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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. A comparison of patient dose and occupational eye dose to the operator and nursing staff during transcatheter cardiac and endovascular procedures. Sci Rep 2023; 13:2391. [PMID: 36765105 PMCID: PMC9918729 DOI: 10.1038/s41598-023-28704-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
The number and complexity of transcatheter procedures continue to increase, raising concerns regarding radiation exposure to patients and staff. Procedures such as transaortic valve implantations (TAVI) have led to cardiologists adopting higher dose techniques, such as digital subtraction angiography (DSA). This study compared the estimated patient and occupational eye dose during coronary angiography (CA), percutaneous coronary intervention (PCI), TAVI workups (TWU), TAVI, endovascular aneurysm repairs (EVAR), and other peripheral diagnostic (VD) and interventional (VI) vascular procedures. A quantitative analysis was performed on patient dose during 299 endovascular and 1498 cardiac procedures. Occupational dose was measured for the cardiologists (n = 24), vascular surgeons (n = 3), scrub (n = 32) and circulator nurses (n = 35). TAVI and EVAR were associated with the highest average dose for all staff, and significantly higher patient dose area product, probably attributable to the use of DSA. Scrub nurses were exposed to higher average doses than the operator and scout nurse during CA, VD and VI. Circulating nurses had the highest average levels of exposure during TAVI. This study has demonstrated that EVAR and TAVI have similar levels of occupational and patient dose, with a notable increase in circulator dose during TAVI. The use of DSA during cardiac procedures is associated with an increase in patient and staff dose, and cardiologists should evaluate whether DSA is necessary. Scrub nurses may be exposed to higher levels of occupational dose than the operator.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, 4059, Australia. .,Cardiovascular Suites, Greenslopes Private Hospital, Greenslopes, Brisbane, QLD, 4120, Australia.
| | - Davide Fontanarosa
- Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, 4059, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, QLD, 2006, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, 4059, Australia
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Kim HO, Lee BC, Park C, Kim JK, Park WJ, Lee JE, Lim HS, Jeong WG. Occupational dose and associated factors during transarterial chemoembolization of hepatocellular carcinoma using real-time dosimetry: A simple way to reduce radiation exposure. Medicine (Baltimore) 2022; 101:e28744. [PMID: 35089250 PMCID: PMC8797565 DOI: 10.1097/md.0000000000028744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/12/2022] [Indexed: 01/05/2023] Open
Abstract
Transarterial chemoembolization is the standard treatment option for intermediate-stage hepatocellular carcinoma (HCC). However, during the interventional procedure, occupational radiation protection is compromised. The use of real-time radiation dosimetry could provide instantaneous radiation doses. This study aimed to evaluate the occupational dose of the medical staff using a real-time radiation dosimeter during transarterial chemoembolization (TACE) for HCC, and to investigate factors affecting the radiation exposure dose.This retrospective observational study included 70 patients (mean age: 66 years; age range: 38-88 years; male: female = 59: 11) who underwent TACE using real-time radiation dosimetry systems between August 2018 and February 2019. Radiation exposure doses of operators, assistants, and technicians were evaluated. Patients' clinical, imaging, and procedural information was analyzed.The mean dose-area product (DAP) and fluoroscopy time during TACE were 66.72 ± 55.14 Gycm2 and 12.03 ± 5.95 minutes, respectively. The mean radiation exposure doses were 24.8 ± 19.5, 2.0 ± 2.2, and 1.65 ± 2.0 μSv for operators, assistants, and technicians, respectively. The radiation exposure of the operators was significantly higher than that of the assistants or technicians (P < .001). The perpendicular position of the adjustable upper-body lead protector (AULP) on the table was one factor reducing in the radiation exposure of the assistants (P < .001) and technicians (P = .040). The DAP was a risk factor for the radiation exposure of the operators (P = .003) and technicians (P < .001).Occupational doses during TACE are affected by DAP and AULP positioning. Placing the AULP in the perpendicular position during fluoroscopy could be a simple and effective way to reduce the radiation exposure of the staff. As the occupational dose influencing factors vary by region or institution, further study is needed.
