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Abumoussa A, Flores A, Cornea CM, Thapa D, Petty A, Gelinne A, Elton S, Quinsey C, Sasaki-Adams D, Solander S, Ho J, Yap E, Lee YZ. Synthetic interpolated DSA for radiation exposure reduction via gamma variate contrast flow modeling: a retrospective cohort study. Eur Radiol Exp 2024; 8:25. [PMID: 38361025 PMCID: PMC10869670 DOI: 10.1186/s41747-023-00404-2] [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: 05/02/2023] [Accepted: 10/20/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA) yields high cumulative radiation dosages (RD) delivered to patients. We present a temporal interpolation of low frame rate angiograms as a method to reduce cumulative RDs. METHODS Patients undergoing interventional evaluation and treatment of cerebrovascular vasospasm following subarachnoid hemorrhage were retrospectively identified. DSAs containing pre- and post-intervention runs capturing the full arterial, capillary, and venous phases with at least 16 frames each were selected. Frame rate reduction (FRR) of the original DSAs was performed to 50%, 66%, and 75% of the original frame rate. Missing frames were regenerated by sampling a gamma variate model (GVM) fit to the contrast response curves to the reduced data. A formal reader study was performed to assess the diagnostic accuracy of the "synthetic" studies (sDSA) compared to the original DSA. RESULTS Thirty-eight studies met inclusion criteria (average RD 1,361.9 mGy). Seven were excluded for differing views, magnifications, or motion. GVMs fit to 50%, 66%, and 75% FRR studies demonstrated average voxel errors of 2.0 ± 2.5% (mean ± standard deviation), 6.5 ± 1.5%, and 27 ± 2%, respectively for anteroposterior projections, 2.0 ± 2.2%, 15.0 ± 3.1%, and 14.8 ± 13.0% for lateral projections, respectively. Reconstructions took 0.51 s/study. Reader studies demonstrated an average rating of 12.8 (95% CI 12.3-13.3) for 75% FRR, 12.7 (12.2-13.2) for 66% FRR and 12.0 (11.5-12.5) for 50% FRR using Subjective Image Grading Scale. Kendall's coefficient of concordance resulted in W = 0.506. CONCLUSION FRR by 75% combined with GVM reconstruction does not compromise diagnostic quality for the assessment of cerebral vasculature. RELEVANCE STATEMENT Using this novel algorithm, it is possible to reduce the frame rate of DSA by as much as 75%, with a proportional reduction in radiation exposure, without degrading imaging quality. KEY POINTS • DSA delivers some of the highest doses of radiation to patients. • Frame rate reduction (FRR) was combined with bolus tracking to interpolate intermediate frames. • This technique provided a 75% FRR with preservation of diagnostic utility as graded by a formal reader study for cerebral angiography performed for the evaluation of cerebral vasospasm. • This approach can be applied to other types of angiography studies.
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Affiliation(s)
- Andrew Abumoussa
- Department of Neurosurgery, UNC School of Medicine, Chapel Hill, NC, 27516, USA.
| | - Alex Flores
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Christiana M Cornea
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Diwash Thapa
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Amy Petty
- Department of Dermatology - Duke University, Durham, NC, 27710, USA
| | - Aaron Gelinne
- Department of Neurosurgery, UNC School of Medicine, Chapel Hill, NC, 27516, USA
| | - Scott Elton
- Department of Neurosurgery, UNC School of Medicine, Chapel Hill, NC, 27516, USA
| | - Carolyn Quinsey
- Department of Neurosurgery, UNC School of Medicine, Chapel Hill, NC, 27516, USA
| | - Deanna Sasaki-Adams
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Sten Solander
- Department of Radiology, UNC School of Medicine, Chapel Hill, NC, 27516, USA
| | - James Ho
- Department of Neurology, UNC School of Medicine, Chapel Hill, NC, 27516, USA
| | - Edward Yap
- Department of Neurosurgery, UNC School of Medicine, Chapel Hill, NC, 27516, USA
| | - Yueh Z Lee
- Department of Radiology, UNC School of Medicine, Chapel Hill, NC, 27516, USA
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Ryu JC, Yoon JT, Kim BJ, Kim MH, Moon EJ, Suh PS, Roh YH, Moon HH, Kwon B, Lee DH, Song Y. Reduction of Radiation Dose to Eye Lens in Cerebral 3D Rotational Angiography Using Head Off-Centering by Table Height Adjustment: A Prospective Study. Korean J Radiol 2023; 24:681-689. [PMID: 37404110 DOI: 10.3348/kjr.2023.0169] [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: 02/18/2023] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Three-dimensional rotational angiography (3D-RA) is increasingly used for the evaluation of intracranial aneurysms (IAs); however, radiation exposure to the lens is a concern. We investigated the effect of head off-centering by adjusting table height on the lens dose during 3D-RA and its feasibility in patient examination. MATERIALS AND METHODS The effect of head off-centering during 3D-RA on the lens radiation dose at various table heights was investigated using a RANDO head phantom (Alderson Research Labs). We prospectively enrolled 20 patients (58.0 ± 9.4 years) with IAs who were scheduled to undergo bilateral 3D-RA. In all patients' 3D-RA, the lens dose-reduction protocol involving elevation of the examination table was applied to one internal carotid artery, and the conventional protocol was applied to the other. The lens dose was measured using photoluminescent glass dosimeters (GD-352M, AGC Techno Glass Co., LTD), and radiation dose metrics were compared between the two protocols. Image quality was quantitatively analyzed using source images for image noise, signal-to-noise ratio, and contrast-to-noise ratio. Additionally, three reviewers qualitatively assessed the image quality using a five-point Likert scale. RESULTS The phantom study showed that the lens dose was reduced by an average of 38% per 1 cm increase in table height. In the patient study, the dose-reduction protocol (elevating the table height by an average of 2.3 cm) led to an 83% reduction in the median dose from 4.65 mGy to 0.79 mGy (P < 0.001). There were no significant differences between dose-reduction and conventional protocols in the kerma area product (7.34 vs. 7.40 Gy·cm², P = 0.892), air kerma (75.7 vs. 75.1 mGy, P = 0.872), and image quality. CONCLUSION The lens radiation dose was significantly affected by table height adjustment during 3D-RA. Intentional head off-centering by elevation of the table is a simple and effective way to reduce the lens dose in clinical practice.
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Affiliation(s)
- Jae-Chan Ryu
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Tae Yoon
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Byung Jun Kim
- Advanced Therapies, Siemens Healthineers Ltd., Seoul, Korea
| | - Mi Hyeon Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Eun Ji Moon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pae Sun Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Hwa Roh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Hyeon Moon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Sanchez RM, Siiskonen T, Vano E. Current status of diagnostic reference levels in interventional cardiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:041002. [PMID: 36379055 DOI: 10.1088/1361-6498/aca2b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Interventional cardiology provides indisputable benefits for patients but uses a substantial amount of ionising radiation. The diagnostic reference level (DRL) is the tool recommended by the International Commission on Radiological Protection to optimise imaging procedures. In this work, a review of studies dealing with radiation dose or recommending DRL values for interventional cardiology since 2010 is presented, providing quantitative and qualitative results. There are many published papers on coronary angiography (CA) and percutaneous coronary intervention. The DRL values compiled for different continental regions are different: the DRL for CA is about 35 Gy cm2for Europe and 83 Gy cm2for North America. These differences emphasise the need to establish national DRLs considering different social and/or economic factors and the harmonisation of the survey methodology. Surveys with a large amount of data collected with the help of dose management systems provide more reliable information with less chance of statistical bias than those with a small amount of data. The complexity of procedures and improvements in technology are important factors that affect the radiation dose delivered to patients. There is a need for additional data on structural and electrophysiological procedures. The analysis of paediatric procedures is especially difficult because some studies present results split into age bands and others into weight bands. Diagnostic procedures are better described, but there is a great variety of therapeutic procedures with different DRL values (up to a factor of nine) and these require a dedicated review.
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Affiliation(s)
- Roberto M Sanchez
- Hospital Clinico Universitario San Carlos, Medical Physics, Madrid, Spain
| | - Teemu Siiskonen
- Radiation and Nuclear Safety Authority-STUK, Helsinki, Finland
| | - Eliseo Vano
- Radiology Department, Universidad Complutense de Madrid, Madrid, Spain
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Anthony G, Liang Y, Zhao X. Performance evaluation of two interventional fluoroscope suites for cardiovascular imaging. J Appl Clin Med Phys 2022; 23:e13741. [PMID: 35950644 DOI: 10.1002/acm2.13741] [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: 12/20/2021] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 11/09/2022] Open
Abstract
Interventional cardiology involves catheter-based treatment of heart disease, generally through fluoroscopically guided interventional procedures. Patients can be subject to considerable radiation dose due to prolonged fluoroscopy time and radiographic exposure, and therefore efforts to minimize patient dose should always be undertaken. Developing standardized, effective quality control programs for these systems is a difficult task owing to cross-vendor differences and automated control of imaging protocols. Furthermore, analyses of radiation dose should be performed in the context of its associated effects on image quality. The aim of the study is to investigate radiation dose and image quality in two fluoroscopic systems used for interventional cardiology procedures. Image quality was assessed in terms of spatial resolution and modulation transfer function, signal-to-noise and contrast-to-noise ratios, and spatial-temporal resolution of fluoroscopy and cineradiography images with phantoms simulating various patient thicknesses under routine cardiology protocols. The entrance air kerma (or air kerma rate) was measured and used to estimate entrance surface dose (or dose rate) in the phantoms.
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Affiliation(s)
- Gregory Anthony
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, Indiana, USA
| | - Yun Liang
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Xuandong Zhao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
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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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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Impact of dose reducing software on patient and staff temple dose during fluoroscopically guided pacemaker insertion, closure devices implantation and coronary angiography procedures. Phys Eng Sci Med 2022; 45:589-599. [PMID: 35532868 PMCID: PMC9239962 DOI: 10.1007/s13246-022-01126-2] [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: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 11/03/2022]
Abstract
AbstractThe aim of this study is to investigate the effectiveness of dose reducing software (ClarityIQ) on patient and staff dose during fluoroscopically guided cardiac procedures. Dose measurements were collected in a room without dose reducing software (n = 157) and compared with similar procedures performed in two rooms with the software (n = 1141). Procedures included diagnostic coronary angiography, percutaneous coronary intervention, deployment of cardiac closure devices (for occlusion of atrial septal defect, patent foramen ovale, and atrial appendage) and insertion of permanent pacemakers. The dose reducing software was found to be effective in reducing patient and staff dose by approximately 50%. This study has added to the limited literature reporting on the capability of dose reducing software to decrease radiation exposure during the implantation of cardiac closure devices, as well as demonstrating a reduction in dose to the cardiologist and nursing staff. Administrators should ensure timely upgrades to angiographic equipment to safeguard patients and staff against the potentially adverse effects of radiation exposure. Regardless of the use of dose reducing software, the mean occupational dose during closure devices was in descending order scout > scrub > cardiologist. Scrub nurse dose was found to be higher than the cardiologist during closure devices (0.98/0.26 μSv) and diagnostic coronary angiograms (1.51/0.82 μSv). Nursing staff should be aware that their levels of radiation dose during some cardiac procedures may come close to or even exceed that of the cardiologist.
