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Manninen AL, Järvinen J, Sierpowska J, Mäkelä TJ, Rissanen TT. Implantation of CRT pacemaker during pregnancy: estimated fetal radiation dose. RADIATION PROTECTION DOSIMETRY 2024; 200:1477-1485. [PMID: 39216989 DOI: 10.1093/rpd/ncae182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 07/31/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
The benefits of a cardiac resynchronization therapy (CRT) implantation are known in severe heart failure and its implantation may also be considered during pregnancy to ensure safe pregnancy and delivery for both the mother and the fetus. This study on a patient case aimed to estimate the absorbed dose (AD) to the fetus during the CRT implantation of 21st week of the pregnant woman. AD measurement was done using anthropomorphic phantom, radiophotoluminescence dosemeters and Monte Carlo simulation utilizing kerma area product (KAP) of the procedures. The measured AD for a phantom's uterus and heart was 0.116 and 14.7 mGy with total KAP of 27.9 Gycm2. The estimated actual AD to the fetus and the mother's heart was 0.004 and 1.2 mGy, with total KAP of 1.5 Gycm2. The dose to the fetus can be minimized with the optimized procedure.
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Affiliation(s)
- Anna-Leena Manninen
- Department of Diagnostic Radiology, Oulu University Hospital, PO Box 10, FI-90029 Oulu, Finland
| | - Jukka Järvinen
- Turku Heart Center, Department of Cardiology, Turku University Hospital, PO Box 52, 20521 Turku, Finland
- Medical Imaging Centre of Southwest Finland, Department of Radiology, Turku University Hospital, PO Box 52, 20521 Turku, Finland
- Department of Medical Physics, Turku University Hospital, PO Box 52, 20521 Turku, Finland
| | - Joanna Sierpowska
- Department of Radiology, Central Hospital of North Karelia, FI-80210 Joensuu, Finland
| | - Timo J Mäkelä
- OYS Heart Center, Oulu University Hospital, Pohde, PO Box 10, FI-90029 Oulu, Finland
| | - Tuomas T Rissanen
- Heart Center, Central Hospital of North Karelia, Siunsote, FI-80210 Joensuu, Finland
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2
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Granata C, Sofia C, Francavilla M, Kardos M, Kasznia-Brown J, Nievelstein RA, Olteanu BS, Owens C, Salerno S, Sorantin E, Apine I. Let's talk about radiation dose and radiation protection in children. Pediatr Radiol 2024:10.1007/s00247-024-06009-0. [PMID: 39095613 DOI: 10.1007/s00247-024-06009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
Children are more sensitive to ionizing radiation than adults. Even though the risk is very low, exposure from radiological examinations can possibly cause them long-term side effects. Recent large epidemiological studies involving children and young adults have added evidence suggesting that even small doses of radiation, such as those from computed tomography scans, might slightly increase the risk of developing cancer later in life. Therefore, even though radiologic studies are essential for an accurate diagnosis and management of various conditions, it is crucial to minimize radiation exposure. This article addresses radiation protection for children in the medical use of ionizing radiation and it is set in the context of the European legislative framework regarding radiation protection. It advocates for a holistic approach to paediatric radiological tests. This approach includes the key principles of radiation protection, such as the justification of imaging procedures supported by referral guidelines, as well as the optimization of techniques (according to the ALARA principle) and effective communication with parents about the benefits and the risks of radiologic procedures. Protecting children from unnecessary radiation is not only a technical challenge, but also a moral obligation and a legal requirement.
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Affiliation(s)
- Claudio Granata
- Department of Radiology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Via Dell'Istria, 65, 34137, Trieste, TS, Italy.
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| | | | - Marek Kardos
- Department of Functional Diagnostics, Children's Cardiac Center, Bratislava, Slovakia
| | - Joanna Kasznia-Brown
- Department of Radiology, Musgrove Park Hospital, University of Bristol, Bristol, UK
| | - Rutger Aj Nievelstein
- Department of Radiology & Nuclear Medicine, University Medical Center Utrecht & Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands
| | - Bogdan Stefan Olteanu
- Department of Radiology, Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | | | - Sergio Salerno
- UOC di Radiologia Pediatrica, ARNAS Civico, Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | | | - Ilze Apine
- Department of Radiology, Riga Stradin's University, Riga, Latvia
- Department of Radiology, Children Clinical University Hospital, Riga, Latvia
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3
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Justich C. Opportunities and challenges of social media communication in radiology from the EUSOBI young club: the patient perspective. Eur Radiol 2024:10.1007/s00330-024-10900-7. [PMID: 39088041 DOI: 10.1007/s00330-024-10900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 05/24/2024] [Accepted: 06/15/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Caroline Justich
- Chair of ESR Patient Advisory Group, Vienna, Austria.
- Founder of Be accepted, Vienna, Austria.
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Chawla T, Gopee-Ramanan P, Green CR, Hartery A, Kassam Z, Murray N, Vu KN, Kirkpatrick IDC. CAR/CETARS/CSAR Practice Guideline on Imaging the Adult Patient With Right Lower Quadrant Pain. Can Assoc Radiol J 2024:8465371241266568. [PMID: 39066632 DOI: 10.1177/08465371241266568] [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: 07/28/2024] Open
Abstract
In 2023, the Canadian Society of Abdominal Radiology (CSAR) and Canadian Emergency, Trauma, and Acute Care Radiology Society (CETARS) received Canadian Association of Radiologists (CAR) member feedback that there was an unmet educational need for guidance in the imaging investigation of right lower quadrant (RLQ) pain. Members requested specific guidance on how to handle controversial scenarios including which test to order when, specifics of imaging protocols, and managing pregnant patients who have RLQ pain-all from a Canadian perspective. After conducting an exhaustive literature review, the working group agreed that a Canadian-specific set of guidelines was warranted. The management recommendations presented in this guideline were discussed as a group to achieve expert consensus. As the workup for RLQ pain can vary considerably in the paediatric population, the scope of this paper was restricted to adults (18 years of age or older). Whenever possible, the best evidence was used to inform the clinical guidance, and where gaps existed, the guidelines reflect consensus among experts in the field. The result is a framework to aid in this process of managing patients with RLQ pain across various clinical scenarios while addressing current questions and controversies, particularly those most relevant to the Canadian healthcare system.
