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Monroe EJ, Chick JFB, Stacey AW, Millard NE, Geyer JR, Ramoso LR, Ghodke BV, Hallam DK. Radiation dose reduction during intra-arterial chemotherapy for retinoblastoma: a retrospective analysis of 96 consecutive pediatric interventions using five distinct protocols. Pediatr Radiol 2021; 51:649-657. [PMID: 33231717 DOI: 10.1007/s00247-020-04892-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/27/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intra-arterial chemotherapy (IAC) represents a mainstay of retinoblastoma treatment in children. Patients with retinoblastoma are uniquely at risk for secondary malignancies and are sensitive to the ionizing effects of radiation. OBJECTIVE To retrospectively review a single institution's experience with IAC for retinoblastoma and the effect of variable intra-procedural imaging techniques on radiation exposure. MATERIALS AND METHODS Twenty-four consecutive patients, with a mean age of 30.8±16.3 months (range: 3.2-83.4 months), undergoing IAC for retinoblastoma between May 2014 and May 2020 (72 months) were included. No patients were excluded. The primary outcome was radiation exposure and secondary outcomes included technical success and procedural adverse events. Technical success was defined as catheterization of the ophthalmic or meningolacrimal artery and complete delivery of chemotherapy. Each procedure was retrospectively reviewed and categorized as one of five imaging protocol types. Protocol types were characterized by uniplanar versus multiplanar imaging and digital subtraction angiographic versus roadmap angiographic techniques. Radiation exposure, protocol utilization, the association of protocol and radiation exposure were assessed. RESULTS During 96 consecutive interventions, 109 ocular treatments were performed. Thirteen of the 96 (15.5%) treatments were bilateral. Ocular technical success was 106 of 109 (97.2%). All three treatment failures were successfully repeated within a week. Mean fluoroscopy time was 6.4±6.2 min (range: 0.7-31.1 min). Mean air kerma was 36.2±52.2 mGy (range: 1.4-215.0 mGy). There were two major (1.8%) complications and four (3.7%) minor complications. Of the 96 procedures, 10 (10.4%), 9 (9.4%), 13 (13.5%), 28 (29.2%) and 36 (37.5%) were performed using protocol types A, B, C, D and E, respectively. For protocol type A, mean fluoroscopy time was 10.3±6.8 min (range: 3.0-25.4 min) and mean air kerma was 118.2±61.2 mGy (range: 24.5-167.3 mGy). For protocol type E, mean fluoroscopy time was 3.1±3.2 min (range: 0.7-15.1 min) and mean air kerma was 5.4±4.2 mGy (range: 1.4-19.5 mGy). Fluoroscopy time and air kerma decreased over time, corresponding to the reduced use of multiplanar imaging and digital subtraction angiography. In the first quartile (procedures 1-24), 8 (33.3%), 7 (29.2%), 2 (8.3%), 6 (25.0%) and 1 (4.2%) were performed using protocol types A, B, C, D and E, respectively. Mean fluoroscopy time was 10.5±8.2 min (range: 2.4-28.1 min) and mean air kerma was 84.2±71.6 mGy (range: 12.8-215.0 mGy). In the final quartile (procedures 73-96), 24 (100%) procedures were performed using protocol type E. Mean fluoroscopy time was 3.5±4.0 min (range: 0.7-15.1 min) and mean air kerma was 5.0±4.3 mGy (range: 1.4-18.0 mGy), representing 66.7% and 94.1% reductions from the first quartile, respectively. Technical success in the second half of the experience was 100%. CONCLUSION Sequence elimination, consolidation from biplane imaging to lateral-only imaging, and replacing digital subtraction with roadmap angiography dramatically reduced radiation exposure during IAC for retinoblastoma without adversely affecting technical success or safety.
