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Ria F, D’Ercole L, Origgi D, Paruccini N, Pierotti L, Rampado O, Rossetti V, Strocchi S, Torresin A, Torresin A, Pierotti L, Belli G, Bregant P, Isoardi P, Mari A, Nitrosi A, Nocetti L, Paruccini N, Quattrocchi MG, Radice A, Rampado O, Scrittori N, Sottocornola C, Strocchi S, Sutto M, Zatelli G, Acchiappati D, Aoja RA, Brambilla M, Branchini M, Cannatà V, Costi T, Cutaia C, D.’Ercole L, Del Vecchio A, Delle Canne S, Di Pasquale M, Elisabetta S, Fabbri C, Faico MD, Fantinato D, Ghetti C, Giannelli M, Giordano C, Grisotto S, Guidi G, Lisciandro F, Manco L, Giorgio Marini P, Moresco P, Oberhofer N, Origgi D, Palleri F, Pasquali C, Pasquino M, Peruzzo A, Petrillo G, Pini S, Rembado D, Ria F, Riccardi L, Rosasco R, Serelli G, Soavi R, Stasi M, Taddeucci A, Tonini E, Trianni A, Turano P, Venturi G, Zefiro D, Zito F. Statement of the Italian Association of Medical Physics (AIFM) task group on radiation dose monitoring systems. Insights Imaging 2022; 13:23. [PMID: 35124735 PMCID: PMC8818083 DOI: 10.1186/s13244-022-01155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022] Open
Abstract
The evaluation of radiation burden in vivo is crucial in modern radiology as stated also in the European Directive 2013/59/Euratom—Basic Safety Standard. Although radiation dose monitoring can impact the justification and optimization of radiological procedure, as well as effective patient communication, standardization of radiation monitoring software is far to be achieved. Toward this goal, the Italian Association of Medical Physics (AIFM) published a report describing the state of the art and standard guidelines in radiation dose monitoring system quality assurance. This article reports the AIFM statement about radiation dose monitoring systems (RDMSs) summarizing the different critical points of the systems related to Medical Physicist Expert (MPE) activities before, during, and after their clinical implementation. In particular, the article describes the general aspects of radiation dose data management, radiation dose monitoring systems, data integrity, and data responsibilities. Furthermore, the acceptance tests that need to be implemented and the most relevant dosimetric data for each radiological modalities are reported under the MPE responsibility.
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Lin PJP, Goode AR, Corwin FD, Fisher RF, Balter S, Wunderle KA, Schueler BA, Kim DS, Zhang J, Zhou YJ, Jenkins PA, Mahmood U, Lin T, Zhao H, Park MA, Trianni A, Lendle M, Kuhls-Gilcrist A, Jans JC, Desponds L, Banasiak G, Backes S, Snyder C, Snyder A, Lu M, Gonzalez S. Report of AAPM Task Group 272: Comprehensive acceptance testing and evaluation of fluoroscopy imaging systems. Med Phys 2022; 49:e1-e49. [PMID: 35032394 DOI: 10.1002/mp.15429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
Modern fluoroscopes used for image guidance have become quite complex. Adding to this complexity are the many regulatory and accreditation requirements that must be fulfilled during acceptance testing of a new unit. Further, some of these acceptance tests have pass/fail criteria, while others do not, making acceptance testing a subjective and time consuming task. The AAPM Task Group 272 Report spells out the details of tests that are required and gives visibility to some of the tests that while not yet required, are recommended as good practice. The organization of the report begins with the most complicated fluoroscopes used in interventional radiology or cardiology, continues with general fluoroscopy and mobile C-arms. Finally, the Appendices of the report provide useful information, an example report form and topics that needed their own section due to the level of detail. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pei-Jan Paul Lin
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Allen R Goode
- Department of Radiology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Frank D Corwin
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Ryan F Fisher
- Department of Radiology, The MetroHealth System, Cleveland, OH, 44109, USA
| | - Stephen Balter
- Departments of Medicine and Radiology, Columbia University Medical Center, New York, NY, 10021, USA
| | - Kevin A Wunderle
- Department of Radiology, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Beth A Schueler
- Radiology Department, Mayo Clinic, Rochester, MN, 55905, USA
| | - Don-Soo Kim
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jie Zhang
- Department of Radiology, University of Kentucky, Lexington, KY, 40536, USA
| | - Yifang Jimmy Zhou
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Peter A Jenkins
- Department of Radiology, University of Utah Health, Salt Lake City, UT, 84132, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Teh Lin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Hui Zhao
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Mi-Ae Park
- Department of Radiology, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Annalisa Trianni
- Medical Physics Department, Udine University Hospital, Udine, 33100, Italy
| | | | | | - Jan C Jans
- Philips Healthcare, Best, 5680 DA, The Netherlands
| | | | | | - Steve Backes
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Carl Snyder
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Angela Snyder
- Atirix Medical Systems, Inc., Minneapolis, MN, 55305, USA
| | - Minghui Lu
- Varex Imaging Corporation, San Jose, CA, 95134, USA
| | - Scott Gonzalez
- Food and Drug Administration, Health and Human Services, Silver Spring, MD, 20993, USA
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Longo R, Padovani R, Bertocchi L, De Denaro M, Milotti E, Rigon L, Valenti M, Sartor G, de Crescenzo S, Strigari L, Mascaro L, Turra A, Mazzocchi S, Torresin A, Pignoli E, Guidi G, De Ponti E, Brambilla M, Paiusco M, Diliberto R, Traino A, Soriani A, Buonamici FB, Stasi M, Trianni A, Scalchi P, Cavedon C, Francescon P, Ropolo R, Hrsak H. Training for the future: 8 years of Master of Advanced Studies in medical physics in Trieste. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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4