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Affiliation(s)
- Hyoung Ook Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Chan Park
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Jae Kyu Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Won-Ju Park
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
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Engström A, Isaksson M, Javid R, Lundh C, Båth M. A case study of cost-benefit analysis in occupational radiological protection within the healthcare system of Sweden. J Appl Clin Med Phys 2021; 22:295-304. [PMID: 34505345 PMCID: PMC8504601 DOI: 10.1002/acm2.13421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 11/12/2022] Open
Abstract
The aim of the present study was to demonstrate cases of cost-benefit analysis within healthcare, of how economic factors can be considered in occupational radiological protection, in agreement with the as low as reasonably achievable principle and present Swedish legislations. In the first part of the present study, a comparison of examples within health economics used by authorities and institutes in Sweden was made. The comparison focused on value of a statistical life, quality-adjusted life year, and monetary cost assigned to a unit of collective dose for radiation protection purposes (α-value). By this comparison, an α-value was determined as an interval between $45 and $450 per man-mSv, for the Swedish society in 2021. The α-value interval can be interpreted as following: Less than $45 per man-mSv is a good investment. From $45 to $450 per man-mSv, other factors than costs and collective dose are important to consider. More than $450 per man-mSv is too expensive. In the second part of the present study, seven cases of cost-benefit analyses in occupational radiological protection were provided. The present study focused specifically on cases where the relevant factors were costs and collective dose. The present case study shows a large variation in costs per collective dose from different types of occupational radiological protection, used at Skaraborg Hospital in Sweden.
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Affiliation(s)
| | - Mats Isaksson
- Department of Radiation PhysicsInstitute of Clinical SciencesSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Reza Javid
- Department of Research and DevelopmentSkaraborg HospitalSkövdeSweden
| | - Charlotta Lundh
- Department of Radiation PhysicsInstitute of Clinical SciencesSahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of Medical Physics and Biomedical EngineeringSahlgrenska University HospitalGothenburgSweden
| | - Magnus Båth
- Department of Radiation PhysicsInstitute of Clinical SciencesSahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of Medical Physics and Biomedical EngineeringSahlgrenska University HospitalGothenburgSweden
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Wilson-Stewart K, Hartel G, Fontanarosa D. Occupational radiation exposure to the head is higher for scrub nurses than cardiologists during cardiac angiography. J Adv Nurs 2019; 75:2692-2700. [PMID: 31144368 DOI: 10.1111/jan.14085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 10/26/2022]
Abstract
AIMS This study aimed to compare the head dose of a cardiologist to scrub and scout nurses during cardiac angiography. DESIGN A correlational longitudinal quantitative design was used to examine the relationship between the variable of occupational dose to the medical operator when compared with the dose to the scrub and scout nurses. METHODS A quantitative analysis was performed on data collected during coronary angiograms (N = 612) for one cardiologist and 22 nurses performing either the scrub or scout role between May 2015 and February 2017. Analysis was based on log-transformed dose levels and reported as geometric means and associated 95% confidence intervals. RESULTS It was found that scrub nurses received on average 41% more head dose than the cardiologist during diagnostic procedures and 52% higher doses during interventional cases. CONCLUSION Nurses working in fluoroscopic cardiovascular procedures should be provided with appropriate training and protective equipment, notably lead skull caps, to minimize their occupational radiation exposure. IMPACT There is a notable lack of research evaluating the occupational head and eye exposure to nurses involved in fluoroscopic procedures. This study found that during diagnostic coronary angiograms, the scrub nurses received 41% more occupational head dose than the cardiologist and 52% higher head doses during interventional cases. Radial access resulted in higher doses to scrub nurses than femoral artery access. It is advisable that staff wear protective lead glasses and skull caps and use appropriately positioned ceiling mounted lead shields to minimize the risk of adverse effects of occupational exposure to ionizing radiation.
