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D'Ercole L, Rosi A, Bernardi G, Compagnone G, Orlacchio A, Padovani R, Palma A, Grande S. National survey to update the diagnostic reference levels in interventional radiology procedures in Italy: working methodology. J Radiol Prot 2024; 44:011505. [PMID: 38232403 DOI: 10.1088/1361-6498/ad1fe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
Interventional Radiology (IR) deals with the diagnosis and treatment of various diseases through medically guided imaging. It provides unquestionable benefits to patients, but requires, in many cases, the use of high doses of ionizing radiation with a high impact on radiation risks to patients and to overall dose to the population. The International Commission on Radiological Protection introduced Diagnostic reference levels (DRLs) as an effective tool to facilitate dose verification and optimize protection for patients undergoing radiological procedures. In addition, EURATOM Council Directive 2013/59 and its Italian transposition (Legislative Decree 101/2020) have reiterated that DRLs must be established for many common radiological diagnostic procedures to compare the radiation dose delivered for the same diagnostic examination. Within this framework, Istituto Superiore di Sanità-Italian National Institute of Health (ISS)-, in collaboration with relevant Italian Scientific Societies, has provided documents on DRLs in radiological practices such as diagnostic and IR and diagnostic nuclear medicine. These reference documents enable National Hospitals to comply national regulation. The implementation of DRLs in IR is a difficult task because of the wide distribution of doses to patients even within the same procedure. Some studies have revealed that the amount of radiation in IR procedures is influenced more by the complexity of the procedure than by the weight of the patient, so complexity should be included in the definition of DRLs. For this reason, ISS promoted a survey among a sample of Italian Centers update national DRL in IR procedures with related complexity factors than can be useful for other radiological centers and to standardize the DRLs values. In the present paper the procedural methodology developed by ISS and used for the survey will be illustrated.
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Affiliation(s)
- L D'Ercole
- S.C. Fisica Sanitaria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Rosi
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
| | - G Bernardi
- Struttura Sanitaria Polimedica di CODESS Friuli-Venezia Giulia, Pradamano (Udine), Italy
| | - G Compagnone
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Orlacchio
- Department of Surgical Science, 'Tor Vergata' University-Emergency Radiology-University Hospital 'Tor Vergata', Rome, Italy
| | - R Padovani
- International Center for Theoretical Physics, Trieste, Italy
| | - A Palma
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
| | - S Grande
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
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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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Sulieman A, Tamam N, Khandaker MU, Bradley D, Padovani R. Radiation exposure management techniques during endoscopic retrograde cholangio-pancreatography procedures. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.108991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Struelens L, Covens P, Benadjaoud M, Auvinen A, Gianicolo E, Wegener A, Domienik J, Carinou E, Dragusin O, Teles P, Widmark A, Ciraj-Bjelac O, Andreassi MG, Padovani R. 69. The European epidemiological study (EURALOC) on radiation-induced lens opacities among interventional cardiologists. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Padovani R, Compagnone G, D’Ercole L, Orlacchio A, Bernardi G, Rosi A, Campanella F. 345. Italian diagnostic reference levels for diagnostic and interventional radiology. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.354] [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: 11/16/2022] Open
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Vañó E, Miller DL, Martin CJ, Rehani MM, Kang K, Rosenstein M, Ortiz-López P, Mattsson S, Padovani R, Rogers A. ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging. Ann ICRP 2018; 46:1-144. [PMID: 29065694 DOI: 10.1177/0146645317717209] [Citation(s) in RCA: 389] [Impact Index Per Article: 64.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract – The International Commission on Radiological Protection (ICRP) first introduced the term ‘diagnostic reference level’ (DRL) in 1996 in Publication 73. The concept was subsequently developed further, and practical guidance was provided in 2001. The DRL has been proven to be an effective tool that aids in optimisation of protection in the medical exposure of patients for diagnostic and interventional procedures. However, with time, it has become evident that additional advice is needed. There are issues related to definitions of the terms used in previous guidance, determination of the values for DRLs, the appropriate interval for re-evaluating and updating these values, appropriate use of DRLs in clinical practice, methods for practical application of DRLs, and application of the DRL concept to newer imaging technologies. This publication is intended as a further source of information and guidance on these issues. Some terminology has been clarified. In addition, this publication recommends quantities for use as DRLs for various imaging modalities, and provides information on the use of DRLs for interventional procedures and in paediatric imaging. It suggests modifications in the conduct of DRL surveys that take advantage of automated reporting of radiation-dose-related quantities, and highlights the importance of including information on DRLs in training programmes for healthcare workers. The target audience for this publication is national, regional, and local authorities; professional societies; and facilities that use ionising radiation for medical purposes, and responsible staff within these facilities. A full set of the Commission’s recommendations is provided.
