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Bakır M, Rumeli Ş, Ertargın M, Teker N, Azizoğlu M, Gazioğlu Türkyılmaz G. Comparison of Radiation Doses for Different Techniques in Fluoroscopy-Guided Lumbar Facet Medial Branch Blocks: A Retrospective Cohort Study. Life (Basel) 2024; 14:1179. [PMID: 39337962 PMCID: PMC11433151 DOI: 10.3390/life14091179] [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: 08/20/2024] [Revised: 09/12/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
Chronic lumbar facet pain is commonly treated with fluoroscopy-guided facet medial branch blocks (FMBBs). However, the associated radiation exposure of both patients and clinicians is a growing concern. This study aimed to compare radiation doses and fluoroscopy times between two techniques, i.e., oblique and posterior-anterior (PA) fluoroscopic approaches, while also examining the impact of physician experience on these metrics. A retrospective analysis was conducted on 180 patients treated at Mersin University Hospital Pain Clinic between January and July 2024. Patients were divided into two groups: 90 received the oblique technique (Group O) and 90 received the AP technique (Group A). Radiation dose and fluoroscopy time data were collected for each patient. The AP technique was associated with significantly lower radiation doses (mean 66 mGy) and shorter fluoroscopy times (mean 28 s) compared to the oblique technique (mean radiation dose of 109 mGy and fluoroscopy time of 46 s) (p < 0.001). Physician experience also influenced these outcomes, with more experienced physicians consistently using less radiation. The AP technique should be considered for FMBBs, as it reduces radiation exposure while maintaining procedural efficiency, highlighting the importance of experience in optimizing outcomes.
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Affiliation(s)
- Mesut Bakır
- Division of Pain Medicine, Department of Anesthesiology and Reanimation, Faculty of Medicine, Mersin University, Mersin 33343, Turkey
| | - Şebnem Rumeli
- Division of Pain Medicine, Department of Anesthesiology and Reanimation, Faculty of Medicine, Mersin University, Mersin 33343, Turkey
| | - Mehmet Ertargın
- Division of Pain Medicine, Department of Anesthesiology and Reanimation, Faculty of Medicine, Mersin University, Mersin 33343, Turkey
| | - Nurettin Teker
- Division of Pain Medicine, Department of Anesthesiology and Reanimation, Faculty of Medicine, Mersin University, Mersin 33343, Turkey
| | - Mustafa Azizoğlu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Mersin University, Mersin 33343, Turkey
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Nguyen DL, Grimm LJ, Nelson JS, Johnson KS, Ghate SV. Screening the Implant-Augmented Breast with Digital Breast Tomosynthesis: Is Tomosynthesis Necessary for Non-implant-Displaced Views? JOURNAL OF BREAST IMAGING 2024; 6:261-270. [PMID: 38703091 PMCID: PMC11129616 DOI: 10.1093/jbi/wbae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To determine cancer visualization utility and radiation dose for non-implant-displaced (ID) views using standard protocol with digital breast tomosynthesis (DBT) vs alternative protocol with 2D only when screening women with implant augmentation. METHODS This retrospective cohort study identified women with implants who underwent screening DBT examinations that had abnormal findings from July 28, 2014, to December 31, 2021. Three fellowship-trained breast radiologists independently reviewed examinations retrospectively to determine if the initially identified abnormalities could be visualized on standard protocol (DBT with synthesized 2D (S2D) for ID and non-ID views) and alternate protocol (DBT with S2D for ID and only the S2D images for non-ID views). Estimated exam average glandular dose (AGD) and associations between cancer visualization with patient and implant characteristics for both protocols were evaluated. RESULTS The study included 195 patients (mean age 55 years ± 10) with 223 abnormal findings. Subsequent biopsy was performed for 86 abnormalities: 59 (69%) benign, 8 (9%) high risk, and 19 (22%) malignant. There was no significant difference in malignancy visualization rate between standard (19/223, 8.5%) and alternate (18/223, 8.1%) protocols (P = .92), but inclusion of the DBT for non-ID views found one additional malignancy. Total examination AGD using standard protocol (21.9 mGy ± 5.0) was significantly higher than it would be for estimated alternate protocol (12.6 mGy ± 5.0, P <.001). This remained true when stratified by breast thickness: 6.0-7.9 cm, 8.0-9.9 cm, >10.0 cm (all P <.001). CONCLUSION The inclusion of DBT for non-ID views did not significantly increase the cancer visualization rate but did significantly increase overall examination AGD.
