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Aly A, Tsapaki V, Ahmed AZ, Own A, Patro S, Al Naemi H, Kharita MH. Clinical diagnostic reference levels in neuroradiology based on clinical indication. RADIATION PROTECTION DOSIMETRY 2024; 200:755-762. [PMID: 38702851 PMCID: PMC11148473 DOI: 10.1093/rpd/ncae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/27/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
This study focuses on patient radiation exposure in interventional neuroradiology (INR) procedures, a field that has advanced significantly since its inception in the 1980s. INR employs minimally invasive techniques to treat complex cerebrovascular diseases in the head, neck, and spine. The study establishes diagnostic reference levels (DRLs) for three clinical indications (CIs): stroke (S), brain aneurysms (ANs), and brain arteriovenous malformation (AVM). Data from 209 adult patients were analyzed, and DRLs were determined in terms of various dosimetric and technical quantities. For stroke, the established DRLs median values were found to be 78 Gy cm2, 378 mGy, 118 mGy, 12 min, 442 images, and 15 runs. Similarly, DRLs for brain AN are 85 Gy cm2, 611 mGy, 95.5 mGy, 19.5, 717 images, and 26 runs. For brain AVM, the DRL's are 180 Gy cm2, 1144 mGy, 537 mGy, 36 min, 1375 images, and 31 runs. Notably, this study is unique in reporting DRLs for specific CIs within INR procedures, providing valuable insights for optimizing patient safety and radiation exposure management.
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Affiliation(s)
- Antar Aly
- Medical Physics Section, Hamad Medical Corporation, Doha 3050, Qatar
- Radiology Department, Weill Cornell Medicine, Doha 24144, Qatar
| | - Virginia Tsapaki
- Medical Physics Department, Konstantopoulio Hospital, 142 33 Nea Ionia, Athens, Greece
| | | | - Ahmed Own
- Neurosurgery Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Satya Patro
- Neurosurgery Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Huda Al Naemi
- Radiology Department, Weill Cornell Medicine, Doha 24144, Qatar
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2
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D'Alessio A, Strocchi S, Dalmasso F, Cannillo B, Matheoud R, Ponzetti A, Aimonetto S, Cernigliaro M, Azzalin G, Giorgianni A, Natrella M, Carriero A, Guzzardi G, Brambilla M. Effective and organ doses in patient undergoing interventional neuroradiology procedures: A multicentre study. Phys Med 2024; 122:103383. [PMID: 38810393 DOI: 10.1016/j.ejmp.2024.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/22/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Radiation doses to adult patients submitted to cerebral angiography and intracranial aneurysms treatments were assessed by using DICOM Radiation Dose Structured Reports (RDSR) and Monte Carlo simulations. Conversion factors to estimate effective and organ doses from Kerma-Area Product (PKA) values were determined. METHODS 77 cerebral procedures performed with five angiographic equipment installed in three Italian centres were analyzed. Local settings and acquisition protocols were considered. The geometrical, technical and dosimetric data of 16,244 irradiation events (13305 fluoroscopy, 2811 digital subtraction angiography, 128 cone-beam CT) were extracted from RDSRs by local dose monitoring systems and were input in MonteCarlo PCXMC software to calculate effective and organ doses. Finally, conversion factors to determine effective and organ doses from PKA were determined. Differences between centres were assessed through statistical analysis and accuracy of dose calculation method based on conversion factors was assessed through Bland-Altman analysis. RESULTS Large variations in PKA (14-561 Gycm2) and effective dose (1.2-73.5 mSv) were observed due to different degrees of complexity in the procedures and angiographic system technology. The most exposed organs were brain, salivary glands, oral mucosa, thyroid and skeleton. The study highlights the importance of recent technology in reducing patient exposure (about fourfold, even more in DSA). No statistically significant difference was observed in conversion factors between centres, except for some organs. A conversion factor of 0.09 ± 0.02 mSv/Gycm2 was obtained for effective dose. CONCLUSIONS Organ and effective doses were assessed for neuro-interventional procedures. Conversion factors for calculating effective and organ doses from PKA were provided.
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Affiliation(s)
- Andrea D'Alessio
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
| | - Sabina Strocchi
- Medical Physics Department, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federico Dalmasso
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | - Barbara Cannillo
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Roberta Matheoud
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Alex Ponzetti
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy; Medical Physics Postgraduate School, University of Turin, Turin, Italy
| | - Stefania Aimonetto
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | | | - Giulia Azzalin
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Andrea Giorgianni
- Neuroradiology Department, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Massimiliano Natrella
- Radiology Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | - Alessandro Carriero
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
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Molinaro S, Mistretta F, Russo R, Risi G, Venturi F, Bergui M. Cineangiography versus standard digital subtraction angiography in mechanical thrombectomy: lowering the radiation exposure without sacrificing the outcome. J Neurointerv Surg 2024:jnis-2023-021289. [PMID: 38262728 DOI: 10.1136/jnis-2023-021289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Endovascular thrombectomy has become a standard procedure for the treatment of acute ischemic stroke caused by large vessel occlusion. Radiation exposure to the patient and operators during mechanical thrombectomy procedures is a concern. METHODS The use of a high frames per second unmasked protocol-cineangiography (CINE)-derived from cardiac intervention could mitigate radiation exposure without sacrificing procedural and clinical outcomes. RESULTS The analysis of a prospective-maintained monocentric database of 131 patients who underwent mechanical thrombectomy (65 with the CINE protocol and 66 with the conventional digital subtraction angiography (DSA) protocol) showed a significant reduction in radiation exposure for both air kerma (AK) and dose-area product (DAP) indicators (AK 463.7 mGy vs 772 mGy, P<0.01; DAP 41.35 Gy/cm2 CINE vs 83.77 Gy/cm2 DSA, P<0.01), with no differences regarding both safety and efficacy outcomes (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b 78.4% CINE and 81.5% DSA, P=0.79; overall complications rate both intracranial and extracranial 23% CINE and 19.6% DSA, P=0.65). There were no significant differences in post-thrombectomy radiographic hemorrhagic conversion rate (P=0.77) or functional independence on discharge defined as modified Rankin Scale score ≤2 (P=0.39). A post-hoc image assessment of vessel point occlusion and recanalization mTICI score performed by three experienced interventional neuroradiologists not involved in the procedure showed a non-significant difference between the two groups regarding occlusion point (0.928 vs 0.953, P=0.31) and recanalization grade (0.814 vs 0.847, P=0.62). CONCLUSIONS Our initial experience demonstrated that reduction of the quality of CINE images caused no modifications in safety and efficacy and should fit within the context of diagnostic requests in an intracranial revascularization procedure.