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Pizano A, Khurram A, Chamseddin K, Timaran CH, Baig S, Shih M, Xi Y, Guild J, Kirkwood ML. New imaging technology system reduces patient radiation dose during peripheral arterial endovascular interventions. J Vasc Surg 2022; 76:500-504. [PMID: 35367567 DOI: 10.1016/j.jvs.2022.03.865] [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: 02/03/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Radiation exposure and imaging quality are among the main concerns in endovascular procedures. The Clear VD11 PURE platform technology system (Siemens Healthineers, Erlangen, Germany) has been reported to lower the radiation dose and improve image quality. In the present study, we evaluated whether the radiation dose during peripheral arterial endovascular procedures had decreased after implementation of this new imaging system. METHODS The patient characteristics (age, gender, body mass index [BMI]), procedure type (diagnostic, balloon angioplasty, atherectomy, stenting), body location (aortoiliac, superficial femoral artery, tibial artery), reference air kerma (RAK), kerma area product (KAP), and fluoroscopy time (FT) were recorded during peripheral artery interventions performed 1 year before (group A) and 1 year after (group B) the CLEAR system upgrade. The procedures were performed in an Artis zeego hybrid room (Siemens Healthineers) with the same providers. A general linear model was used to estimate the average difference between groups adjusted by procedure type and patient age, gender, and BMI. Additionally, to control for variations in case complexity, groups A and B were matched by age, gender, BMI, lesion location, and intervention type. Propensity score matching and a paired t test were used to compare the KAP, RAK, and FT stratified by single intervention procedures. RESULTS A total of 487 endovascular procedures were performed: 209 in group A and 278 in group B. A total of 111 single intervention procedures from each group were matched (1:1), with a mean age of 61 ± 8 years and a BMI of 26.5 ± 4 kg/m2. The median KAP, RAK, and FT for group A were 28.8 Gy · cm2 (interquartile range [IQR], 24-34 Gy · cm2), 146 mGy (IQR, 123-173 mGy), and 12 minutes (IQR, 10-14 minutes), respectively. The median KAP, RAK, and FT for group B were 18.3 Gy · cm2 (IQR, 16-22 Gy · cm2), 71.2 mGy (IQR, 60-85 mGy), and 10.4 minutes (IQR, 9-12 minutes), respectively. The KAP, RAK, and FT were significantly decreased in group B by 24% (P = .005), 41% (P < .001), and 22% (P = .002), respectively, compared with the values for group A. Stratified by single intervention procedures, the KAP and RAK had decreased significantly in group B (36% [P = .002] and 51% [P < .001], respectively) compared with group A. The FT decrease of 13% in group B was not statistically significant (P = .20). CONCLUSIONS Use of the Clear VD11 PURE platform system (Siemens Healthineers) reduced the patient radiation dose by 51% during endovascular peripheral interventions. The similar FTs for the matched single intervention procedures before and after the upgrade indicated consistent case complexity and surgeon practice. This platform appears to be an effective system for lowering the radiation dose.
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Affiliation(s)
- Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ali Khurram
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Division of Medical Physics, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Guild
- Division of Medical Physics, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Abdo MH, Michaelsen J, Langenbrink L, Wiertz M, Altiok E, Hoffmann R. Impact of tube angulations and imaging mode on radiation dosage using image noise reduction technology. Coron Artery Dis 2022; 33:153-154. [PMID: 34411010 DOI: 10.1097/mca.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mourad Haj Abdo
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen
| | - Jochen Michaelsen
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen
| | - Lukas Langenbrink
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen
| | - Michael Wiertz
- Department of Radiotherapy, Academy for Health Professions
- Department Medical-Technology Radiology Assistance, University Hospital Aachen
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Rainer Hoffmann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen
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Nocum DJ, Robinson J, Halaki M, Båth M, Thompson JD, Thompson N, Moscova M, Liang E, Mekiš N, Reed W. Predictors of radiation dose for uterine artery embolisation are angiography system-dependent. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:011502. [PMID: 34985415 DOI: 10.1088/1361-6498/ac480b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre's practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura,n= 95) and Group II (Azurion,n= 95) demonstrated a significant reduction in kerma-area product (KAP) and Ka, r (reference air kerma) by 63% (143.2 Gy cm2vs 52.9 Gy cm2;P< 0.001,d= 0.8) and 67% (0.6 Gy vs 0.2 Gy;P< 0.001,d= 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy cm2and the limits of agreement were +28.49 and -27.71 Gy cm2, and thus illustrated no proportional bias. The resultant MLR model was considered system-dependent and validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose. Interventional radiologist and interventional radiographer familiarisation of the system's features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.
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Affiliation(s)
- Don J Nocum
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John Robinson
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Magnus Båth
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - John D Thompson
- Department of Radiography, School of Health and Society, University of Salford, Salford M6 6PU, United Kingdom
| | - Nadine Thompson
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Moscova
- Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Eisen Liang
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Sydney Fibroid Clinic, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Nejc Mekiš
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Warren Reed
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Marosfoi M, Orrù E, Rabinovich M, Newman S, Patel NV, Wakhloo AK. Endovascular Treatment of Intracranial Aneurysms. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Trunz LM, Eschelman DJ, Gonsalves CF, Adamo RD, Dave JK. Investigation of Radiation Dose Estimates and Image Quality Between Commercially Available Interventional Fluoroscopy Systems for Fluoroscopically Guided Interventional Procedures. Acad Radiol 2021; 28:1559-1569. [PMID: 32224035 DOI: 10.1016/j.acra.2020.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/12/2020] [Accepted: 02/23/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate differences in radiation dose and image quality for single-plane flat-panel-detector based interventional fluoroscopy systems from two vendors using phantom study and clinical procedures. MATERIALS AND METHODS AlluraClarityIQ (Philips) and Artis Q (Siemens-Healthineers) interventional fluoroscopy systems were evaluated. Phantom study included comparison of system-reported air-kerma rates (AKR) for clinical protocols with simulated patient thicknesses (20-40 cm). Differences in system-reported radiation dose estimates, cumulative-air-kerma (CAK) and kerma-area-product (KAP), for different clinical procedures were investigated. Subset analysis investigated differences in CAK, KAP and other factors affecting radiation dose when the same patients underwent repeat embolization procedures performed by the same physician on the two different fluoroscopy systems. Two blinded interventional radiologists reviewed image-quality for these procedures using a five-point scale (1-5; 5-best) for five parameters. RESULTS Phantom study revealed that air-kerma rates was significantly higher for Artis Q system for 30-40cm of simulated patient thicknesses (p < 0.05). Overall data analysis from 4381 clinical cases revealed significant differences in CAK and KAP for certain procedures (p < 0.05); with significantly lower values for AlluraClarityIQ systems (median CAK lower by: 29%-58%). Subset analysis with 40 patients undergoing repeat embolization procedures on both systems revealed that median CAK and KAP were significantly lower for AlluraClarityIQ systems (p < 0.02) by 45% and 31%, respectively. Image quality scores for AlluraClarityIQ systems were significantly greater (mean difference range for five parameters: 1.3-1.6; p < 0.005). CONCLUSION Radiation dose and image quality differences were observed between AlluraClarityIQ and Artis Q systems. AlluraClarityIQ systems showed lower radiation utilization and an increase in subjective perception of image quality.
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Werncke T, Kemling M, Tashenov S, Hinrichs JB, Meine TC, Maschke SK, Kyriakou Y, Wacker FK, Meyer BC. Comparison of a contrast-to-noise ratio-driven exposure control and a regular detector dose-driven exposure control in abdominal imaging in a clinical angiography system. Med Phys 2021; 48:7641-7656. [PMID: 34651705 DOI: 10.1002/mp.15288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 05/28/2021] [Accepted: 09/20/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The first purpose of this phantom study was to verify whether a contrast-to-noise ratio (CNR)-driven exposure control (CEC) can maintain target CNR in angiography more precisely compared to a conventional detector dose-driven exposure control (DEC). The second purpose was to estimate the difference between incident air kerma produced by CEC and DEC when both exposure controls reach the same CNR. METHODS A standardized 3D-printed phantom with an iron foil and a cavity, filled with iodinated contrast material, was developed to measure CNR using different image acquisition settings. This phantom was placed into a stack of polymethylmethacrylate and aluminum plates, simulating a patient equivalent thickness (PET) of 2.5-40 cm. Images were acquired using fluoroscopy and digital radiography modes with CEC using one image quality level and four image quality gradients and DEC having three different detector dose levels. The spatial frequency weighted CNR and incident air kerma were determined. The differences in incident air kerma between DEC and CEC were estimated. RESULTS When using DEC, CNR decreased continuously with increasing attenuation, while CEC within physical limits maintained a predefined CNR level. Furthermore, CEC could be parameterized to deliver the CNR as a predefined function of PET. To provide a given CNR level, CEC used equal or lower air kerma than DEC. The mean estimated incident air kerma of CEC compared to DEC was between 3% (PET 20 cm) and 40% (PET 27.5 cm) lower in fluoroscopy and between 1% (PET 20 cm) and 55% (PET 2.5 cm) lower in digital radiography while maintaining CNR. CONCLUSION Within physical and legislative limits, the CEC allows for a flexible adjustment of the CNR as a function of PET. Thus, the CEC enables task-dependent examination protocols with predefined image quality in order to easier achieve the as low as reasonably achievable principle. CEC required equal or lower incident air kerma than DEC to provide similar CNR, which allows for a substantial reduction of skin radiation dose in these situations.
