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Ohno S, Konta S, Shindo R, Yamamoto K, Isobe R, Inaba Y, Suzuki M, Zuguchi M, Chida K. Effect of backscatter radiation on the occupational eye-lens dose. JOURNAL OF RADIATION RESEARCH 2024; 65:450-458. [PMID: 38818635 PMCID: PMC11262866 DOI: 10.1093/jrr/rrae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/21/2024] [Indexed: 06/01/2024]
Abstract
We quantified the level of backscatter radiation generated from physicians' heads using a phantom. We also evaluated the shielding rate of the protective eyewear and optimal placement of the eye-dedicated dosimeter (skin surface or behind the Pb-eyewear). We performed diagnostic X-rays of two head phantoms: Styrofoam (negligible backscatter radiation) and anthropomorphic (included backscatter radiation). Radiophotoluminescence glass dosimeters were used to measure the eye-lens dose, with or without 0.07-mm Pb-equivalent protective eyewear. We used tube voltages of 50, 65 and 80 kV because the scattered radiation has a lower mean energy than the primary X-ray beam. The backscatter radiation accounted for 17.3-22.3% of the eye-lens dose, with the percentage increasing with increasing tube voltage. Furthermore, the shielding rate of the protective eyewear was overestimated, and the eye-lens dose was underestimated when the eye-dedicated dosimeter was placed behind the protective eyewear. We quantified the backscatter radiation generated from physicians' heads. To account for the effect of backscatter radiation, an anthropomorphic, rather than Styrofoam, phantom should be used. Close contact of the dosimeter with the skin surface is essential for accurate evaluation of backscatter radiation from physician's own heads. To assess the eye-lens dose accurately, the dosimeter should be placed near the eye. If the dosimeter is placed behind the lens of the protective eyewear, we recommend using a backscatter radiation calibration factor of 1.2-1.3.
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Affiliation(s)
- Saya Ohno
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Satoe Konta
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Ryota Shindo
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Keisuke Yamamoto
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Rio Isobe
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Yohei Inaba
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
| | - Masatoshi Suzuki
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
| | - Masayuki Zuguchi
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
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Roberto MR, Leite LMA, Cruz ARP, Khoury H, de Barros VSM, Neves JR, Cartaxo JM, Ubeda C, Asfora VK. Medical staff dose estimation during pediatric cardiac interventional procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021516. [PMID: 38722296 DOI: 10.1088/1361-6498/ad4905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
The purpose of this study is to evaluate the occupational doses (eye lens, extremities and whole body) in paediatric cardiac interventional and diagnostic catheterization procedures performed in a paediatric reference hospital located in Recife, Pernambuco. For eye lens dosimetry, the results show that the left eye receives a higher dose than the right eye, and there is a small difference between the doses received during diagnostic (D) and therapeutic (T) procedures. The extrapolated annual values for the most exposed eye are close to the annual limit. For doses to the hands, it was observed that in a significant number of procedures (37 out of 45 therapeutic procedures, or 82%) at least one hand of the physician was exposed to the primary beam. During diagnostic procedures, the physician's hand was in the radiation field in 11 of the 17 catheterization procedures (65%). This resulted in a 10-fold increase in dose to the hands. The results underscore the need for optimization of radiation safety and continued efforts to engage staff in a radiation safety culture.
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Affiliation(s)
| | - Luiz M A Leite
- Nuclear Energy Departament, Universidade Federal de Pernambuco-UFPE, Recife, Brazil
| | - Arícia R P Cruz
- Nuclear Energy Departament, Universidade Federal de Pernambuco-UFPE, Recife, Brazil
| | - Helen Khoury
- Nuclear Energy Departament, Universidade Federal de Pernambuco-UFPE, Recife, Brazil
| | | | - Juliana R Neves
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
| | - Jéssica M Cartaxo
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
| | - Carlos Ubeda
- Medical Technology Department, Health Sciences Faculty, Tarapaca University, Arica, Chile
| | - Viviane K Asfora
- Nuclear Energy Departament, Universidade Federal de Pernambuco-UFPE, Recife, Brazil
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Ruff C, Partovi S, Strobel I, Kaleth S, Herz K, Nikolaou K, Levitin A, Kirksey L, Syha R, Artzner C, Grözinger G. Radiation Exposure and Safety Considerations in Interventional Radiology: Comparison of a Twin Robotic X-ray System to a Conventional Angiography System. J Clin Med 2024; 13:2732. [PMID: 38792273 PMCID: PMC11122633 DOI: 10.3390/jcm13102732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/25/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: To evaluate radiation exposure in standard interventional radiology procedures using a twin robotic X-ray system compared to a state-of-the-art conventional angiography system. Methods: Standard interventional radiology procedures (port implantation, SIRT, and pelvic angiography) were simulated using an anthropomorphic Alderson RANDO phantom (Alderson Research Laboratories Inc. Stamford, CT, USA) on an above-the-table twin robotic X-ray scanner (Multitom Rax, Siemens Healthineers, Forchheim, Germany) and a conventional below-the-table angiography system (Artis Zeego, Siemens Healthineers, Forchheim, Germany). The phantom's radiation exposure (representing the potential patient on the procedure table) was measured with thermoluminescent dosimeters. Height-dependent dose curves were generated for examiners and radiation technologists in representative positions using a RaySafe X2 system (RaySafe, Billdal, Sweden). Results: For all scenarios, the device-specific dose distribution differs depending on the imaging chain, with specific advantages and disadvantages. Radiation exposure for the patient is significantly increased when using the Multitom Rax for pelvic angiography compared to the Artis Zeego, which is evident in the dose progression through the phantom's body as well as in the organ-related radiation exposure. In line with these findings, there is an increased radiation exposure for the performing proceduralist, especially at eye level, which can be significantly minimized by using protective equipment (p < 0.001). Conclusions: In this study, the state-of-the-art conventional below-the-table angiography system is associated with lower radiation dose exposures for both the patient and the interventional radiology physician compared to an above-the-table twin robotic X-ray system for pelvic angiographies. However, in other clinical scenarios (port implantation or SIRT), both devices are suitable options with acceptable radiation exposure.
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Affiliation(s)
- Christer Ruff
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Sasan Partovi
- Interventional Radiology, Cleveland Clinic Main Campus, Cleveland, OH 44195, USA
| | - Isabella Strobel
- Department of Radiation Protection, University Hospital Tuebingen, Auf der Morgenstelle 24, 72076 Tuebingen, Germany
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany
| | - Stella Kaleth
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Klaus Herz
- Department of Radiation Protection, University Hospital Tuebingen, Auf der Morgenstelle 24, 72076 Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Abraham Levitin
- Interventional Radiology, Cleveland Clinic Main Campus, Cleveland, OH 44195, USA
| | - Levester Kirksey
- Vascular Surgery, Cleveland Clinic Main Campus, Cleveland, OH 44195, USA
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
- Department of Diagnostic and Interventional Radiology, Prosper Hospital, Muehlenstraße 27, 45659 Recklinghausen, Germany
| | - Christoph Artzner
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
- Department of Diagnostic and Interventional Radiology, Diakonie Klinikum Stuttgart, Rosenbergstraße 38, 70176 Stuttgart, Germany
| | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
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Clauss N, Kuntz S, Colvard B, Ohana M, Mertz L, Lejay A, Chakfe N. Intraoperative Staff Radiation Exposure During Aortic Endovascular Procedures. Ann Vasc Surg 2024; 106:16-24. [PMID: 38641000 DOI: 10.1016/j.avsg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The risk of radiation exposure in the surgical operating room (OR) and/or catheterization laboratory is now well established. Complex endovascular procedures often require multiple approaches and different positioning of the staff members around the patient, potentially increasing the levels of radiations exposure. Our goal was to evaluate the levels of radiation exposure of the members of the staff during endovascular aortic procedures in order to propose radioprotection optimization. METHODS We included 41 aortic endovascular procedures out of 114 procedures performed between January 12, 2014, and August 31, 2015, including 24 standard endovascular aortic aneurysm repair (EVAR), 7 EVAR with iliac branch (EVARib), 8 complex fenestrated/branched EVAR (F/B EVAR), and 2 thoracic EVAR (TEVAR). Procedures were performed in an OR equipped with a carbon fiber table and a mobile fluoroscopy C-arm. We collected the usual dosimetry data given by the C-arm as well as the patient's peak skin dose (PSD). In all staff members, radiation exposure was measured with thermoluminescent chip dosimeters placed on both temples, on posterior sides of both hands, and on both lower legs. RESULTS PSD levels were low for EVAR because 24 patients had values below the reading threshold. PSD significantly increased with more complex procedures. Main operator (MO) received the higher level of irradiation on whole body, hands, and ankles. Eye lenses irradiation was higher on both assistant operators (AOs). Other members received low levels of irradiation. We found a high ranges of radiation exposure with a high risk of exposure for the AO, mainly for F/B EVAR and EVARib. CONCLUSIONS Even if all personal protections are used, staff positioning is a major point that must be considered. If MO is supposed to be the most exposed to X-rays, specific conditions of positioning of the AO may be at risk of exposure.
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Affiliation(s)
- Nicolas Clauss
- Unit of Radiophysic and Radioprotection, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- GEPROMED, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Benjamin Colvard
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH
| | - Mickael Ohana
- Department of Radiology, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Luc Mertz
- Unit of Radiophysic and Radioprotection, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Unit of Radiophysic and Radioprotection, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France; GEPROMED, Strasbourg, France; Fédération de Médecine Translationelle (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d'Accueil EA3072 "Mitochondrie, Stress Oxydant et Protection Musculaire", Université de Strasbourg, Strasbourg, France
| | - Nabil Chakfe
- Unit of Radiophysic and Radioprotection, Les Hôpitaux Universitaires de Strasbourg, University of Strasbourg, Strasbourg, France; GEPROMED, Strasbourg, France; Fédération de Médecine Translationelle (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d'Accueil EA3072 "Mitochondrie, Stress Oxydant et Protection Musculaire", Université de Strasbourg, Strasbourg, France.
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Ramanathan V, Senarathna HS, Gunaratna HU, Bandara PM, Horadigala CJ. Establishment of institutional diagnostic reference level for coronary angiography procedures in Sri Lanka. RADIATION PROTECTION DOSIMETRY 2023; 199:2311-2317. [PMID: 37624229 DOI: 10.1093/rpd/ncad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023]
Abstract
Amongst many interventional procedures performed in a cardiac catheterisation laboratory, the coronary angiography (CAG) is the most frequently performed cardiac interventional procedure. A diagnostic reference level (DRL) is an effective tool to optimise the radiation exposure to patients and staff whilst maintaining the adequate diagnostic image quality. The aim of the study was to establish institutional DRLs for the CAG procedures performed at a selected private hospital in Colombo, Sri Lanka. A total of 325 CAG procedures were selected for this study from two C-arm machines. The institutional DRLs of cumulative dose length product (DAP) and fluoroscopic time for the CAG procedure were calculated. The established institutional DRL for accumulated DAP and fluoroscopic time are 10 610 mGycm2 and 2.31 min, respectively. As this study conducted at only one institute we recommend to develop national DRLs for mostly performing interventional procedures in Sri Lanka by considering all influencing factors to optimise the patient dose.