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Affiliation(s)
- Tanya Chawla
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Prasaanthan Gopee-Ramanan
- Department of Radiology, McMaster University Health Sciences Centre (HSC - 3N26), Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Angus Hartery
- Discipline of Radiology, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St John's, NL, Canada
| | - Zahra Kassam
- Department of Medical Imaging, Western University, London, ON, Canada
- St. Joseph's Health Care London, London, ON, Canada
| | - Nicolas Murray
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kim-Nhien Vu
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
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Benavides E, Krecioch JR, Connolly RT, Allareddy T, Buchanan A, Spelic D, O'Brien KK, Keels MA, Mascarenhas AK, Duong ML, Aerne-Bowe MJ, Ziegler KM, Lipman RD. Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations. J Am Dent Assoc 2024; 155:280-293.e4. [PMID: 38300176 DOI: 10.1016/j.adaj.2023.12.002] [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: 07/26/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND The value of dental radiographs to oral health care decision making must be balanced with radiation safety to minimize patient exposure and occupational risk of oral health care providers. This review summarizes recommendations and regulatory guidance regarding dental radiography and cone-beam computed tomography. An expert panel presents recommendations on radiation safety, appropriate imaging practices, and reducing radiation exposure. TYPES OF STUDIES REVIEWED A systematic search run in Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews identified relevant topical systematic reviews, organizational guidelines, and regulatory reviews published in the peer-reviewed literature since 2010. A supplemental search of the gray literature (eg, technical reports, standards, and regulations) identified topical nonindexed publications. Inclusion criteria required relevance to primary oral health care (ie, general or pediatric dentistry). RESULTS A total of 95 articles, guidance documents, and regulations met the inclusion criteria. Resources were characterized as applicable to all modalities, operator and occupational protection, dose reduction and optimization, and quality assurance and control. PRACTICAL IMPLICATIONS Understanding factors affecting imaging safety and applying fundamental principles of radiation protection consistent with federal, state, and local requirements are essential for limiting patient ionizing radiation exposure, in conjunction with implementing optimal imaging procedures to support prudent use of dental radiographs and cone-beam computed tomographic imaging. The regulatory guidance and best practice recommendations summarized in this article should be followed by dentists and other oral health care providers.
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Perdomo AA, Badawy MK, Mignone C, Forster JC. Exceeding radiation thresholds for cataract induction in diagnostic imaging: a paediatric case report. RADIATION PROTECTION DOSIMETRY 2024; 200:417-422. [PMID: 38195763 DOI: 10.1093/rpd/ncad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
This case report investigates the radiation dose received by a paediatric patient with a ventricular assist device who underwent four non-contrast brain computed tomography (CT) scans, two brain perfusion CT scans and two head angiographic CT scans. The total estimated absorbed dose to the lens of the eye is above the 500 mGy radiation-induced cataract threshold. It is recommended that this patient and those with similar imaging histories have routine follow-up with an ophthalmologist. It is also recommended that radiation dose tracking and an electronic medical alert program be implemented to allow the identification of patients who may exceed tissue reaction thresholds.
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Affiliation(s)
- Amanda Alison Perdomo
- Department of Physics, University of Adelaide, Adelaide 5005, South Australia, Australia
- Department of Medical Imaging, The Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia
| | - Mohamed Khaldoun Badawy
- Monash Health Imaging, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton 3800, VIC, Australia
| | - Cristina Mignone
- Department of Medical Imaging, The Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia
| | - Jake Cameron Forster
- Department of Physics, University of Adelaide, Adelaide 5005, South Australia, Australia
- Medical Physics & Radiation Safety, South Australia Medical Imaging, Adelaide 5005, South Australia, Australia
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7
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Masuda T, Takei Y, Arao S. Is the use of gonad protection protectors necessary during infants chest radiography? RADIOLOGIA 2024; 66:107-113. [PMID: 38614527 DOI: 10.1016/j.rxeng.2022.08.003] [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: 06/30/2022] [Accepted: 08/21/2022] [Indexed: 04/15/2024]
Abstract
INTRODUCTION AND OBJECTIVES To compare gonad doses with and without a gonad protector and to optimize the use of gonadal protectors in infants thorax radiography. MATERIALS AND METHODS Two pediatric anthropomorphic phantoms are used: an X-ray system for KXO-50SS/DRX-3724HD, and a digital radiography system for CALNEO Smart C12, with and without a gonad protector during infants thorax radiography. A real time skin dosimeter is placed on the X-ray system, and a real time skin dosimeter is inserted on the front side of the mammary gland, the front and back sides of the true pelvis level, and on the ovaries and testes. The X-ray system is irradiated 15 times using phantoms with and without a gonad protector. The measured entrance patient doses values of for the real time skin dosimeter are compared for each phantom, with and without the gonad protector. RESULTS The medium of measured entrance patient doses values for front side dose of the true pelvis level with and without the protector are 10.00 and 5.00 μGy at newborn, and 10.00 and 0.00μGy at one year, respectively. The medium of measured entrance patient doses values for the back side dose of the true pelvis level with and without the protector are 0.00 and 0.00 μGy at both newborn one year, respectively. The measured entrance patient doses cannot be detected in the ovaries and testes with or without the protector. No significant differences are observed in the measured entrance patient doses values for the front and back side doses of the pelvis, ovaries, and testes at newborn and one year, with and without the protector (p>0.05). CONCLUSIONS No significant difference was observed in gonad dose measurements with and without the gonad protector during infants chest radiography. We believe that gonadal protector wearing is not necessary.
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Affiliation(s)
- T Masuda
- Departamento de Tecnología Radiológica, Facultad de Ciencia y Tecnología de la Salud, Universidad de Bienestar Médico de Kawasaki, Kurashiki, Okayama, Japan.