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Affiliation(s)
- Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Marius Kemling
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Stanislav Tashenov
- Advanced Therapies, Cancer Therapy, Define, Siemens Healthcare GmbH, Forchheim, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Timo C Meine
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Yiannis Kyriakou
- Customer Services, Education, Education Architecture & Design, Siemens Healthcare GmbH, Forchheim, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Thomas RP, Bastian MB, Viniol S, König AM, Amin SS, Eldergash O, Schnabel J, Gyánó M, Szöllősi D, Góg I, Kiss JP, Osváth S, Szigeti KP, Mahnken AH. Digital Variance Angiography in Selective Lower Limb Interventions. J Vasc Interv Radiol 2021; 33:104-112. [PMID: 34653607 PMCID: PMC8844582 DOI: 10.1016/j.jvir.2021.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the potential benefits of digital variance angiography (DVA) in selective lower limb angiography and to compare the performance of 2 DVA algorithms (conventional DVA1 and the recently developed DVA2) to that of digital subtraction angiography (DSA). MATERIALS AND METHODS From November 2019 to May 2020, 112 iodinated contrast media (ICM) and 40 carbon dioxide (CO2) angiograms were collected from 15 and 13 peripheral artery disease patients, respectively. The DVA files were retrospectively generated from the same unsubtracted source file as DSA. The objectively calculated contrast-to-noise ratio (CNR) and the subjective visual image quality of DSA, DVA1, and DVA2 images were statistically compared using the Wilcoxon signed-rank test. The images were evaluated by 6 radiologists (R.P.T., S.V., A.M.K., S.S.A., O.E., and J.S.) from 2 centers using a 5-grade Likert scale. RESULTS Both DVA algorithms produced similar increase (at least 2-fold) in CNR values (P < .001) and significantly higher image quality scores than DSA, independent of the contrast agent used. The overall scores with ICM were 3.61 ± 0.05 for DSA, 4.30 ± 0.04 for DVA1, and 4.33 ± 0.04 for DVA2 (each P < .001 vs DSA). The scores for CO2 were 3.10 ± 0.14 for DSA, 3.63 ± 0.13 for DVA1 (P < .001 vs DSA), and 3.38 ± 0.13 for DVA2 (P < .05 vs DSA). CONCLUSIONS DVA provides higher CNR and significantly better image quality in selective lower limb interventions irrespective of the contrast agent used. Between DVA algorithms, DVA1 is preferred because of its identical or better image quality than DVA2. DVA can potentially help the interventional decision process and its quality reserve might allow dose management (radiation/ICM reduction) in the future.
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Affiliation(s)
- Rohit P Thomas
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany.
| | - Moritz B Bastian
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Simon Viniol
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Alexander M König
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Sandeep S Amin
- Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Osama Eldergash
- Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Johannes Schnabel
- Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Marcell Gyánó
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Kinepict Health Ltd, Budapest, Hungary
| | - Dávid Szöllősi
- Kinepict Health Ltd, Budapest, Hungary; Department of Biophysics and Radiation Biology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - István Góg
- Kinepict Health Ltd, Budapest, Hungary; Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Szabolcs Osváth
- Kinepict Health Ltd, Budapest, Hungary; Department of Biophysics and Radiation Biology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Krisztián P Szigeti
- Kinepict Health Ltd, Budapest, Hungary; Department of Biophysics and Radiation Biology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
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14
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Sanchez RM, Vano E, Salinas P, Gonzalo N, Escaned J, Fernández JM. High filtration in interventional practices reduces patient radiation doses but not always scatter radiation doses. Br J Radiol 2020; 94:20200774. [PMID: 33180554 DOI: 10.1259/bjr.20200774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES In fluoroscopy-guided interventional practices, new dose reduction systems have proved to be efficient in the reduction of patient doses. However, it is not clear whether this reduction in patient dose is proportionally transferred to operators' doses. This work investigates the secondary radiation fields produced by two kinds of interventional cardiology units from the same manufacturer with and without dose reduction systems.Methods:Data collected from a large sample of clinical procedures over a 2-year period (more than 5000 procedures and 340,000 radiation events) and the DICOM radiation dose structured reports were analysed. RESULTS The average cumulative Hp(10) per procedure measured at the C-arm was similar for the standard and the dose reduction systems (452 vs 476 μSv respectively). The events analysis showed that the ratio Hp(10)/KAP at the C-arm was (mean ± SD) 5 ± 2, 10 ± 4, 14 ± 4 and 14 ± 6 μSv·Gy-1·cm-2 for the beams with no added filtration, 0.1, 0.4 and 0.9 mm Cu respectively and suggested that the main cause for the increment of the ratio Hp(10)/KAP vs the "standard system" is the use of higher beam filtration in the "dose reduction" system. CONCLUSION Dose reduction systems are beneficial to reduce KAP in patients and their use should be encouraged, but they may not be equally effective to reduce occupational doses. Interventionalists should not overlook their own personal protection when using new technologies with dose reduction systems. ADVANCES IN KNOWLEDGE Dose reduction technology in interventional systems may increase scatter dose for operators. Personal protection should not be overlooked with dose reduction systems.
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Affiliation(s)
- Roberto M Sanchez
- Medical Physics Service and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Radiology Department, Medicine Faculty of the Universidad Complutense de Madrid, Madrid, Spain
| | - Eliseo Vano
- Medical Physics Service and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Radiology Department, Medicine Faculty of the Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Salinas
- Cardiology department and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nieves Gonzalo
- Cardiology department and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Javier Escaned
- Cardiology department and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jose M Fernández
- Medical Physics Service and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Javor D, Moyses J, Loewe C, Schernthaner RE. Radiation dose reduction capabilities of a new C-arm system with optimized hard- and software. Eur J Radiol 2020; 134:109367. [PMID: 33221618 DOI: 10.1016/j.ejrad.2020.109367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the radiation dose reduction capabilities and the image quality of a new C-arm system in comparison to a standard C-arm system. METHOD Prospective, randomized, IRB approved two-arm trial design. 49 consecutive patients with primary or secondary liver cancer were treated with transarterial chemoembolization (TACE) on two different angiography units. 28 patients were treated on a conventional angiography unit B, 21 patients on unit A which provides improved hardware and optimized image processing algorithms. Dose area product (DAP) and fluoroscopy time were recorded. DSA image quality of all procedures was assessed on a four-rank-scale by two independent and blinded readers. RESULTS Both cohorts showed no significant differences with regard to patient characteristics, tumor burden and fluoroscopy time. The new system resulted in a statistically significant reduction of cumulative DAP of 72% compared to the old platform (median 76 vs. 269 Gy*cm2). Individually, Fluoro-DAP and DSA-DAP decreased by 48% and 77% (p = 0.012 and p < 0.01), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms. CONCLUSIONS The new C-arm system significantly reduced radiation exposure for TACE procedures without increased radiation time or negative impact on DSA image quality. The combination of optimized hardware and software yields the highest radiation dose reduction and is of utmost importance for patients and interventionalists.
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Affiliation(s)
- Domagoj Javor
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Johanna Moyses
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ruediger E Schernthaner
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Digital Variance Angiography in Lower-Limb Angiography with Metal Implants. Cardiovasc Intervent Radiol 2020; 44:452-459. [PMID: 33145701 PMCID: PMC7864852 DOI: 10.1007/s00270-020-02697-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/18/2020] [Indexed: 11/18/2022]
Abstract
Purpose The presence of metal implants may reduce angiographic image quality due to automated beam adjustments. Digital variance angiography (DVA) is reported to be superior to digital subtraction angiography (DSA) with increased contrast-to-noise ratio (CNR) and better image quality. The aim of the study was to evaluate whether DVA could counterbalance the image quality impairment of lower-limb angiographies with metal implants. Materials and Methods From November 2019 to January 2020, 85 raw lower-limb iodine contrast angiograms of 12 patients with metal implants were processed retrospectively with DVA analyses. For objective comparison, CNR of DSA and DVA images was calculated and the ratio CNRDVA/CNRDSA was determined. Visual image quality was evaluated in a paired comparison and by a five-grade Likert scale by three experienced radiologists. Results The CNR was calculated and compared in 1252 regions of interest in 37 image pairs containing metal implants. The median ratio of CNRDVA/CNRDSA was 1.84 with an interquartile range of 1.35–2.32. Paired comparison resulted in 84.5% in favour of DVA with an interrater agreement of 83.2% (Fleiss κ 0.454, p < 0.001). The overall image quality scores for DSA and DVA were 3.64 ± 0.08 and 4.43 ± 0.06, respectively (p < 0.001, Wilcoxon signed-rank test) with consistently higher individual ratings for DVA. Conclusion Our small-sample pilot study shows that DVA provides significantly improved image quality in lower-limb angiography with metal implants, compared to DSA imaging. The improved CNR suggest that this approach could reduce radiation exposure for lower-limb angiography with metal implants. Level of Evidence Level 4, case studies
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Cavallari M, D'Ercole L, Klersy C, Sanfilippo G, Sgreccia A, Huasen B, Thyrion Zappoli F, Lafe E. Typical values related to the complexity of interventional treatment of acute ischemic stroke. Phys Med 2020; 78:129-136. [PMID: 33002734 DOI: 10.1016/j.ejmp.2020.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Interventional Neuroradiology (INR) procedures are often complex, requiring prolonged high-dose exposures. This leads to increased radiation exposure to both patient and operating staff. The purpose of this study is to identify parameters related to the complexity of acute ischemic stroke (AIS) procedures that increase patient exposure and derive DRLs according to ICRP 135. METHODS Data from 145 patients treated for AIS between 2017 and 2019 in a Hub Stroke center were retrospectively analyzed. Dosimetric parameters, demographic and clinical data were collected for each patient. The INR operator and the fluoroscopy system used were included. RESULTS A multivariable analysis was performed to identify which parameters significantly influence the dosimetric data. Thrombus location and the use of stent retriever were noted as the most likely parameters of complex INR procedures. Male sex is an indicator of complex procedure only with regards to the Kerma area product and the air kerma. Patient age significantly affects the exposure time alone. Senior or more experienced operator's data demonstrated reduced patient's exposure time and therefore the KAP and Kar values. The type of X-ray equipment influenced the outcome of the procedure in terms of number of images acquired. Typical values obtained are 168 Gycm2, 0.68 Gy, 19 min and 181 images. CONCLUSION Typical values derived in this study promote patient dose optimization, when considering the complexity of INR procedures. The clinical variables related to the complexity of procedure that mainly affect the dosimetric data in our experience are thrombus location and use of stent retrievers.
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Affiliation(s)
- Monica Cavallari
- Fondazione IRCCS Policlinico San Matteo Pavia e Università degli Studi di Milano, Italy.
| | | | | | | | | | - Bella Huasen
- Lancashire University teaching Hospitals Preston, UK
| | | | - Elvis Lafe
- Fondazione IRCCS Policlinico San Matteo Pavia, Italy
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18
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Feasibility of low-dose digital subtraction angiography protocols for the endovascular treatment of intracranial dural arteriovenous fistulas. Neuroradiology 2020; 63:267-273. [PMID: 32857215 DOI: 10.1007/s00234-020-02537-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among neurointerventional procedures, the embolization of complex shunt lesions usually requires more radiation dose. We aimed to evaluate the procedural outcome and safety in using low-dose DSA protocols for intracranial dural arteriovenous fistula (AVF) embolization treatment. METHODS Between January 2014 and July 2018, 55 patients with dural AVFs who underwent endovascular treatment were included in the study. The low-dose group (n = 27) included from January 2016 used various low-dose DSA protocols made by modifying the thickness of the copper filter or the detector entrance dose. We compared radiation dose metrics, such as air-kerma, kerma-air product (KAP), and fluoroscopy time, as well as clinical and imaging outcomes with the conventional-dose group (n = 28) included before January 2016. RESULTS The total KAP was 40.1% lower in the low-dose group (87.9 vs. 146.7 Gy cm2, p = 0.002). The average number of DSA runs (25.1 vs. 25.5, p = 0.86) and fluoroscopy times (77.4 vs. 69.7 min, p = 0.48) were similar between the groups. An immediate favorable occlusion rate (total or near total occlusion) was achieved in 41 (74.5%) patients. Ten patients (18.2%) underwent additional procedures due to residual (n = 6) and/or recurrent (n = 5) lesions. At a median of 10 months follow-up, 45 patients (86.5%) had achieved favorable occlusion. Treatment outcomes showed no significant between-group differences. There was one case (1.8%) of procedure-related complications in the low-dose group. All but one patient showed favorable clinical outcomes (modified Rankin score ≤ 2). CONCLUSION The low-dose protocols were feasible by showing significant radiation dose reduction and acceptable procedural outcome.
