopic images were acquired using 5 SIDs ranging from 100 to 130 cm and 2 collimations (full field of view, collimated field of view: 6 × 6 cm). The iron foil CNRs were calculated, and radiation doses in terms of air kerma rate were obtained and assessed using a multivariate regression. Second, 5 angiographic scenarios were created in 2 anesthetized pigs. Fluoroscopic images were acquired at 2 SIDs (110 and 130 cm) and both collimations. Two blinded experienced readers compared image quality to the reference image using full field of view at an SID of 110 cm. Air kerma rate was obtained and compared using t tests. RESULTS Using DEC, both CNR and air kerma rate increased significantly at longer SID and collimation below the air kerma rate limit. When using CEC, CNR was significantly less dependent of SID, collimation, and patient thickness. Air kerma rate decreased at longer SID and tighter collimation. After reaching the air kerma rate limit, CEC behaved similarly to DEC. In the animal study using DEC, image quality and air kerma rate increased with longer SID and collimation ( P < 0.005). Using CEC, image quality was not significantly different than using longer SID or tighter collimation. Air kerma rate was not significantly different at longer SID but lower using collimation ( P = 0.012). CONCLUSIONS CEC maintains the image quality with varying SID and collimation stricter than DEC, does not increase the air kerma rate at longer SID and reduces it with tighter collimation. After reaching the air kerma rate limit, CEC and DEC perform similarly.
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Affiliation(s)
- Thomas Werncke
- From the Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany (T.W., L.S., S.K.M., T.C.M., C.L.A., F.K.W., B.C.M.); Department of Diagnostic and Interventional Radiology and Neuroradiology, St. Bernward Hospital, Hildesheim, Germany (J.B.H.); and Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany (I.B., R.R.)
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Choi TW, Chung JW. Radiation dose during transarterial chemoembolization and associated factors. Abdom Radiol (NY) 2024:10.1007/s00261-024-04370-0. [PMID: 38831076 DOI: 10.1007/s00261-024-04370-0] [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: 10/28/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE To provide detailed reports on radiation doses during transarterial chemoembolization (TACE) in the cone-beam computed tomography (CBCT) era and to identify the associated factors. METHODS This retrospective study included 385 consecutive patients who underwent initial conventional TACE for hepatocellular carcinoma (HCC) between January 2016 and December 2017. In most cases, CBCT was performed at the common hepatic artery or celiac axis to confirm the location of the tumor and the three-dimensional hepatic artery anatomy. Superselective TACE was performed for all technically feasible cases. Information on total dose area product (DAP), total cumulative air kerma (CAK), fluoroscopy time, and DAP and CAK of each digital subtraction angiography (DSA) and CBCT scan was recorded. Multiple linear regression analysis was performed to identify the factors associated with increased DAP during TACE. RESULTS The mean values of total DAP and CAK were 165.2 ± 81.2 (Gy·cm²) and 837.1 ± 571.0 (mGy), respectively. The mean fluoroscopy time was 19.1 ± 10.3 min. The mean DAP caused by fluoroscopy, DSA, and CBCT was 51.8 ± 43.9, 28.0 ± 24.1, and 83.9 ± 42.1 Gy·cm², respectively. Male sex, a high body mass index, largest tumor size > 3 cm, presence of aberrant right and left hepatic arteries, and superselective TACE were identified as independent predictors of increased total DAP during TACE. CONCLUSION We were able to provide detailed reports on radiation doses during TACE and associated factors.