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Affiliation(s)
- Stefano Molinaro
- Interventional Neuroradiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Mistretta
- Department of Surgical Sciences, Università degli Studi di Torino, Torino, Italy
| | - Riccardo Russo
- Surgical Science, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gaetano Risi
- Radiology, Università degli Studi di Torino, Torino, Italy
| | - Fabrizio Venturi
- Neuroradiology, Azienda Ospedaliera S Croce e Carle Cuneo, Cuneo, Italy
| | - Mauro Bergui
- Interventional Neuroradiology, Università degli Studi di Torino, Torino, Italy
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Zeleňák K, Šalát D, Kolarovszki B, Kurča E, Zeleňáková J, Koçer N. Embolization of Ruptured Infratentorial Pial AVM in Pregnancy. Life (Basel) 2023; 13:life13040896. [PMID: 37109425 PMCID: PMC10144631 DOI: 10.3390/life13040896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
A primigravida 22-year-old woman, at a gestation of 23 weeks, experienced bleeding from a pial arteriovenous malformation (AVM) located in the right cerebellum. After interdisciplinary consensus and with the informed consent of the patient and her family, AVM embolization was performed. Complete occlusion of the AVM was achieved by embolization with PHIL (precipitating hydrophobic injectable liquid). The calculated dose in the uterus was less than 1 µSv, which represents a negligible risk of harmful effects on the fetus. She delivered a baby at 37 weeks of gestation by cesarean section without complications. No congenital disorders were diagnosed by standard screening methods until the age of the newborn was two years. The angiography protocol must be optimized to minimize the radiation dose. Adequate shielding protection of the uterus is important. Premature termination of pregnancy is not necessary. Multidisciplinary care of neurologists, neurosurgeons, interventional radiologists, anesthesiologists, neonatologists, and obstetricians is necessary.
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Sanchez RM, Siiskonen T, Vano E. Current status of diagnostic reference levels in interventional cardiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:041002. [PMID: 36379055 DOI: 10.1088/1361-6498/aca2b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Interventional cardiology provides indisputable benefits for patients but uses a substantial amount of ionising radiation. The diagnostic reference level (DRL) is the tool recommended by the International Commission on Radiological Protection to optimise imaging procedures. In this work, a review of studies dealing with radiation dose or recommending DRL values for interventional cardiology since 2010 is presented, providing quantitative and qualitative results. There are many published papers on coronary angiography (CA) and percutaneous coronary intervention. The DRL values compiled for different continental regions are different: the DRL for CA is about 35 Gy cm2for Europe and 83 Gy cm2for North America. These differences emphasise the need to establish national DRLs considering different social and/or economic factors and the harmonisation of the survey methodology. Surveys with a large amount of data collected with the help of dose management systems provide more reliable information with less chance of statistical bias than those with a small amount of data. The complexity of procedures and improvements in technology are important factors that affect the radiation dose delivered to patients. There is a need for additional data on structural and electrophysiological procedures. The analysis of paediatric procedures is especially difficult because some studies present results split into age bands and others into weight bands. Diagnostic procedures are better described, but there is a great variety of therapeutic procedures with different DRL values (up to a factor of nine) and these require a dedicated review.
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Affiliation(s)
- Roberto M Sanchez
- Hospital Clinico Universitario San Carlos, Medical Physics, Madrid, Spain
| | - Teemu Siiskonen
- Radiation and Nuclear Safety Authority-STUK, Helsinki, Finland
| | - Eliseo Vano
- Radiology Department, Universidad Complutense de Madrid, Madrid, Spain
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6
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Vano E, Loose R, Frija G, Paulo G, Efstathopoulos E, Granata C, Corridori R, Torresin A, Andersson JS, Tsapaki V, Ammon J, Hoeschen C. Notifications and alerts in patient dose values for computed tomography and fluoroscopy-guided interventional procedures. Eur Radiol 2022; 32:5525-5531. [PMID: 35294584 PMCID: PMC9279248 DOI: 10.1007/s00330-022-08675-w] [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: 10/01/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/04/2022]
Abstract
The terms "notifications" and "alerts" for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to help in optimisation for CT and for fluoroscopy-guided interventional procedures as well as in the analysis of unintended and accidental medical exposures. The paper also includes cautions in setting the alert values and discusses the benefits of using patient dose management systems for the alerts, their registry and follow-up, and the differences between notifications, alerts, and trigger levels for individual procedures and the terms used for the collective approach, such as diagnostic reference levels. KEY POINTS: • Notifications and alerts on patient dose values for computed tomography (CT) and fluoroscopy-guided interventional procedures (FGIP) allow to improve radiation safety and contribute to the avoidance of radiation injuries and unintended and accidental exposures. • Alerts may be established before the imaging procedures (as in CT) or during and after the procedures as for FGIP. • Dose management systems should include notifications and alerts and their registry for the hospital quality programmes.
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Affiliation(s)
- Eliseo Vano
- Radiology Department, Complutense University, 28040, Madrid, Spain.