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Kaye EA, Aherne EA, Duzgol C, Häggström I, Kobler E, Mazaheri Y, Fung MM, Zhang Z, Otazo R, Vargas HA, Akin O. Accelerating Prostate Diffusion-weighted MRI Using a Guided Denoising Convolutional Neural Network: Retrospective Feasibility Study. Radiol Artif Intell 2020; 2:e200007. [PMID: 33033804 DOI: 10.1148/ryai.2020200007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the feasibility of accelerating prostate diffusion-weighted imaging (DWI) by reducing the number of acquired averages and denoising the resulting image using a proposed guided denoising convolutional neural network (DnCNN). MATERIALS AND METHODS Raw data from the prostate DWI scans were retrospectively gathered between July 2018 and July 2019 from six single-vendor MRI scanners. There were 103 datasets used for training (median age, 64 years; interquartile range [IQR], 11), 15 for validation (median age, 68 years; IQR, 12), and 37 for testing (median age, 64 years; IQR, 12). High b-value diffusion-weighted (hb DW) data were reconstructed into noisy images using two averages and reference images using all 16 averages. A conventional DnCNN was modified into a guided DnCNN, which uses the low b-value DW image as a guidance input. Quantitative and qualitative reader evaluations were performed on the denoised hb DW images. A cumulative link mixed regression model was used to compare the readers' scores. The agreement between the apparent diffusion coefficient (ADC) maps (denoised vs reference) was analyzed using Bland-Altman analysis. RESULTS Compared with the original DnCNN, the guided DnCNN produced denoised hb DW images with higher peak signal-to-noise ratio (32.79 ± 3.64 [standard deviation] vs 33.74 ± 3.64), higher structural similarity index (0.92 ± 0.05 vs 0.93 ± 0.04), and lower normalized mean square error (3.9% ± 10 vs 1.6% ± 1.5) (P < .001 for all). Compared with the reference images, the denoised images received higher image quality scores from the readers (P < .0001). The ADC values based on the denoised hb DW images were in good agreement with the reference ADC values (mean ADC difference ranged from -0.04 to 0.02 × 10-3 mm2/sec). CONCLUSION Accelerating prostate DWI by reducing the number of acquired averages and denoising the resulting image using the proposed guided DnCNN is technically feasible. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Elena A Kaye
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Emily A Aherne
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Cihan Duzgol
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Ida Häggström
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Erich Kobler
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Yousef Mazaheri
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Maggie M Fung
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Zhigang Zhang
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Ricardo Otazo
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Hebert A Vargas
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Oguz Akin
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
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Borota L, Patz A. SPOT REGION OF INTEREST IMAGING: A NOVEL FUNCTIONALITY AIMED AT X-RAY DOSE REDUCTION IN NEUROINTERVENTIONAL PROCEDURES. RADIATION PROTECTION DOSIMETRY 2020; 188:322-331. [PMID: 31950175 PMCID: PMC7315134 DOI: 10.1093/rpd/ncz290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
AIM OF THE STUDY The aim of this study was to describe a new functionality aimed at X-ray dose reduction, referred to as spot region of interest (Spot ROI) and to compare it with existing dose-saving functionalities, spot fluoroscopy (Spot F), and conventional collimation (CC). MATERIAL AND METHODS Dose area product, air kerma, and peak skin dose were measured for Spot ROI, Spot F, and CC in three different fields of view (FOVs) 20 × 20 cm, 15 × 15 cm, and 11 × 11 cm using an anthropomorphic head phantom RS-230T. The exposure sequence was 5 min of pulsed fluoroscopy (7.5 pulses per s) followed by 7× digital subtraction angiography (DSA) runs with 30 frames per DSA acquisition (3 fps × 10 s). The collimation in Spot F and CC was adjusted such that the size of the anatomical area exposed was as large as the Spot ROI area in each FOV. RESULTS The results for all FOVs were the following: for the fluoroscopy, all measured parameters for Spot ROI and Spot F were lower than corresponding values for CC. For DSA and DSA plus fluoroscopy, all measured parameters for Spot ROI were lower than corresponding parameters for Spot F and CC. CONCLUSION Spot ROI is a promising dose-saving technology that can be applied in fluoroscopy and acquisition. The biggest benefit of Spot ROI is its ability to keep the entire FOV information always visible.
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Affiliation(s)
- Ljubisa Borota
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Andreas Patz
- Canon Medical Systems Europe BV, Zilverstraat 1, 2718 RP, Zoetermeer, The Netherlands
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Kraemer BF, Tesche C, Hapfelmeier A, Finsterer S, Ebersberger U, Schlüter M, Ziegler M, Martens E, Laugwitz KL, Schmidt M. Radiation Dose Reduction Using a Novel Fluoroscopy System in Patients Undergoing Diagnostic Invasive Coronary Angiography. J Thorac Imaging 2020; 36:52-56. [PMID: 32251233 DOI: 10.1097/rti.0000000000000510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive coronary angiography (ICA) still causes a significant amount of radiation exposure for patients and operators. In February 2017, the Azurion system was introduced, a new-generation fluoroscopy image acquisition and processing system. Radiation exposure in patients undergoing ICA was assessed comparing the novel Azurion 7 F12 angiography system to its predecessor Allura Xper in a randomized manner. METHODS Radiation exposure was prospectively analyzed in 238 patients undergoing diagnostic ICA. Patients were randomly assigned to the novel Azurion system (119 patients) or its predecessor Allura Xper system (119 patients). In each patient, 8 predefined standard projections (5 left coronary artery, 3 right coronary artery) were performed. Image quality was quantified by grading of the images on the basis of a 5-point grading system. RESULTS Radiation dose area product was significantly lower in the Azurion group 109 (interquartile range [IQR 75-176] cGy cm) compared with the Allura Xper group 208 [IQR 134-301] cGy cm (P<0.001). Body mass index (26.6 [IQR 23.9-29.7] kg/m vs. 26.2 [IQR 24.2-29.4] kg/m; P=0.607), body surface area (1.96 [IQR 1.81-2.11] m vs. 1.90 [IQR 1.77-20.4] m; P=0.092), and procedure duration (1.5 [IQR 1.2-2.3] min vs. 1.6 [IQR 1.2-2.5] min; P=0.419) were similar in both groups. Images from the Azurion system were at least of equal quality compared with Allura Xper (image quality grade 4.82±0.45 vs. 4.75±0.52, P=0.43). CONCLUSION Use of the novel Azurion 7 F12 angiography system resulted in a significant reduction of dose area product in patients undergoing diagnostic ICA by 56%.
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Affiliation(s)
| | - Christian Tesche
- Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen.,Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University
| | | | | | | | | | - Martin Ziegler
- Department of Cardiology, Kreisklinik Ebersberg, Ebersberg
| | - Eimo Martens
- Department of Cardiology, Klinikum Rechts der Isar, Technical University of Munich
| | - Karl-Ludwig Laugwitz
- Department of Cardiology, Klinikum Rechts der Isar, Technical University of Munich
| | - Martin Schmidt
- Department of Cardiology, Kreisklinik Ebersberg, Ebersberg
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Forbrig R, Ozpeynirci Y, Grasser M, Dorn F, Liebig T, Trumm CG. Radiation dose and fluoroscopy time of modern endovascular treatment techniques in patients with saccular unruptured intracranial aneurysms. Eur Radiol 2020; 30:4504-4513. [PMID: 32193640 PMCID: PMC8093177 DOI: 10.1007/s00330-020-06777-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Objectives Modern endovascular treatment of unruptured intracranial aneurysms (UIAs) demands for observance of diagnostic reference levels (DRLs). The national DRL (250 Gy cm2) is only defined for coiling. We provide dosimetric data for the following procedures: coiling, flow diverter (FD), Woven EndoBridge (WEB), combined techniques. Methods A retrospective single-centre study of saccular UIAs treated between 2015 and 2019. Regarding dosimetric analysis, the parameters dose area product (DAP) and fluoroscopy time were investigated for the following variables: endovascular technique, aneurysm location, DSA protocol, aneurysm size, and patient age. Results Eighty-seven patients (59 females, mean age 54 years) were included. Total mean and median DAP (Gy cm2) were 119 ± 73 (89–149) and 94 (73; 130) for coiling, 128 ± 53 (106–151) and 134 (80; 176) for FD, 128 ± 56 (102–153) and 118 (90; 176) for WEB, and 165 ± 102 (110–219) and 131 (98; 209) for combined techniques (p > .05). Regarding the aneurysm location, neither DAP nor fluoroscopy time was significantly different (p > .05). The lowest and highest fluoroscopy times were recorded for WEB and combined techniques, respectively (median 26 and 94 min; p < .001). A low-dose protocol yielded a 43% reduction of DAP (p < .001). Significantly positive correlations were found between DAP and both aneurysm size (r = .320, p = .003) and patient age (r = .214, p = .046). Conclusions This UIA study establishes novel local DRLs for modern endovascular techniques such as FD and WEB. A low-dose protocol yielded a significant reduction of radiation dose. Key Points • This paper establishes local diagnostic reference levels for modern endovascular treatment techniques of unruptured intracranial aneurysms, including flow diverter stenting and Woven EndoBridge device. • Dose area product was not significantly different between endovascular techniques and aneurysm locations, but associated with aneurysm size and patient age. • A low-dose protocol yielded a significant reduction of dose area product and is particularly useful when applying materials with a high radiopacity (e.g. platinum coils).