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Affiliation(s)
- Kelly Wilson-Stewart
- Cardiovascular Suites, Greenslopes Private Hospital, Brisbane, Qld, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
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Maeng JY, Song Y, Sung YS, Kim TI, Lee DH, Kim TH. Feasibility of ultra-low radiation dose digital subtraction angiography: Preliminary study in a simplified cerebral angiography phantom. Interv Neuroradiol 2019; 25:589-595. [PMID: 31096837 DOI: 10.1177/1591019919850302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The objective of this article is to evaluate the feasibility of cerebral digital subtraction angiography (DSA) using ultra-low radiation dose settings in a simplified cerebral angiography phantom. MATERIALS AND METHODS We created a silicone phantom capable of producing a simplified cerebral DSA. A total of 18 DSA sets were obtained with gradual six-step reduction of the detector entrance dose (DED) from 1.82 to 0.08 μGy per frame, while standard, postprocessing algorithm (PPA) and copper filter (0.3 mm) with PPA (CwP) algorithm reconstruction protocols were applied. We quantitatively compared their signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) and qualitatively analyzed the images' qualities in terms of image sharpness, contrast, and noise as investigated by five observers. RESULTS The SNR and CNR, which decreased with lowering of the DED in the standard protocol group, were significantly compensated by using the PPA. The values were approximately double in the PPA (11.5 ± 2.9) and CwP (11.0 ± 2.5) groups compared with the standard (5.4 ± 1.1) group in the DED of 0.24 μGy per frame as well as in the other values. The total scores of the observers according to the protocols showed a tendency to decrease as the DED lowered. On average, the PPA (96.3 ± 34.6) and CwP (91.3 ± 29.9) groups yielded higher results than the standard protocol (83.7 ± 46.7). CONCLUSION Given that the current DED ranges from 1.82 to 3.60 μGy per frame for routine cerebral DSA, our results indicate that DED can be decreased to 15%-30% of the current dose level in vessels 2-4 mm in diameter if image-improvement algorithms are applied.
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Affiliation(s)
- Jun Young Maeng
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Yu Sub Sung
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Tae-Il Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Radiological Science, Kangwon National University, Samcheok-si, Kangwon-do, Korea
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Wilson‐Stewart K, Shanahan M, Fontanarosa D, Davidson R. Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature. J Appl Clin Med Phys 2018; 19:282-297. [PMID: 30294978 PMCID: PMC6236819 DOI: 10.1002/acm2.12461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/19/2018] [Accepted: 07/14/2018] [Indexed: 11/16/2022] Open
Abstract
Fluoroscopy is a method used to provide real time x-ray imaging of the body during medical procedures to assist with medical diagnosis and treatment. Recent technological advances have seen an increase in the number of fluoroscopic examinations being performed. Nurses are an integral part of the team conducting fluoroscopic investigations and are often located close to the patient resulting in an occupational exposure to radiation. The purpose of this review was to examine recent literature which investigates occupational exposure received by nursing staff during cardiovascular fluoroscopic procedures. Articles published between 2011 and 2017 have been searched and comprehensively reviewed on the referenced medical search engines. Twenty-four relevant studies were identified among which seventeen investigated nursing dose comparative to operator dose. Seven researched the effectiveness of interventions in reducing occupational exposure to nursing staff. While doctors remain at the highest risk of exposure during procedures, evidence suggests that nursing staff may be at risk of exceeding recommended dose limits in some circumstances. There is also evidence of inconsistent use of personal protection such as lead glasses and skull caps by nursing staff to minimize radiation exposure. Conclusions: The review has highlighted a lack of published literature focussing on dose to nurses. There is a need for future research in this area to inform nursing staff of factors which may contribute to high occupational doses and of methods for minimizing the risk of exposure, particularly regarding the importance of utilizing radiation protective equipment.
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Affiliation(s)
- Kelly Wilson‐Stewart
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQldAustralia
- Cardiovascular SuitesGreenslopes Private HospitalBrisbaneQldAustralia
- Faculty of HealthUniversity of CanberraCanberraACTAustralia
| | | | - Davide Fontanarosa
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQldAustralia
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneQldAustralia
| | - Rob Davidson
- Faculty of HealthUniversity of CanberraCanberraACTAustralia
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Sailer AM, Vergoossen L, Paulis L, van Zwam WH, Das M, Wildberger JE, Jeukens CRLPN. Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring. Cardiovasc Intervent Radiol 2017; 40:1756-1762. [PMID: 28500459 PMCID: PMC5651709 DOI: 10.1007/s00270-017-1690-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/03/2017] [Indexed: 10/31/2022]
Abstract
PURPOSE Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. MATERIALS AND METHODS Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. RESULTS Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) µSv/Gy cm2 versus (phase 2) 0.08 (0.02-0.24) µSv/Gy cm2, p = 0.002]. CONCLUSION Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions.