| | - Reinhard Loose
- Institute of Medical Physics, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Guy Frija
- Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal
| | - Efstathios Efstathopoulos
- Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Claudio Granata
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Virginia Tsapaki
- Medical Physics, Konstantopoulio General Hospital, Nea Ionia, Greece
| | - Josefin Ammon
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Christoph Hoeschen
- Institut Für Medizintechnik, Otto-Von-Guericke Universität, Magdeburg, Germany
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Kaatsch HL, Schneider J, Brockmann C, Brockmann MA, Overhoff D, Becker BV, Waldeck S. Radiation exposure during angiographic interventions in interventional radiology - risk and fate of advanced procedures. Int J Radiat Biol 2022; 98:865-872. [PMID: 34982640 DOI: 10.1080/09553002.2021.2020362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Advanced angiographic procedures in interventional radiology are becoming more important and are more frequently used, especially in the treatment of several acute life-threatening diseases like stroke or aortic injury. In recent years, technical advancement has led to a broader spectrum of interventions and complex procedures with longer fluoroscopy times. This involves the risk of higher dose exposures, which, in rare cases, may cause deterministic radiation effects, e.g. erythema in patients undergoing angiographic procedures. Against this background, these procedures recently also became subject to national and international regulations regarding radiation protection. At the same time, individual risk assessment of possible stochastic radiation effects for each patient must be weighed up against the anticipated benefits of the therapy itself. Harmful effects of the administered dose are not limited to the patient but can also affect the radiologist and the medical staff. In particular, the development of cataracts in interventionalists is a rising matter of concern. Furthermore, long-term effects of repeated and prolonged x-ray exposure have long been neglected by radiologists but have come into focus in the past years. CONCLUSIONS With all this in mind, this review discusses different efforts to reduce radiation exposition levels for patients and medical staff by means of technical, personal as well as organizational measures.
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Affiliation(s)
| | - Julian Schneider
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
| | - Carolin Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Daniel Overhoff
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
| | | | - Stephan Waldeck
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
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8
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Angular Super-Resolution in X-Ray Projection Radiography Using Deep Neural Network: Implementation on Rotational Angiography. Biomed J 2022; 46:154-162. [PMID: 35026475 PMCID: PMC10105049 DOI: 10.1016/j.bj.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/30/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Rotational angiography acquires radiographs at multiple projection angles to demonstrate superimposed vasculature. However, this comes at the expense of the inherent risk of increased ionizing radiation. In this paper, building upon a successful deep learning model, we developed a novel technique to super-resolve the radiography at different projection angles to reduce the actual projections needed for a diagnosable radiographic procedure. METHODS Ten models were trained for different levels of angular super-resolution (ASR), denoted as ASRN, where for every N+2 frames, the first and the last frames were submitted as inputs to super-resolve the intermediate N frames. RESULTS The results show that large arterial structures were well preserved in all ASR levels. Small arteries were adequately visualized in lower ASR levels but progressively blurred out in higher ASR levels. Noninferiority of image quality was demonstrated in ASR1-4 (99.75% confidence intervals: -0.16-0.03, -0.19-0.04, -0.17-0.01, -0.15-0.05 respectively). CONCLUSIONS ASR technique is capable of super-resolving rotational angiographic frames at intermediate projection angles.
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9
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Garrett L, Ung MC, Einicke J, Zimprich A, Fenzl F, Pawliczek D, Graw J, Dalke C, Hölter SM. Complex Long-term Effects of Radiation on Adult Mouse Behavior. Radiat Res 2021; 197:67-77. [PMID: 34237145 DOI: 10.1667/rade-20-00281.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/24/2021] [Indexed: 11/03/2022]
Abstract
We have shown previously that a single radiation event (0.063, 0.125 or 0.5 Gy, 0.063 Gy/min) in adult mice (age 10 weeks) can have delayed dose-dependent effects on locomotor behavior 18 months postirradiation. The highest dose (0.5 Gy) reduced, whereas the lowest dose (0.063 Gy) increased locomotor activity at older age independent of sex or genotype. In the current study we investigated whether higher doses administered at a higher dose rate (0.5, 1 or 2 Gy, 0.3 Gy/min) at the same age (10 weeks) cause stronger or earlier effects on a range of behaviors, including locomotion, anxiety, sensorimotor and cognitive behavior. There were clear dose-dependent effects on spontaneous locomotor and exploratory activity, anxiety-related behavior, body weight and affiliative social behavior independent of sex or genotype of wild-type and Ercc2S737P heterozygous mice on a mixed C57BL/6JG and C3HeB/FeJ background. In addition, smaller genotype- and dose-dependent radiation effects on working memory were evident in males, but not in females. The strongest dose-dependent radiation effects were present 4 months postirradiation, but only effects on affiliative social behaviors persisted until 12 months postirradiation. The observed radiation-induced behavioral changes were not related to alterations in the eye lens, as 4 months postirradiation anterior and posterior parts of the lens were still normal. Overall, we did not find any sensitizing effect of the mutation towards radiation effects in vivo.
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Affiliation(s)
- Lillian Garrett
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Developmental Genetics, Neuherberg, Germany
| | - Marie-Claire Ung
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Developmental Genetics, Neuherberg, Germany
| | - Jan Einicke
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Developmental Genetics, Neuherberg, Germany
| | - Annemarie Zimprich
- Technical University Munich, School of Life Science Weihenstephan, Freising, Germany
| | - Felix Fenzl
- Technical University Munich, School of Life Science Weihenstephan, Freising, Germany
| | - Daniel Pawliczek
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Developmental Genetics, Neuherberg, Germany
| | - Jochen Graw
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Developmental Genetics, Neuherberg, Germany
| | - Claudia Dalke
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Developmental Genetics, Neuherberg, Germany
| | - Sabine M Hölter
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Developmental Genetics, Neuherberg, Germany.,Technical University Munich, School of Life Science Weihenstephan, Freising, Germany
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Peter Y, Speelman A, Daries V. Measurement of the average radiation dose to the local skin and thyroid gland during intracranial aneurysm coil embolization. Radiography (Lond) 2021; 27:255-259. [DOI: 10.1016/j.radi.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/07/2023]
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11
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Roser P, Birkhold A, Preuhs A, Ochs P, Stepina E, Strobel N, Kowarschik M, Fahrig R, Maier A. XDose: toward online cross-validation of experimental and computational X-ray dose estimation. Int J Comput Assist Radiol Surg 2021; 16:1-10. [PMID: 33274400 PMCID: PMC7822800 DOI: 10.1007/s11548-020-02298-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE As the spectrum of X-ray procedures has increased both for diagnostic and for interventional cases, more attention is paid to X-ray dose management. While the medical benefit to the patient outweighs the risk of radiation injuries in almost all cases, reproducible studies on organ dose values help to plan preventive measures helping both patient as well as staff. Dose studies are either carried out retrospectively, experimentally using anthropomorphic phantoms, or computationally. When performed experimentally, it is helpful to combine them with simulations validating the measurements. In this paper, we show how such a dose simulation method, carried out together with actual X-ray experiments, can be realized to obtain reliable organ dose values efficiently. METHODS A Monte Carlo simulation technique was developed combining down-sampling and super-resolution techniques for accelerated processing accompanying X-ray dose measurements. The target volume is down-sampled using the statistical mode first. The estimated dose distribution is then up-sampled using guided filtering and the high-resolution target volume as guidance image. Second, we present a comparison of dose estimates calculated with our Monte Carlo code experimentally obtained values for an anthropomorphic phantom using metal oxide semiconductor field effect transistor dosimeters. RESULTS We reconstructed high-resolution dose distributions from coarse ones (down-sampling factor 2 to 16) with error rates ranging from 1.62 % to 4.91 %. Using down-sampled target volumes further reduced the computation time by 30 % to 60 %. Comparison of measured results to simulated dose values demonstrated high agreement with an average percentage error of under [Formula: see text] for all measurement points. CONCLUSIONS Our results indicate that Monte Carlo methods can be accelerated hardware-independently and still yield reliable results. This facilitates empirical dose studies that make use of online Monte Carlo simulations to easily cross-validate dose estimates on-site.