| | - Y Takei
- Departamento de Tecnología Radiológica, Facultad de Ciencia y Tecnología de la Salud, Universidad de Bienestar Médico de Kawasaki, Kurashiki, Okayama, Japan
| | - S Arao
- Departamento de Tecnología Radiológica, Facultad de Ciencia y Tecnología de la Salud, Universidad de Bienestar Médico de Kawasaki, Kurashiki, Okayama, Japan
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8
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MacDermott R, Berger FH, Phillips A, Robins JA, O’Keeffe ME, Mughli RA, MacLean DB, Liu G, Heipel H, Nathens AB, Qamar SR. Initial Imaging of Pregnant Patients in the Trauma Bay-Discussion and Review of Presentations at a Level-1 Trauma Centre. Diagnostics (Basel) 2024; 14:276. [PMID: 38337792 PMCID: PMC10855036 DOI: 10.3390/diagnostics14030276] [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: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Trauma is the leading non-obstetric cause of maternal and fetal mortality and affects an estimated 5-7% of all pregnancies. Pregnant women, thankfully, are a small subset of patients presenting in the trauma bay, but they do have distinctive physiologic and anatomic changes. These increase the risk of certain traumatic injuries, and the gravid uterus can both be the primary site of injury and mask other injuries. The primary focus of the initial management of the pregnant trauma patient should be that of maternal stabilization and treatment since it directly affects the fetal outcome. Diagnostic imaging plays a pivotal role in initial traumatic injury assessment and should not deviate from normal routine in the pregnant patient. Radiographs and focused assessment with sonography in the trauma bay will direct the use of contrast-enhanced computed tomography (CT), which remains the cornerstone to evaluate the potential presence of further management-altering injuries. A thorough understanding of its risks and benefits is paramount, especially in the pregnant patient. However, like any other trauma patient, if evaluation for injury with CT is indicated, it should not be denied to a pregnant trauma patient due to fear of radiation exposure.
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Affiliation(s)
- Roisin MacDermott
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - Ferco H. Berger
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - Andrea Phillips
- Tory Trauma Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Jason A. Robins
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - Michael E. O’Keeffe
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - Rawan Abu Mughli
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
| | - David B. MacLean
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Grace Liu
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Heather Heipel
- Department of Medicine (Emergency Medicine), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Avery B. Nathens
- Tory Trauma Program, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Sadia Raheez Qamar
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (R.M.); (F.H.B.); (J.A.R.); (M.E.O.); (R.A.M.)
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Chen J, Tu J, Huang S, Zhu Z, Tu Y. Is It Appropriate to Completely Eliminate Contact Shielding during CT Examination? A Discourse Based on Experimental Findings. HEALTH PHYSICS 2024; 126:46-55. [PMID: 37792391 DOI: 10.1097/hp.0000000000001742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Through the integration of experimental data and literature, this study examines whether complete elimination of contact shielding during CT examination is warranted, with a particular focus on potential impacts to children's thyroid and pregnant women, as well as limitations associated with contact shielding. Methods: The thermoluminescent dosimeter (TLD) tablets were inserted into the phantom's five organs and tissues. Select fixed exposure, automatic exposure control (AEC), and use contact shielding combined into four experimental modes, with scanning of the phantom's four parts. Obtain the absorbed dose measurements within or outside the FOV. Statistical analysis was conducted using SPSS software. Results: (1) The AEC significantly reduces dose within and outside the FOV, with a dose reduction of 40%-60%. (2) The application of contact shielding outside the FOV significantly reduced the dose adjoin the FOV. (3) Both the use of AEC mode and contact shielding can effectively minimize the dose, with a reduction of 50-80%. (4) The shielding within the FOV may introduce image artifacts or interfere with AEC, the implementation of contact shielding outside FOV provides little reduction in radiation exposure risk through previous literature. (5) Contact shielding exhibits certain drawbacks in all aspects. Conclusion: The utilization of AEC mode in clinical CT should be widely adopted to minimize patient radiation exposure. In general, contact shielding both inside and outside the FOV should be avoided during exposure. However for children under 12 years old with thyroid gland examination, contact shielding could maximally reduce external radiation and may be appropriate. Pregnant women require careful evaluation when considering the use of contact shielding. Contact shielding should not be entirely abandoned.
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Affiliation(s)
- Jiwei Chen
- Department of Medical Engineering, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China
| | - Jianchun Tu
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China
| | - Shengyan Huang
- Department of Nursing, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China
| | - Zhenhua Zhu
- Department of Medical Engineering, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu 215300, P.R. China
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Di Rosso J, Krasser A, Tschauner S, Guss H, Sorantin E. Bismuth Shielding in Head Computed Tomography-Still Necessary? J Clin Med 2023; 13:25. [PMID: 38202032 PMCID: PMC10779489 DOI: 10.3390/jcm13010025] [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: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction: Cranial CT scans are associated with radiation exposure to the eye lens, which is a particularly radiosensitive organ. Children are more vulnerable to radiation than adults. Therefore, it is essential to use the available dose reduction techniques to minimize radiation exposure. According to the European Consensus on patient contact shielding by the IRCP from 2021, shielding is not recommended in most body areas anymore. This study aims to evaluate whether bismuth shielding as well as its combination with other dose-saving technologies could still be useful. Methods: Cranial CT scans of a pediatric anthropomorphic phantom were performed on two up-to-date MDCT scanners. Eye lens dose measurements were performed using thermoluminescent dosimeters. Furthermore, the impact of BS and of the additional placement of standoff foam between the patient and BS on image quality was also assessed. Results: Bismuth shielding showed a significant lens dose reduction in both CT scanners (GE: 41.50 ± 4.04%, p < 0.001; Siemens: 29.75 ± 6.55%, p = 0.00). When combined with AEC, the dose was lowered even more (GE: 60.75 ± 3.30%, p < 0.001; Siemens: 41.25 ± 8.02%, p = 0.00). The highest eye dose reduction was achieved using BS + AEC + OBTCM (GE: 71.25 ± 2.98%, p < 0.001; Siemens: 58.75 ± 5.85%, p < 0.001). BS caused increased image noise in the orbital region, which could be mitigated by foam placement. Eye shielding had no effect on the image noise in the cranium. Conclusions: The use of BS in cranial CT can lead to a significant dose reduction, which can be further enhanced by its combination with other modern dose reduction methods. BS causes increase in image noise in the orbital region but not in the cranium. The additional use of standoff foam reduces image noise in the orbital region.
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Affiliation(s)
- Jana Di Rosso
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, 8036 Graz, Austria (E.S.)
| | - Andreas Krasser
- Competence Centre for Medical Physics and Radiation Protection, University Hospital Graz, 8036 Graz, Austria
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, 8036 Graz, Austria (E.S.)
| | - Helmuth Guss
- Competence Centre for Medical Physics and Radiation Protection, University Hospital Graz, 8036 Graz, Austria
| | - Erich Sorantin
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, 8036 Graz, Austria (E.S.)