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Affiliation(s)
- Vijitha Ramanathan
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Hasalanka S Senarathna
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Hasun U Gunaratna
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Praneeth M Bandara
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
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Jerele C, Lovrič D, Kuhelj D. Pediatric Interventional Neuroradiology: Opportunities and Challenges. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040715. [PMID: 37189964 DOI: 10.3390/children10040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
Pediatric interventional neuroradiology (PINR) is a relatively new field of diagnostic and therapeutic care in the pediatric population that has seen considerable advances in recent decades. However, it is still lagging behind adult interventional neuroradiology due to a variety of reasons, including the lack of evidence validating pediatric-specific procedures, the relative absence of pediatric-specific equipment, and the challenges in establishing and maintaining PINR competencies in a relatively small number of cases. Despite these challenges, the number and variety of PINR procedures are expanding for a variety of indications, including unique pediatric conditions, and are associated with reduced morbidity and psychological stigma. Continued technological advances, such as improved catheter and microwire designs and novel embolic agents, are also contributing to the growth of the field. This review aims to increase awareness of PINR and provide an overview of the current evidence base for minimally invasive neurological interventions in children. Important considerations, such as sedation, contrast agent use, and radiation protection, will also be discussed, taking into account the distinct characteristics of the pediatric population. The review highlights the usefulness and benefits of PINR and emphasizes the need for ongoing research and development to further advance this field.
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Affiliation(s)
- Cene Jerele
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1104 Ljubljana, Slovenia
| | - Dimitrij Lovrič
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia
| | - Dimitrij Kuhelj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1104 Ljubljana, Slovenia
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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8
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Masubuchi Y, Chida K, Inaba Y, Kageyama M, Shimada S, Yamashita A. [Patient Radiation Dose for Percutaneous Coronary Intervention by Treatment Area: Dosimetry Using DRLs 2020]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:1306-1313. [PMID: 36198569 DOI: 10.6009/jjrt.2022-1309] [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] [Indexed: 06/16/2023]
Abstract
PURPOSE Skin injury in patients due to radiation exposure has been a complication in percutaneous coronary intervention (PCI) for a long time. To the best of our knowledge, there have been no reports comparing radiation dose by treatment area with diagnostic reference levels (DRLs) 2020, although the radiation dose varies by treatment area in PCI. METHODS In this study, the treatment areas were classified into four segments (i.e., AHA #1-3, AHA #4, AHA #5-10, and AHA #11-15), and each segment was compared with DRLs 2020. This retrospective study included 984 consecutive patients with single-vessel disease and non-chronic total occlusion. PCI was performed on a single device. RESULTS The median radiation dose was 1640.8 mGy, and the radiation dose for AHA #4 was 2732.0 mGy, which was significantly higher than the other treatment areas (p<0.001). In AHA #4, the radiation dose increased due to the heavy use of the left cranial view, and the patient background contributed to the increased lesion complexity. Therefore, it was challenging to evaluate AHA #4 and the other treatment areas with a uniform DRL value. CONCLUSION Establishing a subdivided index for each treatment area is crucial if DRLs are used as a reference during procedures and as a guide for dose optimization.
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Affiliation(s)
- Yusuke Masubuchi
- Department of Radiology, Nasu Red Cross Hospital
- Department of Radiological Examination and Technology, Tohoku University Graduate School of Medicine
| | - Koichi Chida
- Department of Radiological Examination and Technology, Tohoku University Graduate School of Medicine
- Disaster Medical Radiology, Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University
| | - Yohei Inaba
- Department of Radiological Examination and Technology, Tohoku University Graduate School of Medicine
- Disaster Medical Radiology, Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University
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Jones AK, Wunderle KA, Fruscello T, Simanowith M, Cline B, Dharmadhikari S, Duan X, Durack JC, Hirschl D, Kim DS, Mahmood U, Mann SD, Martin C, Metwalli Z, Moirano JM, Neill RA, Newsome J, Padua H, Schoenfeld AH, Miller DL. Patient Radiation Doses in Interventional Radiology Procedures: Comparison of fluoroscopy dose indices from the American College of Radiology Dose Index Registry-Fluoroscopy (DIR-Fluoro) Pilot to the RAD-IR study. J Vasc Interv Radiol 2022; 34:556-562.e3. [PMID: 36031041 DOI: 10.1016/j.jvir.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare interventional radiology fluoroscopically-guided intervention (FGI) radiation dose index distributions from the American College of Radiology (ACR) Fluoroscopy Dose Index Registry (DIR-Fluoro) pilot to the Radiation Doses in Interventional Radiology (RAD-IR) study. MATERIALS AND METHODS Individual and grouped ACR Common IDs (procedure types) from the DIR-Fluoro pilot were matched to procedure types in the RAD-IR study. Fifteen comparisons were made. Distribution parameters including the 10th, 25th, 50th, 75th, and 95th percentiles were compared for fluoroscopy time (FT), cumulative air kerma (Ka,r), and kerma area product (PKA). Two derived indices were computed using median dose indices. The procedure-averaged reference air kerma rate (Ka,r¯) was computed as Ka,r / FT. The procedure-averaged X-ray field size at the reference point (Ar¯) was computed as PKA / (Ka,r * 1,000). RESULTS Median FT was equally likely to be higher or lower in the DIR-Fluoro pilot compared to RAD-IR, while maximum FT was almost twice as likely to be higher in DIR-Fluoro than RAD-IR. Median Ka,r was lower in the DIR-Fluoro pilot for all procedures, as was median PKA. The maximum Ka,r and PKA were more often higher in the DIR-Fluoro pilot compared to RAD-IR. Ka,r¯ followed the same pattern as Ka,r, while Ar¯ was often greater in DIR-Fluoro. CONCLUSIONS Median dose indices have decreased since the RAD-IR study. Typical Ka,r rates are lower, a result of the use of lower default dose rates. However, opportunities for quality improvement exist, including a renewed focus on tight collimation of the imaging field of view.
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Affiliation(s)
- A Kyle Jones
- The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1472, Houston, TX 77030.
| | | | | | | | | | | | - Xinhui Duan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Usman Mahmood
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Zeyad Metwalli
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - Donald L Miller
- United States Food and Drug Administration, Silver Spring, MD
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Kozuma K, Chikamori T, Hashimoto J, Honye J, Ikeda T, Ishiwata S, Kato M, Kondo H, Matsubara K, Matsumoto K, Matsumoto N, Motoyama S, Obunai K, Sakamoto H, Soejima K, Suzuki S, Abe K, Amano H, Hioki H, Iimori T, Kawai H, Kosuge H, Nakama T, Suzuki Y, Takeda K, Ueda A, Yamashita T, Hirao K, Kimura T, Nagai R, Nakamura M, Shimizu W, Tamaki N. JCS 2021 Guideline on Radiation Safety in Cardiology. Circ J 2022; 86:1148-1203. [DOI: 10.1253/circj.cj-21-0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ken Kozuma
- Division of Cardiology, Teikyo University Hospital
| | | | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine
| | - Junko Honye
- Department of Cardiology, Kikuna Memorial Hospital
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | - Mamoru Kato
- Department of Radiology, Akita Cerebrospinal and Cardiovascular Center
| | | | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Kazuma Matsumoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | | | | | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital
| | - Shigeru Suzuki
- Department of Radiology, Totsuka Kyouritsu Daini Hospital
| | - Koichiro Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University
| | - Hideo Amano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | | | - Hideki Kawai
- Department of Cardiology, Fujita Health University
| | | | | | | | | | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | | | - Kenzo Hirao
- Division of Cardiovascular Medicine, AOI Universal Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Ryozo Nagai
- Department of Cardiovascular Medicine, Jichi Medical University
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine
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Lee NJ, Leung E, Buchanan IA, Geiselmann M, Coury JR, Simhon ME, Zuckerman S, Buchholz AL, Pollina J, Jazini E, Haines C, Schuler TC, Good CR, Lombardi J, Lehman RA. A multicenter study of the 5-year trends in robot-assisted spine surgery outcomes and complications. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:9-20. [PMID: 35441099 PMCID: PMC8990386 DOI: 10.21037/jss-21-102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/12/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Although a growing amount of literature that suggests robots are safe and can achieve comparable outcomes to conventional techniques, much of this literature is limited by small sample sizes and single-surgeon or single center series. Furthermore, it is unclear what the impact of robotic technology has made on operative and clinical outcomes over time. This is the first and largest multicenter study to examine the trends in outcomes and complications after robot-assisted spine surgery over a 5-year period. METHODS Adult (≥18 years old) patients who underwent spine surgery with robot-assistance between 2015 and 2019 at four unique spine centers. The robotic systems used included the Mazor Renaissance, Mazor X, and Mazor Stealth Edition. Patients with incomplete data were excluded from this study. The minimum follow-up was 90 days. RESULTS A total of 722 adult patients were included (117 Renaissance, 477 X, 128 Stealth). Most patient and operative factors (e.g., sex, tobacco status, total instrumented levels, and pelvic fixation,) were similar across the years. Mean ± standard deviation Charlson comorbidity index (CCI) was 1.5±1.5. The most commonly reported diagnoses included high grade spondylolisthesis (40.6%), degenerative disc disease (18.4%), and degenerative scoliosis (17.6%). Mean (standard deviation) number of instrumented levels was 3.8±3.4. From 2015 to 2019, average robot time per screw improved from 7.2 to 5.5 minutes (P=0.004, R2=0.649). Average fluoroscopy time per screw improved from 15.2 to 9.4 seconds (P=0.002). Rates of both intraoperative screw exchange for misplaced screw (2015-2016: 2.7%, 2019: 0.8%, P=0.0115, R2=0.1316) and robot abandonment (2015-2016: 7.1%, 2019: 1.1%, P=0.011, R2=0.215) improved significantly over time. The incidence of other intraoperative complications (e.g., dural tear, loss of motor/sensory function, blood transfusion) remained consistently low, but similar throughout the years. The length of stay (LOS) decreased by nearly 1 day from 2015 to 2019 (P=0.007, R2=0.779). 90-day reoperation rates did not change significantly. CONCLUSIONS At four institutions among seven surgeons, we demonstrate robot screw accuracy, reliability, operative efficiency, and radiation exposure improved significantly from 2015 to 2019. 90-day complication rates remained low and LOS decreased significantly with time. These findings further validate continued usage of robot-assisted spine surgery and the path toward improved value-based care.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Eric Leung
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ian A. Buchanan
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Matthew Geiselmann
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Josephine R. Coury
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Matthew E. Simhon
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Scott Zuckerman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Avery L. Buchholz
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - John Pollina
- Department of Neurosurgery, State University of New York, Buffalo, NY, USA
| | - Ehsan Jazini
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | - Colin Haines
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | - Thomas C. Schuler
- Department of Orthopaedics, Virginia Spine Institute, Reston, VA, USA
| | | | - Joseph Lombardi
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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Iddins CJ, DiCarlo AL, Ervin MD, Herrera-Reyes E, Goans RE. Cutaneous and local radiation injuries. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:10.1088/1361-6498/ac241a. [PMID: 34488201 PMCID: PMC8785213 DOI: 10.1088/1361-6498/ac241a] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
The threat of a large-scale radiological or nuclear (R/N) incident looms in the present-day climate, as noted most recently in an editorial in Scientific American (March 2021). These large-scale incidents are infrequent but affect large numbers of people. Smaller-scale R/N incidents occur more often, affecting smaller numbers of people. There is more awareness of acute radiation syndrome (ARS) in the medical community; however, ionising radiation-induced injuries to the skin are much less understood. This article will provide an overview of radiation-induced injuries to the skin, deeper tissues, and organs. The history and nomenclature; types and causes of injuries; pathophysiology; evaluation and diagnosis; current medical management; and current research of the evaluation and management are presented. Cutaneous radiation injuries (CRI) or local radiation injuries (LRI) may lead to cutaneous radiation syndrome, a sub-syndrome of ARS. These injuries may occur from exposure to radioactive particles suspended in the environment (air, soil, water) after a nuclear detonation or an improvised nuclear detonation (IND), a nuclear power plant incident, or an encounter with a radioactive dispersal or exposure device. These incidents may also result in a radiation-combined injury; a chemical, thermal, or traumatic injury, with radiation exposure. Skin injuries from medical diagnostic and therapeutic imaging, medical misadministration of nuclear medicine or radiotherapy, occupational exposures (including research) to radioactive sources are more common but are not the focus of this manuscript. Diagnosis and evaluation of injuries are based on the scenario, clinical picture, and dosimetry, and may be assisted through advanced imaging techniques. Research-based multidisciplinary therapies, both in the laboratory and clinical trial environments, hold promise for future medical management. Great progress is being made in recognising the extent of injuries, understanding their pathophysiology, as well as diagnosis and management; however, research gaps still exist.