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Affiliation(s)
- Philipp Roser
- Pattern Recognition Lab, Friedrich-Alexander Universität Erlangen-Nürnberg, 91058, Erlangen, Germany.
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg, 91052, Erlangen, Germany.
| | - Annette Birkhold
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Alexander Preuhs
- Pattern Recognition Lab, Friedrich-Alexander Universität Erlangen-Nürnberg, 91058, Erlangen, Germany
| | - Philipp Ochs
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Elizaveta Stepina
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Norbert Strobel
- Institute of Medical Engineering Schweinfurt, University of Applied Sciences Würzburg-Schweinfurt, 97421, Schweinfurt, Germany
| | - Markus Kowarschik
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Rebecca Fahrig
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander Universität Erlangen-Nürnberg, 91058, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg, 91052, Erlangen, Germany
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12
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Ung MC, Garrett L, Dalke C, Leitner V, Dragosa D, Hladik D, Neff F, Wagner F, Zitzelsberger H, Miller G, de Angelis MH, Rößler U, Vogt Weisenhorn D, Wurst W, Graw J, Hölter SM. Dose-dependent long-term effects of a single radiation event on behaviour and glial cells. Int J Radiat Biol 2020; 97:156-169. [PMID: 33264576 DOI: 10.1080/09553002.2021.1857455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The increasing use of low-dose ionizing radiation in medicine requires a systematic study of its long-term effects on the brain, behaviour and its possible association with neurodegenerative disease vulnerability. Therefore, we analysed the long-term effects of a single low-dose irradiation exposure at 10 weeks of age compared to medium and higher doses on locomotor, emotion-related and sensorimotor behaviour in mice as well as on hippocampal glial cell populations. MATERIALS AND METHODS We determined the influence of radiation dose (0, 0.063, 0.125 or 0.5 Gy), time post-irradiation (4, 12 and 18 months p.i.), sex and genotype (wild type versus mice with Ercc2 DNA repair gene point mutation) on behaviour. RESULTS The high dose (0.5 Gy) had early-onset adverse effects at 4 months p.i. on sensorimotor recruitment and late-onset negative locomotor effects at 12 and 18 months p.i. Notably, the low dose (0.063 Gy) produced no early effects but subtle late-onset (18 months) protective effects on sensorimotor recruitment and exploratory behaviour. Quantification and morphological characterization of the microglial and the astrocytic cells of the dentate gyrus 24 months p.i. indicated heightened immune activity after high dose irradiation (0.125 and 0.5 Gy) while conversely, low dose (0.063 Gy) induced more neuroprotective features. CONCLUSION This is one of the first studies demonstrating such long-term and late-onset effects on brain and behaviour after a single radiation event in adulthood.
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Affiliation(s)
- Marie-Claire Ung
- Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,Institute of Pathology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,Institute of Radiation Medicine, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,Research Unit of Radiation Cytogenetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Lillian Garrett
- Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Claudia Dalke
- Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | | | - Daniel Dragosa
- Technische Universität München, Freising-Weihenstephan, Germany
| | - Daniela Hladik
- Technische Universität München, Freising-Weihenstephan, Germany
| | - Frauke Neff
- Institute of Pathology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Florian Wagner
- Institute of Radiation Medicine, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Horst Zitzelsberger
- Research Unit of Radiation Cytogenetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Gregor Miller
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Martin Hrabĕ de Angelis
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,Department of Experimental Genetics, School of Life Science Weihenstephan, Technische Universität München, Freising, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Ute Rößler
- Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg, Germany
| | - Daniela Vogt Weisenhorn
- Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Wolfgang Wurst
- Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,Chair of Developmental Genetics, Faculty of Life and Food Sciences Weihenstephan, Technische Universität München, Freising-Weihenstephan, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jochen Graw
- Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Sabine M Hölter
- Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.,Technische Universität München, Freising-Weihenstephan, Germany
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13
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Huynh TJ, Morton RP, Levitt MR, Ghodke BV, Wink O, Hallam DK. Republished: Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique. J Neurointerv Surg 2020; 12:e8. [PMID: 33060177 DOI: 10.1136/neurintsurg-2017-013052.rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 11/03/2022]
Abstract
We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture.
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Affiliation(s)
- Thien J Huynh
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Ryan P Morton
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Basavaraj V Ghodke
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Onno Wink
- Philips Healthcare, Bothell, Washington, USA
| | - Danial K Hallam
- Department of Radiology, University of Washington, Seattle, Washington, USA .,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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14
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Margolis A, Loparich A, Raz E, Fleisher KE. Use of Intraoperative Biplanar Fluoroscopy for Minimally Invasive Retrieval of a Broken Dental Needle. J Oral Maxillofac Surg 2020; 78:1922-1925. [PMID: 32768404 DOI: 10.1016/j.joms.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/27/2022]
Abstract
This report describes a case of needle breakage during a left-sided inferior alveolar nerve block to perform restorative dentistry on a 56-year-old male patient. The needle was removed in conjunction with interventional neuroradiology using biplanar fluoroscopy.