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Nan X, Chan E, Wong KSC, Ng J, Izwan S, Cooper M, Damodaran R. Laparoscopic Cholecystectomy in Pregnancy: A Seven-Year Retrospective Study From an Australian Tertiary Center. Cureus 2023; 15:e50034. [PMID: 38186520 PMCID: PMC10768355 DOI: 10.7759/cureus.50034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/09/2024] Open
Abstract
Background Cholecystectomy is the second most common non-obstetric indication for surgery during pregnancy; however, there is little recent literature specifically exploring perioperative care approaches, and a paucity of Australian data exists. This study investigates the incidence of laparoscopic cholecystectomy (LC) during pregnancy, peri-operative management, and post-operative outcomes in a single Australian tertiary center. Methods A retrospective analysis of LCs performed on pregnant patients between the ages of 16 and 50 years at a tertiary hospital between 2016 and 2023 was completed. Results Twenty-three patients underwent LC. The median gestational age was 17+4 weeks (4+3-30+6). Cases were performed in all three trimesters, with the majority in the second trimester (n=12, 52.2%). Surgery indications were recurrent biliary colic (n=11, 47.8%), acute cholecystitis (n=8, 34.8%), and gallstone pancreatitis (n=4, 17.4%). Obstetrics and Gynecology (O&G) consultations occurred in 56.5% (n=13) of cases. Fetal heart rate (FHR) was recorded perioperatively in 82.6% (n=19) of cases. Preoperative steroids were given to 40% of eligible patients. An intraoperative cholangiogram was performed in 12 (52.2%) cases, of which eight (66.7%) utilized abdominal shielding. There was no perioperative maternal mortality nor fetal loss. Surgical morbidities were pancreatitis (n=1), bile leak (n=1), and intraoperatively recognized bile duct injury (n=1). Two threatened preterm labors and five (26.3%) preterm deliveries occurred. Conclusion Performing LC in pregnancy does carry a risk of major morbidity; however, there was no mortality or fetal loss across all trimesters. The decision to perform abdominal shielding during an intraoperative cholangiogram should be approached sensitively in a case-by-case manner, given recent paradigm shifts in radiology. A multidisciplinary approach with standardized local perioperative care policies regarding procedures such as O&G consultation, perioperative steroid use, and FHR monitoring is strongly recommended.
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Affiliation(s)
- Xinyi Nan
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
- School of Medicine and Dentistry, Griffith University, Gold Coast, AUS
| | - Erick Chan
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
- School of Medicine and Dentistry, Griffith University, Gold Coast, AUS
| | - Kok Sum Chloe Wong
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
| | - Justin Ng
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, AUS
| | - Sara Izwan
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
- School of Medicine and Dentistry, Griffith University, Gold Coast, AUS
| | - Michelle Cooper
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
| | - Ramesh Damodaran
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
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12
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Long M, Albeshan S, Alashban Y, England A, Moore N, Young R, Bezzina P, McEntee MF. The effect of contact radiation shielding on breast dose during CT abdomen-pelvis: a phantom study. RADIATION PROTECTION DOSIMETRY 2023; 199:2104-2111. [PMID: 37551012 DOI: 10.1093/rpd/ncad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023]
Abstract
This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen-pelvis examinations using automatic tube current modulation to protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 μSv without ODM (1.92-1.91 μSv, p = 0.49) and increased by 0.03 μSv with ODM (1.53-1.56 μSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 μSv with shielding (1.91-1.56 μSv, p = 0.24) and by 0.39 μSv without shielding (1.92-1.53 μSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen-pelvis.
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Affiliation(s)
- Maria Long
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Salman Albeshan
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, PO Box 145111, Riyadh 4545, Saudi Arabia
| | - Yazeed Alashban
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, PO Box 145111, Riyadh 4545, Saudi Arabia
| | - Andrew England
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Niamh Moore
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Rena Young
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
| | - Paul Bezzina
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida MSD 2080, Malta
| | - Mark F McEntee
- Medical Imaging and Radiation Therapy Department, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, Cork T12 AK54, Ireland
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13
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Stogiannos N, Psimitis A, Bougias H, Georgiadou E, Leandrou S, Papavasileiou P, Polycarpou I, Malamateniou C, McEntee MF. Exploring radiographers' perceptions and knowledge about patient lead shielding: a cross-sectional study in Greece and Cyprus. RADIATION PROTECTION DOSIMETRY 2023; 199:1401-1409. [PMID: 37415570 DOI: 10.1093/rpd/ncad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
The present study aimed to explore radiographers' knowledge, clinical practice and perceptions regarding the use of patient lead shielding in Greece and Cyprus. Qualitative data were analyzed using conceptual content analysis and through the classification of findings into themes and categories. A total of 216 valid responses were received. Most respondents reported not being aware of the patient shielding recommendations issued by the American Association of Physicists in Medicine (67%) or the guidance issued by the British Institute of Radiology (69%). Shielding-related training was generally not provided by radiography departments (74%). Most of them (85%) reported that they need specific guidance on lead shielding practices. Also, 82% of the respondents said that lead shielding should continue to be used outside the pelvic area when imaging pregnant patients. Pediatric patients are the most common patient category to which lead shielding was applied. Significant gaps in relevant training have been identified among radiographers in Greece and Cyprus, highlighting the need for new protocols and provision of adequate training on lead shielding practices. Radiography departments should invest in appropriate shielding equipment and adequately train their staff.