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Affiliation(s)
- Derek L Nguyen
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Lars J Grimm
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Jeffrey S Nelson
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Karen S Johnson
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Sujata V Ghate
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
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Matković A, Ferenc T, Dimjašević L, Drinković M, Lovreković B, Popić J, Mužar RM, Vidjak V. Patient's knowledge regarding radiation exposure from various imaging modalities: a pilot study. RADIATION PROTECTION DOSIMETRY 2023; 200:91-96. [PMID: 37930816 DOI: 10.1093/rpd/ncad276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023]
Abstract
To determine patients' knowledge about ionising radiation used in diagnostic imaging and whether they were adequately informed about the procedure they were referred to. A cross-sectional study was conducted at the University Hospital Merkur, Zagreb, Croatia during 2019-20. A questionnaire with 14 questions was given to patients in waiting rooms for imaging examinations. Statistical analysis was conducted using the standard software package. Chi-square with Yates correction was used to determine differences in patients' answers between those who received the explanation about the procedure and those who did not. The differences depending on the educational level were also evaluated. The survey was completed by 374 participants (200 women, 174 men) with a mean age of 55.45 ± 15.92 y. Of all patients, 8.63% had no formal education or only finished elementary school, 52.83% had finished high school and 38.55% had a college or a higher degree. The referring physicians informed 63.66% of participants about the radiological exam they were being referred to, and 226 thought that the given explanation was sufficient. Most patients knew that some radiological procedures use ionising radiation. Only 47.37% of respondents correctly identified MRI as a non-ionising method, whereas 37.40% of participants recognised chest X-ray as the modality with the lowest radiation dose. Higher-educated patients had better knowledge of radiological procedures and the potential risks. The study demonstrated suboptimal patients' knowledge about ionising radiation, and additional efforts in their education are needed.
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Affiliation(s)
- Andro Matković
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Thomas Ferenc
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Lucija Dimjašević
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Martin Drinković
- Department of Radiology, Polyclinic Drinković, 10000 Zagreb, Croatia
| | - Bruno Lovreković
- Department of General and Sports Traumatology and Orthopedic Surgery, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Jelena Popić
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, 10000 Zagreb, Croatia
- Department of Radiology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Rhea M Mužar
- Department for Plastic, Reconstructive and Aesthetic Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Vinko Vidjak
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
- Department of Radiology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Nguyen DL, Boron A, Oluyemi ET, Myers KS, Mullen LA, Ambinder EB. Comparison of Diagnostic Mammography-Guided Biopsy and Digital Breast Tomosynthesis-Guided Biopsy of Suspicious Breast Calcifications: Results in 1354 Biopsies. AJR Am J Roentgenol 2023; 220:212-223. [PMID: 36102725 DOI: 10.2214/ajr.22.28320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND. Studies have shown improved targeting and sampling of noncalcified lesions (asymmetries, masses, and architectural distortion) with digital breast tomosynthesis (DBT)-guided biopsy in comparison with digital mammography (DM)-guided stereotactic biopsy. Literature that compares the two techniques specifically for sampling calcifications has been scarce. OBJECTIVE. The purpose of this study was to compare the performance and outcomes of DM- and DBT-guided biopsy of suspicious calcifications. METHODS. This retrospective study included 1310 patients (mean age, 58 ± 12 [SD] years) who underwent a total of 1354 9-gauge vacuum-assisted core biopsies of