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Affiliation(s)
- Carol J Iddins
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
| | - Andrea L DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States of America
| | - Mark D Ervin
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
| | | | - Ronald E Goans
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
- MJW Corporation, Buffalo, NY, United States of America
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13
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Wei KC, Lai SF, Huang WL, Yang KC, Lai PC, Wei WJ, Chang TH, Huang YC, Tsai YC, Lin SC, Lin SJ, Lin SC. An innovative targeted therapy for fluoroscopy-induced chronic radiation dermatitis. J Mol Med (Berl) 2022; 100:135-146. [PMID: 34689211 PMCID: PMC8724166 DOI: 10.1007/s00109-021-02146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/24/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Fluoroscopy-induced chronic radiation dermatitis (FICRD) is a complication of fluoroscopy-guided intervention. Unlike acute radiation dermatitis, FICRD is different as delayed onset and usually appears without preexisting acute dermatitis. Unfortunately, the chronic and progressive pathology of FICRD makes it difficult to treat, and some patients need to receive wide excision and reconstruction surgery. Due to lack of standard treatment, investigating underlying mechanism is needed in order to develop an effective therapy. Herein, the Hippo pathway is specifically identified using an RNA-seq analysis in mild damaged skin specimens of patients with FICRD. Furthermore, specific increase of the Yes-associated protein (YAP1), an effector of the Hippo pathway, in skin region with mild damage plays a protective role for keratinocytes via positively regulating the numerous downstream genes involved in different biological processes. Interestingly, irradiated-keratinocytes inhibit activation of fibroblasts under TGF-β1 treatment via remote control by an exosome containing YAP1. More importantly, targeting one of YAP1 downstream genes, nuclear receptor subfamily 3 group C member 1 (NR3C1), which encodes glucocorticoid receptor, has revealed its therapeutic potential to treat FICRD by inhibiting fibroblasts activation in vitro and preventing formation of radiation ulcers in a mouse model and in patients with FICRD. Taken together, this translational research demonstrates the critical role of YAP1 in FICRD and identification of a feasible, effective therapy for patients with FICRD. KEY MESSAGES: • YAP1 overexpression in skin specimens of radiation dermatitis from FICRD patient. • Radiation-induced YAP1 expression plays protective roles by promoting DNA damage repair and inhibiting fibrosis via remote control of exosomal YAP1. • YAP1 positively regulates NR3C1 which encodes glucocorticoid receptor expression. • Targeting glucocorticoid receptor by prednisolone has therapeutic potential for FICRD patient.
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Affiliation(s)
- Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Cosmetic Applications and Management, Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan
- Department of Dermatology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Fan Lai
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Wei-Lun Huang
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuo-Chung Yang
- Department of Dermatology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ping-Chin Lai
- The Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Wan-Ju Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tsung-Hsien Chang
- Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Yun-Chen Huang
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Chuan Tsai
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shin-Chih Lin
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sun-Jang Lin
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Chieh Lin
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Sakamoto H, Moritake T, Sun L, Kobayashi I, Kawauchi S, Abe T, Tsukamoto A, Morimoto Y, Daida H, Matsumaru Y. Monitoring and Protection against Radiation Dose to Eyes of Operators Performing Neuroendovascular Procedures: A Nationwide Study in Japan. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:354-360. [PMID: 37502341 PMCID: PMC10370920 DOI: 10.5797/jnet.oa.2021-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/25/2021] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To meet the new standard of the annual dose limit for the eye lens recommended by the International Commission on Radiation Protection, radiation doses of neuroendovascular procedures in Japanese institutions were investigated. METHODS Radiation doses to operators involved in 304 neuroendovascular procedures at 30 Japanese institutions were prospectively surveyed. The institutions recruited at an annual meeting of the Japanese Society for Neuroendovascular Therapy participated voluntarily. A maximum of 10 wireless dosimeters were attached to the radiation protection (RP) goggles, the ceiling-mounted RP shielding screen, and the operators' forehead and neck over the protective clothing. Doses recorded inside the goggles were defined as eye lens doses for operators who wore RP goggles, while doses to the forehead were defined as eye lens doses for those who did not. The shielding effect rates of the protection devices were calculated, and statistical analysis was performed for the comparison of radiation doses. RESULTS From 296 analyzed cases, mean eye lens radiation doses per procedure were 0.088 mGy for the left eye and 0.041 mGy for the right eye. For the left eye, that dose without RP equipment was 0.176 mGy and that with RP goggles plus an RP shielding screen was 0.034 mGy. Four parameters, including left eye dose, air kerma at the patient entrance reference point, fluoroscopic time, and the total number of frames, were assessed for five types of neurovascular procedures. Of them, transarterial embolization for dural arteriovenous fistula was associated with the highest eye lens dose at 0.138 mGy. The shielding effect rates of protection goggles were 60% for the left and 55% for the right RP goggle. The mean doses to the inner and outer surfaces of the RP shielding screen were 0.831 mGy and 0.040 mGy, respectively, amounting to a shielding effect rate of 95%. CONCLUSION To meet the new standard, both RP goggles and RP shielding screens are strongly recommended to be used effectively. Without proper use of radiological protection devices, the number of neuroendovascular procedures that one operator performs per year will be limited under the new guideline.
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Affiliation(s)
- Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Takashi Moritake
- Department of National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Chiba, Japan
| | - Lue Sun
- Health and Medical Research Institute, Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan
| | - Ikuo Kobayashi
- Research Institute of Nuclear Engineering, University of Fukui, Tsuruga, Fukui, Japan
- Nagase Landauer Ltd., Tsukuba, Ibaraki, Japan
| | | | - Toshi Abe
- Department of Radiobiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | | | - Yuh Morimoto
- Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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15
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Stanev S, Kostova-Lefterova D, Dineva S. Patient doses in endovascular and hybrid revascularization of aortoiliac segment. Br J Radiol 2021; 94:20210439. [PMID: 34591595 DOI: 10.1259/bjr.20210439] [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
OBJECTIVES Constantly increasing number of procedures performed - endovascular or hybrid in patients with aortoiliac occlusive disease during the last decades finds its explanation in the lower morbidity and mortality rates, compared to bypass surgery. The purpose of the current survey was to estimate patients' radiation exposure in aortoiliac segment after endovascular or hybrid revascularization and to study the main factors which have direct contribution. METHODS A retrospective study of 285 procedures conducted with the help of a mobile C-arm system in 223 patients was performed. Procedures were grouped according to criteria such as: type of intervention, vascular access, level of complexity and operating team. Different analyses were performed within the groups and dose values. RESULTS The median values of kerma-air product (KAP), the number of series and the peak skin dose (PSD) significantly increase with the increasing number of vascular accesses: for one access (16.68 Gy.cm2, 6 and 336 mGy), for two (56.93 Gy.cm2, 11 and 545 mGy), and for three (102.28 Gy.cm2, 15 and 781 mGy). Significant dependence was observed in the case of single access site between the type of access and the dose values: hybrid and retrograde common femoral artery/superficial femoral artery (CFA/SFA) endovascular accesses, 10.06 Gy.cm2/301 mGy and 13.23 Gy.cm2/318 mGy respectively, in contrast with the contralateral CFA and left brachial access, 33 Gy.cm2/421 mGy and 38.33 Gy.cm2/448 mGy respectively. CONCLUSION The results demonstrate that the most important factors increasing the dose values are number and type of vascular accesses, followed by the combination and number of implanted stents with the complexity of the procedure. The PSD values for a single procedure were between 2 and 12 times lower than those IAEA proposed as trigger levels for radiation-induced erythema. This study shows that trigger levels were not reached even for patients with repeated procedures in the same segment in 1-year period. ADVANCES IN KNOWLEDGE The study gives important understanding and clarity on the growing awareness for dose-modifying factors during endovascular and hybrid revascularization of aortoiliac segment.
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Affiliation(s)
| | - Desislava Kostova-Lefterova
- National Cardiology Hospital, Sofia, Bulgaria.,Medical University - Pleven, Pleven, Bulgaria.,Aleksandrovska University Hospital, Sofia, Bulgaria
| | - Svetla Dineva
- National Cardiology Hospital, Sofia, Bulgaria.,Aleksandrovska University Hospital, Sofia, Bulgaria.,Medical University - Sofia, Sofia, Bulgaria
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Araki F, Umeno S. SURFACE DOSE ESTIMATION BY A KAP METER FOR KILOVOLTAGE X-RAY BEAMS. RADIATION PROTECTION DOSIMETRY 2021; 195:124-131. [PMID: 34423373 DOI: 10.1093/rpd/ncab122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 06/12/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
This study aims to estimate the entrance surface dose (ESD) of a water phantom for kilovoltage x-ray beams using an air kerma area product meter (KAP meter) equipped in an x-ray unit. The KAP meter was calibrated in terms of the ESD determined by a plane-parallel ionization chamber based on a 60Co absorbed dose-to-water calibration coefficient, ${N}_{D,w}^{{}^{60}\mathrm{C}\mathrm{o}}$. The ESD measured using the KAP meter was verified by comparing it with that estimated by the air kerma calibration coefficient, NK, for x-ray beam qualities. The ratio of ESDs based on ${N}_{D,w}^{{}^{60}\mathrm{C}\mathrm{o}}$ and NK was 1.003 on average and independent of the beam quality. The ESD by the KAP meter was an agreement within ±1.5% with that measured using the plane-parallel chamber for 10 × 10-30 × 30 cm2 fields with a source-surface distance of 75-150 cm. It was possible to estimate the ESD directly in a water phantom for x-ray beams without correction factors compared to the existing air kerma calibration, using a KAP meter calibrated based on ${N}_{D,w}^{{}^{60}\mathrm{C}\mathrm{o}}$.