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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Ohashi H, Kawamura D, Hatano K, Ohashi S, Tochigi S, Isoshima A, Nagashima H, Otani K, Karagiozov K, Tani S, Murayama Y. Intraoperative Cone-Beam Computed Tomography Assessment of Spinal Pedicle Screws Placement Precision Is in Full Agreement with Postoperative Computed Tomography Assessment. World Neurosurg 2023; 175:e254-e263. [PMID: 36966912 DOI: 10.1016/j.wneu.2023.03.062] [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: 10/23/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To assess agreement between pedicle screw placement evaluated on postoperative computed tomography (CT) and on intraoperative cone-beam CT (CBCT) and compare procedure characteristics when using first-generation and second-generation robotic C-arm systems in the hybrid operating room. METHODS All patients who received pedicle screws for spinal fusion at our institution between June 2009 and September 2019 and underwent intraoperative CBCT and postoperative CT were included. The CBCT and CT images were reviewed by 2 surgeons to assess the screw placement using the Gertzbein-Robbins and the Heary classifications. Intermethod agreement of screw placement classifications as well as interrater agreement were assessed using Brennan-Prediger and Gwet agreement coefficients. Procedure characteristics using first-generation and second-generation generation robotic C-arm systems were compared. RESULTS Fifty-seven patients were treated with 315 pedicle screws at thoracic, lumbar, and sacral levels. No screw had to be repositioned. On CBCT, accurate placement was found for 309 screws (98.1%) using the Gertzbein-Robbins classification and 289 (91.7%) using the Heary classification and on CT, these were 307 (97.4%) and 293 (93.0%), respectively. Intermethod between CBCT and CT and interrater agreements between the 2 raters were almost perfect (>0.90) for all assessment. There were no significant differences in mean radiation dose (P = 0.83) and fluoroscopy time (P = 0.82), but length of surgery using the second-generation system was estimated at 107.7 minutes (95% confidence interval, 31.9-183.5 minutes; P = 0.006) shorter. CONCLUSIONS Intraoperative CBCT provides accurate assessment of pedicle screw placement and enables intraoperative repositioning of misplaced screws.
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Affiliation(s)
- Hiroki Ohashi
- Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
| | - Daichi Kawamura
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Keisuke Hatano
- Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - So Ohashi
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Satoru Tochigi
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Akira Isoshima
- Department of Neurosurgery, Omori Red Cross Hospital, Ota-ku, Tokyo, Japan
| | - Hiroyasu Nagashima
- Department of Neurosurgery, Jikei University School of Medicine Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Katharina Otani
- Siemens Healthcare K.K., AT Innovation Department, Gate City Osaki West Tower, Shinagawa-ku, Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Satoshi Tani
- Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Sótonyi P, Berczeli M, Gyánó M, Legeza P, Mihály Z, Csobay-Novák C, Pataki Á, Juhász V, Góg I, Szigeti K, Osváth S, Kiss JP, Nemes B. Radiation Exposure Reduction by Digital Variance Angiography in Lower Limb Angiography: A Randomized Controlled Trial. J Cardiovasc Dev Dis 2023; 10:jcdd10050198. [PMID: 37233165 DOI: 10.3390/jcdd10050198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND digital variance angiography (DVA) provides higher image quality than digital subtraction angiography (DSA). This study investigates whether the quality reserve of DVA allows for radiation dose reduction during lower limb angiography (LLA), and compares the performance of two DVA algorithms. METHODS this prospective block-randomized controlled study enrolled 114 peripheral arterial disease patients undergoing LLA into normal dose (ND, 1.2 µGy/frame, n = 57) or low-dose (LD, 0.36 µGy/frame, n = 57) groups. DSA images were generated in both groups, DVA1 and DVA2 images were generated in the LD group. Total and DSA-related radiation dose area product (DAP) were analyzed. Image quality was assessed on a 5-grade Likert scale by six readers. RESULTS the total and DSA-related DAP were reduced by 38% and 61% in the LD group. The overall visual evaluation scores (median (IQR)) of LD-DSA (3.50 (1.17)) were significantly lower than the ND-DSA scores (3.83 (1.00), p < 0.001). There was no difference between ND-DSA and LD-DVA1 (3.83 (1.17)), but the LD-DVA2 scores were significantly higher (4.00 (0.83), p < 0.01). The difference between LD-DVA2 and LD-DVA1 was also significant (p < 0.001). CONCLUSIONS DVA significantly reduced the total and DSA-related radiation dose in LLA, without affecting the image quality. LD-DVA2 images outperformed LD-DVA1, therefore DVA2 might be especially beneficial in lower limb interventions.