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Affiliation(s)
- Alexander Margolis
- Resident, Department of Oral and Maxillofacial Surgery, NYU College of Dentistry, Bellevue Hospital, NYU Langone Health, New York, NY.
| | - Alyssa Loparich
- Resident, Department of Oral and Maxillofacial Surgery, NYU College of Dentistry, Bellevue Hospital, NYU Langone Health, New York, NY
| | - Eytan Raz
- Assistant Professor Radiology, NYU Langone Health, New York, NY
| | - Kenneth E Fleisher
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, NYU College of Dentistry, Bellevue Hospital, NYU Langone Health, New York, NY
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15
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Almallouhi E, Al Kasab S, Sattur MG, Lena J, Jabbour PM, Sweid A, Chalouhi N, Gooch MR, Starke RM, Peterson EC, Yavagal DR, Chen SH, Li Y, Gross BA, Tonetti DA, Zussman BM, Stone JG, Jadhav AP, Jankowitz BT, Young CC, Lim DH, Levitt MR, Osbun JW, Spiotta AM. Incorporation of transradial approach in neuroendovascular procedures: defining benchmarks for rates of complications and conversion to femoral access. J Neurointerv Surg 2020; 12:1122-1126. [DOI: 10.1136/neurintsurg-2020-015893] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 01/19/2023]
Abstract
BackgroundThe transradial approach (TRA) has gained increasing popularity for neuroendovascular procedures. However, the experience with TRA in neuroangiography is still in early stages in most centers, and the safety and feasibility of this approach have not been well established. The purpose of this study is to report the safety and feasibility of TRA for neuroendovascular procedures.MethodsWe reviewed charts from six institutions in the USA to include consecutive patients who underwent diagnostic or interventional neuroendovascular procedures through TRA from July 2018 to July 2019. Collected data included baseline characteristics, procedural variables, complications, and whether there was a crossover to transfemoral access.ResultsA total of 2203 patients were included in the study (age 56.1±15.2, 60.8% women). Of these, 1697 (77%) patients underwent diagnostic procedures and 506 (23%) underwent interventional procedures. Successfully completed procedures included aneurysm coiling (n=97), flow diversion (n=89), stent-assisted coiling (n=57), balloon-assisted coiling (n=19), and stroke thrombectomy (n=76). Crossover to femoral access was required in 114 (5.2%). There were no major complications related to the radial access site. Minor complications related to access site were seen in 14 (0.6%) patients.ConclusionIn this early stage of transforming to the ‘radial-first’ approach for neuroendovascular procedures, TRA was safe with low complication rates for both diagnostic and interventional procedures. A wide range of procedures were completed successfully using TRA.
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16
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ÖZDEMİR Hİ, ÇINAR C, BOZKAYA H, TOPAL S, ORAN İ. Servikokranial damarlar için dijital subtraksiyon anjiyografi ve multislice bilgisayarlı tomografi: Radyasyon dozlarının karşılaştırılması. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.471927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Özdemir Hİ, Çınar C, Bozkaya H, Topal S, Oran İ. Servikokranial damarlar için dijital subtraksiyon anjiografi ve multislice bilgisayarlı tomografi anjiografi radyasyon dozlarının karşılaştırılması. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.662373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Reimer RP, Flatten D, Lichtenstein T, Zopfs D, Neuhaus V, Kabbasch C, Maintz D, Borggrefe J, Große Hokamp N. Virtual Monoenergetic Images from Spectral Detector CT Enable Radiation Dose Reduction in Unenhanced Cranial CT. AJNR Am J Neuroradiol 2019; 40:1617-1623. [PMID: 31537517 DOI: 10.3174/ajnr.a6220] [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] [Received: 05/17/2019] [Accepted: 08/05/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate whether improved gray-white matter differentiation in cranial CT by means of 65- keV virtual monoenergetic images enables a radiation dose reduction compared to conventional images. MATERIALS AND METHODS One hundred forty consecutive patients undergoing 171 spectral detector CTs of the head between February and November 2017 (56 ± 19 years of age; male/female ratio, 56%/44%) were retrospectively included. The tube current-time product was reduced during the study period, resulting in 61, 55, and 55 patients being examined with 320, 290, and 260 mAs, respectively. All other scanning parameters were kept identical. The volume CT dose index was recorded. ROIs were placed in gray and white matter on conventional images and copied to identical positions in 65- keV virtual monoenergetic images. The contrast-to-noise ratio was calculated. Two radiologists blinded to the reconstruction technique evaluated image quality on a 5-point Likert-scale. Statistical assessment was performed using ANOVA and Wilcoxon test adjusted for multiple comparisons. RESULTS The mean volume CT dose index was 55, 49.8, and 44.7 mGy using 320, 290, and 260 mAs, respectively. Irrespective of the volume CT dose index, noise was significantly lower in 65- keV virtual monoenergetic images compared with conventional images (65- keV virtual monoenergetic images/conventional images: extraocular muscle with 49.8 mGy, 3.7 ± 1.3/5.6 ± 1.6 HU, P < .001). Noise slightly increased with a reduced radiation dose (eg, extraocular muscle in conventional images: 5.3 ± 1.4/5.6 ± 1.6/6.1 ± 2.1 HU). Overall, the contrast-to-noise ratio in 65- keV virtual monoenergetic images was superior to that in conventional images irrespective of the volume CT dose index (P < .001). Particularly, 65-keV virtual monoenergetic images with 44.7 mGy showed significantly lower noise and a higher contrast-to-noise ratio than conventional images with 55 mGy (P < .001). Subjective analysis confirmed better image quality in 65- keV virtual monoenergetic images, even using 44.7 mGy. CONCLUSIONS The 65-keV virtual monoenergetic images from spectral detector CT allow radiation dose reduction in cranial CT. While this proof of concept included a radiation dose reduction of 19%, our data suggest that even greater reduction appears achievable.