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Affiliation(s)
- F Araki
- Department of Health Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - S Umeno
- SAGA Heavy Ion Medical Accelerator in Tosu, 3049 Harakogamachi, Tosu, Saga, 841-0071, Japan
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Association of occupational direct radiation exposure to the hands with longitudinal melanonychia and hand eczema in spine surgeons: a survey by the society for minimally invasive spinal treatment (MIST). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3702-3708. [PMID: 34427761 DOI: 10.1007/s00586-021-06973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/19/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the association between occupational direct radiation exposure to the hands and longitudinal melanonychia (LM) and hand eczema in spine surgeons. METHODS A web-based questionnaire survey of the Society for Minimally Invasive Spinal Treatment (MIST) in Japan was conducted. The proportion of LM and hand eczema in hands with high and low-radiation exposure was compared using Fisher's exact test. The odds ratios (ORs) and their 95% confidence intervals (CIs) for the prevalence of LM and hand eczema in the high-radiation exposure hands were calculated using generalized estimating equations for logistic regression as control for the correlation of observations among the same individuals and possible confounders. RESULTS Among 324 members of the society, responses were received from 229 members (70.7%). A total of 454 hands from 227 participants were analysed. The prevalence of LM and hand eczema was 43% and 29%, respectively. In a hand-by-hand comparison, more hands had LM in the high-radiation exposure group than the low-radiation exposure group (90 [40%] vs. 39 [17%], respectively, p < 0.001). A similar trend was observed for hand eczema (63 [28%] vs. 33 [15%], respectively, p = 0.001). The adjusted OR for high-radiation exposure hands was 3.18 (95% CI: 2.24-4.52). Consistent results were obtained for hand eczema, with an adjusted OR of 2.26 (95% CI: 1.67-3.06). CONCLUSION The present study suggests that direct radiation exposure to physician's hands is associated with LM and hand eczema. Those with LM and radially biased hand eczema may have had high direct radiation exposure.
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Liao JB, Chen W, Lee HS, Wu SR, Wei KC. Histopathology of fluoroscopy-induced radiation ulcer: a case series study in comparison with morphea. J Dtsch Dermatol Ges 2021; 18:447-454. [PMID: 32413216 DOI: 10.1111/ddg.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/03/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Histopathologic diagnosis of fluoroscopy-induced radiation ulcer (FIRU) can be challenging if the past history of radiation exposure is unknown. Morphea is the most important differential diagnosis. This study was intended to identify clinical and pathologic features that can be used to distinguish FIRU from morphea. PATIENTS AND METHODS We performed a retrospective study on 25 specimens from 15 patients with FIRU and 21 specimens from 21 patients with morphea. Clinical findings and pathological features were analyzed. RESULTS Thirteen of 15 patients (86.7 %) with FIRU underwent angioplasty for coronary artery disease, and eleven patients had lesions in the right subscapular area. Compared with morphea, FIRU patients were more likely to display non-inflammatory infiltrates (28 %), bizarre fibroblasts (100 %), sclerosis (48 %), telangiectasia (96 %), vascular damage (64 %), and loss of skin appendages (100 %). In morphea, bizarre fibroblasts were rare (14 %), while telangiectasia (62 %) and loss of skin appendages (62 %) were variable. Loss of CD34+ cells and compression of elastic fibers could not be used to distinguish between FIRU and morphea. CONCLUSIONS Skin lesion in the right subscapular area with presence of bizarre fibroblasts, sclerosis, telangiectasia, and loss of cutaneous appendages as seen with histology are highly characteristic of the radiation damage associated with fluoroscopic angiography.
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Affiliation(s)
- Jia-Bin Liao
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Shu Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Department of Dermatology, Pingtung Hospital, Ministry of Health and Welfare, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shiou-Rong Wu
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Supawat B, Wattanapongpitak S, Tima S, Kothan S, Tungjai M. Effect of fluoroscopic X-rays combined with iodinated radiographic contrast media on human hematological parameters. TOXICOLOGY AND ENVIRONMENTAL HEALTH SCIENCES 2021. [DOI: 10.1007/s13530-021-00093-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Fum WKS, Wong JHD, Tan LK. Monte Carlo-based patient internal dosimetry in fluoroscopy-guided interventional procedures: A review. Phys Med 2021; 84:228-240. [PMID: 33849785 DOI: 10.1016/j.ejmp.2021.03.004] [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: 06/19/2020] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This systematic review aims to understand the dose estimation approaches and their major challenges. Specifically, we focused on state-of-the-art Monte Carlo (MC) methods in fluoroscopy-guided interventional procedures. METHODS All relevant studies were identified through keyword searches in electronic databases from inception until September 2020. The searched publications were reviewed, categorised and analysed based on their respective methodology. RESULTS Hundred and one publications were identified which utilised existing MC-based applications/programs or customised MC simulations. Two outstanding challenges were identified that contribute to uncertainties in the virtual simulation reconstruction. The first challenge involves the use of anatomical models to represent individuals. Currently, phantom libraries best balance the needs of clinical practicality with those of specificity. However, mismatches of anatomical variations including body size and organ shape can create significant discrepancies in dose estimations. The second challenge is that the exact positioning of the patient relative to the beam is generally unknown. Most dose prediction models assume the patient is located centrally on the examination couch, which can lead to significant errors. CONCLUSION The continuing rise of computing power suggests a near future where MC methods become practical for routine clinical dosimetry. Dynamic, deformable phantoms help to improve patient specificity, but at present are only limited to adjustment of gross body volume. Dynamic internal organ displacement or reshaping is likely the next logical frontier. Image-based alignment is probably the most promising solution to enable this, but it must be automated to be clinically practical.
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Affiliation(s)
- Wilbur K S Fum
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
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21
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Mach JC, Omar A, Barone HE, Harb A, Abujudeh H. Fluoroscopy and MRI Induced Skin Injuries: A Review of Diagnostic, Management, and Preventative Principles. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-020-00376-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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High-Dose Fluoroscopically Guided Procedures in Patients: Radiation Management Recommendations for Interventionalists. Cardiovasc Intervent Radiol 2020; 44:849-856. [PMID: 33184693 DOI: 10.1007/s00270-020-02703-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/31/2020] [Indexed: 12/19/2022]
Abstract
The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. In addition to the risks from fluoroscopic-guided interventional procedures of tissue injuries, recent studies have drawn attention to the risk of stochastic effects. Guidelines exist for preprocedural planning and radiation management during the procedure. The concept of a substantial radiation dose level (SRDL) is helpful for patient follow-up for tissue injury. The uncommon nature of tissue injuries requires the interventionalist to be responsible for follow-up of patients who receive substantial radiation doses. Dose management systems for recognizing and avoiding higher patient exposures have been introduced. The European Directive provides a legal framework and requirements for equipment, training, dose monitoring, recording and optimization that are helpful in radiation risk management.
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Javor D, Moyses J, Loewe C, Schernthaner RE. Radiation dose reduction capabilities of a new C-arm system with optimized hard- and software. Eur J Radiol 2020; 134:109367. [PMID: 33221618 DOI: 10.1016/j.ejrad.2020.109367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the radiation dose reduction capabilities and the image quality of a new C-arm system in comparison to a standard C-arm system. METHOD Prospective, randomized, IRB approved two-arm trial design. 49 consecutive patients with primary or secondary liver cancer were treated with transarterial chemoembolization (TACE) on two different angiography units. 28 patients were treated on a conventional angiography unit B, 21 patients on unit A which provides improved hardware and optimized image processing algorithms. Dose area product (DAP) and fluoroscopy time were recorded. DSA image quality of all procedures was assessed on a four-rank-scale by two independent and blinded readers. RESULTS Both cohorts showed no significant differences with regard to patient characteristics, tumor burden and fluoroscopy time. The new system resulted in a statistically significant reduction of cumulative DAP of 72% compared to the old platform (median 76 vs. 269 Gy*cm2). Individually, Fluoro-DAP and DSA-DAP decreased by 48% and 77% (p = 0.012 and p < 0.01), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms. CONCLUSIONS The new C-arm system significantly reduced radiation exposure for TACE procedures without increased radiation time or negative impact on DSA image quality. The combination of optimized hardware and software yields the highest radiation dose reduction and is of utmost importance for patients and interventionalists.
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Affiliation(s)
- Domagoj Javor
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Johanna Moyses
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ruediger E Schernthaner
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Kiang SC, Huh AS, Davis JR, Abou-Zamzam AM, Tomihama RT. Health Care System-Wide Analysis Identifies High Radiation Use Factors and Behaviors in Surgery. Am Surg 2020; 87:616-622. [PMID: 33135941 DOI: 10.1177/0003134820951488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Usage of radiation among various surgical specialists has not been comprehensively evaluated. A systems-based analysis evaluating intraoperative radiation can help identify high use factors and dose reduction behaviors leading to quality improvement initiatives. METHODS A retrospective review of all operative fluoroscopic-guided procedures from 2010 to 2017 from 4 hospitals in a tertiary academic health care system was performed. RESULTS One thousand two hundred fifty-two cases were analyzed, and notable trends in metrics including type of equipment, procedures, surgical field, surgical specialty, and dose reduction techniques were demonstrated. Higher radiation exposures were correlated with fixed vs. mobile C-arm usage (1229 mGy vs. 331 mGy, P = .001), abdominal/pelvic procedures (429.2 mGy vs. 274.0 mGy, P = .002), and embolization (2450.6 mGy vs. 328.2 mGy, P = .019). Vascular surgery averaged 40 times higher radiation exposure per patient than other specialties (613.3 mGy vs. 15.6 mGy, P = .001). Notably, vascular surgeons utilized dose reduction techniques less frequently than urology (21.5% vs. 70%, P = .001) but more than neurosurgery and orthopedics (21.5% vs. 1.3% and 0%, P = .001, respectively). CONCLUSIONS A system-wide health care analysis identified vascular surgery procedures, use of a fixed C-arm, abdominal/pelvic procedures, and embolization cases as having the highest radiation exposure. These data can serve as baseline information for future quality improvement initiatives regarding fluoroscopy usage by surgeons.