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Affiliation(s)
- Péter Sótonyi
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - Márton Berczeli
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
| | - Marcell Gyánó
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - Péter Legeza
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
| | - Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
| | - Csaba Csobay-Novák
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - Ákos Pataki
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - Viktória Juhász
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
| | - István Góg
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Vascular Surgery, Hungarian Defence Forces Medical Centre, Róbert Károly körút 44, 1134 Budapest, Hungary
| | - Krisztián Szigeti
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Tűzoltó u. 37-47, 1094 Budapest, Hungary
| | - Szabolcs Osváth
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Tűzoltó u. 37-47, 1094 Budapest, Hungary
| | - János P Kiss
- Kinepict Health Ltd., Szilágyi Erzsébet Fasor 31, 1027 Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Tűzoltó u. 37-47, 1094 Budapest, Hungary
| | - Balázs Nemes
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary
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Alizadeh LS, Koch V, Vogl TJ, Yel I, Gruenewald L, Albrecht MH, Herrmann E, von Knebel-Doeberitz PL, Booz C. Value of Latest-generation Cone-beam Computed Tomography for Post Lipiodol-embolization Imaging in Hepatic Transarterial Chemoembolization in Comparison with Multi-detector Computed Tomography. Acad Radiol 2022; 29:e109-e118. [PMID: 34598867 DOI: 10.1016/j.acra.2021.07.029] [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: 04/09/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate image quality, radiation dose (phantom study) and tumor volumetry of intraprocedural cone-beam computed tomography (CBCT) compared to postprocedural multidetector computed tomography (MDCT) in patients undergoing hepatic conventional transarterial chemoembolization (cTACE). MATERIALS AND METHODS One hundred fourteen patients (64/50 female/male; mean age, 57 ± 14 years) who had undergone cTACE including intraprocedural-CBCT and postprocedural-MDCT were retrospectively enrolled. Subjective image quality (IQ) and suitability for assessing Lipiodol distribution were compared using 4-point Likert scales; additionally, lesion to liver contrast (LLC) and contrast-to-noise-ratio (CNR) were compared. Tumor volumes were measured semi-automatically and compared to magnetic resonance imaging (MRI). Effective doses were measured using an anthropomorphic phantom. RESULTS The suitability of CBCT for assessing Lipiodol distribution during cTACE was comparable to MDCT (mean score, 3.2 ± 0.6) and CBCT (3.4 ± 1.0, p = 0.29). Subjective overall IQ was rated with a mean score of 3.2 ± 0.7 (κ = 0.66) in CBCT and 3.1 ± 0.4 (κ = 0.57, p = 0.15) in MDCT. Evaluation of LLC showed significant differences between CBCT and MDCT (mean scores 3.6 ± 1.2 and 2.6 ± 1.5, respectively). CNR analysis demonstrated comparable mean values for CBCT and MDCT (3.5 ± 1.3 vs. 3.4 ± 1.8, p = 0.31). No significant differences were found regarding tumor volumetry (mean volumes: CBCT, 27.0 ± 17.4 mm3; MDCT: 26.8 ± 16.0 mm3; p = 0.66) in comparison to T2-weighted MRI (25.9 ± 17.6 mm3). Effective doses were 3.2 ± 0.6 mSv (CBCT) and 2.5 ± 0.3 mSv (MDCT) (p < 0.001). No cTACE-related complications (bleeding, non-target embolization) were missed on intraprocedural CBCT in comparison to postprocedural MDCT. CONCLUSION Latest-generation intraprocedural CBCT provides suitable assessment of Lipiodol distribution and similar image quality compared to MDCT while allowing for robust volumetric tumor measurements and immediate complication control by visualizing non-target embolization and hematoma. Therefore, it may improve patient safety and outcome as well as clinical workflow compared to postprocedural MDCT in hepatic cTACE in certain cases.