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Affiliation(s)
- R P Reimer
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - D Flatten
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - T Lichtenstein
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - D Zopfs
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - V Neuhaus
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - C Kabbasch
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - D Maintz
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J Borggrefe
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - N Große Hokamp
- From the Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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19
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Huo W, Pi Y, Feng M, Qi Y, Gao Y, Caracappa PF, Chen Z, Xu XG. VirtualDose-IR: a cloud-based software for reporting organ doses in interventional radiology. Phys Med Biol 2019; 64:095012. [PMID: 30822765 PMCID: PMC7480071 DOI: 10.1088/1361-6560/ab0bd5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A cloud-based software, VirtualDose-IR (Virtual Phantoms Inc., Albany, New York, USA), designed to report organ doses and effective doses for a diverse patient population from interventional radiology (IR) procedures has been developed and tested. This software is based on a comprehensive database of Monte Carlo-generated organ dose built with a set of 21 anatomically realistic patient phantoms. The patient types included in this database are both male and female people with different ages reflecting reference adults, obese people with different BMIs and pregnant women at different gestational stages. Selectable parameters such as patient type, tube voltage, filtration thickness, beam direction, field size, and irradiation site are also considered in VirtualDose-IR. The software has been implemented using the 'Software as a Service (SaaS)' delivery concept permitting simultaneous multi-user, multi-platform access without requiring local installation. The patient doses resulting from different target sites and patient populations were reported using the VirtualDose-IR system. The patient doses under different source to surface distances (SSD) and beam angles calculated by VirtualDose-IR and Monte Carlo simulations were compared. For most organs, the dose differences between VirtualDose-IR results and Monte Carlo results were less than 0.3 mGy at 15 000 mGy * cm2 kerma-area product (KAP). The organ dose results were compared with measurement data previously reported in literatures. The doses to organs that were located within the irradiation field match closely with experimental measurement data. The differences in the effective dose values between calculated using VirtualDose-IR and those measured were less than 2.5%. The dose errors of most organs between VirtualDose-IR and literature results were less than 40%. These results validate the accuracy of organ doses reported by VirtualDose-IR. With the inclusion of pre-specified clinical IR examination parameters (such as beam direction, target location, field of view and beam quality) and the latest anatomically realistic patient phantoms in Monte Carlo simulations, VirtualDose-IR provides users with accurate dose information in order to systematically compare, evaluate, and optimize IR plans.
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Affiliation(s)
- Wanli Huo
- School of Physical Sciences, University of Science and Technology of China, Hefei, China
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20
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Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients. Eur Radiol 2019; 29:3506-3515. [DOI: 10.1007/s00330-019-06062-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/08/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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21
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Acton H, James K, Kavanagh RG, O'Tuathaigh C, Moloney D, Wyse G, Fanning N, Maher M, O'Connor OJ. Monitoring neurointerventional radiation doses using dose-tracking software: implications for the establishment of local diagnostic reference levels. Eur Radiol 2018; 28:3669-3675. [PMID: 29651772 DOI: 10.1007/s00330-018-5405-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/10/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is potential for high radiation exposure during neurointerventional procedures. Increasing regulatory requirements mandate dose monitoring of patients and staff, and justification of high levels of radiation exposure. This paper demonstrates the potential to use radiation dose-tracking software to establish local diagnostic reference levels. METHODS Consecutive neurointerventional procedures, performed in a single institution within a one-year period, were retrospectively studied. Dose area product (DAP) data were collected using dose-tracking software and clinical data obtained from a prospectively generated patient treatment database. RESULTS Two hundred and sixty-four procedures met the selection criteria. Median DAP was 100 Gy.cm2 for aneurysm coiling procedures, 259 Gy.cm2 for arteriovenous malformation (AVM) embolisation procedures, 87 Gy.cm2 for stroke thrombolysis/thrombectomy, and 74 Gy.cm2 for four-vessel angiography. One hundred and nine aneurysm coiling procedures were further studied. Six significant variables were assessed using stepwise regression analysis to determine effect on DAP. Aneurysm location (anterior vs posterior circulation) had the single biggest effect (p = 0.004). CONCLUSIONS This paper confirms variable radiation exposures during neurointerventional procedures. The 75th percentile (used to define diagnostic reference levels) of DAP measurements represents a reasonable guidance metric for monitoring purposes. Results indicate that aneurysm location has the greatest impact on dose during coiling procedures and that anterior and posterior circulation coiling procedures should have separate diagnostic reference levels. KEY POINTS • Dose-tracking software is useful for monitoring patient radiation dose during neurointerventional procedures • This paper provides a template for methodology applicable to any interventional suite • Local diagnostic reference levels were defined by using the 75th percentile of DAP as per International Commission on Radiological Protection recommendations • Aneurysm location is the biggest determinant of radiation dose during coiling procedures. • Anterior and posterior circulation coiling procedures should have separate diagnostic reference levels.
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Affiliation(s)
- Holly Acton
- School of Medicine, University College Cork, Cork, Ireland
| | - Karl James
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Richard G Kavanagh
- School of Medicine, University College Cork, Cork, Ireland. .,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | | | - Deirdre Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael Maher
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Owen J O'Connor
- School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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22
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High-resolution magnetic resonance imaging of intracranial aneurysms treated by flow diversion. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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23
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Huynh TJ, Morton RP, Levitt MR, Ghodke BV, Wink O, Hallam DK. Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique. BMJ Case Rep 2017; 2017:bcr-2017-013052. [PMID: 28824011 DOI: 10.1136/bcr-2017-013052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture.
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Affiliation(s)
- Thien J Huynh
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Ryan P Morton
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Basavaraj V Ghodke
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Onno Wink
- Philips Healthcare, Bothell, Washington, USA
| | - Danial K Hallam
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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Kim DJ, Park MK, Jung DE, Kang JH, Kim BM. Radiation Dose Reduction without Compromise to Image Quality by Alterations of Filtration and Focal Spot Size in Cerebral Angiography. Korean J Radiol 2017; 18:722-728. [PMID: 28670167 PMCID: PMC5447648 DOI: 10.3348/kjr.2017.18.4.722] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/27/2017] [Indexed: 11/24/2022] Open
Abstract
Objective Different angiographic protocols may influence the radiation dose and image quality. In this study, we aimed to investigate the effects of filtration and focal spot size on radiation dose and image quality for diagnostic cerebral angiography using an in-vitro model and in-vivo patient groups. Materials and Methods Radiation dose and image quality were analyzed by varying the filtration and focal spot size on digital subtraction angiography exposure protocols (1, inherent filtration + large focus; 2, inherent + small; 3, copper + large; 4, copper + small). For the in-vitro analysis, a phantom was used for comparison of radiation dose. For the in-vivo analysis, bilateral paired injections, and patient cohort groups were compared for radiation dose and image quality. Image quality analysis was performed in terms of contrast, sharpness, noise, and overall quality. Results In the in-vitro analysis, the mean air kerma (AK) and dose area product (DAP)/frame were significantly lower with added copper filtration (protocols 3 and 4). In the in-vivo bilateral paired injections, AK and DAP/frame were significantly lower with filtration, without significant difference in image quality. The patient cohort groups with added filtration (protocols 3 and 4) showed significant reduction of total AK and DAP/patient without compromise to the image quality. Variations in focal spot size showed no significant differences in radiation dose and image quality. Conclusion Addition of filtration for angiographic exposure studies can result in significant total radiation dose reduction without loss of image quality. Focal spot size does not influence radiation dose and image quality. The routine angiographic protocol should be judiciously investigated and implemented.