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Affiliation(s)
- Sharon C Kiang
- Division of Vascular Surgery, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.,VA Loma Linda Healthcare System, Division of Vascular Surgery, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Austin S Huh
- Section of Vascular and Interventional Radiology, Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Jessica R Davis
- Section of Vascular and Interventional Radiology, Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ahmed M Abou-Zamzam
- Division of Vascular Surgery, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Roger T Tomihama
- Section of Vascular and Interventional Radiology, Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Rizk C, Sarkis A, Bejjani A, Dabin J, Farah J. BENCHMARKING THE DOSE MAP SOFTWARE FOR CLINICAL IMPLEMENTATION AND ESTABLISHMENT OF A LOCAL FOLLOW-UP PROTOCOL FOR THE MANAGEMENT OF SKIN INJURES FOLLOWING COMPLEX INTERVENTIONAL CARDIOLOGY PROCEDURES. RADIATION PROTECTION DOSIMETRY 2020; 190:392-399. [PMID: 32909041 DOI: 10.1093/rpd/ncaa119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 08/15/2020] [Indexed: 06/11/2023]
Abstract
This paper aims to validate the accuracy of the peak skin dose (Dskin,max) computed by the Dose Map software (DMS)-general electric and establish a local follow-up protocol for the management of patient skin injuries following complex interventional cardiology procedures (ICPs). Dskin,max was computed by the DMS and was simultaneously measured by a dense mesh of 72 thermoluminescent dosemeters for 20 ICP. Measured and computed Dskin,max were compared using Lin's concordance coefficient (${\rho}_c$). The implementation of a local follow-up strategy was based on a computed Dskin,max of 2 Gy. After eliminating 2 outliers, the average deviation between the two methods was 6% (range: -36 to +40%). Concordance between the two methods was moderate with ${\rho}_c$ (confidence interval) of 0.9128 (0.8541-0.9486). DMS computes Dskin,max with an acceptable accuracy and can be used to setup an individual follow-up process for patients with high skin exposure and risks.
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Affiliation(s)
- Chadia Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research, 11-8281 Beirut, Lebanon
| | - Antoine Sarkis
- Department of Interventional Cardiology, Hotel Dieu de France Hospital, 16-6830 Beirut, Lebanon
| | - Alice Bejjani
- Lebanese Atomic Energy Commission, National Council for Scientific Research, 11-8281 Beirut, Lebanon
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK-CEN), BE-2400 Mol, Belgium
| | - Jad Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, 94270 Le Kremlin-Bicêtre, France
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26
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Shimizu T, Toyota S, Nakagawa K, Murakami T, Kumagai T, Mori K, Taki T. Reduction of radiation exposure using low pulse rate fluoroscopy during neuroendovascular surgery. Interv Neuroradiol 2020; 27:314-320. [PMID: 32772623 DOI: 10.1177/1591019920949319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endovascular surgery is minimally invasive, but the radiation exposure can be problematic. There is no report assessing whether radiation exposure can be reduced by using a low pulse rate during carotid artery stenting (CAS). The aim of this study was to evaluate whether reducing the pulse rate from 7.5 to 4 frames per second (f/s) can reduce the radiation exposure while maintaining safety during CAS procedure. METHODS We retrospectively reviewed the radiation data and clinical features of all 100 patients who underwent CAS between 2014 and 2019. We changed the pulse rate from 7.5 to 4 f/s in 2017. The fluoroscopic time (FT), dose area product (DAP), and total air kerma (AK) were collected. Statistical analyses were performed between the pulse rate and clinical outcomes, including radiation exposure.
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Affiliation(s)
- Takeshi Shimizu
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Shingo Toyota
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Kanji Nakagawa
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tomoaki Murakami
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tetsuya Kumagai
- Department of Neurosurgery, Wakakusa-Daiichi Hospital, Higashiosaka, Japan
| | - Kanji Mori
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Takuyu Taki
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Japan
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Jang S, Lee Y, Seo S, Jin YW, Lee WJ. Rogue cell-like chromosomal aberrations in peripheral blood lymphocytes of interventional radiologists: A case study. Mutat Res 2020; 856-857:503234. [PMID: 32928374 DOI: 10.1016/j.mrgentox.2020.503234] [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: 05/25/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
We report two cases of interventional radiologists who had been exposed to radiation while performing fluoroscopically-guided interventional procedures (FGIPs), mainly transcatheter arterial chemoembolization, percutaneous catheter drainage, and percutaneous transhepatic biliary drainage procedures, for over 10 years. They had a unique multi-aberrant cell type with not only high numbers of dicentrics and/or centric rings but also excess acentric double minutes, similar to a rogue cell. As revealed in a self-administered questionnaire, they wore personal dosimeters and protective equipment at all times and used shielding devices during interventional fluoroscopy procedures. However, the exposed dose levels derived from cytogenetic dosimetry were much higher than the doses recorded on their personal dosimeters. A large number of unstable and stable chromosomal aberrations that were found in the peripheral blood lymphocytes of these interventional radiologists might be due to repeated and long-term exposure to ionizing radiation while performing FGIPs. Further investigations of chromosomal aberrations in interventional radiologists may improve the understanding of the long-term effects of radiation exposure on medical personnel.
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Affiliation(s)
- Seongjae Jang
- Laboratory of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
| | - Younghyun Lee
- Laboratory of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Songwon Seo
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Young Woo Jin
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Won-Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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28
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Liao JB, Chen W, Lee HS, Wu SR, Wei KC. Histopathologie des Röntgenulkus: Fallserie mit Vergleich zur zirkumskripten Sklerodermie. J Dtsch Dermatol Ges 2020; 18:447-455. [PMID: 32413233 DOI: 10.1111/ddg.14092_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/03/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Jia-Bin Liao
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Shu Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Department of Dermatology, Pingtung Hospital, Ministry of Health and Welfare, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shiou-Rong Wu
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Walsh C, O’Reilly G, Murphy D. Patient cumulative radiation exposure—the potential for unintended consequences. Eur Radiol 2020; 30:4434-4437. [DOI: 10.1007/s00330-020-06800-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/19/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022]
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30
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P M, M AJ, L D. Assessment of Patient Dose with Special Look at Pediatrics during Cardiovascular Imaging. J Biomed Phys Eng 2020; 10:51-58. [PMID: 32158711 PMCID: PMC7036411 DOI: 10.31661/jbpe.v0i0.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/10/2018] [Indexed: 11/16/2022]
Abstract
Background During interventional cardiology processes, patients especially women and children receive high radiation doses due to their sensitivity. Objective In this study, we evaluated a pediatric patient dose separately in those undergone intervention cardiac procedure. Material and Methods In this cross sectional study, a public hospital with 252 patients, Entrance Skin Dose (ESD) and Dose-Area Product (DAP) were recorded. Prior to the beginning of fluoroscopic procedure, the chest thickness and Body Mass Index (BMI) of patients were measured. Furthermore, kV, mAs, angle of tube and time of angiography and angioplasty were recorded. Results Children ratio to all patients underwent the cardiovascular imaging was 1.8. The means of patients' ESD, DAP and fluoroscopy time were 178.3±17 mGy, 1123.6±11 μGycm2 and 281.4±181.2 s, respectively for coronary angiography. The females were 96.8 under 30 years and their dose mean was 276±37 mGy, 368±24 μGycm2 for ESD and DAP received, respectively with 376s fluoroscopy time. Mean mAs was 359±34 and kV was 71.23±2.7. Above all, a direct and significant correlation was found between the patients' chest thickness with kV (p=0.037, r = 0.11) and mAs (p<0.001, r = 0.28) variations. Conclusion The results demonstrated that the number of children referred to the cardiology department and also the dose rate received by them during this test was higher than the data provided for children in developing countries. Paying attention to the children's perception of high-fluorescence time is necessary in comparison with total angiography time in order to reduce the number of radiation injuries among pediatrics.
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Affiliation(s)
- Mehnati P
- PhD, Cardiovascular Research Center, Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asghari Jafarabadi M
- PhD, Department of Statistics and Epidemiology, Faculty of Health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Danaee L
- MSc, Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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31
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Corrigall RS, Martin CJ, Scott I. Observations of tissue reactions following neuroradiology interventional procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:N9-N15. [PMID: 31770725 DOI: 10.1088/1361-6498/ab5bf4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A study has been undertaken over a period of eight years of tissue reactions in interventional radiology patients receiving cumulative air kerma values to their scalp above 3 Gy. Patients receiving doses to the scalp above this trigger level have been followed up to determine when effects occur and to provide reassurance if they do. The study has shown that hair thinning and hair loss are the more likely effects and may occur in 50% of patients at dose above 4.5 Gy.
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Affiliation(s)
- R S Corrigall
- Health Physics, Gartnavel Royal Hospital, Glasgow, G12 0XH, United Kingdom
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Sakamoto H, Igarashi T, Kato M, Kawauchi S, Kato H, Tsukamoto A, Moritake T, Akahane M. [Examination of Effectiveness Verification and Additional Items in Angiography and IVR of DRLs 2015]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:210-217. [PMID: 32074530 DOI: 10.6009/jjrt.2020_jsrt_76.2.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Japanese Diagnostic Reference Levels (DRLs) were released as "Japan DRLs 2015" from Japan Network for Research and Information on Medical Exposure (J-RIME) in June 2015. In "Japan DRLs 2015", DRLs in angiography and interventional procedures are set at a fluoroscopic dose rate of 20 mGy/min at the interventional reference point using a phantom. In order to achieve optimization with DRLs, then it need to be revised regularly. Therefore, we (research group to examine the effect of Japan DRLs 2015 and the necessity of additional items in angiography and vascular interventions) examined the effects of "Japan DRLs 2015" on angiography and interventional procedures. And we also investigated for DRLs revision in the future. As a result, it turned out that it is important to create DRLs in medical procedures that can be effectively used in clinical settings.
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Affiliation(s)
- Hajime Sakamoto
- Department of Radiology, Yamanashi University Hospital (Current address: Department of Radiological Technology, Faculty of Health Science, Juntendo University)
| | - Takayuki Igarashi
- Department of Medical Technology, Radiological Section, Asahi General Hospital (Current address: Department of Radiological Technology, International University of Health and Welfare Narita Hospital)
| | - Mamoru Kato
- Department of Radiology and Nuclear Medicine, Akita Cerebrospinal and Cardiovascular Center
| | | | | | | | - Takashi Moritake
- Department of Radiological Health Science, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health
| | - Masaaki Akahane
- Department of Radiology, School of Medicine, International University of Health and Welfare
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Gutiérrez-Barrios A, Camacho-Galán H, Medina-Camacho F, Cañadas-Pruaño D, Jimenez-Moreno A, Calle-Perez G, Vázquez-García R. Effective Reduction of Radiation Exposure during Cardiac Catheterization. Tex Heart Inst J 2019; 46:167-171. [PMID: 31708696 DOI: 10.14503/thij-17-6548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Exposure to ionizing radiation during cardiac catheterization can have harmful consequences for patients and for the medical staff involved in the procedures. Minimizing radiation doses during the procedures is essential. We investigated whether fine-tuning the radiation protocol reduces radiation doses in the cardiac catheterization laboratory. In January 2016, we implemented a new protocol with reduced radiation doses in the Hospital de Jerez catheterization laboratory. We analyzed 170 consecutive coronary interventional procedures (85 of which were performed after the new protocol was implemented) and the personal dosimeters of the interventional cardiologists who performed the procedures. Overall, the low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%-70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%-90.1%; P <0.001) during percutaneous coronary interventions. We also found that the annual deep (79%, P=0.026) and shallow (62.2%, P=0.035) radiation doses to which primary operators were exposed decreased significantly under the low-radiation protocol. These dose reductions were achieved without increasing the volume of contrast media, fluoroscopy time, or rates of procedural complications, and without reducing the productivity of the laboratory. Optimizing the radiation safety protocol effectively reduced radiation exposure in patients and operators during cardiac catheterization procedures.