suspicious calcifications performed at a single institution from May 22, 2017, to December 31, 2021. The decision to use a DM-guided or DBT-guided technique was made at the discretion of the radiologist performing the biopsy. Procedure time, the number of exposures during the procedure, and the histopathologic outcomes were recorded. The two techniques were compared using a two-sample t test for continuous variables and a chi-square test for categoric variables. Additional tests were performed using generalized estimating equations to control for the effect of the individual radiologist performing the biopsy. RESULTS. A total of 348 (26%) biopsies used DM guidance, and 1006 (74%) used DBT guidance. The mean procedure time was significantly lower for DBT-guided biopsy (14.9 ± 8.0 [SD] minutes) than for DM-guided biopsy (24.7 ± 14.3 minutes) (p < .001). The mean number of exposures was significantly lower for DBT-guided biopsy (4.1 ± 1.0 [SD] exposures) than for DM-guided biopsy (9.1 ± 3.3 exposures) (p < .001). The differences in procedure time and number of exposures remained significant (both p < .001) when controlling for the effect of the radiologist performing the biopsy. There were no significant differences (all p > .05) between DM-guided and DBT-guided biopsy in terms of the malignancy rate on initial biopsy (20% vs 19%), the rate of high-risk lesion upgrading (14% vs 22%), or the final malignancy rate (23% vs 22%). CONCLUSION. DBT-guided biopsy of suspicious calcifications can be performed with shorter procedure time and fewer exposures compared with DM-guided biopsy, without a significant difference in rates of malignancy or high-risk lesion upgrading. CLINICAL IMPACT. The use of a DBT-guided, rather than a DM-guided, biopsy technique for suspicious calcifications can potentially reduce patient discomfort and radiation exposure without affecting clinical outcomes.
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Affiliation(s)
- Derek L Nguyen
- Johns Hopkins Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Agnieszka Boron
- Johns Hopkins Medicine, 601 N Caroline St, Baltimore, MD 21287
| | | | - Kelly S Myers
- Johns Hopkins Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Lisa A Mullen
- Johns Hopkins Medicine, 601 N Caroline St, Baltimore, MD 21287
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Delaney FT, Doinn TÓ, Broderick JM, Stanley E. Readability of patient education materials related to radiation safety: What are the implications for patient-centred radiology care? Insights Imaging 2021; 12:148. [PMID: 34674063 PMCID: PMC8531160 DOI: 10.1186/s13244-021-01094-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/22/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Increasing numbers of patients and carers rely on online resources for healthcare information. Radiation safety can be misunderstood by patients and clinicians and lead to patient anxiety. We aimed to assess the readability of online patient educational materials (PEMs) related to radiation safety. METHODS A total of 84 articles pertaining to radiation safety from 14 well-known online resources were identified. PEMs were then analysed using Readability Studio Professional Edition Version 2019. Readability was assessed using eight different instruments: the Flesch-Kincaid Reading Grade Level, Raygor Estimate, SMOG, Coleman-Liau, Fry, FORCAST, Gunning Fog, and Flesch Reading Ease Score formula. The mean reading grade level (RGL) of each article was compared to the 6th and 8th grade reading level using 1-sample t-tests. RESULTS The cumulative mean RGL for all 84 articles was 13.3 (range = 8.6-17.4), and none were written at or below the 6th or 8th grade level. The cumulative mean RGL exceeded the 6th grade reading level by an average of 7.3 levels (95% CI, 6.8-7.8; p < 0.001) and the 8th grade level by an average of 5.3 grade levels (95% CI, 4.8-5.8; p < 0.001). The mean Flesch Reading Ease Score was 39/100 ('difficult'). CONCLUSION Currently available online PEMs related to radiation safety are still written at higher than recommended reading levels. Radiation safety is a topic in which the specialist training of radiologists is crucial in providing guidance to patients. Addressing the readability of online PEMs can improve radiology-patient communication and support the shift to a patient-centred model of practice.