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Affiliation(s)
- Eric J Monroe
- Section of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S R-5417, Seattle, WA, 98105, USA. .,Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Jeffrey Forris Beecham Chick
- Section of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S R-5417, Seattle, WA, 98105, USA.,Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Andrew W Stacey
- Section of Ocular Oncology, Department of Ophthalmology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Nathan E Millard
- Cancer and Blood Disorders Center, Section of Neuro-Oncology and Retinoblastoma, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - J Russell Geyer
- Cancer and Blood Disorders Center, Section of Neuro-Oncology and Retinoblastoma, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - L Ray Ramoso
- Section of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S R-5417, Seattle, WA, 98105, USA
| | - Basavaraj V Ghodke
- Section of Neurointerventional Radiology, Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Danial K Hallam
- Section of Neurointerventional Radiology, Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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Studzińska E, Staniszewska MA. Impact of Allura Clarity Technology on Radiation Dose Exposure During Left Atrial Appendage Closure. Pol J Radiol 2017; 82:598-602. [PMID: 29662591 PMCID: PMC5894036 DOI: 10.12659/pjr.902350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/24/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To evaluate the impact of the Clarity IQ technology on reducing radiation risk in patients undergoing cardiac interventional radiology (IR) procedures. MATERIAL/METHODS Phantom studies were performed with two angiographic systems, FD10 Allura Xper and FD10 Allura Clarity. In the study, we performed left atrial appendage closure. Dosimetric measurements were performed with thermoluminescent dosimeters (TLD) placed inside a CIRS anthropomorphic phantom. Radiation risk was estimated based on the TLD readings and expressed as the dose absorbed by particular organs. The Mann-Whitney U test was carried out to test for significance of differences in the absorbed radiation doses between the techniques. RESULTS During left atrial appendage closure, the estimated dose absorbed by particular organs was lower in the case of the FD10 Allura Clarity system in comparison to the Allura Xper. In this procedure, dose reduction for particular organs ranged between 49-86%. CONCLUSIONS Application of the FD10 Allura Clarity system resulted in a significant dose reduction, thereby leading to a significant decrease in radiation risk for patients undergoing IR procedures.
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Baumann F, Peña C, Kloeckner R, Katzen BT, Gandhi R, Benenati JB. The Effect of a New Angiographic Imaging Technology on Radiation Dose in Visceral Embolization Procedures. Vasc Endovascular Surg 2017; 51:183-187. [PMID: 28424042 DOI: 10.1177/1538574417698903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the impact of a new angiographic imaging technology on radiation dose during visceral embolization procedures involving both fluoroscopy and digital subtraction angiography. MATERIAL AND METHODS A retrospective analysis from a single-center consecutive series of patients was performed comparing 2 angiographic imaging systems. The AlluraClarity (CIQ; Philips Healthcare, Best, the Netherlands) was used in 100 patients (n = 59 male, mean age: 70.6 years) from July 2013 to April 2014 and compared to the former AlluraXper (AX) technology used in 139 patients (n = 71 male, mean age: 70.1 years) from May 2011 to June 2013. Patients were categorized according to body mass index (BMI [kg/m2])-group 1: BMI <25, group 2: BMI ≥25 and <30, and group 3: BMI ≥30. Fluoroscopy time, the total dose of iodinated contrast administered, and procedural AirKerma (Ka, r [mGy]) were obtained. RESULTS Mean BMI was 26.4 ± 5.0 kg/m2 in the CIQ and 26.4 ± 7.1 kg/m2 in the AX group ( P = .93). Fluoroscopy time and the amount of contrast media were equally distributed. Ka, r was 1342.9 mGy versus 2214.8 mGy ( P < .001, t test) when comparing CIQ to AX. Comparing CIQ to AX, BMI subgroup analysis revealed a mean Ka, r of 970.1 to 1586.1 mGy ( P = .003, t test), 1484.7 to 2170.1 mGy ( P = .02, t test), and 1848.8 to 3348.9 mGy ( P = .001, t test) in BMI groups 1, 2, and 3, respectively. CONCLUSION The CIQ technology significantly reduced mean radiation dose by 39.4% for visceral embolization procedures when compared to fluoroscopy time and contrast media dose. This dose relationship was consistent across all BMI groups.