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Retico A, Avanzo M, Boccali T, Bonacorsi D, Botta F, Cuttone G, Martelli B, Salomoni D, Spiga D, Trianni A, Stasi M, Iori M, Talamonti C. Enhancing the impact of Artificial Intelligence in Medicine: A joint AIFM-INFN Italian initiative for a dedicated cloud-based computing infrastructure. Phys Med 2021; 91:140-150. [PMID: 34801873 DOI: 10.1016/j.ejmp.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/23/2022] Open
Abstract
Artificial Intelligence (AI) techniques have been implemented in the field of Medical Imaging for more than forty years. Medical Physicists, Clinicians and Computer Scientists have been collaborating since the beginning to realize software solutions to enhance the informative content of medical images, including AI-based support systems for image interpretation. Despite the recent massive progress in this field due to the current emphasis on Radiomics, Machine Learning and Deep Learning, there are still some barriers to overcome before these tools are fully integrated into the clinical workflows to finally enable a precision medicine approach to patients' care. Nowadays, as Medical Imaging has entered the Big Data era, innovative solutions to efficiently deal with huge amounts of data and to exploit large and distributed computing resources are urgently needed. In the framework of a collaboration agreement between the Italian Association of Medical Physicists (AIFM) and the National Institute for Nuclear Physics (INFN), we propose a model of an intensive computing infrastructure, especially suited for training AI models, equipped with secure storage systems, compliant with data protection regulation, which will accelerate the development and extensive validation of AI-based solutions in the Medical Imaging field of research. This solution can be developed and made operational by Physicists and Computer Scientists working on complementary fields of research in Physics, such as High Energy Physics and Medical Physics, who have all the necessary skills to tailor the AI-technology to the needs of the Medical Imaging community and to shorten the pathway towards the clinical applicability of AI-based decision support systems.
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Affiliation(s)
- Alessandra Retico
- National Institute for Nuclear Physics (INFN), Pisa Division, 56127 Pisa, Italy
| | - Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Tommaso Boccali
- National Institute for Nuclear Physics (INFN), Pisa Division, 56127 Pisa, Italy
| | - Daniele Bonacorsi
- University of Bologna, 40126 Bologna, Italy; INFN, Bologna Division, 40126 Bologna, Italy
| | - Francesca Botta
- Medical Physics Unit, Istituto Europeo di oncologia IRCCS, 20141 Milan, Italy
| | - Giacomo Cuttone
- INFN, Southern National Laboratory (LNS), 95123 Catania, Italy
| | | | | | | | - Annalisa Trianni
- Medical Physics Unit, Ospedale Santa Chiara APSS, 38122 Trento, Italy
| | - Michele Stasi
- Medical Physics Unit, A.O. Ordine Mauriziano di Torino, 10128 Torino, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy.
| | - Cinzia Talamonti
- Department Biomedical Experimental and Clinical Science "Mario Serio", University of Florence, 50134 Florence, Italy; INFN, Florence Division, 50134 Florence, Italy
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Andersson J, Bednarek DR, Bolch W, Boltz T, Bosmans H, Gislason-Lee AJ, Granberg C, Hellstrom M, Kanal K, McDonagh E, Paden R, Pavlicek W, Khodadadegan Y, Torresin A, Trianni A, Zamora D. Estimation of patient skin dose in fluoroscopy: summary of a joint report by AAPM TG357 and EFOMP. Med Phys 2021; 48:e671-e696. [PMID: 33930183 DOI: 10.1002/mp.14910] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/04/2021] [Accepted: 04/23/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio is almost certainly highly favorable. However, X-ray-induced skin injuries may occur due to high absorbed patient skin doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve the clinical practice. There is a need for a refined metric regarding follow-up of X-ray-induced patient injuries and the knowledge gap regarding skin dose-related patient information from fluoroscopy devices must be filled. The most useful metric to indicate a risk of erythema, epilation or greater skin injury that also includes actionable information is the peak skin dose, that is, the largest dose to a region of skin. MATERIALS AND METHODS The report is based on a comprehensive review of best practices and methods to estimate peak skin dose found in the scientific literature and situates the importance of the Digital Imaging and Communication in Medicine (DICOM) standard detailing pertinent information contained in the Radiation Dose Structured Report (RDSR) and DICOM image headers for FGI devices. Furthermore, the expertise of the task group members and consultants have been used to bridge and discuss different methods and associated available DICOM information for peak skin dose estimation. RESULTS The report contributes an extensive summary and discussion of the current state of the art in estimating peak skin dose with FGI procedures with regard to methodology and DICOM information. Improvements in skin dose estimation efforts with more refined DICOM information are suggested and discussed. CONCLUSIONS The endeavor of skin dose estimation is greatly aided by the continuing efforts of the scientific medical physics community, the numerous technology enhancements, the dose-controlling features provided by the FGI device manufacturers, and the emergence and greater availability of the DICOM RDSR. Refined and new dosimetry systems continue to evolve and form the infrastructure for further improvements in accuracy. Dose-related content and information systems capable of handling big data are emerging for patient dose monitoring and quality assurance tools for large-scale multihospital enterprises.