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Affiliation(s)
- Francis T Delaney
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Tiarnán Ó Doinn
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - James M Broderick
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Emma Stanley
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
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Abstract
The fear of radiation on the part of patients and/or clinical staff can hamper adequate shared medical decision making. Typically, one-sided medical radiation risk communication methods with limited effectiveness are employed, such as paternalistic, risk numerology, and quality "assurance" approaches. More study is needed to determine patient preferences and potential fears associated with medical imaging radiation, and the results can provide insights for such discussions. Worry about the potential risks associated with medical imaging radiation has been shown to be substantial in the US population. The level of concern differs by sex, race/ethnicity, education, nationality, and overall health, suggesting that more care and individualized communication and discussion methods need to be employed by clinical staff. The opportunities for improved dialogue with patients (and parents of patients) and the public in general are plentiful.
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Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 84, New York, NY 10065
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Hay JL, Baser RE, Westerman JS, Ford JS. Prevalence and Correlates of Worry About Medical Imaging Radiation Among United States Cancer Survivors. Int J Behav Med 2018; 25:569-578. [PMID: 29872990 DOI: 10.1007/s12529-018-9730-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer survivors undergo lifelong surveillance regimens that involve repeated diagnostic medical imaging. As many of these diagnostic tests use ionizing radiation, which may modestly increase cancer risks, they may present a source of worry for survivors. The aims of this paper are to describe cancer survivors' level of worry about medical imaging radiation (MIR) and to identify patterns of MIR worry across subgroups defined by cancer type, other medical and demographic factors, and physician trust. METHOD This cross-sectional study used the 2012-2013 Health Information National Trends Survey of US adults conducted by the National Cancer Institute. The analysis focused on the 452 respondents identifying as cancer survivors. Weighted logistic regression analysis was used to evaluate factors associated with higher MIR worry (reporting "some" or "a lot" of MIR worry). RESULTS Nearly half (42%) of the sample reported higher worry about MIR. Unadjusted and adjusted logistic regressions indicated higher rates of MIR worry among those with lower incomes, those who self-reported poorer health, and those who completed cancer treatment within the past 10 years. Receipt of radiation treatment was associated with higher MIR worry in unadjusted analysis. CONCLUSION Worries about MIR are relatively common among cancer survivors. An accurate assessment of the rates and patterns of worry could aid efforts to improve these individuals' survivorship care and education.
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA.
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joy S Westerman
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA
| | - Jennifer S Ford
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA
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Maino P, Presilla S, Colli Franzone PA, van Kuijk SM, Perez RS, Koetsier E. Radiation Dose Exposure for Lumbar Transforaminal Epidural Steroid Injections and Facet Joint Blocks Under CT vs. Fluoroscopic Guidance. Pain Pract 2018; 18:798-804. [DOI: 10.1111/papr.12677] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/21/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Paolo Maino
- Pain Management Center; Neurocenter of Southern Switzerland; Ospedale Regionale di Lugano; Lugano Switzerland
| | - Stefano Presilla
- Medical Physics Unit; Ospedale Regionale di Bellinzona e Valli; Bellinzona Switzerland
| | - Paola A. Colli Franzone
- Pain Management Center; Neurocenter of Southern Switzerland; Ospedale Regionale di Lugano; Lugano Switzerland
| | - Sander M.J. van Kuijk
- Clinical Epidemiology and Medical Technology Assessment; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Roberto S.G.M. Perez
- Department of Anesthesiology; VU University Medical Center; EMGO+ Institute for Health and Care Research; Amsterdam The Netherlands
| | - Eva Koetsier
- Pain Management Center; Neurocenter of Southern Switzerland; Ospedale Regionale di Lugano; Lugano Switzerland
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