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Hersh-Boyle RA, Culp WTN, Brown DC, Luskin AC, Kapatkin AS, Chou PY, Agnello KA, Reetz JA, Oyama MA, Visser LC, Palm CA, Clarke DL. Radiation exposure of dogs and cats undergoing fluoroscopic procedures and for operators performing those procedures. Am J Vet Res 2019; 80:558-564. [PMID: 31140847 DOI: 10.2460/ajvr.80.6.558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate radiation exposure of dogs and cats undergoing procedures requiring intraoperative fluoroscopy and for operators performing those procedures. SAMPLE 360 fluoroscopic procedures performed at 2 academic institutions between 2012 and 2015. PROCEDURES Fluoroscopic procedures were classified as vascular, urinary, respiratory, cardiac, gastrointestinal, and orthopedic. Fluoroscopy operators were classified as interventional radiology-trained clinicians, orthopedic surgeons, soft tissue surgeons, internists, and cardiologists. Total radiation exposure in milligrays and total fluoroscopy time in minutes were obtained from dose reports for 4 C-arm units. Kruskal-Wallis equality of populations rank tests and Dunn pairwise comparisons were used to compare differences in time and exposure among procedures and operators. RESULTS Fluoroscopy time (median, 35.80 minutes; range, 0.60 to 84.70 minutes) was significantly greater and radiation exposure (median, 137.00 mGy; range, 3.00 to 617.51 mGy) was significantly higher for vascular procedures than for other procedures. Median total radiation exposure was significantly higher for procedures performed by interventional radiology-trained clinicians (16.10 mGy; range, 0.44 to 617.50 mGy), cardiologists (25.82 mGy; range, 0.33 to 287.45 mGy), and internists (25.24 mGy; range, 3.58 to 185.79 mGy). CONCLUSIONS AND CLINICAL RELEVANCE Vascular fluoroscopic procedures were associated with significantly longer fluoroscopy time and higher radiation exposure than were other evaluated fluoroscopic procedures. Future studies should focus on quantitative radiation monitoring for patients and operators, importance of operator training, intraoperative safety measures, and protocols for postoperative monitoring of patients.
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Osei B, Xu L, Johnston A, Darko S, Darko J, Osei E. Retrospective study of patients radiation dose during cardiac catheterization procedures. Br J Radiol 2019; 92:20181021. [PMID: 31045448 PMCID: PMC6636266 DOI: 10.1259/bjr.20181021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory. METHODS We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient's clinical radiation dose data [kerma-area-product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital's RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software. RESULTS The overall patient median age was 67.0 (range: 26.0-97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9-61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1-203.2), 80.2 (18.9-208.5), 83.7 (48.0-246.1), 113.8 (60.9-284.5), 91.7 (6.0-426.0) and 51.1 (7.0-175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3-3794.0), 1384.7 (291.7-4021.8), 1607.0 (883.5-4448.3), 2260.2 (867.4-5311.9), 1589.3 (100.2-7237.4) and 463.8 (67.7-1695.9) mGy respectively. CONCLUSION We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories. ADVANCES IN KNOWLEDGE We have investigated local patients' radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.
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Affiliation(s)
| | | | | | - Sara Darko
- Department of Clinical Trials, Grand River Regional Cancer Centre, Kitchener, ON, Canada
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A dosimetric study of skin toxicity induced by 3-D conventional and intensity-modulated radiotherapy techniques using immobilization mask for treatment of head-and-neck (nasopharyngeal cancer) carcinoma: a prospective study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396918000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundThe purpose of this study was to investigate variations in surface dose, with and without the use of a Klarity® Mask (Orfit Industries America, Wijnegem, Belgium), using intensity-modulated radiotherapy (IMRT) and 3-D conventional radiotherapy (3D-CRT).Materials and methodsThermoluminescent dosimeters (TLDs) together with a phantom were used to examine acute skin toxicity during nasopharyngeal cancer treatment. These plans were sequentially delivered to the perspex phantom. Dosimeters were placed in five fixed regions over the skin. A Klarity mask for immobilization was used for covering the head, neck, and shoulder. The phantom was irradiated with and without a Klarity Mask, using IMRT and 3D-CRT, respectively.ResultsThe Klarity mask increased the skin doses for IMRT and 3D-CRT approximately 18·6% and 8·6%, respectively, from the prescribed maximum skin dose using treatment planning system (TPS). Additionally, the average percentage dose between IMRT and 3D-CRT received on the surface region was 30·9%, 24·9% with and without Klarity mask respectively. The average percentage dose received on surfaces from the total therapeutic dose 70 Gy, without using the mask was 7·7% and 5·7%, for IMRT and 3D-CRT, respectively. The TPS overestimated the skin dose for IMRT planning by 20%, and for 3D-CRT by 16·6%, compared with TLD measurements.ConclusionsThe results of this study revealed that IMRT significantly increases acute skin toxicity, compared with CRT. Although it is recommended to use Klarity mask as a sparing tool of normal tissue, it increases the risk of skin toxicity. In conclusion, skin dose is an important issue of focus during radiotherapy.
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Rizk C, Fares G, Vanhavere F, Farah J. MEASUREMENT OF PATIENT SKIN DOSE DISTRIBUTIONS IN THREE LEBANESE INTERVENTIONAL CARDIOLOGY SUITES. RADIATION PROTECTION DOSIMETRY 2019; 183:375-385. [PMID: 30165531 DOI: 10.1093/rpd/ncy152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/28/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Using a mesh of 30 thermoluminescent dosemeters, adults' patient skin doses were measured for 99 coronary angiography (CA) and 89 percutaneous coronary interventions (PCI) performed in three Lebanese hospitals. Average peak skin dose (Dskin,max) were 152 mGy (range: 16-1144) for CAs and 576 mGy (range: 7-3361) for PCIs. While only four patients had a Dskin,max value exceeding the 2 Gy threshold for skin injuries, several patients had skin dose values above 1 Gy at several distinct locations proving that Dskin,max alone is not sufficient for repetitive procedures; 2D dose maps are required instead. Dskin,max correlated well with total air kerma-area product (PKA,T) for PCI in Hospitals 1 and 2 (R = 0.91 and 0.76, respectively) enabling the setup of an alert level at PKA,T = 240 and 210 Gy cm2, respectively, corresponding to a Dskin,max of 2 Gy. This was not possible for Hospital 3 due to weak correlations between Dskin,max and PKA,T.
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Affiliation(s)
- C Rizk
- Lebanese Atomic Energy Commission, National Council for Scientific Research, PO Box 11-8281, Riad El Solh, Beirut, Lebanon
- Faculty of Sciences, Saint Joseph University, PO Box 11-514, Riad El Solh, Beirut, Lebanon
| | - G Fares
- Faculty of Sciences, Saint Joseph University, PO Box 11-514, Riad El Solh, Beirut, Lebanon
| | - F Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang 200, Mol, Belgium
| | - J Farah
- Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, Le Kremlin-Bicêtre, France
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Sato H, Kittaka D, Ohsawa M, Kato K. A study on fluoroscopic images in exposure reduction techniques - Focusing on the image quality of fluoroscopic images and exposure images. J Appl Clin Med Phys 2019; 20:125-131. [PMID: 30933408 PMCID: PMC6448158 DOI: 10.1002/acm2.12549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/26/2018] [Accepted: 01/20/2019] [Indexed: 11/30/2022] Open
Abstract
The quality of the present day fluoroscopic images is sufficiently high for use as exposure images depending on the environment where the fluoroscopic images are recorded. In some facilities which use fluoroscopic images as exposure images they are recorded with a radiological x‐ray diagnostic device equipped with a fluoroscopic storage function. There are, however, cases where fluoroscopic images cannot be used as exposure images because the quality of the fluoroscopic image cannot be assured in the environment where the fluoroscopic images are recorded. This poses problems when stored fluoroscopic images are used in place of exposure images without any clearly established standard. In the present study, we establish that stored fluoroscopic images can be used as exposure images by using gray values obtained from profile curves. This study finds that replacement of stored fluoroscopic images with exposure images requires 20.1 or higher gray scale value differences between the background and signal, using a 20 cm thick acrylic phantom (here an adult abdomen as representing the human body) as the specific geometry. This suggests the conclusion that the gray value can be considered a useful index when using stored fluoroscopic images as exposure images.
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Affiliation(s)
- Hisaya Sato
- Showa University Graduate School of Health Sciences, Tokyo, Japan.,Department of Radiological Technology, Showa University Hospital, Tokyo, Japan
| | - Daisuke Kittaka
- Department of Radiological Technology, Showa University Hospital, Tokyo, Japan
| | - Miwa Ohsawa
- Department of Radiological Technology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Kyoichi Kato
- Showa University Graduate School of Health Sciences, Tokyo, Japan.,Department of Unification Radiological Technology, Showa University, Tokyo, Japan
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Sclerotic Ulcerated Plaque on the Back: Answer. Am J Dermatopathol 2019; 41:314-315. [PMID: 30893080 DOI: 10.1097/dad.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Crowhurst JA, Whitby M, Savage M, Murdoch D, Robinson B, Shaw E, Gaikwad N, Saireddy R, Hay K, Walters DL. Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography. J Med Radiat Sci 2019; 66:20-29. [PMID: 30488575 PMCID: PMC6399189 DOI: 10.1002/jmrs.315] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/27/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Diagnostic coronary angiography (CA) uses ionising radiation with relatively high doses, which impact on both patients and staff. This study sought to identify which patient and procedural factors impact patient and operator dose the most during CA. METHODS Patient and procedure related variables impacting on Kerma area product (PKA ) and operator dose (OD) were collected for 16 months. Procedures were separated into 10 different procedure categories. PKA was used for patient dose and OD was measured with an instantly downloadable dosimeter (IDD) - downloaded at the end of each procedure. High and low radiation dose was defined by binary variables based on the 75th percentile of the continuous measures. Univariate and multivariate regression were used to identify predictors. RESULTS Of 3860 patients included, the IDD was worn for 2591 (61.7%). Obesity (BMI > 30 compared to BMI < 25) was the strongest predictor for both a PKA (odds ratio (OR) = 19.1 (95% CI 13.5-26.9) P < 0.001) and OD (OR = 3.3 (2.4-4.4) P < 0.001) above the 75th percentile. Male gender, biplane imaging, the X-ray unit used, operator experience and procedure type also predicted a high PKA . Radial access, male gender, biplane imaging and procedure type also predicted a high OD. CONCLUSION Radiation dose during CA is multifactorial and is dependent on patient and procedure related variables. Many factors impact on both PKA and OD but obesity is the strongest predictor for both patients and operators to receive a high radiation dose.