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Affiliation(s)
- Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Daniel R Bednarek
- State University of New York, 875 Ellicott St, Buffalo, NY, 14203-1070, USA
| | - Wesley Bolch
- University of Florida, 1275 Center Drive, Gainesville, FL, 32611-6131, USA
| | - Thomas Boltz
- Orange Factor Imaging Physicists, 4035 E Captain Dreyfus Ave, Phoenix, AZ, 85032, USA
| | - Hilde Bosmans
- University of Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | | | - Christoffer Granberg
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Max Hellstrom
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Kalpana Kanal
- University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Ed McDonagh
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Robert Paden
- Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | | | - Yasaman Khodadadegan
- Progressive Insurance, Customer Relation Management, 6300 Wilson Mills Rd., Mayfield Village, OH, 44143, USA
| | - Alberto Torresin
- Niguarda Ca'Granda Hospital, Via Leon Battista Alberti 5, Milano, 20149, Italy
| | - Annalisa Trianni
- Udine University Hospital, Piazzale S. Maria Della Misericordia, n. 15, 33100, Udine, Italy
| | - David Zamora
- University of Washington Medical Center, 6852 31st Ave NE, Seattle, WA, 98115-7245, USA
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Collavino J, Soligo M, Zattoni F, Trianni A, Sannino M, Sekulovic S, La Falce S, De Giorgi G, Dal Moro F. Radiation exposure during endoscopic procedures to treat urinary tract stones: impact of patients’ and stones’ characteristics. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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7
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Sciahbasi A, Piccaluga E, Andreassi MG, Trianni A, Rosi A, Sarandrea A, Longoni M, Germinal F, Santucci S, Bernardi G, Rigattieri S, La Manna A, Castiglioni B, Limbruno U, Mauro C, Tarantino F, Esposito G, Musumeci G, Tarantini G. [SICI-GISE Position paper: Enhancing radiation safety in the catheterization laboratory]. G Ital Cardiol (Rome) 2019; 20:14S-28S. [PMID: 31593188 DOI: 10.1714/3219.31965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The radiation dose received by interventional cardiologists during their activity in the catheterization laboratory is a matter of concern in terms of possible deterministic and stochastic risk. At the same time, very often, the knowledge of the effect and consequences of radiation exposure in the interventional cardiology community is limited. This document endorsed by the Italian Society of Interventional Cardiology (SICI-GISE) provides recommendations for cardiologists' radiation protection. Radiation safety considerations dedicated to women and other staff personnel working in the catheterization laboratory are also discussed.
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Affiliation(s)
| | - Emanuela Piccaluga
- Cardiologia-Emodinamica, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | | | - Antonella Rosi
- Centro Nazionale delle Tecnologie Innovative per la Sanità Pubblica, Istituto Superiore di Sanità, Roma
| | | | - Matteo Longoni
- Emodinamica e Cardiologia Interventistica, Ospedale San Raffaele, Milano
| | - Francesco Germinal
- U.O.C. Cardiologia Interventistica ed Emodinamica, Ospedale "Vito Fazzi", Lecce
| | - Stefano Santucci
- U.O.S. Cardiologia Interventistica, Emodinamica ed Elettrostimolazione, AOU Sant'Andrea, Roma
| | | | - Stefano Rigattieri
- U.O.S. Cardiologia Interventistica, Emodinamica ed Elettrostimolazione, AOU Sant'Andrea, Roma
| | - Alessio La Manna
- Dipartimento Cardio-Toraco-Vascolare, AOU Policlinico "Vittorio Emanuele", Catania
| | | | - Ugo Limbruno
- U.O.C. Cardiologia, Ospedale Misericordia, Grosseto
| | - Ciro Mauro
- U.O.C. Cardiologia, Ospedale Cardarelli, Napoli
| | | | | | | | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiache, Toraciche e Vascolari, Policlinico Universitario di Padova
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Kortesniemi M, Tsapaki V, Trianni A, Russo P, Maas A, Källman HE, Brambilla M, Damilakis J. The European Federation of Organisations for Medical Physics (EFOMP) White Paper: Big data and deep learning in medical imaging and in relation to medical physics profession. Phys Med 2018; 56:90-93. [PMID: 30449653 DOI: 10.1016/j.ejmp.2018.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 01/04/2023] Open
Abstract
Big data and deep learning will profoundly change various areas of professions and research in the future. This will also happen in medicine and medical imaging in particular. As medical physicists, we should pursue beyond the concept of technical quality to extend our methodology and competence towards measuring and optimising the diagnostic value in terms of how it is connected to care outcome. Functional implementation of such methodology requires data processing utilities starting from data collection and management and culminating in the data analysis methods. Data quality control and validation are prerequisites for the deep learning application in order to provide reliable further analysis, classification, interpretation, probabilistic and predictive modelling from the vast heterogeneous big data. Challenges in practical data analytics relate to both horizontal and longitudinal analysis aspects. Quantitative aspects of data validation, quality control, physically meaningful measures, parameter connections and system modelling for the future artificial intelligence (AI) methods are positioned firmly in the field of Medical Physics profession. It is our interest to ensure that our professional education, continuous training and competence will follow this significant global development.