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Affiliation(s)
- Frederic Baumann
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA.,2 Clinical and Interventional Angiology, University Hospital of Zurich, Zurich, Switzerland
| | - Constantino Peña
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - Roman Kloeckner
- 2 Clinical and Interventional Angiology, University Hospital of Zurich, Zurich, Switzerland.,3 Clinic for Interventional Radiology, University Hospital of Mainz, Mainz, Germany
| | - Barry T Katzen
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - Ripal Gandhi
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
| | - James B Benenati
- 1 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, FL, USA
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Gislason-Lee AJ, Keeble C, Egleston D, Bexon J, Kengyelics SM, Davies AG. Comprehensive assessment of patient image quality and radiation dose in latest generation cardiac x-ray equipment for percutaneous coronary interventions. J Med Imaging (Bellingham) 2017; 4:025501. [PMID: 28491907 PMCID: PMC5412945 DOI: 10.1117/1.jmi.4.2.025501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/14/2017] [Indexed: 11/14/2022] Open
Abstract
This study aimed to determine whether a reduction in radiation dose was found for percutaneous coronary interventional (PCI) patients using a cardiac interventional x-ray system with state-of-the-art image enhancement and x-ray optimization, compared to the current generation x-ray system, and to determine the corresponding impact on clinical image quality. Patient procedure dose area product (DAP) and fluoroscopy duration of 131 PCI patient cases from each x-ray system were compared using a Wilcoxon test on median values. Significant reductions in patient dose ([Formula: see text]) were found for the new system with no significant change in fluoroscopy duration ([Formula: see text]); procedure DAP reduced by 64%, fluoroscopy DAP by 51%, and "cine" acquisition DAP by 76%. The image quality of 15 patient angiograms from each x-ray system (30 total) was scored by 75 clinical professionals on a continuous scale for the ability to determine the presence and severity of stenotic lesions; image quality scores were analyzed using a two-sample [Formula: see text]-test. Image quality was reduced by 9% ([Formula: see text]) for the new x-ray system. This demonstrates a substantial reduction in patient dose, from acquisition more than fluoroscopy imaging, with slightly reduced image quality, for the new x-ray system compared to the current generation system.
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Affiliation(s)
| | - Claire Keeble
- University of Leeds, Division of Epidemiology and Biostatistics, Leeds, United Kingdom
| | - Daniel Egleston
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
| | - Josephine Bexon
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
| | | | - Andrew G. Davies
- University of Leeds, Division of Biomedical Imaging, Leeds, United Kingdom
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Joshi A, Gislason-Lee AJ, Keeble C, Sivananthan UM, Davies AG. Can image enhancement allow radiation dose to be reduced whilst maintaining the perceived diagnostic image quality required for coronary angiography? Br J Radiol 2017; 90:20160660. [PMID: 28124572 DOI: 10.1259/bjr.20160660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this research was to quantify the reduction in radiation dose facilitated by image processing alone for percutaneous coronary intervention (PCI) patient angiograms, without reducing the perceived image quality required to confidently make a diagnosis. METHODS Incremental amounts of image noise were added to five PCI angiograms, simulating the angiogram as having been acquired at corresponding lower dose levels (10-89% dose reduction). 16 observers with relevant experience scored the image quality of these angiograms in 3 states-with no image processing and with 2 different modern image processing algorithms applied. These algorithms are used on state-of-the-art and previous generation cardiac interventional X-ray systems. Ordinal regression allowing for random effects and the delta method were used to quantify the dose reduction possible by the processing algorithms, for equivalent image quality scores. RESULTS Observers rated the quality of the images processed with the state-of-the-art and previous generation image processing with a 24.9% and 15.6% dose reduction, respectively, as equivalent in quality to the unenhanced images. The dose reduction facilitated by the state-of-the-art image processing relative to previous generation processing was 10.3%. CONCLUSION Results demonstrate that statistically significant dose reduction can be facilitated with no loss in perceived image quality using modern image enhancement; the most recent processing algorithm was more effective in preserving image quality at lower doses. Advances in knowledge: Image enhancement was shown to maintain perceived image quality in coronary angiography at a reduced level of radiation dose using computer software to produce synthetic images from real angiograms simulating a reduction in dose.
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Affiliation(s)
- Anuja Joshi
- 1 Division of Biomedical Imaging, University of Leeds, Leeds, UK
| | | | - Claire Keeble
- 1 Division of Biomedical Imaging, University of Leeds, Leeds, UK.,2 Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | | | - Andrew G Davies
- 1 Division of Biomedical Imaging, University of Leeds, Leeds, UK
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Gislason-Lee AJ, Keeble C, Malkin CJ, Egleston D, Bexon J, Kengyelics SM, Blackman D, Davies AG. Impact of latest generation cardiac interventional X-ray equipment on patient image quality and radiation dose for trans-catheter aortic valve implantations. Br J Radiol 2016; 89:20160269. [PMID: 27610932 PMCID: PMC5124836 DOI: 10.1259/bjr.20160269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/31/2016] [Accepted: 09/08/2016] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This study aimed to determine the impact on radiation dose and image quality of a new cardiac interventional X-ray system for trans-catheter aortic valve implantation (TAVI) patients compared to the previously-used cardiac X-ray system. METHODS Patient dose and image data were retrospectively collected from a Philips AlluraClarity (new) and Siemens Axion Artis (reference) X-ray system. Patient dose area product (DAP) and fluoroscopy duration of 41 patient cases from each X-ray system were compared using a Wilcoxon test. Ten patient aortograms from each X-ray system were scored by 32 observers on a continuous scale to assess the clinical image quality at the given phase of the TAVI procedure. Scores were dichotomised by acceptability and analysed using a Chi-squared test. RESULTS Significant reductions in patient dose (p << 0.001) were found for the new system with no significant change in fluoroscopy duration (p = 0.052); procedure DAP reduced by 55%, fluoroscopy DAP by 48% and "cine" acquisition DAP by 61%. There was no significant difference between image quality scores of the two X-ray systems (p = 0.06). CONCLUSIONS The new cardiac X-ray system demonstrated a very significant reduction in patient dose with no loss of clinical image quality. Advances in Knowledge: The huge growth of TAVI may impact on the radiation exposure of cardiac patients and particularly on operators including anaesthetists; cumulative exposure of interventional cardiologists performing high volume TAVI over 30-40 years may be harmful. The Phillips Clarity upgrade including improved image enhancement and optimised X-ray settings significantly reduced radiation without reducing clinically acceptable image quality.