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Affiliation(s)
- Anna M. Sailer
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94303 USA
| | - Laura Vergoossen
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Leonie Paulis
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Willem H. van Zwam
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- CARIM School of Cardiovascular Diseases, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- CARIM School of Cardiovascular Diseases, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Cécile R. L. P. N. Jeukens
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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Dynamic Four-Dimensional Computed Tomography Angiography for Neurovascular Pathologies. World Neurosurg 2017; 105:1034.e11-1034.e18. [DOI: 10.1016/j.wneu.2017.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/22/2022]
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Heilmaier C, Kara L, Zuber N, Berthold C, Weishaupt D. Combined Use of a Patient Dose Monitoring System and a Real-Time Occupational Dose Monitoring System for Fluoroscopically Guided Interventions. J Vasc Interv Radiol 2015; 27:584-92. [PMID: 26724965 DOI: 10.1016/j.jvir.2015.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/12/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the effect on patient radiation exposure of the combined use of a patient dose monitoring system and real-time occupational dose monitoring during fluoroscopically guided interventions (FGIs). MATERIALS AND METHODS Patient radiation exposure, in terms of the kerma area product (KAP; Gy ∙ cm(2)), was measured in period 1 with a patient dose monitoring system, and a real-time occupational dose monitoring system was additionally applied in period 2. Mean/median KAP in 19 different types of FGIs was analyzed in both periods for two experienced interventional radiologists combined as well as individually. Patient dose and occupational dose were correlated, applying Pearson and Spearman correlation coefficients. RESULTS Although FGIs were similar in numbers and types over both periods, a substantial decrease was found for period 2 in total mean ± SD/median KAP for both operators together (period 1, 47 Gy ∙ cm(2) ± 67/41 Gy ∙ cm(2); period 2, 37 Gy ∙ cm(2) ± 69/34 Gy ∙ cm(2)) as well as for each individual operator (for all, P < .05). Overall, KAP declined considerably in 15 of 19 types of FGIs in period 2. Mean accumulated dose per intervention was 4.6 µSv, and mean dose rate was 0.24 mSv/h. There was a strong positive correlation between patient and occupational dose (r = 0.88). CONCLUSIONS Combined use of a patient dose monitoring system and a real-time occupational dose monitoring system in FGIs significantly lessens patient and operator doses.
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Affiliation(s)
- Christina Heilmaier
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland.
| | - Levent Kara
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland
| | - Niklaus Zuber
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland
| | - Christian Berthold
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland
| | - Dominik Weishaupt
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli Zurich, Birmensdorferstreet 497, Zurich CH-8063, Switzerland
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Wojak JC, Abruzzo TA, Bello JA, Blackham KA, Hirsch JA, Jayaraman MV, Dariushnia SR, Meyers PM, Midia M, Russell EJ, Walker TG, Nikolic B. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2015; 26:1596-608. [DOI: 10.1016/j.jvir.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022] Open
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11
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Kortman HGJ, Smit EJ, Oei MTH, Manniesing R, Prokop M, Meijer FJA. 4D-CTA in neurovascular disease: a review. AJNR Am J Neuroradiol 2014; 36:1026-33. [PMID: 25355812 DOI: 10.3174/ajnr.a4162] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CT angiography is a widely used technique for the noninvasive evaluation of neurovascular pathology. Because CTA is a snapshot of arterial contrast enhancement, information on flow dynamics is limited. Dynamic CTA techniques, also referred to as 4D-CTA, have become available for clinical practice in recent years. This article provides a description of 4D-CTA techniques and a review of the available literature on the application of 4D-CTA for the evaluation of intracranial vascular malformations and hemorrhagic and ischemic stroke. Most of the research performed to date consists of observational cohort studies or descriptive case series. These studies show that intracranial vascular malformations can be adequately depicted and classified by 4D-CTA, with DSA as the reference standard. In ischemic stroke, 4D-CTA better estimates thrombus burden and the presence of collateral vessels than conventional CTA. In intracranial hemorrhage, 4D-CTA improves the detection of the "spot" sign, which represents active ongoing bleeding.
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Affiliation(s)
- H G J Kortman
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - E J Smit
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - M T H Oei
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - R Manniesing
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - M Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - F J A Meijer
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
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