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Affiliation(s)
- Nikolaos Stogiannos
- Discipline of Medical Imaging and Radiation Therapy, University College Cork, Cork, T12 R229, Ireland
- Division of Midwifery and Radiography, City University of London, London, EC1V OHB, United Kingdom
- Medical Imaging Department, Corfu General Hospital, Corfu 49100, Greece
| | | | - Haralabos Bougias
- Department of Clinical Radiology, Ioannina University Hospital, Ioannina 45110, Greece
| | | | - Stephanos Leandrou
- School of Science, European University Cyprus, Nicosia 1516, Cyprus
- School of Mathematical Sciences, Computer Science and Engineering, City University of London, London, EC1V 0HB, United Kingdom
| | - Periklis Papavasileiou
- Section of Radiography and Radiotherapy, Department of Biomedical Sciences, School of Health Sciences, University of West Attica, Athens 12243, Greece
| | - Irene Polycarpou
- Department of Health Sciences, European University Cyprus, Nicosia 1516, Cyprus
| | - Christina Malamateniou
- Division of Midwifery and Radiography, City University of London, London, EC1V OHB, United Kingdom
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne 1007, Switzerland
| | - Mark F McEntee
- Discipline of Medical Imaging and Radiation Therapy, University College Cork, Cork, T12 R229, Ireland
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14
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Alkhateeb SM, Bamusa A, Almutairi N, Barayan B, Alamodi H, Alnadawi F, Alnowaimi M. Effectiveness of protective thyroid shield in chest X-ray imaging. Radiat Phys Chem Oxf Engl 1993 2023; 209:110965. [PMID: 37065502 PMCID: PMC10089664 DOI: 10.1016/j.radphyschem.2023.110965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
Chest X-ray imaging is the most common X-ray imaging method for diagnosing coronavirus disease. The thyroid gland is one of the most radiation-sensitive organs of the body, particularly in infants and children. Therefore, it must be protected during chest X-ray imaging. Yet, because it has benefits and drawbacks, using a thyroid shield as protection during chest X-ray imaging is still up for debate.Therefore, this study aims to clarify the need for using a protective thyroid shield during chest X-ray imaging. This study was performed using different dosimeters (silica beads as a thermoluminescent dosimeter and an optically stimulated luminance dosimeter) embedded in an adult male ATOM dosimetric phantom. The phantom was irradiated using a portable X-ray machine with and without thyroid shielding. The dosimeter readings indicated that a thyroid shield reduced the radiation dose to the thyroid gland by 69% ± 18% without degrading the obtained radiograph. The use of a protective thyroid shield during chest X-ray imaging is recommended because its benefits outweigh the risks.
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Affiliation(s)
- Shyma M Alkhateeb
- Radiologic Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulkreem Bamusa
- Radiologic Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nawaf Almutairi
- Radiologic Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Badr Barayan
- Radiologic Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hasan Alamodi
- Radiologic Sciences Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fouad Alnadawi
- Nuclear Engineering Department, Faculty of Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majdi Alnowaimi
- Nuclear Engineering Department, Faculty of Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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Granata C, Briers E, Candela-Juan C, Damilakis J, De Bondt T, Faj D, Foley S, Frija G, de Las Heras Gala H, Hiles P, Pauwels R, Sans Merce M, Simantirakis G, Vano E, Gilligan P. European survey on the use of patient contact shielding during radiological examinations. Insights Imaging 2023; 14:108. [PMID: 37336849 PMCID: PMC10279619 DOI: 10.1186/s13244-023-01452-3] [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: 01/09/2023] [Accepted: 05/09/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Contact shielding (CS) of patients during X-ray studies has been used for decades to protect radiosensitive organs. This practice has not changed much despite increasing evidence that CS is not useful in many cases. The Gonad And Patient Shielding (GAPS) group-founded by representatives of the main European bodies involved in radiology-promoted this survey to assess the current practice of CS among European radiology departments and the attitude towards a non-shielding policy. METHODS Over a four-month period (15 May-15th September 2021) European Society of Radiology and European Society of Paediatric Radiology radiologist members were invited to respond to a web-based questionnaire consisting of 59 questions. RESULTS 225 centres from 35 countries responded to this survey. CS was routinely applied in at least one radiological modality in 49.2% of centres performing studies in adults, 57.5% of centres performing studies in children, and 47.8% of centres performing studies on pregnant women. CS was most frequently used in conventional radiography, where the most frequently shielded organs were the gonads, followed by thyroid, female breasts, and eye lens. 83.6% respondents would follow European recommendations on the use of CS when provided by the main European bodies involved in radiology. CONCLUSIONS This review shows that CS is still largely used across Europe. However, a non-shielding policy could be adopted in most departments if European professional societies provided recommendations. In this regard, a strong commitment by European and national professional societies to educate and inform practitioners, patients and carers is paramount. CLINICAL RELEVANCE STATEMENT According to this survey expectations of patients and carers, and skepticism among professionals about the limited benefits of CS are the most important obstacles to the application of a no-shielding policy. A strong commitment from European and national professional societies to inform practitioners, patients and carers is fundamental.
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Affiliation(s)
- Claudio Granata
- Department of Paediatric Radiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
| | - Erik Briers
- Member ESR‑Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - Cristian Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands
- Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - John Damilakis
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- University of Crete, Iraklion, Crete, Greece
| | - Timo De Bondt
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- VITAZ, Department of medical physics, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
- AZ Sint-Blasius, Department of medical physics, Kroonveldlaan 50, 9200, Dendermonde, Belgium
| | - Dario Faj
- European Radiation Dosimetry Group, Neuherberg, Germany
- Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Shane Foley
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- European Federation of Radiographer Societies, Utrecht, Belgium
- Radiography and Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Guy Frija
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- Université de Paris, Paris, France
| | | | - Peter Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK
| | - Ruben Pauwels
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Marta Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany
- Geneva University Hospitals, Geneva, Switzerland
| | - Georgios Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany
- Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - Eliseo Vano
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria
- Radiology Department, Complutense University, Madrid, Spain
| | - Patrick Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands
- Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland
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16
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Hurley L, Alashban Y, Albeshan S, England A, McEntee MF. The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study. Diagn Interv Radiol 2023; 29:555-560. [PMID: 37129301 PMCID: PMC10679606 DOI: 10.4274/dir.2023.232126] [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: 01/20/2023] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety of axial skeleton X-ray examinations. METHODS Using an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds technique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (μSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student's t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding. RESULTS A total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 μSv (P = 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant. CONCLUSION This study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols.
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Affiliation(s)
- Lauren Hurley
- Department of Medical Imaging and Radiation Therapy, University College Cork, School of Medicine, Brookfield Health Sciences, Munster, Ireland
| | - Yazeed Alashban
- Department of Radiological Sciences, King Saud University, College of Applied Medical Sciences, Riyadh, Saudi Arabia
| | - Salman Albeshan
- Department of Radiological Sciences, King Saud University, College of Applied Medical Sciences, Riyadh, Saudi Arabia
| | - Andrew England
- Department of Medical Imaging and Radiation Therapy, University College Cork, School of Medicine, Brookfield Health Sciences, Munster, Ireland
| | - Mark F. McEntee
- Department of Medical Imaging and Radiation Therapy, University College Cork, School of Medicine, Brookfield Health Sciences, Munster, Ireland
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17
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Fiebich M, Ammon J, Borowski M, de Las Heras Gala H, Loose R, Mentzel HJ, Poppe B. [Use of patient radiation shielding in diagnostic and interventional radiology]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01157-0. [PMID: 37171543 DOI: 10.1007/s00117-023-01157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
The use of patient contact shielding provides an opportunity to reduce patient radiation exposure. Recently, the use has been the subject of controversy. The Radiation Protection Committee has published a recommendation on the use of patient radiation shields by considering the recent findings on dose savings but also the risks of incorrect use. In this article, a specification for the more frequently used types of X‑ray examination is given, which describes whether and which radiation contact shielding should be used. This is accompanied by a rationale for the use or non-use of patient radiation protection agents. Problems and possible errors are explained, as well as how to deal with special situations such as pregnant women and children.