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Affiliation(s)
| | - Claire Keeble
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | | | - Daniel Egleston
- Division of Biomedical Imaging, University of Leeds, Leeds, UK
| | - Josephine Bexon
- Division of Biomedical Imaging, University of Leeds, Leeds, UK
| | | | - Daniel Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Andrew G Davies
- Division of Biomedical Imaging, University of Leeds, Leeds, UK
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Durrani RJ, Fischman AM, van der Bom IMJ, Kim E, Nowakowski FS, Patel RS, Lookstein RA. Radiation dose reduction utilizing noise reduction technology during uterine artery embolization: a pilot study. Clin Imaging 2016; 40:378-81. [PMID: 27133671 DOI: 10.1016/j.clinimag.2015.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/22/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the radiation dose reduction during uterine artery embolization utilizing dose reduction technology. METHODS A total of 58 women underwent uterine artery embolization. A total of 26 procedures were performed in a standard fluoroscopy suite; 32 procedures were performed utilizing a novel imaging platform. Radiation dose data and acquisition parameters were compared. RESULTS The new platform provided significant reduction in the median radiation dose (P<.001): from 389Gy cm(2) to 145Gy cm(2). There were no differences between the groups with regard to acquisition parameters. CONCLUSION The new imaging platform provided a 61% dose reduction during uterine artery embolization without a significant change in acquisition parameters.
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Affiliation(s)
- Raisa J Durrani
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level Room 801, New York, NY 10029.
| | - Aaron M Fischman
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level Room 801, New York, NY 10029.
| | | | - Edward Kim
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level Room 801, New York, NY 10029.
| | - F Scott Nowakowski
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level Room 801, New York, NY 10029.
| | - Rahul S Patel
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level Room 801, New York, NY 10029.
| | - Robert A Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, MC Level Room 801, New York, NY 10029.
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Wen X, Jiang X, Li R, Zhang J, Yang P, Shen B. Novel X-Ray Imaging Technology Allows Substantial Patient Radiation Reduction without Image Quality Impairment in Repetitive Transarterial Chemoembolization for Hepatocellular Carcinoma. Acad Radiol 2015; 22:1361-7. [PMID: 26472122 DOI: 10.1016/j.acra.2015.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES To assess patient radiation dose reduction and the image quality of a new X-ray imaging technology during repetitive transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). METHODS Fifty HCC patients (36 men; 57 ± 11 years) undergoing repetitive TACE were first randomly assigned to receive a TACE treatment on a reference X-ray system or a low-dose system with advanced real-time image processing. The alternate system was used for a repeated TACE (treatment interval, 0.5-6 months). Fluoroscopy time, number of digital subtraction angiography (DSA), air kerma (AK), and dose area product (DAP) were compared between the two systems and between the two repetitive TACE. Three interventional radiologists independently rated the image quality in blinded offline readings. RESULTS Fluoroscopy time (8.7 ± 5.9 minutes vs. 8.7 ± 7.9 minutes, P = .981), numbers of DSA runs (6 ± 4 vs. 6 ± 4, P = .735), and exposure images (173 ± 86 vs. 168 ± 91, P = .916) were equivalent between the two systems. No statistical difference in X-ray usage was found between repeated treatments. Compared to the reference system, the technology significantly reduced AK and DAP by 48.6% (0.17 ± 0.13 Gy vs. 0.41 ± 0.36 Gy, P < .0001) and 50.3% (77.3 ± 55.2 Gy cm(2) vs. 195.0 ± 155.5 Gy cm(2), P < .0001), respectively. Image quality was rated comparable between the new system and the reference, with average scores of 3.9 ± 0.3 versus 4.4 ± 0.3 in fluoroscopy and 4.5 ± 0.2 versus 4.3 ± 0.3 in DSA. CONCLUSIONS Patient radiation exposure can be substantially reduced by a factor of approximately two with the novel X-ray imaging technology while maintaining image quality.