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Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Franziska Dorn
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christoph G Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Orrù E, Mekabaty AE, Millan DS, Pearl MS, Gailloud P. Removal of Antiscatter Grids for Spinal Digital Subtraction Angiography: Dose Reduction without Loss of Diagnostic Value. Radiology 2020; 295:390-396. [PMID: 32125257 DOI: 10.1148/radiol.2020191786] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Spinal digital subtraction angiography (DSA) exposes patients and operators to substantial amounts of radiation. Antiscatter grid (ASG) removal is used to decrease radiation exposure but may reduce image quality. Purpose To determine whether ASG removal during spinal DSA in adults reduces radiation dose while maintaining diagnostic image quality and whether dose reduction is related to body mass index (BMI). Materials and Methods This Health Insurance Portability and Accountability Act-compliant prospective study included adults undergoing spinal DSA between January and December 2016. Each procedure included an additional angiographic acquisition performed twice, once with and once without ASG, either documenting the artery of Adamkiewicz (no pathology group) or the condition leading to the procedure (pathology group). Dose differences between study acquisitions and the influence of BMI were evaluated via paired t test. Two neurointerventionalists blinded to acquisition protocols were asked to independently evaluate a sample of 40 study acquisitions (20 with ASG, 20 without ASG) from 20 randomly selected participants to (a) rate image quality, (b) categorize findings, and (c) determine whether images had been obtained with or without ASG. Percentage agreement on image quality, findings categorization, and ability to correctly identify the acquisition protocol was calculated for both readers. Results Fifty-three participants (mean age ± standard deviation, 51 years ± 15.2; 32 men) were evaluated. ASG removal reduced the mean dose per acquisition by approximately 33% (mean dose-area product and air kerma decreased from 202 to 135.6 µGy/m2 and from 35.3 to 24 mGy, respectively; P < .001) independently of BMI (P = .3). Both readers evaluated all images (40 of 40) as being of diagnostic quality and correctly categorized findings in 19 of 20 (95%) cases. Overall percentage agreement for correct protocol identification was 60% (12 of 20) for grid-in and 45% (nine of 20) for grid-out images. Conclusion Antiscatter grid removal during spinal digital subtraction angiography decreased participants' radiation exposure while preserving diagnostic image quality. © RSNA, 2020.
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Affiliation(s)
- Emanuele Orrù
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
| | - Amgad El Mekabaty
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
| | - Diego San Millan
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
| | - Monica S Pearl
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
| | - Philippe Gailloud
- From the Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans St, Baltimore, MD 21287
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Paniagua BYM, Múnera IDR. Técnicas de imagen para la reducción de radiación ionizante. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ortenzia O, Trojani V, Bertolini M, Nitrosi A, Iori M, Ghetti C. Radiation dose reduction and static image quality assessment using a channelized hotelling observer on an angiography system upgraded with clarity IQ. Biomed Phys Eng Express 2020; 6:025008. [PMID: 33438634 DOI: 10.1088/2057-1976/ab73f6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of this paper was the comparison of radiation dose and imaging quality before and after the Clarity IQ technology installation in a Philips AlluraXper FD20/20 angiography system using a Channelized Hotelling Observer model (CHO). The core characteristics of the Allura Clarity IQ technology are its real-time noise reduction algorithms (NRT) combined with state-of-the-art hardware; this technology allows to implement acquisition protocols able to significantly reduce patient entrance dose. To measure the system performances in terms of image quality we used a contrast detail phantom in a clinical scatter condition. A Leeds TO10 phantom has been imaged between two 10 cm thick homogeneous solid water slabs. Fluoroscopy images were acquired using a cerebral protocol at 3 dose levels (low, medium and high) with a field- of view (FOV) of 31 cm. Cineangiography images were acquired using a cerebral protocol at 2 fps. Thus, 4 acquisitions were obtained for the conventional technology and 4 acquisitions were taken after the Clarity IQ upgrade, for a total of 8 different image sets. A validated 40 Gabor channels CHO with an internal noise model compared the image sets. Human observers' studies were carried out to tune the internal noise parameter. We showed that the CHO did not detect any significant difference between any of the image sets acquired using the two technologies. Consequently, this x-ray imaging technology provides a non-inferior image quality with an average patient dose reduction of 57% and 28% respectively in cineangiography and fluoroscopy. The Clarity IQ installation has certainly allowed a considerable improvement in patient and staff safety, while maintaining the same image quality.
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Affiliation(s)
- O Ortenzia
- Servizio di Fisica Sanitaria, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
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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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Significant Radiation Dose Reduction Using a Novel Angiography Platform in Patients Undergoing Cryoballoon Pulmonary Vein Isolation. J Thorac Imaging 2019; 35:167-172. [PMID: 31373946 DOI: 10.1097/rti.0000000000000441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cryoballoon pulmonary vein isolation (cPVI) in patients with atrial fibrillation requires fluoroscopic guidance, causing a relevant amount of radiation exposure. Strategies to reduce radiation exposure in electrophysiologic procedures and specifically cPVI are of great importance. The aim of this study was to evaluate a possible reduction of radiation dose using the novel Azurion 7 F12 x-ray system compared with its predecessor Allura FD10. METHODS In February 2017, the Philips Azurion angiography system was introduced, combining the Allura Clarity radiation dose reduction technology with a more powerful generator, improved image resolution, and a large screen display. In 173 patients undergoing cPVI by a single experienced operator in our institution between December 2016 and April 2018, dose area products (cGy×cm) and image quality were compared using Azurion 7 F12 or Allura FD10 angiography system. RESULTS A significant reduction in total radiation dose expressed as a dose area products of 524 (332; 821) cGy×cm on the Allura system compared with 309 (224; 432) cGy×cm on the Azurion system was observed (P<0.001). The number of imaging scenes recorded were 14.7 versus 13.9, and mean overall imaging quality scores (grading 4.85±0.4 with Azurion vs. 4.80±0.4 with Allura, P=0.38) and scores based on specific quality parameters were similar in both groups. CONCLUSION Use of the new Azurion 7 F12 angiography system substantially reduced radiation doses compared with the previous generation reference system, Allura Clarity, without compromising imaging quality in patients undergoing cryoballoon pulmonary vein isolation.
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Patient dose in angiographic interventional procedures: A multicentre study in Italy. Phys Med 2019; 64:273-292. [DOI: 10.1016/j.ejmp.2019.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 06/04/2019] [Accepted: 06/15/2019] [Indexed: 01/04/2023] Open
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Hariharan SG, Kaethner C, Strobel N, Kowarschik M, DiNitto J, Albarqouni S, Fahrig R, Navab N. Preliminary results of DSA denoising based on a weighted low-rank approach using an advanced neurovascular replication system. Int J Comput Assist Radiol Surg 2019; 14:1117-1126. [PMID: 30977093 DOI: 10.1007/s11548-019-01968-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE 2D digital subtraction angiography (DSA) has become an important technique for interventional neuroradiology tasks, such as detection and subsequent treatment of aneurysms. In order to provide high-quality DSA images, usually undiluted contrast agent and a high X-ray dose are used. The iodinated contrast agent puts a burden on the patients' kidneys while the use of high-dose X-rays expose both patients and medical staff to a considerable amount of radiation. Unfortunately, reducing either the X-ray dose or the contrast agent concentration usually results in a sacrifice of image quality. MATERIALS AND METHODS To denoise a frame, the proposed spatiotemporal denoising method utilizes the low-rank nature of a spatially aligned temporal sequence where variation is introduced by the flow of contrast agent through a vessel tree of interest. That is, a constrained weighted rank-1 approximation of the stack comprising the frame to be denoised and its temporal neighbors is computed where the weights are used to prevent the contribution of non-similar pixels toward the low-rank approximation. The method has been evaluated using a vascular flow phantom emulating cranial arteries into which contrast agent can be manually injected (Vascular Simulations Replicator, Vascular Simulations, Stony Brook NY, USA). For the evaluation, image sequences acquired at different dose levels as well as different contrast agent concentrations have been used. RESULTS Qualitative and quantitative analyses have shown that with the proposed approach, the dose and the concentration of the contrast agent could both be reduced by about 75%, while maintaining the required image quality. Most importantly, it has been observed that the DSA images obtained using the proposed method have the closest resemblance to typical DSA images, i.e., they preserve the typical image characteristics best. CONCLUSION Using the proposed denoising approach, it is possible to improve the image quality of low-dose DSA images. This improvement could enable both a reduction in contrast agent and radiation dose when acquiring DSA images, thereby benefiting patients as well as clinicians. Since the resulting images are free from artifacts and as the inherent characteristics of the images are also preserved, the proposed method seems to be well suited for clinical images as well.
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Affiliation(s)
- Sai Gokul Hariharan
- Computer Aided Medical Procedures, Technische Universität München, Munich, Germany.
- Siemens Healthineers AG, Advanced Therapies, Forchheim, Germany.
| | | | - Norbert Strobel
- Siemens Healthineers AG, Advanced Therapies, Forchheim, Germany
- Fakultät für Elektrotechnik, Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Schweinfurt, Germany
| | - Markus Kowarschik
- Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
- Siemens Healthineers AG, Advanced Therapies, Forchheim, Germany
| | | | - Shadi Albarqouni
- Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
| | - Rebecca Fahrig
- Siemens Healthineers AG, Advanced Therapies, Forchheim, Germany
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
- Whiting School of Engineering, Johns Hopkins University, Baltimore, USA
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Choi J, Kim B, Choi Y, Shin NY, Jang J, Choi HS, Jung SL, Ahn KJ. Image Quality of Low-Dose Cerebral Angiography and Effectiveness of Clinical Implementation on Diagnostic and Neurointerventional Procedures for Intracranial Aneurysms. AJNR Am J Neuroradiol 2019; 40:827-833. [PMID: 30948380 DOI: 10.3174/ajnr.a6029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Awareness of the potential for exposure to high doses of radiation from interventional radiologic procedures has increased. The purpose of this study was to evaluate image quality and dose reduction of low-dose cerebral angiography during diagnostic and therapeutic procedures for intracranial aneurysms. MATERIALS AND METHODS A retrospective review of 1137 prospectively collected patients between January 2012 and June 2014 was performed. Beginning in April 2013, a dose-reduction strategy was implemented. Subjective image-quality assessment of 506 standard and 540 low-dose cerebral angiography images was performed by 2 neuroradiologists using a 5-point scale and was tested using noninferiority statistics. Radiation dose-area product and air kerma of 1046 diagnostic and 317 therapeutic procedures for intracranial aneurysms were analyzed and compared between groups before (group 1) and after (group 2) clinical implementation of a dose-reduction strategy. RESULTS The image quality of the low-dose cerebral angiography was not inferior on the basis of results from the 2 readers. For diagnostic cerebral angiography, the mean dose-area product and air kerma were 140.8 Gy×cm2 and 1.0 Gy, respectively, in group 1 and 82.0 Gy×cm2 and 0.6 Gy in group 2 (P < .001, P < .001). For the neurointerventional procedure, the mean dose-area product and air kerma were 246.0 Gy×cm2 and 3.7 Gy, respectively, in group 1 and 169.8 Gy×cm2 and 3.3 Gy in group 2 (P < .001, P = .291). CONCLUSIONS With low-dose cerebral angiography, image quality was maintained, and implementation of dose-reduction strategies reduced radiation doses in patients undergoing diagnostic and neurointerventional procedures for intracranial aneurysms.