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Affiliation(s)
- Mika Kortesniemi
- HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Virginia Tsapaki
- Medical Physics Department, Konstantopoulio General Hospital, Athens, Greece
| | - Annalisa Trianni
- Medical Physics Department, Udine University Hospital, Udine, Italy
| | - Paolo Russo
- University of Naples "Federico II", Department of Physics "Ettore Pancini", Naples, Italy
| | - Ad Maas
- Society for Medical Physics of the Netherlands, Utrecht, Netherlands
| | | | - Marco Brambilla
- Medical Physics Department, University Hospital of Novara, Novara, Italy
| | - John Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Greece
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Torresin A, Damilakis J, Bardies M, Brambilla M, Trianni A, Evans S, Figueira AR, Tsapaki V. [I066] EFOMP guidelines on the transposition of EU BSS art.60 in national legislations. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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10
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de las Heras Gala H, Torresin A, Dasu A, Rampado O, Delis H, Giron IH, Theodorakou C, Andersson J, Holroyd J, Edyvean S, Delpon G, Caprile P, Peterlin P, Trianni A, Wg E. [OA176] The CBCT protocol of EFOMP-ESTRO-IAEA is alive: Update by eurados and din. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Jaschke W, Bartal G, Trianni A, Belli AM. Fighting the Gender Gap in Interventional Radiology: Facts and Fiction Relating to Radiation. Cardiovasc Intervent Radiol 2018; 41:1254-1256. [PMID: 29696371 PMCID: PMC6021469 DOI: 10.1007/s00270-018-1968-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Werner Jaschke
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Gabriel Bartal
- Department of Radiology, Meir Medical Center, Street, Tchernichovsky 59, 44281, Kfar Saba, Israel
| | - Annalisa Trianni
- Department of Physics, Udine University Hospital, Piazzale, S. Maria Della Misericordia, n. 15, 33100, Udine, Italy
| | - Anna-Maria Belli
- Radiology Department, St. George's University Hospitals NHS Foundation Trust, London, UK
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12
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Fedon C, Caballo M, Longo R, Trianni A, Sechopoulos I. Internal breast dosimetry in mammography: Experimental methods and Monte Carlo validation with a monoenergetic x-ray beam. Med Phys 2018; 45:1724-1737. [DOI: 10.1002/mp.12792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/05/2017] [Accepted: 01/19/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christian Fedon
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; PO Box 9101 6500 HB Nijmegen The Netherlands
- Istituto Nazionale di Fisica Nucleare (INFN); sezione di Trieste; 34127 Trieste Italy
| | - Marco Caballo
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; PO Box 9101 6500 HB Nijmegen The Netherlands
| | - Renata Longo
- Istituto Nazionale di Fisica Nucleare (INFN); sezione di Trieste; 34127 Trieste Italy
- Dipartimento di Fisica; Università degli Studi di Trieste; 34127 Trieste Italy
| | - Annalisa Trianni
- Medical Physics Department; Azienda Sanitaria Universitaria Integrata (ASUIUD) - Presidio Ospedaliero “S. Maria della Misericordia”; p.le S. Maria della Misericordia, 15 33100 Udine Italy
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; PO Box 9101 6500 HB Nijmegen The Netherlands
- Dutch Expert Center for Screening (LRCB); PO Box 6873 6503 GJ Nijmegen The Netherlands
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13
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Jarvinen H, Farah J, Siiskonen T, Ciraj-Bjelac O, Dabin J, Carinou E, Domienik-Andrzejewska J, Kluszczynski D, Knežević Ž, Kopec R, Majer M, Malchair F, Negri A, Pankowski P, Sarmento S, Trianni A. Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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14
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Grimaldi F, Valotto C, Barbina G, Visentini D, Trianni A, Cerruto MA, Zattoni F. The Possible Role of Chromogranin A as a Prognostic Factor in Organ-Confined Prostate Cancer. Int J Biol Markers 2018; 21:229-34. [PMID: 17177161 DOI: 10.1177/172460080602100406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical significance of neuroendocrine differentiation in patients who have undergone surgery for localized prostate cancer is still unclear. The aims of this study were to assess the relationship between serum neuroendocrine markers and well-known prognostic factors in prostate cancer (pathological staging, definitive Gleason score and serum PSA) and to search for correlations between serum chromogranin A (CgA) levels and pathological findings. Forty-one consecutive patients who had undergone radical retropubic prostatectomy for clinically localized prostate cancer were evaluated. Serum PSA, CgA and neuron-specific enolase were measured immediately before surgery. Twenty-six surgical specimens were phenotypically and immunohistochemically evaluated using an antibody against CgA. Significant correlations were found between serum CgA, pathological staging and Gleason score (p=0.049 and p=0.038, respectively). Serum CgA did not correlate with PSA, patient age, or immunohistochemical findings. There was a significant correlation between positive immunohistochemical CgA staining and Gleason score (p=0.014). An increase in serum CgA levels, independent of PSA values, might be the expression of pathologically more advanced tumor stage and higher Gleason score; this could help to identify a high-risk patient group eligible for adjuvant therapy.