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Affiliation(s)
- Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Min Keun Park
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Da Eun Jung
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jung Han Kang
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea
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25
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Boddu SR, Abramson DH, Marr BP, Francis JH, Gobin YP. Selective ophthalmic artery chemosurgery (SOAC) for retinoblastoma: fluoroscopic time and radiation dose parameters. A baseline study. J Neurointerv Surg 2016; 9:1107-1112. [PMID: 29030462 DOI: 10.1136/neurintsurg-2016-012758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/20/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate fluoroscopic time and radiation dose parameters, and factors affecting these parameters, during selective ophthalmic artery chemosurgery (SOAC) for retinoblastoma. MATERIALS AND METHODS Retrospective review from the prospective database of all patients with retinoblastoma treated with SOAC over a 5-year period (September 2009-January 2015) at a single institution after receiving institutional review board approval. Patient demographics, arterial approach, access device, side of treatment, number of SOAC cycles/patient, number of drugs/SOAC, and radiation parameters (outcome variables), including the fluoroscopic time, dose-area product (DAP), and total radiation dose, were obtained from the database. Generalized linear regression was used for univariate and multivariate analysis of the outcome variables. RESULTS In 218 patients (M:F=94:124), 272 eyes were treated by 833 SOAC infusions during 792 procedures. Mean age, weight, SOAC cycle/patient, and drugs/cycle were 19±19.5 months, 11.4±6.4 kg, 2.72±1.6, and 2.48±0.8, respectively. Mean fluoroscopic time, DAP, and doses were 10.2±8.4 min, 218.7±240.8 cGy.cm2, and 42.3±41.4 mGy, respectively. Radiation parameters (fluoroscopic time, DAP, and dose) were significantly lower (p<0.001) for the ophthalmic artery (OA) approach (7.5±5.4; 147.7±138.4; 28.5±29.4) than with middle meningeal artery (13.4±5.6; 242±138; 51.4±27) and balloon-assisted infusion in the internal carotid artery (ICA; 17.8±11.5; 449.8±361; 81.8±63.3). Radiation parameters for microcatheter access (8.6±7.1; 193.4±181.3; 42.3±37) were significantly lower (p<0.001) than with the ICA (17.8±11.5; 449.8±361; 81.8±63.3). Radiation parameters for bilateral IA chemotherapy (IAC; 16.8±11.6; 320.7±268.7; 60.8±45.6) were significantly higher (p<0.001) than for unilateral IAC (8.9±6.6; 212.7±247; 42±41). CONCLUSIONS In SOAC for retinoblastoma, the OA approach, microcatheter access, and unilateral treatment were associated with significantly lower radiation parameters. We established benchmark radiation parameters for retinoblastoma SOAC in our patient cohort.
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Affiliation(s)
- Srikanth R Boddu
- Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - David H Abramson
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Brian P Marr
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Jasmine H Francis
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Y Pierre Gobin
- Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
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Hazards of Ionizing Radiation and its Impact on Spine Surgery. World Neurosurg 2016; 92:353-359. [DOI: 10.1016/j.wneu.2016.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 12/28/2022]
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Bertolini M, Benecchi G, Amici M, Piola A, Piccagli V, Giordano C, Nocetti L. Attenuation assessment of medical protective eyewear: the AVEN experience. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:279-289. [PMID: 27122122 DOI: 10.1088/0952-4746/36/2/279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The goal of this paper is to test the attenuation capability of seven models of protective eyewear used in routine clinical practice. Scattered radiation from a standard patient was simulated by using a water tank located over the treatment couch of a GE Innova 3100 x-ray angiography system. Seven protective eyewear models were tested using an anthropomorphic phantom mimicking the first operator. At each test, 4 thermoluminiscent dosimeters were placed on the phantom (respectively in front of the protective eyewear, under the eyewear, on the left earpiece and at chest level) in order to have an eyewear-independent reference. A test session without glasses was also acquired. Each model was tested with standard posterior-anterior (PA) projections and the two most common protective eyewear were tested using LAO90° and LAO45°CRA30° projections. A worst-case scenario was created to be sure of having an upper limit for the assessment of eyewear attenuation in routine clinical practice. In PA projections, the absolute attenuation value ranged between 71% and 81%, while relative attenuation between dose measured at eye lens and that measured at eyewear earpiece ranged from 67% to 85%. The slightly wider range was probably due to scatter radiation variability; anyway, differences are still included in the variable uncertainty of experimental measurements. It is worth noting that #3 eyewear model (the one without lateral protection) allows an attenuation similar to that of #5 eyewear model (with 0.5 mm lead lateral protection) in LAO90° and LAO45°CRA30° projections. Despite the experimental limitations, a description of the radiation properties of protective eyewear concerning radiation attenuation can be useful to rely on protection devices which can be used in routine clinical practice.