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Affiliation(s)
- J Choi
- From the Department of Radiology (J.C.), St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - B Kim
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Y Choi
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - N Y Shin
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - J Jang
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H S Choi
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S L Jung
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K J Ahn
- Department of Radiology (B.K., Y.C., N.Y.S., J.J., H.S.C., S.L.J., K.J.A.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients. Eur Radiol 2019; 29:3506-3515. [DOI: 10.1007/s00330-019-06062-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/08/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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Sung KH, Jung YJ, Cha H, Chung CY, Lee K, Park MS. Effect of metallic tools on scattered radiation dose during the use of C-arm fluoroscopy in orthopaedic surgery. JOURNAL OF RADIATION RESEARCH 2019; 60:1-6. [PMID: 30247685 PMCID: PMC6373686 DOI: 10.1093/jrr/rry073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/27/2018] [Indexed: 06/08/2023]
Abstract
This study investigated the effect of metallic tools on the scattered radiation dose delivered to surgeons' radiosensitive organs while simulating hip surgery using C-arm fluoroscopy. Two phantoms, a pelvis and a Rando phantom, were used to simulate a patient and a surgeon in this study. Photoluminescence dosimeters were inserted into the Rando phantom in the positions of the eye, thyroid and gonad. A drill was positioned above the hip of the pelvis phantom or beside the pelvis phantom of the same height. For each drill location, the scattered radiation dose was measured when the angle to the operator phantom was 45°; this was repeated when the angle was 90°. The scattered radiation doses to the eye, thyroid and gonad when the drill was placed beside the pelvis phantom with 90° angulation to the operator phantom were significantly lower than the reference values and those when the drill was placed beside the pelvis phantom at a 45° angulation to the operator phantom. The scattered radiation doses to the eye and thyroid when the drill was placed above the hip were significantly lower than the references values. Of the four different scenarios, the scattered radiation doses to the eye, thyroid and gonad were lowest when the drill was placed beside the pelvis phantom with 90° angulation. This study showed that the scattered radiation doses to radiosensitive organs were affected by the location and angle of the metallic tools in relation to the operator. Therefore, orthopedic surgeons should consider the effect of metallic tools on the scattered radiation dose during intraoperative use of C-arm fluoroscopy.
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Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, Korea
| | - Young-Jun Jung
- Department of Bio-convergence Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea
| | - Hyemi Cha
- Department of Bio-convergence Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, Korea
| | - Kisung Lee
- Department of Bio-convergence Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea
- School of Biomedical Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-Gu, Sungnam, Gyeonggi, Korea
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Gyánó M, Góg I, Óriás VI, Ruzsa Z, Nemes B, Csobay-Novák C, Oláh Z, Nagy Z, Merkely B, Szigeti K, Osváth S, Sótonyi P. Kinetic Imaging in Lower Extremity Arteriography: Comparison to Digital Subtraction Angiography. Radiology 2019; 290:246-253. [DOI: 10.1148/radiol.2018172927] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Marcell Gyánó
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - István Góg
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Viktor I. Óriás
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Zoltán Ruzsa
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Balázs Nemes
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Csaba Csobay-Novák
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Zoltán Oláh
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Zsuzsa Nagy
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Béla Merkely
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Krisztián Szigeti
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Szabolcs Osváth
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
| | - Péter Sótonyi
- From Kinepict Health Ltd, Budapest, Hungary (M.G., I.G., V.I.Ó., K.S., S.O.); and Heart and Vascular Center (M.G., V.I.Ó., Z.R., B.N., C.C.N., Z.O., Z.N., B.M., P.S.) and Department of Biophysics and Radiation Biology (I.G., K.S., S.O.), Semmelweis University, Városmajor u. 68, Budapest H-1122, Hungary
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Busse T, Reifart J, Reifart N. Influence of novel X‐ray imaging technology on radiation exposure during chronic total occlusion procedures. Catheter Cardiovasc Interv 2018; 92:1268-1273. [DOI: 10.1002/ccd.27785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/05/2018] [Accepted: 06/24/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Tilmann Busse
- Dr Horst‐Schmidt‐Kliniken Ludwig‐Erhard‐Str. 100, 65199 Wiesbaden Germany
| | - Joerg Reifart
- Kerckhoff‐Klinik GmbH Benekestraße 2‐8, 61231 Bad Nauheim Germany
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Buytaert D, Eloot L, Mauti M, Drieghe B, Gheeraert P, Taeymans Y, Bacher K. Evaluation of patient and staff exposure with state of the art X-ray technology in cardiac catheterization: A randomized controlled trial. J Interv Cardiol 2018; 31:807-814. [PMID: 30168209 DOI: 10.1111/joic.12553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cardiac catheterization procedures result in high patient radiation exposure and corresponding staff doses are reported to be among the highest for medical staff. The purpose of current randomized controlled study was to quantify the potential radiation dose reduction for both patient and staff, enabled by recent X-ray technology. This technology is equipped with advanced image processing algorithms, real-time dose monitoring, and an acquisition chain optimized for cardiac catheterization applications. METHODS A total of 122 adult patients were randomly assigned to one of two cath labs, either the reference X-ray modality (Allura Xper FD10, Philips Healthcare, the Netherlands) or the new X-ray system (AlluraClarity FD20/10 Philips Healthcare, the Netherlands). Exposure parameters and staff dosimeter readings were recorded for each exposure. Technical measurements were performed to define the radiation scatter behavior. RESULTS With the newer equipment, patient radiation dose is reduced (as total dose-area product) by 67% based on geometric means with 95%CI of 53%, 77% for diagnostic and interventional procedures. The C-arm and leg dosimeter readings were both reduced with 65% (P < 0.001), while for the collar and chest dosimeter readings no statistically significant reduction was noticed. CONCLUSION The new x-ray and image processing technology, significantly reduces patient dose in coronary angiographies, and PCIs by 67%. In general, scatter dose was also reduced, yet for some dosimeters the reduction was limited and not statistically significant. This study clearly indicates that the scatter behavior is highly dependent on C-arm rotation, operator movement and height, dosimeter position, beam filtration, clinical procedure type and system geometry.
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Affiliation(s)
- Dimitri Buytaert
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Liesbeth Eloot
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | | | - Benny Drieghe
- Heart Centre, Ghent University Hospital, Ghent, Belgium
| | | | - Yves Taeymans
- Heart Centre, Ghent University Hospital, Ghent, Belgium
| | - Klaus Bacher
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
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Radiation dose reduction with frame rate conversion in X-ray fluoroscopic imaging systems with flat panel detector: basic study and clinical retrospective analysis. Eur Radiol 2018; 29:985-992. [DOI: 10.1007/s00330-018-5620-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/09/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022]
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Noise reduction technology reduces radiation dose in chronic total occlusions percutaneous coronary intervention: a propensity score-matched analysis. Int J Cardiovasc Imaging 2018; 34:1185-1192. [DOI: 10.1007/s10554-018-1343-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/21/2018] [Indexed: 10/24/2022]
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Sullivan PM, Harrison D, Badran S, Takao CM, Ing FF. Reduction in Radiation Dose in a Pediatric Cardiac Catheterization Lab Using the Philips AlluraClarity X-ray System. Pediatr Cardiol 2017; 38:1583-1591. [PMID: 28770307 DOI: 10.1007/s00246-017-1700-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/25/2017] [Indexed: 01/27/2023]
Abstract
The objective of this study was to compare radiation doses and imaging quality using Philips AlluraClarity (Philips Healthcare, Best, The Netherlands) X-ray system and an older generation reference system. AlluraClarity is a new generation fluoroscopy system designed to reduce radiation without compromising image quality, but reports of its use in pediatric patients are limited. Dose area products (DAP, mGy cm2) and DAP/kg were compared in patients catheterized using Allura Xper and AlluraClarity systems over a year of use for each. Randomly selected studies from each system were assessed for image quality. The 430 patients imaged with Clarity were larger than the 332 imaged with Xper (median BSA: 0.74 vs. 0.64 m2, p = 0.06), and median total fluoroscopic times (TFT) were similar (15.8 vs. 16.1 min, p = 0.37). Median DAPs were 8661 mGy cm2 (IQR: 18,300 mGy cm2) and 4523 mGy cm2 (IQR: 11,596 mGy cm2) with Xper and Clarity, respectively (p < 0.001). There was a reduction in median DAP in all procedure categories. After adjustment for BSA, TFT, and procedure type, using Clarity was associated with a 57.5% (95% CI 51.5-62.8%, p < 0.001) reduction in DAP for all procedures. Reductions did not significantly differ by weight (<10 kg, 10-40 kg, ≥ 40 kg). There was an adjusted percent reduction in DAP for each procedure category ranging from 39.0% (95% CI 25.6-50.1%, p < 0.001) for cardiac biopsies with or without coronary angiography to 67.6% (95% CI 61.2-72.8%, p < 0.001) for device occlusions. Mean overall imaging quality scores (4.3 ± 0.8 with Clarity vs. 4.4 ± 0.6 with Xper, p = 0.62) and scores based on specific quality parameters were similar in the two groups. Use of AlluraClarity substantially reduced radiation doses compared to the older generation reference system without compromising imaging quality in a pediatric cardiac catheterization lab.
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Affiliation(s)
- Patrick M Sullivan
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. .,Children's Hospital Los Angeles Heart Center, 4650 Sunset Blvd., #34, Los Angeles, CA, USA.
| | - David Harrison
- Division of General Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sarah Badran
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Cheryl M Takao
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Frank F Ing
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Corliss BM, Bennett J, Brennan MM, Rosemaryam A, Hartman C, Stetler WR, Polifka AJ, Hoh BL, Arreola MM, Fox WC. The Patient Size Setting: A Novel Dose Reduction Strategy in Cerebral Endovascular Neurosurgery Using Biplane Fluoroscopy. World Neurosurg 2017; 110:e636-e641. [PMID: 29180081 DOI: 10.1016/j.wneu.2017.11.056] [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: 10/08/2017] [Revised: 11/10/2017] [Accepted: 11/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND In some fluoroscopy machines, the dose-rate output of the fluoroscope is tied to a selectable patient size. Although patient size may play a significant role in visceral or cardiac procedures, head morphology is less variable, and high dose outputs may not be necessary even in very obese patients. We hypothesized that very small patient size setting can be used to reduce dose for cerebral angiography without compromising image quality. METHODS Patients who underwent endovascular neurosurgical procedures during the 2015-2016 academic year were identified, and estimated procedural air kerma (AK) was tabulated retrospectively. Technologists were instructed to begin using the very small patient size setting for all procedures performed using our Philips Allura Xper FD20 biplane fluoroscopy system beginning in March 2016. No changes were made in a second procedure room using a Toshiba Infinix system. Student t tests and logistic regression models were used to compare radiation exposure before and after March 1, 2016, for both machines. RESULTS For diagnostic cerebral angiograms performed on the Philips system (n = 302), AK was reduced by approximately 17% (1277 vs. 1061 mGy; P = 0.0006.) Changes in table height, total fluoroscopy time, patient weight, and body mass index did not contribute to this difference. No significant change was seen in total AK using the Toshiba system (n = 237). Blinded review by a neuroradiologist did not demonstrate any change in image quality. CONCLUSIONS Using the very small patient size reduces fluoroscopy dose by 17% for cerebral angiography without impacting image quality.