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Affiliation(s)
- F Grimaldi
- Endocrinology and Metabolism Unit, S.M . Misericordia General Hospital, Udine, Italy
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15
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Jaschke W, Schmuth M, Trianni A, Bartal G. Radiation-Induced Skin Injuries to Patients: What the Interventional Radiologist Needs to Know. Cardiovasc Intervent Radiol 2017; 40:1131-1140. [PMID: 28497187 PMCID: PMC5489635 DOI: 10.1007/s00270-017-1674-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
For a long time, radiation-induced skin injuries were only encountered in patients undergoing radiation therapy. In diagnostic radiology, radiation exposures of patients causing skin injuries were extremely rare. The introduction of fast multislice CT scanners and fluoroscopically guided interventions (FGI) changed the situation. Both methods carry the risk of excessive high doses to the skin of patients resulting in skin injuries. In the early nineties, several reports of epilation and skin injuries following CT brain perfusion studies were published. During the same time, several papers reported skin injuries following FGI, especially after percutaneous coronary interventions and neuroembolisations. Thus, CT and FGI are of major concern regarding radiation safety since both methods can apply doses to patients exceeding 5 Gy (National Council on Radiation Protection and Measurements threshold for substantial radiation dose level). This paper reviews the problem of skin injuries observed after FGI. Also, some practical advices are given how to effectively avoid skin injuries. In addition, guidelines are discussed how to deal with patients who were exposed to a potentially dangerous radiation skin dose during medically justified interventional procedures.
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Affiliation(s)
- Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Matthias Schmuth
- Department of Dermatology, Venereology and Allergology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Annalisa Trianni
- Department of Physics, Udine University Hospital, Piazzale S. Maria Della Misericordia, n. 15, 33100, Udine, Italy
| | - Gabriel Bartal
- Department of Radiology, Meir Medical Center, Street Tchernichovsky 59, 44281, Kfar Saba, Israel
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Zagorska A, Bliznakova K, Trianni A, Vassileva J. A MC study on the eye lens dose distribution for medical staff in interventional radiology. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Dabin J, Negri A, Farah J, Ciraj-Bjelac O, Clairand I, De Angelis C, Domienik J, Jarvinen H, Kopec R, Majer M, Malchair F, Novák L, Siiskonen T, Vanhavere F, Trianni A, Knežević Ž. Characterisation of grids of point detectors in maximum skin dose measurement in fluoroscopically-guided interventional procedures. Phys Med 2015; 31:1112-1117. [DOI: 10.1016/j.ejmp.2015.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/26/2015] [Accepted: 08/28/2015] [Indexed: 10/22/2022] Open
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Sechopoulos I, Trianni A, Peck D. The DICOM Radiation Dose Structured Report: What It Is and What It Is Not. J Am Coll Radiol 2015; 12:712-3. [DOI: 10.1016/j.jacr.2015.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
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Farah J, Trianni A, Ciraj-Bjelac O, Clairand I, De Angelis C, Delle Canne S, Hadid L, Huet C, Jarvinen H, Negri A, Novák L, Pinto M, Siiskonen T, Waryn MJ, Knežević Ž. Characterization of XR-RV3 GafChromic®
films in standard laboratory and in clinical conditions and means to evaluate uncertainties and reduce errors. Med Phys 2015; 42:4211-26. [DOI: 10.1118/1.4922132] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Farah J, Trianni A, Carinou E, Ciraj-Bjelac O, Clairand I, Dabin J, De Angelis C, Domienik J, Jarvinen H, Kopec R, Majer M, Malchair F, Negri A, Novák L, Siiskonen T, Vanhavere F, Knežević Ž. Measurement of maximum skin dose in interventional radiology and cardiology and challenges in the set-up of European alert thresholds. Radiat Prot Dosimetry 2015; 164:138-142. [PMID: 25316909 DOI: 10.1093/rpd/ncu314] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To help operators acknowledge patient dose during interventional procedures, EURADOS WG-12 focused on measuring patient skin dose using XR-RV3 gafchromic films, thermoluminescent detector (TLD) pellets or 2D TL foils and on investigating possible correlation to the on-line dose indicators such as fluoroscopy time, Kerma-area product (KAP) and cumulative air Kerma at reference point (CK). The study aims at defining non-centre-specific European alert thresholds for skin dose in three interventional procedures: chemoembolization of the liver (CE), neuroembolization (NE) and percutaneous coronary interventions (PCI). Skin dose values of >3 Gy (ICRP threshold for skin injuries) were indeed measured in these procedures confirming the need for dose indicators that correlate with maximum skin dose (MSD). However, although MSD showed fairly good correlation with KAP and CK, several limitations were identified challenging the set-up of non-centre-specific European alert thresholds. This paper presents preliminary results of this wide European measurement campaign and focuses on the main challenges in the definition of European alert thresholds.