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Affiliation(s)
- M Fiebich
- Institut für Medizinische Physik und Strahlenschutz, Technische Hochschule Mittelhessen, Wiesenstr. 14, 35390, Gießen, Deutschland.
| | - J Ammon
- Institut für Medizinische Physik, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - M Borowski
- Institut für Röntgendiagnostik und Nuklearmedizin, Klinikum Braunschweig, Braunschweig, Deutschland
| | | | - R Loose
- Institut für Medizinische Physik, Klinikum Nürnberg Nord (i. R.), Nürnberg, Deutschland
| | - H-J Mentzel
- Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Deutschland
| | - B Poppe
- Universitätsklinik für Medizinische Strahlenphysik, Medizinischer Campus Pius-Hospital, Department für Medizinische Physik und Akustik, Carl-von-Ossietzky-Universität Oldenburg, Oldenburg, Deutschland
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18
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Satharasinghe D, Niroshan N, Jeyasugiththan J. AWARENESS OF PAEDIATRIC RADIOLOGICAL PROTECTION AND IMAGING PARAMETERS AMONG GROUP OF SRI LANKAN RADIOGRAPHERS. RADIATION PROTECTION DOSIMETRY 2023; 199:533-539. [PMID: 36897047 DOI: 10.1093/rpd/ncad047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The present survey evaluated the level of awareness of radiological protection concepts and imaging parameters among Sri Lankan radiographers for the first time. The data were collected using an electronic questionnaire of 22 questions on demographic data, awareness of radiation protection concepts and imaging parameters. Only 84 out of 122 (68.8%) requested radiographers to return the questionnaire. More than 85% had ≥3 years of experience in the radiography field. The average scores for questions on best practices, imaging parameters and radiation protection were 75, 75.8 and 70.2%, respectively, with an overall score of 73.4%. Significant confusion existed on protective shielding, paediatric consenting capability, use of grids and excess X-ray field during paediatric radiography. Although the overall knowledge and awareness of participants on studied concepts were satisfactory, a continuous professional development credit system and implementation of a code of practice are required to improve the quality of radiography practice.
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19
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Tarkiainen J, Nadhum M, Heikkilä A, Rinta-Kiikka I, Joutsen A. RADIATION DOSE OF THE EYE LENS IN CT EXAMINATIONS OF THE BRAIN IN CLINICAL PRACTICE-THE EFFECT OF RADIOGRAPHER TRAINING TO OPTIMISE GANTRY TILT AND SCAN LENGTH. RADIATION PROTECTION DOSIMETRY 2023; 199:391-398. [PMID: 36691891 PMCID: PMC10077499 DOI: 10.1093/rpd/ncad002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Lenses are always exposed to radiation in brain computed tomography (CT) scans. However, the lens dose can be reduced by excluding lens from scanning area by optimising gantry tilt and scan length. The object of this study is to retrospectively analyse if the optimisation by gantry tilt and scan length have been adequate in the CT scan of the brain, and to prospectively analyse the effect of radiographer training to the quality of the CT examinations. This study was conducted in two parts. In all, 329 brain CTs performed in the Tampere University Hospital from 2017 to 2019 were revised retrospectively. The prospective part included 51 brain CT studies conducted in October 2021. Dose to the eye of the lens was modelled using CT-Expo using zero-degree beam angle and scan lengths to expose the lens either to the primary or scattered radiation. Non-zero gantry tilt had been used in a large proportion of the CT examinations in the retrospective setting, 84.8%. However, the lenses were successfully excluded from the scan area in only 1.8% of the examinations. In the prospective part, the gantry tilt was used in 98% of the studies and the proportion of successful examinations rose from 1.8 to 11.8%. The lens dose decreased significantly when the eyes were excluded from the imaging area. The modelled lens dose in the large retrospective part was 25.9 mGy (17.8-49.2 mGy) when the eyes were included and 1.5 mGy (0.4-1.9 mGy) when the eyes were excluded. The lens dose was similar in the small prospective part. Despite the gantry tilt is widely used, unnecessary lens irradiation occurs extensively because of suboptimal gantry tilt and scan length. The training of radiographers reduces the radiation exposure to the lens by more optimal gantry tilt and scan length.
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Affiliation(s)
| | - Miia Nadhum
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Annele Heikkilä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Atte Joutsen
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
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20
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Nagy E, Tschauner S, Schramek C, Sorantin E. Paediatric CT made easy. Pediatr Radiol 2023; 53:581-588. [PMID: 36333494 PMCID: PMC10027642 DOI: 10.1007/s00247-022-05526-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/28/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
Paediatric computed tomography (CT) imaging has always been associated with challenges. Although the technical background of CT imaging is complex, it is worth considering the baseline aspects of radiation exposure to prevent unwanted excess radiation in paediatric patients. In this review, we discuss the most relevant factors influencing radiation exposure, and provide a simplified and practical approach to optimise paediatric CT.
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Affiliation(s)
- Eszter Nagy
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Clemens Schramek
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Erich Sorantin
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
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21
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Kelaranta A, Mäkelä T, Hyppänen T, Toroi P, Kortesniemi M. EFFECT OF PELVIC LEAD SHIELD ON ORGAN DOSES IN POSTERO-ANTERIOR CHEST RADIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2023; 199:29-34. [PMID: 36347420 DOI: 10.1093/rpd/ncac216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Lead shields are commonly used in X-ray imaging to protect radiosensitive organs and to minimise patient's radiation dose. However, they might also complicate or interfere with the examination, and even decrease the diagnostic value if they are positioned incorrectly. In this study, the radiation dose effect of waist half-apron lead shield was examined via Monte Carlo simulations of postero-anterior (PA) chest radiography examinations using a female anthropomorphic phantom. Relevant organs for dose determination were lungs, breasts, liver, kidneys and uterus. The organ dose reductions varied depending on shield position and organ but were negligible for properly positioned shields. The shield that had the largest effective dose reduction (9%) was partly positioned inside the field of view, which should not be done in practice. Dose reduction was practically 0% for properly positioned shields. Therefore, the use of lead shield in the pelvic region during chest PA examinations should be discontinued.