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Affiliation(s)
- James A. Crowhurst
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Mark Whitby
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Bio‐Medical Technical ServicesThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Michael Savage
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Dale Murdoch
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Brendan Robinson
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Elizabeth Shaw
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Niranjan Gaikwad
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Ramkrishna Saireddy
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Cairns Base HospitalCairnsQueenslandAustralia
| | - Karen Hay
- QIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Darren L. Walters
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
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Perry BC, Ingraham CR, Stewart BK, Valji K, Kanal KM. Monitoring and Follow-Up of High Radiation Dose Cases in Interventional Radiology. Acad Radiol 2019; 26:163-169. [PMID: 29934019 DOI: 10.1016/j.acra.2018.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the implementation of radiation dose monitoring software, create a process for clinical follow-up and documentation of high-dose cases, and quantify the number of patient reported radiation-induced tissue reactions in fluoroscopically guided interventional radiology (IR) and neuro-interventional radiology (NIR) procedures. MATERIALS AND METHODS Web-based radiation dose monitoring software was installed at our institution and a process to flag all procedures with reference point air kerma (Ka,r) > 5000 mGy was implemented. The entrance skin dose was estimated and formal reports generated, allowing for physician-initiated clinical follow-up. To evaluate our process, we reviewed all IR and NIR procedures performed at our hospital over a 1-year period. For all procedures with Ka,r > 5000 mGy, retrospective medical chart review was performed to evaluate for patient reported tissue reactions. RESULTS Three thousand five hundred eighty-two procedures were performed over the 1-year period. The software successfully transferred dose data on 3363 (93.9%) procedures. One thousand three hundred ninety-three (368 IR and 1025 NIR) procedures were further analyzed after excluding 2189 IR procedures with Ka,r < 2000 mGy. Ten of 368 (2.7%) IR and 52 of 1025 (5.1%) NIR procedures exceeded estimated skin doses of 5000 mGy. All 10 IR cases were abdominal/pelvic trauma angiograms with/without embolization; there were no reported tissue reactions. Of 52 NIR cases, 49 were interventions and 3 were diagnostic angiograms. Five of 49 (10.2%) NIR patients reported skin/hair injuries, all of which were temporary. CONCLUSION Software monitoring and documentation of radiation dose in interventional procedures can be successfully implemented. Radiation-induced tissue reactions are relatively uncommon.
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Affiliation(s)
- Brandon C Perry
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357987, Seattle, WA 98195
| | - Christopher R Ingraham
- Department of Radiology, Section of Interventional Radiology, University of Washington and Harborview Medical Center, Seattle, Washington
| | - Brent K Stewart
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357987, Seattle, WA 98195
| | - Karim Valji
- Department of Radiology, Section of Interventional Radiology, University of Washington and Harborview Medical Center, Seattle, Washington
| | - Kalpana M Kanal
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357987, Seattle, WA 98195.
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Liu B, Hirsch JA, Li X, Sheridan RM, Rehani MM, Zheng H, Rabinov JD. Radiation Dose Monitoring for Fluoroscopically Guided Interventional Procedures: Effect on Patient Radiation Exposure. Radiology 2019; 290:744-749. [PMID: 30644807 DOI: 10.1148/radiol.2019180799] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To analyze the clinical effect of continuous dose monitoring and patient follow-up for fluoroscopically guided vascular interventional procedures over 8 years. Materials and Methods In this retrospective study, an in-house semiautomated system was developed for fluoroscopic dose monitoring. The quarterly number of procedures from January 2010 to December 2017 was analyzed with count time series to estimate quarterly change rate. Technologists recorded four dose surrogates in custom fields of institutional dictation software through a Web interface. Radiation doses were transferred automatically to the radiology report and a centralized dose database when the radiologist initiated procedure dictation. A medical physicist reported weekly on procedures with air kerma at the reference point (Ka,r) of 2 Gy or higher to a division-designated radiologist and hospital radiation safety committee who required the attending radiologist to set up follow-up appointments for patients who underwent procedures with a Ka,r greater than or equal to 5 Gy. Results There were a total of 41 585 procedures; 1553 (3.7%) procedures had a Ka,r of 2-5 Gy. Among 240 procedures with Ka,r greater than 5 Gy, 22 had Ka,r greater than 9 Gy. The percentage of high Ka,r procedures decreased over time, going from 5.9% in 2010 to 2.0% in 2017 for procedures with Ka,r of 2-5 Gy and from 1.0% in 2010 to 0.13% in 2017 for procedures with Ka,r greater than or equal to 5 Gy. Relative reduction per quarter was approximately 2.7% (95% confidence interval: 1.5%, 3.8%) for Ka,r of 2-5 Gy and 4.5% (95% confidence interval: 1.5%, 7.6%) for Ka,r greater than or equal to 5 Gy. Conclusion Eight-year temporal trends show three- to eightfold reduction in the number of high-dose procedures. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Balter in this issue.
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Affiliation(s)
- Bob Liu
- From the Departments of Radiology (B.L., J.A.H., X.L., R.M.S., M.M.R., J.D.R.) and Neurosurgery (J.D.R.), and the Biostatistics Center (H.Z.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Joshua A Hirsch
- From the Departments of Radiology (B.L., J.A.H., X.L., R.M.S., M.M.R., J.D.R.) and Neurosurgery (J.D.R.), and the Biostatistics Center (H.Z.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Xinhua Li
- From the Departments of Radiology (B.L., J.A.H., X.L., R.M.S., M.M.R., J.D.R.) and Neurosurgery (J.D.R.), and the Biostatistics Center (H.Z.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Robert M Sheridan
- From the Departments of Radiology (B.L., J.A.H., X.L., R.M.S., M.M.R., J.D.R.) and Neurosurgery (J.D.R.), and the Biostatistics Center (H.Z.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Madan M Rehani
- From the Departments of Radiology (B.L., J.A.H., X.L., R.M.S., M.M.R., J.D.R.) and Neurosurgery (J.D.R.), and the Biostatistics Center (H.Z.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Hui Zheng
- From the Departments of Radiology (B.L., J.A.H., X.L., R.M.S., M.M.R., J.D.R.) and Neurosurgery (J.D.R.), and the Biostatistics Center (H.Z.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - James D Rabinov
- From the Departments of Radiology (B.L., J.A.H., X.L., R.M.S., M.M.R., J.D.R.) and Neurosurgery (J.D.R.), and the Biostatistics Center (H.Z.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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A propensity score matched valuation on feasibility of low frame rate fluoroscopy during primary percutaneous coronary intervention for patients with STEMI. Int J Cardiovasc Imaging 2018; 35:393-399. [PMID: 30386956 DOI: 10.1007/s10554-018-1475-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
The present study aimed to evaluate the feasibility of low frame rate fluoroscopy during primary percutaneous coronary intervention (PPCI) for patients with acute ST elevation myocardial infarction (STEMI). From January 2016 to December 2017, 165 consecutive patients with STEMI who underwent PPCI were retrospectively divided into two groups: the 7.5-frame group (fluoroscopy at 7.5 frames/s) and the 15-frame group (fluoroscopy at 15 frames/s), according to the frame rate of fluoroscopy used in their treatment. Reduction of radiation and safety of fluoroscopy at 7.5 frames/s were compared by a method of propensity score matching (PSM) with fluoroscopy at 15 frames/s. After PSM, there were 56 patients in each group. There were no differences in patients' baseline characteristics between two groups. The 7.5-frame protocol resulted in 48.9% reduction of DAP (9917 ± 5543 cGycm2 vs. 14766 ± 7272 cGycm2, P < 0.001) and 61.1% reduction of AK (1209 ± 562 mGy vs. 1948 ± 1105 mGy, P < 0.001) with comparable procedural time (38.1 ± 15.3 min vs. 38.8 ± 17.2 min, P = 0.830), fluoroscopy time (13.0 ± 7.2 min vs. 13.5 ± 8.1 min, P = 0.703) and contrast volume (122.3 ± 39.4 ml vs. 119.3 ± 49.4 ml, P = 0.725) to the 15-frame group. Meanwhile, this new protocol didn't increase the incidence of contrast-induced nephropathy (23.2% vs. 25.0%, OR = 0.907, 95% CI 0.381-2.157, P = 0.825) and peri-PPCI cumulative adverse events (30.4% vs. 28.6%, OR = 1.090, 95% CI 0.483-2.456, P = 0.836). In conclusion, low frame rate fluoroscopy at 7.5 frames/s is a safe and feasible strategy for reducing radiation during PPCI.
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Jonczyk M, Collettini F, Geisel D, Schnapauff D, Böning G, Wieners G, Gebauer G. Radiation exposure during TACE procedures using additional cone-beam CT (CBCT) for guidance: safety and precautions. Acta Radiol 2018; 59:1277-1284. [PMID: 29490465 DOI: 10.1177/0284185118761203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background During transarterial chemoembolization (TACE), cone-beam computed tomography (CBCT) can be used for tumor and feeding vessel detection as well as postembolization CT imaging. However, there will be additional radiation exposure from CBCT. Purpose To evaluate the additional dose raised through CBCT-assisted guidance in comparison to TACE procedures guided with pulsed digital subtraction angiography (DSA) alone. Material and Methods In 70 of 140 consecutive patients undergoing TACE for liver cancer, CBCT was used to facilitate the TACE. Cumulative dose area product (DAP), cumulative kerma(air), DAP values of DSA, total and cine specific fluoroscopy times (FT) of 1375 DSA runs, and DAP of 91 CBCTs were recorded and analyzed using Spearman's correlation, Mann-Whitney U-test, and Kruskal-Wallis test. P values < 0.05 were considered significant. Results Additional CBCT increased DAP by 2% ( P = 0.737), kerma(air) by 24.6% ( P = 0.206), and FT by 0.02% ( P = 0.453). Subgroup analysis revealed that postembolization CBCT for detection of ethiodized oil deposits added more DAP to the procedure. Performing CBCT-assisted TACE, DSA until first CBCT contributed about 38% to the total DAP. Guidance CBCT acquisitions conduced to 6% of the procedure's DAP. Additional DSA for guidance after CBCT acquisition required approximately 46% of the mean DAP. The last DSA run for documentation purposes contributed about 10% of the DAP. Conclusion CBCT adds radiation exposure in TACE. However, the capability of CBCT to detect vessels and overlay in real-time during fluoroscopy facilitates TACE with resultant reduction of DAPs up to 46%.
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Affiliation(s)
- M Jonczyk
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - F Collettini
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - D Geisel
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - D Schnapauff
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Böning
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Wieners
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Gebauer
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
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Kiang SC, Ahmed KA, Cha VJ, Farley DV, Oyoyo UE, Abou-Zamzam AM, Tomihama RT. Analysis of intraoperative radiation use in vascular surgery: Catalyst for quality improvement in patient and personnel safety. Vascular 2018; 27:144-152. [PMID: 30336745 DOI: 10.1177/1708538118806749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is paucity in the literature reporting radiation usage analysis in vascular surgery. In the era of endovascular surgeries, analyzing the surgeons' use of radiation in vascular procedures can help establish quality improvement initiatives. METHODS A retrospective review was undertaken of intraoperative fluoroscopic-guided vascular surgery procedures at a single institution from 2010 to 2017. Mobile C-arms were utilized to gather the six radiation usage metrics and cases were categorized into 6 anatomic surgical fields and 10 surgical procedure types. RESULTS Three hundred and eighteen vascular surgery cases were analyzed and notable trends in all radiation usage metrics were identified both across the surgical field location and type of surgical procedure. The highest cumulative dose was identified in embolization cases with a mean of 932.5 mGy. The highest fluoroscopic time was seen in atherectomies with a mean of 2629.6 s. In terms of surgical field, the highest cumulative does and fluoroscopic time was identified in abdomen/pelvis procedures with a mean of 352.1 mGy and 1186.8 s, respectively. Analysis of dose reduction techniques also demonstrated notable trends. CONCLUSIONS There were notable trends in the analyzed radiation usage variables both across the surgical field location and type of surgical procedure. Specifically, cases that involve the abdomen/pelvis, embolization and atherectomy have the highest radiation use. These types of cases can be targeted for future improved dose reduction techniques or staged procedures. This data can serve as baseline information for future quality improvement initiatives for patient and personnel radiation exposure safety.