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Werncke T, Meine TC, Hinrichs JB, Maschke SK, Becker LS, Brüsch I, Rumpel R, Wacker FK, Meyer BC. Tantalum-specific contrast-to-noise ratio or conventional detector dose-driven exposure control in angiography: radiation dose and image quality evaluation in a porcine model. Eur Radiol Exp 2022; 6:24. [PMID: 35578057 PMCID: PMC9110612 DOI: 10.1186/s41747-022-00275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this animal study was to compare the fluoroscopic image quality (IQ) and radiation dose between a tantalum (Ta)-specific contrast-to-noise ratio-driven exposure control (Ta-CEC) and a detector dose-driven exposure control (DEC) in abdominal angiography. Methods Nine angiography scenarios were created in seven anaesthetised pigs using Ta-based embolisation material during percutaneous liver and kidney intervention. Fluoroscopic images were acquired using three DEC protocols with different dose levels and Ta-CEC protocols with different IQ levels, sampled in small steps. Polymethyl-methacrylate and aluminium plates were used to simulate attenuation of three water equivalent thicknesses (WET). Three blinded readers evaluated the IQ of DEC and dose equivalent Ta images and selected the Ta-IQ equivalent image corresponding to the DEC image. Results Interobserver agreement for the IQ assessment was 0.43 for DEC, 0.56 for Ta-CEC and for the assessment of incident air kerma at the interventional reference point (Ka,r) for the Ta-IQ equivalent image 0.73. The average IQ of the dose equivalent Ta images was superior compared to the DEC images (p < 0.001) and also for every WET (26, 31, or 36 cm) and dose level (p ≤ 0.022). The average Ka,r for the Ta-IQ equivalent images was 59 ± 16% (mean ± standard deviation) lower compared to the DEC images (p < 0.001). Conclusions Compared to DEC, Ta-CEC significantly improved the fluoroscopic depiction of Ta, while maintaining the Ka,r. Alternatively, the Ka,r can be significantly reduced by using Ta-CEC instead of DEC, while maintaining equivalent IQ.
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Nocum DJ, Robinson J, Halaki M, Båth M, Mekiš N, Liang E, Thompson N, Moscova M, Reed W. UTERINE ARTERY EMBOLISATION: CONTINUOUS QUALITY IMPROVEMENT REDUCES RADIATION DOSE WHILE MAINTAINING IMAGE QUALITY. RADIATION PROTECTION DOSIMETRY 2021; 196:159-166. [PMID: 34595527 DOI: 10.1093/rpd/ncab145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/01/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to introduce a continuous quality improvement (CQI) program for radiation dose optimisation during uterine artery embolisation (UAE) and assess its impact on dose reduction and image quality. The CQI program investigated the effects of optimising radiation dose parameters on the kerma-area product (KAP) and image quality when comparing a 'CQI intervention' group (n = 50) and 'Control' group (n = 50). Visual grading characteristics (VGC) analysis was used to assess image quality, using the 'Control' group as a reference. A significant reduction in KAP by 17% (P = 0.041, d = 0.2) and reference air kerma (Ka, r) by 20% (P = 0.027, d = 0.2) was shown between the two groups. The VGC analysis resulted in an area under the VGC curve (AUCVGC) of 0.54, indicating no significant difference in image quality between the two groups (P = 0.670). The implementation of the CQI program and optimisation of radiation dose parameters improved the UAE radiation dose practices at our centre. The dose reduction demonstrated no detrimental effects on image quality.