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Affiliation(s)
- M Bertolini
- Medical Physics Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures. AJR Am J Roentgenol 2015; 204:W713-9. [PMID: 26001261 DOI: 10.2214/ajr.14.13630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of our study was to survey radiation dose indexes of pediatric peripheral and abdominal fluoroscopically guided procedures from which estimates of diagnostic reference levels (DRLs) can be proposed for both a standard fluoroscope and a novel fluoroscope with advanced image processing and lower radiation dose rates. MATERIALS AND METHODS Radiation dose structured reports were retrospectively collected for 408 clinical pediatric cases: Half of the procedures were performed with a standard imaging technology and half with a novel x-ray technology. Dose-area product (DAP), air Kerma (AK), fluoroscopy time, number of digital subtraction angiography images, and patient mass were collected to calculate and normalize radiation dose indexes for procedures completed with the standard and novel fluoroscopes. RESULTS The study population was composed of 180 and 175 patients who underwent procedures with the standard and novel technology, respectively. The 21 different types of pediatric peripheral and abdominal interventional procedures produced 408 total studies. Median ages, mass and body mass index, fluoroscopy time per procedure, and total number of recorded images for the standard and novel technologies were not statistically different. The area of the x-ray beams was square at the level of the patient with a dimension of 10-13 cm. The dose reduction achieved with the novel fluoroscope ranged from 18% to 51% of the dose required with the standard fluoroscope. The median DAP and AK patient dose indexes were 0.38 Gy · cm(2) and 4.00 mGy, respectively, for the novel fluoroscope. CONCLUSION Estimates of dose indexes of pediatric peripheral and abdominal fluoroscopically guided, clinical procedures should assist in the development of DRLs to foster management of radiation doses of pediatric patients.
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Rehani MM, Gupta R, Bartling S, Sharp GC, Pauwels R, Berris T, Boone JM. Radiological Protection in Cone Beam Computed Tomography (CBCT). ICRP Publication 129. Ann ICRP 2015; 44:9-127. [PMID: 26116562 DOI: 10.1177/0146645315575485] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this publication is to provide guidance on radiological protection in the new technology of cone beam computed tomography (CBCT). Publications 87 and 102 dealt with patient dose management in computed tomography (CT) and multi-detector CT. The new applications of CBCT and the associated radiological protection issues are substantially different from those of conventional CT. The perception that CBCT involves lower doses was only true in initial applications. CBCT is now used widely by specialists who have little or no training in radiological protection. This publication provides recommendations on radiation dose management directed at different stakeholders, and covers principles of radiological protection, training, and quality assurance aspects. Advice on appropriate use of CBCT needs to be made widely available. Advice on optimisation of protection when using CBCT equipment needs to be strengthened, particularly with respect to the use of newer features of the equipment. Manufacturers should standardise radiation dose displays on CBCT equipment to assist users in optimisation of protection and comparisons of performance. Additional challenges to radiological protection are introduced when CBCT-capable equipment is used for both fluoroscopy and tomography during the same procedure. Standardised methods need to be established for tracking and reporting of patient radiation doses from these procedures. The recommendations provided in this publication may evolve in the future as CBCT equipment and applications evolve. As with previous ICRP publications, the Commission hopes that imaging professionals, medical physicists, and manufacturers will use the guidelines and recommendations provided in this publication for implementation of the Commission's principle of optimisation of protection of patients and medical workers, with the objective of keeping exposures as low as reasonably achievable, taking into account economic and societal factors, and consistent with achieving the necessary medical outcomes.
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Sans Merce M, Korchi AM, Kobzeva L, Damet J, Erceg G, Marcos Gonzalez A, Lovblad KO, Mendes Pereira V. The value of protective head cap and glasses in neurointerventional radiology. J Neurointerv Surg 2015; 8:736-40. [DOI: 10.1136/neurintsurg-2015-011703] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/24/2015] [Indexed: 11/04/2022]
Abstract
BackgroundProtection of the head and eyes of the neurointerventional radiologist is a growing concern, especially after recent reports on the incidence of brain cancer among these personnel, and the revision of dose limits to the eye lens. The goal of this study was to determine typical occupational dose levels and to evaluate the efficiency of non-routine radiation protective gear (protective eyewear and cap). Experimental correlations between the dosimetric records of each measurement point and kerma area product (KAP), and between whole body doses and eye lens doses were investigated.MethodsMeasurements were taken using thermoluminescent dosimeters placed in plastic bags and worn by the staff at different places. To evaluate the effective dose, whole body dosimeters (over and under the lead apron) were used.ResultsThe mean annual effective dose was estimated at 0.4 mSv. Annual eye lens exposure was estimated at 17 mSv when using a ceiling shield but without protective glasses. The protective glasses reduced the eye lens dose by a factor of 2.73. The mean annual dose to the brain was 12 mSv; no major reduction was observed when using the cap. The higher correlation coefficients with KAP were found for the dosimeters positioned between the eyes (R2=0.84) and above the apron, and between the eye lens (R2=0.85) and the whole body.ConclusionsUnder the specific conditions of this study, the limits currently applicable were respected. If a new eye lens dose limit is introduced, our results indicate it could be difficult to comply with, without introducing additional protective eyewear.
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Vañó E, Miller DL, Dauer L. Implications in medical imaging of the new ICRP thresholds for tissue reactions. Ann ICRP 2015; 44:118-128. [PMID: 25816265 DOI: 10.1177/0146645314562322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The International Commission on Radiological Protection (ICRP) statement on tissue reactions, issued by the Commission in April 2011, reviewed epidemiological evidence and suggested that there are some tissue reactions where threshold doses are or may be lower than those previously considered. For the lens of the eye, the threshold is now considered to be 0.5 Gy. The absorbed dose threshold for circulatory disease in the heart and brain may be as low as 0.5 Gy. These values can be reached in some patients during interventional cardiology or neuroradiology procedures. They may also be of concern for repeated computed tomography examinations of the head. The new thresholds should be considered in optimisation strategies for clinical procedures, especially in patients likely to require repeated interventions. The new dose thresholds also affect occupational protection for operators and staff. Some operators do not protect their eyes or their brain adequately. After several years of work without proper protection, the absorbed doses to the lens of the eye and the brain of staff can exceed 0.5 Gy. More research is needed to understand the biological effects of cumulative incident air kerma and the instantaneous air kerma rates currently used in medical imaging. The new thresholds, and the need for specific occupational dosimetry related to lens doses, should be considered in radiation protection programmes, and should be included in the education and training of professionals involved in fluoroscopy guided procedures and computed tomography.
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Affiliation(s)
- E Vañó
- Radiology Department, Medicine School and San Carlos Hospital, Complutense University, Madrid, 28040 Spain
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, USA
| | - L Dauer
- Department of Medical Physics, Department of Radiology. Memorial Sloan-Kettering Cancer Center, USA
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