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Affiliation(s)
- Anna Kelaranta
- HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, FI-00290 Helsinki, Finland
- Department of Physics, University of Helsinki, FI-00014 Helsinki, Finland
- Suomen Terveystalo Ltd, Jaakonkatu 3A, FI-00100 Helsinki, Finland
| | - Teemu Mäkelä
- HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, FI-00290 Helsinki, Finland
- Department of Physics, University of Helsinki, FI-00014 Helsinki, Finland
| | - Teemu Hyppänen
- HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, FI-00290 Helsinki, Finland
| | - Paula Toroi
- STUK-Radiation and Nuclear Safety Authority, Jokiniemenkuja 1, FI-01370 Vantaa, Finland
| | - Mika Kortesniemi
- HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, FI-00290 Helsinki, Finland
- Department of Physics, University of Helsinki, FI-00014 Helsinki, Finland
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22
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Gillespie CD, Yates A, Murphy MC, Hughes M, Ewins K, NíAinle F, Bolster F, Rowan M, Foley S, MacMahon PJ. Breast Shielding Combined With an Optimized Computed Tomography Pulmonary Angiography Pregnancy Protocol: A Special Use-Case for Shielding? J Thorac Imaging 2023; 38:36-43. [PMID: 36162076 DOI: 10.1097/rti.0000000000000677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the impact of breast shields on breast dose and image quality when combined with a low-dose computed tomography pulmonary angiography (CTPA) protocol for pregnancy. METHODS A low-dose CTPA protocol, with and without breast shields, was evaluated by anthropomorphic phantom and 20 prospectively recruited pregnant participants from January to October 2019. Thermoluminescent dosimeters measured surface and absorbed breast dose in the phantom and surface breast dose in participants. The Monte-Carlo method estimated the absorbed breast dose in participants. Image quality was assessed quantitatively by regions of interest analysis and subjectively by the Likert scale. Doses and image quality for CTPA alone were compared with CTPA with breast shields. RESULTS Mean surface and absorbed breast dose for CTPA alone were 1.3±0.4 and 2.8±1.5 mGy in participants, and 1.5±0.7 and 1.6±0.6 mGy in the phantom. Shielding reduced surface breast dose to 0.5±0.3 and 0.7±0.2 mGy in the phantom (66%) and study participants (48%), respectively. Absorbed breast dose reduced to 0.9±0.5 mGy (46%) in the phantom.Noise increased with breast shields at lower kV settings (80 to 100 kV) in the phantom; however, in study participants there was no significant difference between shield and no-shield groups for main pulmonary artery noise (no-shield: 34±9.8, shield: 36.3±7.2, P =0.56), SNR (no-shield: 11.2±3.7, shield: 10.8±2.6, P =0.74) or contrast-to-noise ratio (no-shield: 10.0±3.3, shield: 9.3±2.4, P =0.6). Median subjective image quality scores were comparable (no-shield: 4.0, interquartile range: 3.5 to 4.4, shield: 4.3, interquartile range: 4.0 to 4.5). CONCLUSION Combining low-dose CTPA with breast shields confers additional breast-dose savings without impacting image quality and yields breast doses approaching those of low-dose scintigraphy, suggesting breast shields play a role in protocol optimization for select groups.
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Affiliation(s)
| | | | | | | | - Karl Ewins
- Haematology, Mater Misericordiae University Hospital
| | | | - Ferdia Bolster
- Departments of Radiology
- School of Medicine, University College Dublin
| | - Michael Rowan
- Department of Medical Physics, St James Hospital, Dublin, Ireland
| | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin
| | - Peter J MacMahon
- Departments of Radiology
- School of Medicine, University College Dublin
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Dias Cardoso CEM, Bezzina P, Portelli JL. Gonad contact shielding in digital radiography: A questionnaire survey. Eur J Radiol 2023; 158:110620. [PMID: 36521379 DOI: 10.1016/j.ejrad.2022.110620] [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: 08/08/2022] [Revised: 10/16/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The use of gonad contact shielding (GCS) in radiology departments has varied across countries, possibly because, until recently, there was no agreed consensus with mixed evidence supporting its use. This study aims to explore radiographers' use and opinion on GCS in digital radiography (DR) and to evaluate whether radiographers' use of GCS is associated with their gender, highest educational qualification, and/or years of experience. METHOD An online survey was sent via email to potential participants through the Society of Medical Radiographers Malta (SRM) as well as social media posts on local radiography pages. Descriptive and inferential statistics were used to analyse the collected data. RESULTS Almost half of the registered radiographers working in radiology departments in Malta (n = 101/203) completed the survey (49.7 % response rate). 61.4 % of participating radiographers indicated they 'often' use GCS in some patients, with 56.4 % stating they perceive GCS as an effective tool to protect the gonads from radiation exposure in DR. Equally, 56.4 % claimed that GCS use is guided by local rules and/or departmental protocols. While 58.4 % indicated that patients' gender does not impact their use of GCS, patients' age does influence their use. No statistically significant association was noted between radiographers' likeliness of using GCS and their gender, highest educational qualification, and/or years of experience. CONCLUSIONS Some misconceptions and uncertainties among radiographers concerning the benefits and risks of using GCS were noted. Local radiology departments should look into their protocols and assess the need for an update aligned with the latest recommendations.
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Affiliation(s)
| | - Paul Bezzina
- Radiography Department, Faculty of Health Sciences, University of Malta, Msida MSD2090, Malta.
| | - Jonathan L Portelli
- Radiography Department, Faculty of Health Sciences, University of Malta, Msida MSD2090, Malta.