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Affiliation(s)
- J Farah
- Laboratoire de Dosimétrie des Rayonnements Ionisants, Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP17, PRP-HOM/SDE/LDRI BP 17, Fontenay-aux-Roses Cedex 92262, France
| | - A Trianni
- Udine University Hospital (AOUD), Ple S. Maria della Misericordia, 15, Udine 33100, Italy
| | - E Carinou
- Greek Atomic Energy Commission (GAEC), PO Box 60092, Ag. Paraskevi, Athens 15310, Greece
| | - O Ciraj-Bjelac
- VINCA Institute of Nuclear Sciences (VINCA), PO Box 522, Belgrade 11001, Serbia
| | - I Clairand
- Laboratoire de Dosimétrie des Rayonnements Ionisants, Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP17, PRP-HOM/SDE/LDRI BP 17, Fontenay-aux-Roses Cedex 92262, France
| | - J Dabin
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang 200, Mol BE-2400, Belgium
| | - C De Angelis
- Istituto Superiore di Sanità (ISS), Viale Regina Elena 299, Rome 00161, Italy
| | - J Domienik
- Nofer Institute of Occupational Medicine (NIOM), 8 Sw. Teresy, Str., Łódź 91-348, Poland
| | - H Jarvinen
- Radiation and Nuclear Safety Authority (STUK), PO Box 14, Helsinki 00881, Finland
| | - R Kopec
- Institute of Nuclear Physics (IFJ PAN), ul Radzikowskiego 152, Kraków PL-31-342, Poland
| | - M Majer
- Ruđer Bošković Institute (RBI), Bijenička c. 54, Zagreb 10000, Croatia
| | - F Malchair
- Centre Hospitalier Universitaire de Liège (CHUL), Avenue de l'Hôpital, Liège 4000, Belgium
| | - A Negri
- Istituto Oncologico Veneto (IOV), Via Gattamelata 64, Padova 35124, Italy
| | - L Novák
- National Radiation Protection Institute (NRPI), Bartoškova 28, Prague 4 140 00, Czech Republic
| | - T Siiskonen
- Radiation and Nuclear Safety Authority (STUK), PO Box 14, Helsinki 00881, Finland
| | - F Vanhavere
- Belgian Nuclear Research Centre (SCK-CEN), Boeretang 200, Mol BE-2400, Belgium
| | - Ž Knežević
- Ruđer Bošković Institute (RBI), Bijenička c. 54, Zagreb 10000, Croatia
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Kopeć R, Novák L, Carinou E, Clairand I, Dabin J, Datz H, De Angelis C, Farah J, Huet C, Knežević Ž, Järvinen H, Majer M, Malchair F, Negri A, Waschitz SH, Siiskonen T, Szumska A, Trianni A, Vanhavere F. Intercomparison of Gafchromic™ films, TL detectors and TL foils for the measurements of skin dose in interventional radiology. RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Trianni A, Farah J, Carinou E, Clairand I, Dabin J, Deangelis C, Domienik J, Knezevic Z, Kopec R, Malchair F, Negri A, Novak L, Siiskonen T, Vanhavere F. TU-A-116-11: Maximum Patient Skin Dose From Interventional Radiology Procedures and Definition of Alert Thresholds. Med Phys 2013. [DOI: 10.1118/1.4815358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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23
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Farah J, Trianni A, Carinou E, Dabin J, Deangelis C, Domienik J, Knezevic Z, Kopec R, Malchair F, Negri A, Novak L, Siiskonen T, Vanhavere F, Clairand I. SU-E-I-28: Assessment of Maximum Patient Skin Dose for Interventional Radiology Procedures: Method and Uncertainty Analysis. Med Phys 2013. [DOI: 10.1118/1.4814138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Slavich G, Poli S, Spedicato L, Sappa R, Trianni A. [Electrocardiographic identification of the culprit artery and occlusion site in ST-elevation myocardial infarction]. G Ital Cardiol (Rome) 2013; 13:676-84. [PMID: 23022972 DOI: 10.1714/1145.12621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In clinical practice, the identification of the culprit vessel and the localization of the occlusion site in ST-elevation myocardial infarction (STEMI) are provided by coronary angiography. Over the last few years, however, an increasing body of literature focused upon the reassessment of the ECG as a reliable technique to obtain this useful information. The aim of this study was to evaluate the accuracy of electrocardiographic criteria compared to coronary angiography. METHODS On the basis of the available literature, we developed an electrocardiographic algorithm based on the analysis of ST-segment elevation and reciprocal depression, whose accuracy was verified through its use in our cohort of 343 consecutive patients during calendar years 2008-2010. All patients underwent emergent percutaneous coronary intervention in the setting of acute STEMI. Patients with left bundle branch block, pacemaker rhythm and/or with a history of previous reperfusion were excluded. The admission electrocardiograms were reviewed by experienced cardiologists blinded to the angiographic findings. RESULTS The criteria adopted allowed a correct identification of the culprit vessel in 87.5% of cases. The sensitivity for left anterior descending, right coronary artery, left circumflex and diagonal branch/double anterior descending/ramus intermediate was 98.8%, 93.7%, 31.7% and 44.4%, respectively; the specificity was 94.3%, 87.6%, 99.0% and 99.1%, respectively. The proximal/distal location was correctly identified in 62.4% of cases. CONCLUSIONS Our results confirm that careful interpretation of the ECG, which is a versatile and widely available tool, appears useful for the detection of the culprit vessel and the coronary occlusion site in STEMI patients, with relevant implications for clinical management and selection of appropriate therapeutic strategies.
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Affiliation(s)
- Gianaugusto Slavich
- SOC di Cardiologia, Dipartimento Cardiotoracico, Azienda Ospedialiero-Universitaria di Udine, Udine, Italy.