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Affiliation(s)
- Sharon C Kiang
- 1 Department of Surgery, Division of Vascular Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.,2 Department of Surgery, Division of Vascular Surgery, VA Loma Linda Healthcare System, Redlands, CA, USA
| | - Khwaja A Ahmed
- 3 Department of Radiology, Section of Vascular and Interventional Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Victoria J Cha
- 3 Department of Radiology, Section of Vascular and Interventional Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Donald V Farley
- 3 Department of Radiology, Section of Vascular and Interventional Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Udochukwu E Oyoyo
- 3 Department of Radiology, Section of Vascular and Interventional Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ahmed M Abou-Zamzam
- 1 Department of Surgery, Division of Vascular Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Roger T Tomihama
- 3 Department of Radiology, Section of Vascular and Interventional Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Abstract
Interventional radiology in veterinary medicine was adapted from techniques developed in human medicine, and has a variety of applications to treat disease in multiple body systems. Fluoroscopy is required for almost all interventional procedures, requiring knowledge of proper safety techniques for working with ionizing radiation. There are a wide variety of catheters, wires, sheaths, stents, and embolics used in veterinary medicine. Familiarity with their indications and sizing compatibility is essential for procedural success.
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Kostova-Lefterova DD, Nikolov NN, Stanev SS, Stoyanova BB. Patient doses in endovascular and hybrid revascularization of the lower extremities. Br J Radiol 2018; 91:20180176. [PMID: 30028182 DOI: 10.1259/bjr.20180176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Hybrid surgical methods such as remote endarterectomy and endovascular revascularization are fluoroscopy-guided procedures successfully replacing conventional open surgery for treatment of peripheral artery disease (PAD). The aim of this study was to: (1) evaluate the dose parameters describing exposure of patients undergoing endovascular or hybrid revascularization of the lower limb (below the inguinal ligament); (2) compare the data available in the literature with the evaluations of patients' dose values and related factors for patients undergoing such procedures; (3) examine the correlation of doses with certain parameters; (4) estimate the peak skin dose and assess the potential for radiation-induced skin injuries during the procedures. METHODS: Data for 259 patients were extracted retrospectively and analyzed. The procedures were grouped by type of intervention, vascular approach, and level of complexity. The analyses included the correlation of dose values with the operating team. RESULTS: The air kerma-area product (KAP) and fluoroscopy time (FT) values greatly varied depending on the procedure type but also among patients undergoing the same procedure. The type of vascular access has the largest impact on patients' doses. The KAP and FT values for brachial artery were: 347 Gy.cm2 and FT: NA; for contralateral common femoral artery (CFA) approach: 207 Gy.cm2 and 153 s; e.g. significantly higher than for ipsilateral CFA: 96 Gy.cm2 and 78 s; for hybrid surgery: 77 Gy.cm2 and 41 s; and for ipsilateral retrograde popliteal approach: 61 Gy.cm2 and 53 s. The same tendency is observed for the peak skin dose (PSD) values: the highest are for brachial artery (2053 mGy) and contralateral CFA (1325 mGy) approach, followed by the ipsilateral CFA (748 mGy), hybrid surgery (649 mGy), and ipsilateral retrograde popliteal approach (566 mGy). CONCLUSION: Registered dose values and FT for the different procedures do not exceed the International Atomic Energy Agency (IAEA) proposed trigger values for patients' follow-up for radiation-induced skin injuries. The type of vascular access has the highest negative impact on radiation dose levels and resultant KAP, PSD, and FT values. There is a significant increase of the dose values with increase of the number of inserted stents and the level of complexity. This should be considered in planning, especially for patients who undergo multiple diagnostic and therapeutic procedures. ADVANCES IN KNOWLEDGE: This study gives a systematic understanding for patient radiation exposure in endovascular and hybrid revascularization of the lower extremities, thus far absent in the literature.
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Affiliation(s)
- Desislava D Kostova-Lefterova
- 1 Clinic of Vascular Surgery, National Cardiology Hospital , Sofia , Bulgaria.,2 Medical College, Medical University - Pleven , Pleven , Bulgaria
| | - Nadelin N Nikolov
- 1 Clinic of Vascular Surgery, National Cardiology Hospital , Sofia , Bulgaria
| | - Stefan S Stanev
- 1 Clinic of Vascular Surgery, National Cardiology Hospital , Sofia , Bulgaria
| | - Boyka B Stoyanova
- 1 Clinic of Vascular Surgery, National Cardiology Hospital , Sofia , Bulgaria
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Gowda SR, Mitchell CJ, Abouel-Enin S, Lewis C. Radiation risk amongst orthopaedic surgeons - Do we know the risk? J Perioper Pract 2018; 29:115-121. [PMID: 29944026 DOI: 10.1177/1750458918785268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radiation risk amongst orthopaedic surgeons and theatre personnel is increasing with increased use of fluoroscopy imaging. Increased radiation risk has been shown to be associated with an increased risk of malignancies, ocular and thyroid disorders. Very high exposures have been reported in spinal surgery and during intra-medullary nailing. With an increase in modern and percutaneous methods, the use of intra-operative fluoroscopy has increased as well. The aim of this article was to review the available evidence of radiation risk amongst healthcare personnel. A systematic search was carried out in PubMED, CINAHL and Cochrane on intra-operative radiation in trauma and orthopaedic operating room. Inclusion criteria were clinical studies and systematic reviews reporting on radiation exposure, fluoroscopy time and references to specific safety guidelines. This article highlights the safety aspects of radiation protection and harmful effects of radiation during orthopaedic procedures. The responsibility to minimise radiation exposure in operating theatre lies with the team within the operating room.
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Affiliation(s)
- Sushmith R Gowda
- 1 Department of Trauma and Orthopaedics, Royal Centre for Defence Medicine, Birmingham, UK
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Sheen JJ, Jiang YY, Kim YE, Maeng JY, Kim TI, Lee DH. Increase in fluoroscopic radiation dose in successive sessions of multistage Onyx embolization of brain arteriovenous malformations compared with the first session. J Neurointerv Surg 2018; 10:e36. [PMID: 29572266 DOI: 10.1136/neurintsurg-2017-013706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/02/2018] [Accepted: 03/04/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Onyx embolization is a treatment for brain arteriovenous malformations (AVMs). However, multistage embolization usually involves the presence of radiodense Onyx cast from the previous sessions, which may influence the fluoroscopic radiation dose. We compared the fluoroscopic dose between the initial and final embolization sessions. MATERIALS AND METHOD From January 2014 to September 2016, 18 patients underwent multistage Onyx embolization (more than twice) for brain AVMs. The total fluoroscopic duration (minutes), dose-area product (DAP, Gy×cm2), and cumulative air kerma (CAK, mGy) of both the frontal and lateral planes were obtained. We compared the frontal and lateral fluoroscopic dose rates (dose/time) of the final embolization session with those of the initial session. The relationship between the injected Onyx volume and radiation dose was tested. RESULTS The initial and final procedures on the frontal plane showed significantly different fluoroscopic dose rates (DAP: initial 0.668 Gy×cm2/min, final 0.848 Gy×cm2/min, P=0.02; CAK: initial 12.7 mGy/min, final 23.1 mGy/min, P=0.007). Those on the lateral plane also showed a similar pattern (DAP: initial 0.365 Gy×cm2/min, final 0.519 Gy×cm2/min, P=0.03; CAK: initial 6.2 mGy/min, final 12.9 mGy/min, P=0.01). The correlation between the cumulative Onyx volume (vials) and radiation dose ratio of both planes showed an increasing trend (rho 0.4325-0.7053; P=0.0011-0.0730). CONCLUSION Owing to the automatic exposure control function during fluoroscopy, successive Onyx embolization procedures increase the fluoroscopic radiation dose in multistage brain AVM embolization because of the presence of radiodense Onyx mass.
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Affiliation(s)
- Jae Jon Sheen
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Yuan Yuan Jiang
- Department of Biotechnology, Dongguk University, Ilsan, Korea (the Republic of)
| | - Young Eun Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Jun Young Maeng
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Tae-Il Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
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Ichimoto E, Kadohira T, Nakayama T, De Gregorio J. Efficacy of radiation dose reduction due to real-time monitoring and visualization of peak skin dose during coronary angiography and percutaneous coronary intervention. Catheter Cardiovasc Interv 2018; 91:717-722. [PMID: 28557313 DOI: 10.1002/ccd.27150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/29/2017] [Accepted: 04/29/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study assessed that the use of real-time monitoring and visualization of peak skin dose could reduce radiation dose during coronary angiography (CAG) and percutaneous coronary intervention (PCI). BACKGROUND Exposure to ionizing radiation has dose related effects including skin damage. Reducing the radiation exposure is important during CAG and PCI. The skin dose-tracking system (DTS) has a real-time monitor of radiation peak skin dose. METHODS A total of 323 consecutive patients who underwent CAG and PCI between September 2014 and June 2015 were enrolled. Patients were classified into with DTS group (CAG alone in 104 and PCI in 57 patients) or without DTS group (CAG alone in 106 and PCI in 56 patients). RESULTS There was no significant difference in reference air kerma between CAG alone with and without DTS groups. Reference air kerma with DTS group during PCI was lower than without DTS group (204.6 ± 141.1 mGy vs. 294.2 ± 237.4 mGy, P = 0.016). Moreover, kerma area product (17.8 ± 13.0 Gycm2 vs. 25.2 ± 19.3 Gycm2 , P = 0.019) and number of cine runs (12.8 ± 5.0 vs. 15.5 ± 6.5, P = 0.013) with DTS group were lower than without DTS group. Multiple regression analysis showed increased reference air kerma was associated with male gender, body mass index and type B2/C lesion. Conversely, DTS correlated with decreased reference air kerma. CONCLUSIONS The use of DTS could reduce radiation dose during PCI. Real-time radiation monitoring and visualization of peak skin dose was effective for the patients with PCI.
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Affiliation(s)
- Eiji Ichimoto
- Department of Invasive Cardiology, Englewood Hospital and Medical Center, Englewood, New Jersey
| | - Tadayuki Kadohira
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Joseph De Gregorio
- Department of Invasive Cardiology, Englewood Hospital and Medical Center, Englewood, New Jersey
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