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Masuda T, Takei Y, Arao S. ¿Es necesario utilizar protectores de gónadas durante la realización de radiografías de tórax en los lactantes? RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Vogiatzi T, Menz R, Verna C, Bornstein MM, Dagassan-Berndt D. Effect of field of view (FOV) positioning and shielding on radiation dose in paediatric CBCT. Dentomaxillofac Radiol 2022; 51:20210316. [PMID: 35762346 PMCID: PMC10043625 DOI: 10.1259/dmfr.20210316] [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: 07/07/2021] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effect of two different large field of view (FOV) positions in the vertical dimension and shielding (thyroid collar and eyeglasses) on the effective dose and the local doses of various sites of the craniofacial complex. METHODS Organ doses and effective doses were calculated based on the measured doses using 27 pairs of thermoluminescent dosemeters in a paediatric tissue-equivalent of a 10-year-old anthropomorphic phantom. The large FOV of the 3D Accuitomo F170 CBCT scanner was used to image parts of the craniofacial complex. Six protocols were performed: (A) cranial position without shielding; (B) cranial position with shielding; (C) caudal position without shielding; (D) caudal position with shielding, (E) similar to C with 3600 rotation and (F) similar to D with 360° rotation. Measurements were obtained in duplicate, and the relative δ value (%) was applied to compare the average doses between the protocols. RESULTS Changing the FOV position from cranial to caudal without using shielding resulted in an increase of the effective dose of 18.8%. Use of shielding in the caudal position reduced the dose by 31.6%. Local absorbed dose of the thyroid had the most relevant impact on calculation of the effective dose, followed by oesophagus, bone marrow and bone surfaces, especially when comparing the different protocols. CONCLUSIONS Application of shielding devices for thyroid in combination with a most caudal positioning of FOV led to the lowest local absorbed doses as well as the effective dose in a child phantom model.
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Affiliation(s)
- Theodosia Vogiatzi
- Department of Oral Health and Medicine, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Roman Menz
- Division of Radiological Physics, Department of Radiology, University of Basel, Basel, Switzerland
| | - Carlalberta Verna
- Department of Paediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Michael M. Bornstein
- Department of Oral Health and Medicine, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
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26
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Using barium as an internal radioprotective shield for pregnant patients undergoing CT pulmonary angiography: A retrospective study. Phys Med 2022; 102:27-32. [PMID: 36049319 DOI: 10.1016/j.ejmp.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of our retrospective study was to assess the effect of barium sulfate contrast medium on radiation dose and diagnostic quality of CT Pulmonary Angiography (CTPA) in an in-vivo study of pregnant patients. METHODS Our retrospective study included 33 pregnant patients who underwent CTPA to exclude pulmonary embolism. The patients received oral 40% w/v barium solution just prior to the acquisition of their planning radiograph. All CTPA were performed on 64-slice, single-source CT scanners with AEC with noise index = 28.62-31.64 and the allowed mA range of 100-450. However, only 5/33 patients had mA modulation (AEC 100-450 mA range), while 28/33 patients had mA maxed out at the set maximum mA of 450 over the entire scan range. We recorded CTDIvol (mGy), DLP (mGy.cm) and scan length. The same information was recorded in weight-and scanner-matched, non-pregnant patients. Statistical tests included descriptive data (median and interquartile range) and Mann-Whitney test. RESULTS There were no significant differences in CTDIvol and DLP between the barium and control group patients (p > 0.1). The median mA below the diaphragm was significantly higher in each patient with barium compared to the weight and scanner-matched patient without barium. Evaluation of lung and subsegmental lower lobe pulmonary arteries was limited in 85% barium group. Due to thin prospective section thickness (1.25 mm), most patients were scanned at maximum allowed mA for AEC. CONCLUSION Use of AEC with thick barium in pregnant patients undergoing CTPA as an internal radioprotective shield produces counterproductive artifacts and tube current increments.
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Three-Dimensional Distance Mapping Method to Evaluate Mandibular Symmetry and Morphology of Adults with Unilateral Premolar Scissors Bite. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
(1) Objective: This study aimed to evaluate the association between unilateral premolar scissors bite and mandibular symmetry of adults via the 3D distance mapping method. (2) Methods: A total of 53 cone-beam computed tomography (CBCT) images of adults with unilateral premolar scissors bite were set as study samples. A total of 53 age- and sex-matched samples without scissors bite were in the control group. Three-dimensional mandibular models and seven mandibular functional units, including condylar process (Co), coronoid process (Cr), mandibular ramus (Ra), mandibular angle (Ma), alveolar process (Ap), mandibular body (Mb), and chin process (Ch) were constructed and mirrored. After superimposition of the original and the mirrored models, 3D distance maps and deviation analysis were performed to evaluate the mandibular symmetry and morphology. (3) Results: In the study group, the matching percentages of the entire mandible (50.79 ± 10.38%), Ap (67.00 ± 12.68%), Mb (66.62 ± 9.44%), Ra (62.52 ± 11.00%), Ch (80.75 ± 9.86%), and Co (62.78 ± 13.56) were lower than that of the entire mandible (58.60 ± 5.52) (p < 0.01), Ap (73.83 ± 8.88%) (p < 0.01), Mb (72.37 ± 8.69%) (p < 0.01), Ra (68.60 ± 7.56%) (p < 0.01), Ch (85.23 ± 6.80%) (p < 0.01), and Co (67.58 ± 10.32%) (p < 0.05) in the control group. However, Cr and Ma showed no significant difference (p > 0.05). (4) Conclusions: The 3D distance mapping method provided a qualitative and quantitative mandibular symmetry and morphology assessment. Mandibular asymmetry was found in adults with unilateral premolar scissors bites. Mandibular functional units, including the alveolar process, mandibular body, mandibular ramus, chin process, and condylar process, showed significant differences, while no significant difference was observed in the coronoid process and mandibular angle.
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Impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography with small and medium fields of view. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:245-253. [PMID: 35534405 DOI: 10.1016/j.oooo.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography (CBCT) with small and medium fields of view (FOVs). STUDY DESIGN Six CBCT protocols were investigated by exposing an adult anthropomorphic male phantom head without and with thyroid shielding, using 4 small (4 × 5 cm) and 2 medium (10 × 6 cm) FOVs. Twenty metal oxide semiconductor field-effect transistor dosimeters were placed in the phantom head to measure absorbed doses and calculate equivalent doses at 11 sites. Effective doses were calculated based on the tissue weighting factors in International Commission on Radiological Protection Publication 103. The data were analyzed using the independent samples t test. RESULTS Thyroid gland shielding led to significant equivalent dose reductions in many tissues for all protocols. Equivalent dose reductions to the thyroid were significant in all 6 protocols (P ≤ .037). Significant reduction depended on the FOV and ranged between 24.5% and 42.6% for the thyroid gland and 4.9% and 34.5% for other tissues and organs. Effective doses were significantly lower in all protocols (P ≤ .016). CONCLUSIONS Thyroid gland shielding protects the thyroid gland and other organs and should be utilized with all CBCT examinations where feasible.
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