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Muhogora W, Trianni A, Toso F, Devetti A, Padovani R, Msaki P, Kazema R. Comparison of image quality and patient dose for chest x-ray examinations on conventional and low cost computed radiography systems. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2012.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Padovani R, Trianni A, Bokou C, Bosmans H, Jankowski J, Kottou S, Kepler K, Malone J, Tsapaki V, Salat D, Vano E, Vassileva J. Survey on performance assessment of cardiac angiography systems. Radiat Prot Dosimetry 2008; 129:108-111. [PMID: 18310097 DOI: 10.1093/rpd/ncn046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Advances in imaging technology have facilitated the development of increasingly complex interventional cardiac equipment. Consequently, there is a need for definitive equipment requirements. The aim of the study is to assess the performances of different cardiac angiographic systems. A questionnaire was sent to centres participating in SENTINEL Project to collect dosimetry data (typical entrance dose rate in fluoroscopy and imaging mode), image quality evaluations (low and high contrast resolutions) and KAP calibration factors. Results from this survey could contribute to the explanation of patient dose variability in angiographic cardiac procedures and to derive reference levels for cardiac angiographic equipment performance parameters.
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Affiliation(s)
- R Padovani
- Medical Physics Department, Udine Hospital, Italy.
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Padovani R, Vano E, Trianni A, Bokou C, Bosmans H, Bor D, Jankowski J, Torbica P, Kepler K, Dowling A, Milu C, Tsapaki V, Salat D, Vassileva J, Faulkner K. Reference levels at European level for cardiac interventional procedures. Radiat Prot Dosimetry 2008; 129:104-107. [PMID: 18310612 DOI: 10.1093/rpd/ncn039] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In interventional cardiology, a wide variation in patient dose for the same type of procedure has been recognised by different studies. Variation is almost due to procedure complexity, equipment performance, procedure protocol and operator skill. The SENTINEL consortium has performed a survey in nine european centres collecting information on near 2000 procedures, and a new set of reference levels (RLs) for coronary angiography and angioplasty and diagnostic electrophysiology has been assessed for air kerma-area product: 45, 85 and 35 Gy cm2, effective dose: 8, 15 and 6 mSv, cumulative dose at interventional reference point: 650 and 1500 mGy, fluoroscopy time: 6.5, 15.5 and 21 min and cine frames: 700 and 1000 images, respectively. Because equipment performance and set-up are the factors contributing to patient dose variability, entrance surface air kerma for fluoroscopy, 13 mGy min(-1), and image acquisition, 0.10 mGy per frame, have also been proposed in the set of RLs.
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Affiliation(s)
- R Padovani
- Medical Physics Department, Udine Hospital, Italy.
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Foti C, Padovani R, Trianni A, Bokou C, Christofides S, Corbett RH, Kepler K, Korenová Z, Kosunen A, Malone J, Torbica P, Tsapaki V, Vano E, Vassileva J, Zdesar U. Staff dosimetry in interventional cardiology: survey on methods and level of exposure. Radiat Prot Dosimetry 2008; 129:100-103. [PMID: 18287188 DOI: 10.1093/rpd/ncn038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In interventional cardiac procedures, staff operates near the patient in a non-uniformly scattered radiation field. Consequently, workers may receive, over a period, relatively high radiation doses. The measurement of individual doses to personnel becomes critical due to the use of protective devices and, as a consequence of the large number of methods proposed to assess the effective dose, great variability in monitoring programmes is expected among European countries. SENTINEL consortium has conducted a survey on staff dosimetry methods and on the level of staff exposure in 12 European cardiac centres demonstrating the urgent need to harmonise dosimetry methods. From the dosimetry survey, constraint annual effective dose of 1.4 mSv and Hp(0.07) over the protective apron of 14 mSv are proposed for the optimisation the exposure the most-exposed operator.
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Affiliation(s)
- C Foti
- Medical Physics Department, Udine Hospital, Italy.
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Bernardi G, Bar O, Jezewski T, Vano E, Maccia C, Trianni A, Padovani R. Quality criteria for cardiac images: an update. Radiat Prot Dosimetry 2008; 129:87-90. [PMID: 18283064 DOI: 10.1093/rpd/ncn034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The DIMOND II and III Cardiology Groups have agreed on quality criteria for cardiac images and developed a scoring system, to provide a tool to test quality of coronary angiograms, which was demonstrated to be of value in clinical practice. In the last years, digital flat panel technology has been introduced in cardiac angiographic systems and the radiological technique may have been influenced by the better performance of these new detectors. This advance in digital imaging, together with the lesson learned from previous studies, warranted the revision of the quality criteria for cardiac angiographic images as formerly defined. DIMOND criteria were reassessed to allow a simpler evaluation of angiograms. Clinical criteria were simplified and separated from technical criteria. Furthermore, the characteristics of an optimised angiographic technique have been outlined.
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Affiliation(s)
- G Bernardi
- Cardiology Department, Az. Ospedaliero-Universitaria Udine, Italy.