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Affiliation(s)
- Brian M Corliss
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
| | - Jeffrey Bennett
- Department of Radiology, University of Arizona, Tucson, Arizona, USA
| | - Meghan M Brennan
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Azar Rosemaryam
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - Cory Hartman
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - William R Stetler
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam J Polifka
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Brian L Hoh
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
| | - Manuel M Arreola
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - W Christopher Fox
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA
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Stangenberg L, Shuja F, van der Bom IMJ, van Alfen MHG, Hamdan AD, Wyers MC, Guzman RJ, Schermerhorn ML. Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers. Vasc Endovascular Surg 2017; 52:52-58. [DOI: 10.1177/1538574417742211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
High-definition fluoroscopic imaging is required to perform endovascular procedures safely and precisely, especially in complex cases, resulting in longer procedures and increased radiation exposure. This is of importance for training institutions as trainees, even with sound instruction in as low as reasonably achievable (ALARA) principles, tend to have high radiation exposures. Recently, there was an upgrade in the imaging system allowing for comparison of radiation exposure to patients and providers. We performed an analysis of consecutive endovascular aneurysm repair (EVAR) and superficial femoral artery (SFA) interventions in the years 2013 to 2014. We recorded body mass index (BMI) and fluoroscopy time (FT) and subsequently matched 1:1 based on BMI, FT, or both. We determined radiation dose using air kerma (AK) and also recorded individual surgeons’ badge readings. Allura Xper FD20 was upgraded to AlluraClarity with ClarityIQ. We identified a total of 77 EVARs (52 pre and 25 post) and 134 SFA interventions (99 pre and 35 post). Unmatched results for EVAR were BMI pre 26.2 versus post 25.8 (kg/m2, P = .325), FT 28.1 versus 21.2 (minutes, P = .051), and AK 1178.5 versus 581 (mGy, P < .001), respectively. After matching, there was a 53.2% reduction in AK (846.1 vs 395.9 mGy; P = .004) for EVAR. Unmatched results for SFA interventions were BMI pre 28.1 versus post 26.6 ( P = .327), FT 18.7 versus 16.2 ( P = .282), and AK 285.6 versus 106.0 ( P < .001), respectively. After matching, there was a 57.0% reduction in AK (305.0 vs 131.3, P < .001). The total deep dose equivalent from surgeons’ badge readings decreased from 39.5 to 17 mrem ( P = .029). Aortic and peripheral endovascular interventions can be performed with reduced radiation exposure to patients and providers, employing modern fixed imaging systems with advanced dose reduction technology. This is of particular importance in the light of the increasing volume and complexity of endovascular and hybrid procedures as well as the prospect of decades of radiation exposure during training and practice.
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Affiliation(s)
- Lars Stangenberg
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Vascular and Endovascular Surgery, Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fahad Shuja
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Allen D. Hamdan
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark C. Wyers
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Raul J. Guzman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marc L. Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Hoffmann R, Langenbrink L, Reimann D, Kastrati M, Becker M, Piatkowski M, Michaelsen J. Image noise reduction technology allows significant reduction of radiation dosage in cardiac device implantation procedures. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1374-1379. [PMID: 29052249 DOI: 10.1111/pace.13222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 09/24/2017] [Accepted: 10/08/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Novel x-ray systems with real-time image noise reduction technology (INRT) to reduce radiation dose during fluoroscopy and cine acquisition have become available. This study evaluated the reduction of radiation dose in device implantation with INRT. METHODS Radiation dose data from 132 consecutive new device implantation procedures (102 pacemaker [PM] or implantable cardioverter defibrillator [ICD] and 30 cardiac resynchronization therapy [CRT] devices) performed between January 2015 and December 2015 on an angiography system with INRT (Allura ClarityIQ) were collected. For comparison, radiation dose data from 147 consecutive device implantation procedures (121 PM/ICDs and 26 CRT devices) performed between June 2013 and September 2014 on a C-arm system with continuous and pulsed fluoroscopy option (4 frames/second) were evaluated. Total dose area product (DAP), fluoroscopy DAP, and cine DAP were evaluated. RESULTS Patient age, gender and body weight, procedure, and fluoroscopy times were similar between systems. In PM/ICD cases, DAP of INRT and C-arm system was similar (423 ± 381 cGycm2 vs 417 ± 517 cGycm) due to pulsed fluoroscopy with the C-arm system (78% of time) and sparse use of cine. In CRT procedures requiring higher image quality (82% use of continuous fluoroscopy with C-arm system), DAP of INRT was significantly lower (1,544 ± 834 cGycm vs 7,252 ± 6,431 cGycm, P < 0.001) due to less fluoroscopy DAP (1,414 ± 757 cGycm vs 5,854 ± 6,767 cGycm) and less cine DAP (130 ± 106 cGycm vs 1,399 ± 1,342 cGycm). Considering all procedures, total DAP was reduced by 60% using INRT. CONCLUSION Novel INRT results in a substantial lowering of radiation dose in device implantation, in particular, in complex CRT implantation procedures requiring high image quality.
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Affiliation(s)
- Rainer Hoffmann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Lukas Langenbrink
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Doris Reimann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Mirlind Kastrati
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Michael Becker
- Department of Cardiology, Medical Clinic I, University Clinic Aachen, Aachen, Germany
| | - Michal Piatkowski
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Jochen Michaelsen
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
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Characteristics of a New X-Ray Imaging System for Interventional Procedures: Improved Image Quality and Reduced Radiation Dose. Cardiovasc Intervent Radiol 2017; 41:502-508. [PMID: 29090348 PMCID: PMC5801377 DOI: 10.1007/s00270-017-1821-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/12/2017] [Indexed: 01/28/2023]
Abstract
Purpose To compare image quality and radiation exposure between a new angiographic imaging system and the preceding generation system during uterine artery embolization (UAE). Materials and Methods In this retrospective, IRB-approved two-arm study, 54 patients with symptomatic uterine fibroids were treated with UAE on two different angiographic imaging systems. The new system includes optimized acquisition parameters and real-time image processing algorithms. Air kerma (AK), dose area product (DAP) and acquisition time for digital fluoroscopy (DF) and digital subtraction angiography (DSA) were recorded. Body mass index was noted as well. DF image quality was assessed objectively by image noise measurements. DSA image quality was rated by two blinded, independent readers on a four-rank scale. Statistical differences were assessed with unpaired t tests and Wilcoxon rank-sum tests. Results There was no significant difference between the patients treated on the new (n = 36) and the old system (n = 18) regarding age (p = 0.10), BMI (p = 0.18), DF time (p = 0.35) and DSA time (p = 0.17). The new system significantly reduced the cumulative AK and DAP by 64 and 72%, respectively (median 0.58 Gy and 145.9 Gy*cm2 vs. 1.62 Gy and 526.8 Gy*cm2, p < 0.01 for both). Specifically, DAP for DF and DSA decreased by 59% (75.3 vs. 181.9 Gy*cm2, p < 0.01) and 78% (67.6 vs. 312.2 Gy*cm2, p < 0.01), respectively. The new system achieved a significant decrease in DF image noise (p < 0.01) and a significantly better DSA image quality (p < 0.01). Conclusions The new angiographic imaging system significantly improved image quality and reduced radiation exposure during UAE procedures. Electronic supplementary material The online version of this article (doi:10.1007/s00270-017-1821-z) contains supplementary material, which is available to authorized users.
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Borota L, Patz A. Flexible lateral isocenter: A novel mechanical functionality contributing to dose reduction in neurointerventional procedures. Interv Neuroradiol 2017; 23:669-675. [PMID: 28944706 PMCID: PMC5814073 DOI: 10.1177/1591019917728260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim of the study A new functionality that enables vertical mobility of the lateral arm of a
biplane angiographic machine is referred to as the flexible lateral
isocenter. The aim of this study was to analyze the impact of the flexible
lateral isocenter on the air-kerma rate under experimental conditions. Material and methods An anthropomorphic head-and-chest phantom with anteroposterior (AP) diameter
of the chest varying from 22 cm to 30 cm simulated human bodies of different
body constitutions. The angulation of the AP arm in the sagittal plane
varied from 35 degrees to 55 degrees for each AP diameter. The air-kerma
rate (mGy/min) values were read from the system dose display in two settings
for each angle: flexible lateral isocenter and fixed lateral isocenter. Results The air-kerma rate was significantly lower for all AP diameters of the chest
of the phantom when the flexible lateral isocenter was used: (a) For 22 cm,
the p value was 0.028; (b) For 25 cm, the
p value was 0.0169; (c) For 28 cm, the
p value was 0.01005 and (d) For 30 cm, the
p value was 0.01703. Conclusion Our results show that the flexible lateral isocenter contributes
significantly to the reduction of the air-kerma rate, and thus to a safer
environment in terms of dose lowering both for patients and staff.
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Affiliation(s)
- Ljubisa Borota
- 1 Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Patz
- 2 Toshiba Medical Systems Europe, Zoetermeer, the Netherlands
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Faroux L, Blanpain T, Nazeyrollas P, Tassan-Mangina S, Herce B, Tourneux C, Metz D. Trends in Patient Exposure to Radiation in Percutaneous Coronary Interventions Over a 10-Year Period. Am J Cardiol 2017; 120:927-930. [PMID: 28739037 DOI: 10.1016/j.amjcard.2017.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/20/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
Technological progress has made it possible to reduce the dose of radiation delivered by medical x-ray systems. In parallel, interventional coronary procedures have become increasingly complex and consequently, last longer. This study aimed to compare the estimated dose of radiation received by patients in interventional cardiology at 10 years interval (2006 vs 2016). The study population included all patients who underwent interventional coronary procedures in one of the catheterization laboratories of our institution during 2 periods, namely, period 1 from October 2005 to March 2006, and period 2 from November 2015 to October 2016. The primary end point was the estimated dose of radiation received by the patient as assessed by dose area product. In 2016, the estimated dose of radiation received by patients who underwent interventional coronary procedures was on average 78% lower than that received in 2006 (p <0.0001), whereas the fluoroscopy time increased by 54% on average over the same period (p <0.0001). By multivariate analysis, including age, approach, body mass index, fluoroscopy time, and performance of angioplasty, the reduction in radiation remained significant. The radial approach was significantly associated with an increased estimated dose of radiation received (p <0.0001). In conclusion, the estimated dose of radiation received by patients who underwent interventional cardiology procedures has been reduced by 78% over the last decade.