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Affiliation(s)
- Don J Nocum
- San Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - John Robinson
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Halaki
- Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Nejc Mekiš
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Eisen Liang
- San Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- Sydney Adventist Hospital Clinical School, Faculty of Medicine and Health, University of Sydney, Wahroonga, NSW, Australia
| | - Nadine Thompson
- San Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- Sydney Adventist Hospital Clinical School, Faculty of Medicine and Health, University of Sydney, Wahroonga, NSW, Australia
| | - Michelle Moscova
- School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Warren Reed
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Digital variance angiography allows about 70% decrease of DSA-related radiation exposure in lower limb X-ray angiography. Sci Rep 2021; 11:21790. [PMID: 34750427 PMCID: PMC8575921 DOI: 10.1038/s41598-021-01208-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
Our aim was to investigate whether the previously observed higher contrast-to-noise ratio (CNR) and better image quality of Digital Variance Angiography (DVA) - compared to Digital Subtraction Angiography (DSA) - can be used to reduce radiation exposure in lower limb X-ray angiography. This prospective study enrolled 30 peripheral artery disease patients (mean ± SD age 70 ± 8 years) undergoing diagnostic angiography. In all patients, both normal (1.2 µGy/frame; 100%) and low-dose (0.36 µGy/frame; 30%) protocols were used for the acquisition of images in three anatomical regions (abdominal, femoral, crural). The CNR of DSA and DVA images were calculated, and the visual quality was evaluated by seven specialists using a 5-grade Likert scale. For investigating non-inferiority, the difference of low-dose DVA and normal dose DSA scores (DVA30-DSA100) was analyzed. DVA produced two- to three-fold CNR and significantly higher visual score than DSA. DVA30 proved to be superior to DSA100 in the crural region (difference 0.25 ± 0.07, p < 0.001), and there was no significant difference in the femoral (− 0.08 ± 0.06, p = 0.435) and abdominal (− 0.10 ± 0.09, p = 0.350) regions. Our data show that DVA allows about 70% reduction of DSA-related radiation exposure in lower limb X-ray angiography, providing a potential new radiation protection tool for the patients and the medical staff.
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Werncke T, Kemling M, Tashenov S, Hinrichs JB, Meine TC, Maschke SK, Kyriakou Y, Wacker FK, Meyer BC. Impact of a contrast-to-noise ratio driven and material specific exposure control on image quality and radiation exposure in angiography. Phys Med Biol 2021; 66:065020. [PMID: 33709957 DOI: 10.1088/1361-6560/abe83a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Conventional detector-dose driven exposure controls (DEC) do not consider the contrasting material of interest in angiography. Considering the latter when choosing the acquisition parameters should allow for optimization of x-ray quality and consecutively lead to a substantial reduction of radiation exposure. Therefore, the impact of a material-specific, contrast-to-noise ratio (CNR) driven exposure control (CEC) compared to DEC on radiation exposure was investigated. A 3D-printed phantom containing iron, tantalum, and platinum foils and cavities, filled with iodine, barium, and gas (carbon dioxide), was developed to measure the CNR. This phantom was placed within a stack of polymethylmethacrylate and aluminum plates simulating a patient equivalent thickness (PET) of 2.5-40 cm. Fluoroscopy and digital radiography (DR) were conducted applying either CEC or three, regular DEC protocols with parameter settings used in abdominal interventions. CEC protocols where chosen to achieve material-specific CNR values similar to those of DEC. Incident air kerma at the reference point(Ka,r), using either CEC or DEC, was assessed and possible Ka,r reduction for similar CNR was estimated. We show that CEC provided similar CNR as DEC at the same or lower Ka,r. When imaging barium, iron, and iodine Ka,r was substantially reduced below a PET of 20 cm and between 25 cm and 30 cm for fluoroscopy and Dr When imaging platinum and tantalum using fluoroscopy and DR and gas using DR, the Ka,r reduction was substantially higher. We estimate the Ka,r reduction for these materials between 15% and 84% for fluoroscopy and DR between 15% and 93% depending on the PET. The results of this study demonstrate a high potential for skin dose reduction in abdominal radiology when using a material-specific CEC compared to DEC. This effect is substantial in imaging materials with higher energy K-edges, which is beneficial, for example, in long-lasting embolization procedures with tantalum-based embolization material in young patients with arterio-venous malformations.
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Affiliation(s)
- Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
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