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Affiliation(s)
- Xiaofei Wen
- Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Xianxian Jiang
- Image Guided Therapy Systems, Philips Healthcare Australia, SA, Australia
| | - Renfei Li
- Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Junya Zhang
- Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Po Yang
- Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Baozhong Shen
- Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China.
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Radiation-Induced Cataractogenesis: A Critical Literature Review for the Interventional Radiologist. Cardiovasc Intervent Radiol 2015; 39:151-60. [DOI: 10.1007/s00270-015-1207-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
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Bracken JA, Mauti M, Kim MS, Messenger JC, Carroll JD. A Radiation Dose Reduction Technology to Improve Patient Safety During Cardiac Catheterization Interventions. J Interv Cardiol 2015; 28:493-7. [DOI: 10.1111/joic.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- John A. Bracken
- University of Colorado Denver; Aurora Colorado
- Philips Healthcare; Markham, Ontario Canada
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Strauss KJ, Racadio JM, Abruzzo TA, Johnson ND, Patel MN, Kukreja KU, den Hartog MJH, Hoonaert BPA, Nachabe RA. Comparison of pediatric radiation dose and vessel visibility on angiographic systems using piglets as a surrogate: antiscatter grid removal vs. lower detector air kerma settings with a grid - a preclinical investigation. J Appl Clin Med Phys 2015; 16:408-417. [PMID: 26699297 PMCID: PMC5690159 DOI: 10.1120/jacmp.v16i5.5379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 06/03/2015] [Accepted: 06/07/2015] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to reduce pediatric doses while maintaining or improving image quality scores without removing the grid from X‐ray beam. This study was approved by the Institutional Animal Care and Use Committee. Three piglets (5, 14, and 20 kg) were imaged using six different selectable detector air kerma (Kair) per frame values (100%, 70%, 50%, 35%, 25%, 17.5%) with and without the grid. Number of distal branches visualized with diagnostic confidence relative to the injected vessel defined image quality score. Five pediatric interventional radiologists evaluated all images. Image quality score and piglet Kair were statistically compared using analysis of variance and receiver operating curve analysis to define the preferred dose setting and use of grid for a visibility of 2nd and 3rd order vessel branches. Grid removal reduced both dose to subject and imaging quality by 26%. Third order branches could only be visualized with the grid present; 100% detector Kair was required for smallest pig, while 70% detector Kair was adequate for the two larger pigs. Second order branches could be visualized with grid at 17.5% detector Kair for all three pig sizes. Without the grid, 50%, 35%, and 35% detector Kair were required for smallest to largest pig, respectively. Grid removal reduces both dose and image quality score. Image quality scores can be maintained with less dose to subject with the grid in the beam as opposed to removed. Smaller anatomy requires more dose to the detector to achieve the same image quality score. PACS numbers: 87.53.Bn, 87.57.N‐, 87.57.cj, 87.59.cf, 87.59.Dj
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Affiliation(s)
- Keith J Strauss
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine.