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Minimizing exposure to radiation in invasive cardiology using modern dose-reduction technology: Evaluation of the real-life effects. Catheter Cardiovasc Interv 2017; 91:1194-1199. [DOI: 10.1002/ccd.27245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 01/28/2023]
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Saijo T, Seguchi S. Examination of Dose Reduction Using Image Noise Reduction Technology in Cardiovascular X-ray Systems. Nihon Hoshasen Gijutsu Gakkai Zasshi 2017. [PMID: 28637959 DOI: 10.6009/jjrt.2017_jsrt_73.6.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study is to establish radiation exposure dose reduction protocols during cardiac intervention by decreasing the entrance dose at flat panel detector (FPD) with image quality evaluations. For measuring entrance surface dose (ESD), we have used a Radical 9015 dosimeter (6 cc ion chamber) placed under 20 cm thick acrylic plates at the patient's entrance reference point. We performed an image quality assessment based on quantitative as well as visual evaluation of the images obtained via current and dose reduction protocols. The visual evaluation was performed by measuring the signal to noise ratio and contrast using a cine/digital angiography cardiac phantom. The quantitative evaluation was performed by cardiologists and radiological technologists using the five-point scale method. For the dose reduction protocol, we used an image noise reduction technique to prevent the deterioration of image quality. The ESDs for the fluoroscopy and digital cine in the dose reduction protocol were 18.0 mGy/min and 0.18 mGy/frame, respectively, which corresponded to 81% and 49% of the ESD in the current protocol. Our results reveal that the ESD for fluoroscopy was lower than the diagnostic reference level (20 mGy/min) for interventional radiology. We recommend a lower dose setting and the maintenance of image quality using noise reduction techniques. This will ensure use of a lower FPD entrance dose compared to the initial dose setting currently recommended by manufacturers.
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Affiliation(s)
- Takaya Saijo
- Division of Radiology, Department of Medical Technology, Nagoya Daini Red Cross Hospital
| | - Shigenobu Seguchi
- Division of Radiology, Department of Medical Technology, Nagoya Daini Red Cross Hospital
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Kim DJ, Park MK, Jung DE, Kang JH, Kim BM. Radiation Dose Reduction without Compromise to Image Quality by Alterations of Filtration and Focal Spot Size in Cerebral Angiography. Korean J Radiol 2017; 18:722-728. [PMID: 28670167 PMCID: PMC5447648 DOI: 10.3348/kjr.2017.18.4.722] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/27/2017] [Indexed: 11/24/2022] Open
Abstract
Objective Different angiographic protocols may influence the radiation dose and image quality. In this study, we aimed to investigate the effects of filtration and focal spot size on radiation dose and image quality for diagnostic cerebral angiography using an in-vitro model and in-vivo patient groups. Materials and Methods Radiation dose and image quality were analyzed by varying the filtration and focal spot size on digital subtraction angiography exposure protocols (1, inherent filtration + large focus; 2, inherent + small; 3, copper + large; 4, copper + small). For the in-vitro analysis, a phantom was used for comparison of radiation dose. For the in-vivo analysis, bilateral paired injections, and patient cohort groups were compared for radiation dose and image quality. Image quality analysis was performed in terms of contrast, sharpness, noise, and overall quality. Results In the in-vitro analysis, the mean air kerma (AK) and dose area product (DAP)/frame were significantly lower with added copper filtration (protocols 3 and 4). In the in-vivo bilateral paired injections, AK and DAP/frame were significantly lower with filtration, without significant difference in image quality. The patient cohort groups with added filtration (protocols 3 and 4) showed significant reduction of total AK and DAP/patient without compromise to the image quality. Variations in focal spot size showed no significant differences in radiation dose and image quality. Conclusion Addition of filtration for angiographic exposure studies can result in significant total radiation dose reduction without loss of image quality. Focal spot size does not influence radiation dose and image quality. The routine angiographic protocol should be judiciously investigated and implemented.
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Affiliation(s)
- Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Min Keun Park
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Da Eun Jung
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jung Han Kang
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
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Kohlbrenner R, Kolli KP, Taylor AG, Kohi MP, Lehrman ED, Fidelman N, Conrad M, LaBerge JM, Kerlan RK, Gould R. Radiation Dose Reduction during Uterine Fibroid Embolization Using an Optimized Imaging Platform. J Vasc Interv Radiol 2017; 28:1129-1135.e1. [PMID: 28457758 DOI: 10.1016/j.jvir.2017.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To assess radiation dose reduction during uterine fibroid embolization (UFE) using an optimized angiographic processing and acquisition platform. MATERIALS AND METHODS Radiation dose data for 70 women (mean age, 46 y; range, 34-67 y) who underwent UFE were retrospectively analyzed. Twenty-one patients underwent UFE using the baseline fluoroscopic and angiographic image acquisition platform, and 49 underwent UFE after implementing an optimized imaging platform in otherwise identical angiography suites. Cumulative kerma-area product (CKAP), cumulative air kerma (CAK), total fluoroscopy time, and image exposure number were collected for each procedure. Image quality was assessed by 3 interventional radiologists blinded to the platform used for image acquisition and processing. RESULTS Patients undergoing UFE using the new x-ray fluoroscopy platform had significantly lower CKAP and CAK indicators than patients for whom baseline settings were used. Mean CKAP decreased by 60% from 438.5 Gy · cm2 (range, 180.3-1,081.1 Gy · cm2) to 175.2 Gy · cm2 (range, 47.1-757.0 Gy · cm2; P < .0001). Mean CAK decreased by 45% from 2,034.2 mGy (range, 699.3-5,056.0 mGy) to 1,109.8 mGy (range, 256.6-4,513.6 mGy; P = .001). No degradation of image quality was identified through qualitative evaluation. CONCLUSIONS Significant reduction in patient radiation dose indicators can be achieved with use of an optimized image acquisition and processing platform.
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Affiliation(s)
- Ryan Kohlbrenner
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143.
| | - K Pallav Kolli
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Andrew G Taylor
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Maureen P Kohi
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Evan D Lehrman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Nicholas Fidelman
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Miles Conrad
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Jeanne M LaBerge
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Robert K Kerlan
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
| | - Robert Gould
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143
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Baumann F, Peña C, Kloeckner R, Katzen BT, Gandhi R, Benenati JB. The Effect of a New Angiographic Imaging Technology on Radiation Dose in Visceral Embolization Procedures. Vasc Endovascular Surg 2017; 51:183-187. [PMID: 28424042 DOI: 10.1177/1538574417698903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the impact of a new angiographic imaging technology on radiation dose during visceral embolization procedures involving both fluoroscopy and digital subtraction angiography. MATERIAL AND METHODS A retrospective analysis from a single-center consecutive series of patients was performed comparing 2 angiographic imaging systems. The AlluraClarity (CIQ; Philips Healthcare, Best, the Netherlands) was used in 100 patients (n = 59 male, mean age: 70.6 years) from July 2013 to April 2014 and compared to the former AlluraXper (AX) technology used in 139 patients (n = 71 male, mean age: 70.1 years) from May 2011 to June 2013. Patients were categorized according to body mass index (BMI [kg/m2])-group 1: BMI <25, group 2: BMI ≥25 and <30, and group 3: BMI ≥30. Fluoroscopy time, the total dose of iodinated contrast administered, and procedural AirKerma (Ka, r [mGy]) were obtained. RESULTS Mean BMI was 26.4 ± 5.0 kg/m2 in the CIQ and 26.4 ± 7.1 kg/m2 in the AX group ( P = .93). Fluoroscopy time and the amount of contrast media were equally distributed. Ka, r was 1342.9 mGy versus 2214.8 mGy ( P < .001, t test) when comparing CIQ to AX. Comparing CIQ to AX, BMI subgroup analysis revealed a mean Ka, r of 970.1 to 1586.1 mGy ( P = .003, t test), 1484.7 to 2170.1 mGy ( P = .02, t test), and 1848.8 to 3348.9 mGy ( P = .001, t test) in BMI groups 1, 2, and 3, respectively. CONCLUSION The CIQ technology significantly reduced mean radiation dose by 39.4% for visceral embolization procedures when compared to fluoroscopy time and contrast media dose. This dose relationship was consistent across all BMI groups.
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Affiliation(s)
- Frederic Baumann
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA.,2 Clinical and Interventional Angiology, University Hospital of Zurich, Zurich, Switzerland
| | - Constantino Peña
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - Roman Kloeckner
- 2 Clinical and Interventional Angiology, University Hospital of Zurich, Zurich, Switzerland.,3 Clinic for Interventional Radiology, University Hospital of Mainz, Mainz, Germany
| | - Barry T Katzen
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - Ripal Gandhi
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - James B Benenati
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
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Gislason-Lee AJ, Keeble C, Egleston D, Bexon J, Kengyelics SM, Davies AG. Comprehensive assessment of patient image quality and radiation dose in latest generation cardiac x-ray equipment for percutaneous coronary interventions. J Med Imaging (Bellingham) 2017; 4:025501. [PMID: 28491907 PMCID: PMC5412945 DOI: 10.1117/1.jmi.4.2.025501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/14/2017] [Indexed: 11/14/2022] Open
Abstract
This study aimed to determine whether a reduction in radiation dose was found for percutaneous coronary interventional (PCI) patients using a cardiac interventional x-ray system with state-of-the-art image enhancement and x-ray optimization, compared to the current generation x-ray system, and to determine the corresponding impact on clinical image quality. Patient procedure dose area product (DAP) and fluoroscopy duration of 131 PCI patient cases from each x-ray system were compared using a Wilcoxon test on median values. Significant reductions in patient dose ([Formula: see text]) were found for the new system with no significant change in fluoroscopy duration ([Formula: see text]); procedure DAP reduced by 64%, fluoroscopy DAP by 51%, and "cine" acquisition DAP by 76%. The image quality of 15 patient angiograms from each x-ray system (30 total) was scored by 75 clinical professionals on a continuous scale for the ability to determine the presence and severity of stenotic lesions; image quality scores were analyzed using a two-sample [Formula: see text]-test. Image quality was reduced by 9% ([Formula: see text]) for the new x-ray system. This demonstrates a substantial reduction in patient dose, from acquisition more than fluoroscopy imaging, with slightly reduced image quality, for the new x-ray system compared to the current generation system.
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Affiliation(s)
| | - Claire Keeble
- University of Leeds, Division of Epidemiology and Biostatistics, Leeds, United Kingdom
| | - Daniel Egleston
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
| | - Josephine Bexon
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
| | | | - Andrew G. Davies
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
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