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Bernardi G, Padovani R, Trianni A, Morocutti G, Spedicato L, Zanuttini D, Werren M, Wagner LK. The effect of fellows' training in invasive cardiology on radiological exposure of patients. Radiat Prot Dosimetry 2008; 128:72-6. [PMID: 17573367 DOI: 10.1093/rpd/ncm230] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this work was to evaluate and quantify the impact of an invasive training of cardiology fellows on some exposure parameters. From 1 January 2000 to 31 December 2002, three staff members performed 2.582 diagnostic procedures (Group 1) that were compared with 819 performed by, or with the participation of five cardiology fellows (Group 2). Exposure parameters were as follows (Group 1/Group 2): fluoroscopy time 3.8 +/- 4.5/5.5 +/- 5.9 min (+38%), mean number of frames 589 +/- 282/642 +/- 260 (+9%), Kerma-area product (KAP) during fluoroscopy 10.6 +/- 14/15.5 +/- 16 Gycm2 (+45%), KAP during cine-angiography 20.8 +/- 14/22.5 +/- 12 (+8%), total KAP 31.5 +/- 28/38.1 +/- 28 (+21%). Differences were all significant (P <or= 0.001 for all comparisons). For individual fellows, a trend towards reduction of exposure parameters was seen over time, but only KAP(cine) was significant (25.7 +/- 14/22.2 +/- 11 Gycm2, P <or= 0.001). In conclusion, all parameters measured in this study increased significantly in diagnostic procedures performed with fellows when compared with staff members alone, fluoroscopy time and the related KAP in particular. Careful supervision limited these increases so that exposures remained within acceptable limits.
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Affiliation(s)
- Guglielmo Bernardi
- SOC di Cardiologia, Azienda Ospedaliero-Universitaria S Maria della Misericordia, Udine, Italy.
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Abstract
Dynamic digital flat-panel (FD) imaging technology is characterised by a higher sensitivity and image quality compared to image intensifier (II) technology. In this study, an angiography system based on II and one based on FD were compared with respect to system performance and impact of patient dose in interventional cardiology. When entrance surface air kerma rates are measured, the FD system requires a reduced dose rate, of up to 40%. For coronary angiography (CA), fluoroscopy time (FT) and dose-area product (DAP) were 4.3 +/- 5.0 min and 31.2 +/- 30.2 Gy cm2 on the II system and 4.4 +/- 3.8 min and 33.4 +/- 19.2 Gy cm2 with the FD system. For percutaneous transluminal coronary angiography, FT and DAP were 11.4 +/- 10.7 min and 52.1 +/- 45.0 Gy cm2 on II and 10.7 +/- 8.7 min and 66.9 +/- 54.4 Gy cm2 on DF. Data comparison suggests that reduced entrance dose rates do not automatically imply a reduction of patient dose in clinical practice.
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Affiliation(s)
- A Trianni
- Medical Physics Department, S. Maria della Misericordia Hospital, Piazzale S. Maria della Misericordia, 11, 33100 Udine, Italy.
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Trianni A, Chizzola G, Toh H, Quai E, Cragnolini E, Bernardi G, Proclemer A, Padovani R. Patient skin dosimetry in haemodynamic and electrophysiology interventional cardiology. Radiat Prot Dosimetry 2005; 117:241-6. [PMID: 16461492 DOI: 10.1093/rpd/nci756] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
With the increase in number and complexity of interventional cardiology (IC) procedures, it is important to monitor skin dose in order to decrease skin injuries. This study investigated radiation doses for patients undergoing IC procedures, compare results with the literature and define a local dose-area product trigger level for operators to identify situations likely to exceed the threshold for transient skin erythema of 2 Gy. Dosimetric data were collected for 77 haemodynamic and 90 electrophysiological procedures. Mean maximum local skin doses (MSDs) were 0.28 Gy for coronary angiography, 1.03 Gy for percutaneous transluminal coronary angioplasty (PTCA), 0.03 Gy for pacemaker insertion, 0.17 Gy for radiofrequency ablation for nodal tachycardia, 0.10 Gy for WPW and 0.22 Gy for atrial flutter. Since MSD values for the other procedures were well below the deterministic effect limit, a trigger level of 140 Gy cm2 was derived for PTCA procedures alone.
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Affiliation(s)
- A Trianni
- Medical Physics Department, S. Maria della Misericordia Hospital, Piazzale S. Maria della Misericordia, 11, 33100 Udine, Italy.
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Trianni A, Padovani R, Foti C, Cragnolini E, Chizzola G, Toh H, Bernardi G, Proclemer A. Dose to cardiologists in haemodynamic and electrophysiology cardiac interventional procedures. Radiat Prot Dosimetry 2005; 117:111-5. [PMID: 16461486 DOI: 10.1093/rpd/nci764] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Interventional cardiac procedures can be complex and involve extensive use of low dose rate fluoroscopy and high dose rate in image acquisition mode; hence, staff may receive significant radiation exposure. Radiation exposure to operators was assessed in 173 procedures. Fluoroscopy time, number of acquired images and dose-area product were recorded and occupational dose assessed with thermoluminescence dosemeters. The effective dose to the operator was compared with relevant literature data: values found were generally lower than those reported for other interventional cardiology laboratories. This is probably because of the strict radiation protection policy in our centre. Higher effective doses were found for defibrillator implantation and percutaneous transluminal coronary angiography procedures; for other cardiac procedures, effective dose was lower. Yearly extrapolated occupational doses to cardiologists are lower than the regulatory dose limit and in the lower band of doses reported in the literature.
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Affiliation(s)
- A Trianni
- Medical Physics Department, S. Maria della Misericordia Hospital, Piazzale S. Maria della Misericordia, 11, 33100 Udine, Italy.
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