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Kohlbrenner R, Kolli KP, Taylor AG, Kohi MP, Fidelman N, LaBerge JM, Kerlan RK, Agarwal VK, Lehrman ED, Nanavati S, Avrin DE, Gould R. Patient Radiation Dose Reduction during Transarterial Chemoembolization Using a Novel X-Ray Imaging Platform. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2015.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures. AJR Am J Roentgenol 2015; 204:W713-9. [PMID: 26001261 DOI: 10.2214/ajr.14.13630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of our study was to survey radiation dose indexes of pediatric peripheral and abdominal fluoroscopically guided procedures from which estimates of diagnostic reference levels (DRLs) can be proposed for both a standard fluoroscope and a novel fluoroscope with advanced image processing and lower radiation dose rates. MATERIALS AND METHODS Radiation dose structured reports were retrospectively collected for 408 clinical pediatric cases: Half of the procedures were performed with a standard imaging technology and half with a novel x-ray technology. Dose-area product (DAP), air Kerma (AK), fluoroscopy time, number of digital subtraction angiography images, and patient mass were collected to calculate and normalize radiation dose indexes for procedures completed with the standard and novel fluoroscopes. RESULTS The study population was composed of 180 and 175 patients who underwent procedures with the standard and novel technology, respectively. The 21 different types of pediatric peripheral and abdominal interventional procedures produced 408 total studies. Median ages, mass and body mass index, fluoroscopy time per procedure, and total number of recorded images for the standard and novel technologies were not statistically different. The area of the x-ray beams was square at the level of the patient with a dimension of 10-13 cm. The dose reduction achieved with the novel fluoroscope ranged from 18% to 51% of the dose required with the standard fluoroscope. The median DAP and AK patient dose indexes were 0.38 Gy · cm(2) and 4.00 mGy, respectively, for the novel fluoroscope. CONCLUSION Estimates of dose indexes of pediatric peripheral and abdominal fluoroscopically guided, clinical procedures should assist in the development of DRLs to foster management of radiation doses of pediatric patients.
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Evaluation of a Noise Reduction Imaging Technology in Iliac Digital Subtraction Angiography: Noninferior Clinical Image Quality with Lower Patient and Scatter Dose. J Vasc Interv Radiol 2015; 26:642-50.e1. [DOI: 10.1016/j.jvir.2015.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 11/20/2022] Open
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Patient radiation dose reduction using an X-ray imaging noise reduction technology for cardiac angiography and intervention. Heart Vessels 2015; 31:655-63. [DOI: 10.1007/s00380-015-0667-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/20/2015] [Indexed: 12/21/2022]
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Haas NA, Happel CM, Mauti M, Sahyoun C, Tebart LZ, Kececioglu D, Laser KT. Substantial radiation reduction in pediatric and adult congenital heart disease interventions with a novel X-ray imaging technology. IJC HEART & VASCULATURE 2015; 6:101-109. [PMID: 28785634 PMCID: PMC5497176 DOI: 10.1016/j.ijcha.2015.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/10/2015] [Accepted: 01/13/2015] [Indexed: 11/25/2022]
Abstract
Background Pediatric catheterization exposes patients to varying radiation doses. Concerns over the effects of X-ray radiation dose on the patient population have increased in recent years. This study aims at quantifying the patient radiation dose reduction after the introduction of an X-ray imaging technology using advanced real time image noise reduction algorithms and optimized acquisition chain for fluoroscopy and exposure in a pediatric and adult population with congenital heart disease. Methods Patient and radiation dose data was retrospectively collected (July 2012–February 2013) for 338 consecutive patients treated with a system using state of the art image processing and reference acquisition chain (referred as “reference system”). The same data was collected (March–October 2013) for 329 consecutive patients treated with the new imaging technology (Philips AlluraClarity, referred as “new system”). Patients were divided into three weight groups: A) below 10 kg, B) 10–40 kg, and C) over 40 kg. Radiation dose was quantified using dose area product (DAP), while procedure complexity using fluoroscopy time, procedure duration and volume of contrast medium. Results The new system provides significant patient dose reduction compared to the reference system. Median DAP values were reduced in group A) from 140.6 cGy·cm2 to 60.7 cGy·cm2, in group B) from 700.0 cGy·cm2 to 202.2 cGy·cm2 and in group C) from 4490.4 cGy·cm2 to 1979.8 cGy·cm2 with reduction of 57%, 71% and 56% respectively (p < 0.0001 for all groups). Conclusions Despite no other changes in procedural approach, the novel X-ray imaging technology provided substantial radiation dose reduction of 56% or higher. x-ray radiation dose in pediatric patients is of specific concern as congenital heart disease is more often treated by interventional measures. the effect of advanced real time image noise reduction algorithms and optimized acquisition chain for fluoroscopy and exposure was studied. A state of the art image processing and reference acquisition chain was compared to the new imaging technology in 338 vs 329 consecutive patients. Patients were divided into three weight groups: A) below 10 kg, B) 10-40 kg, and C) over 40 kg according to clinical practice and procedure complexity. the novel X-ray imaging technology provided substantial radiation dose reduction of 56% or higher.
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Affiliation(s)
- Nikolaus A Haas
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | - Christoph M Happel
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | | | | | - Lea Z Tebart
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | - Deniz Kececioglu
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | - Kai Thorsten Laser
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
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