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Andreassi MG, Piccaluga E, Sacca SC, Del Greco M, Guagliumi G, Gaita F, Padovani R, Picano E. P574High prevalence of vision impairing cataract and subclinical lens opacities in cardiac catheterization laboratory staff with low-dose x-ray exposure: results from the italian healthy cath lab study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | - M Del Greco
- Santa Chiara Hospital in Trento, Trento, Italy
| | - G Guagliumi
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - F Gaita
- Division of Cardiology, Department of Medical Science, University of Turin, turin, Italy
| | - R Padovani
- International Centre for Theoretical Physics, trento, Italy
| | - E Picano
- Institute of Clinical Physiology, CNR, Pisa, Italy
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Struelens L, Dabin J, Carinou E, Askounis P, Ciraj-Bjelac O, Domienik-Andrzejewska J, Berus D, Padovani R, Farah J, Covens P. Radiation-Induced Lens Opacities among Interventional Cardiologists: Retrospective Assessment of Cumulative Eye Lens Doses. Radiat Res 2018; 189:399-408. [DOI: 10.1667/rr14970.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- L. Struelens
- Radiation Protection Dosimetry and Calibration Group, Belgian Nuclear Research Centre (SCK•CEN), Belgium
| | - J. Dabin
- Radiation Protection Dosimetry and Calibration Group, Belgian Nuclear Research Centre (SCK•CEN), Belgium
| | - E. Carinou
- Dosimetry and Calibration Department, Greek Atomic Energy Commission (EEAE), Agia Paraskevi, Greece
| | - P. Askounis
- Dosimetry and Calibration Department, Greek Atomic Energy Commission (EEAE), Agia Paraskevi, Greece
| | - O. Ciraj-Bjelac
- Vinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - J. Domienik-Andrzejewska
- Radiation Protection Department, Nofer Institute of Occupational Medicine (NIOM), 91-348 Lodz, Poland
| | - D. Berus
- Department of Radiation Protection, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - R. Padovani
- Department of Medical Physics, Abdus Salam International Centre for Theoretical Physics (ICTP), 34151 Trieste, Italy
| | | | - P. Covens
- Department of Radiation Protection, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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Padovani R, Longo R, Bertocchi L, Milotti E, Rigon L, Denaro MD, Brambilla M, Capra E, Cavedon C, Francescon P, Hrsak H, Foti C, Paiusco M, Ropolo R, Torresin A, Turra A, Valentini A. ICTP, Trieste University, italian and croatian medical physics: A training opportunity for young physicists from developing countries. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.169] [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: 10/21/2022] Open
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Padovani R, Lehnert T, Cettour-Rose P, Doenlen R, Auwerx J, Gijs MAM. Miniaturized implantable sensors for in vivo localized temperature measurements in mice during cold exposure. Biomed Microdevices 2015; 18:1. [DOI: 10.1007/s10544-015-0028-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bosmans H, Bliznakova K, Padovani R, Christofides S, Van Peteghem N, Tsapaki V, Caruana CJ, Vassileva J. EUTEMPE-RX, an EC supported FP7 project for the training and education of medical physics experts in radiology. Radiat Prot Dosimetry 2015; 165:518-522. [PMID: 25969526 DOI: 10.1093/rpd/ncv306] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The core activity of the medical physics expert (MPE) is to ensure optimal use of ionising radiation in healthcare. It is essential that these healthcare professionals are trained to the highest level, defined as European Qualifications Framework for Lifelong Learning (EQF) level 8 by the European Commission's Radiation Protection Report 174 'Guidelines on the MPE'. The main objective of the EUTEMPE-RX project is to provide a model training scheme that allows the medical physicist in diagnostic and interventional radiology (D&IR) to reach this high level. A European network of partners was brought together in this FP7 EC project to ensure sufficient expertise in all aspects of the subject and to create a harmonised course programme. Targeted participants are medical physicists in D&IR in hospitals, engineers and scientists in medical device industries and officers working in regulatory authorities. Twelve course modules will be developed at EQF level 8, with radiation safety and diagnostic effectiveness being prevalent subjects. The modules will combine online with face-to-face teaching using a blended learning approach.
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Affiliation(s)
- H Bosmans
- Medical Physics and Quality Control, KU Leuven, Herestraat 49, bus 7003, Leuven 3000, Belgium
| | - K Bliznakova
- Technical University of Varna, Studentska str. 1, Varna 9010, Bulgaria
| | - R Padovani
- University Hospital S. Maria della Misericordia of Udine, Piazzale Santa Maria della Misericordia 15, Udine 700, Italy
| | - S Christofides
- Medical Physics Department, Nicosia General Hospital, Old Nicosia Limassol Road 215, Nicosia 2029, Cyprus
| | - N Van Peteghem
- Medical Physics and Quality Control, KU Leuven, Herestraat 49, bus 7003, Leuven 3000, Belgium
| | - V Tsapaki
- Konstantopoulio General Hospital, 3-5 Agias Olgas Str, Nea Ionia 14233, Attiki, Greece
| | - C J Caruana
- Medical Physics Department, University of Malta, Msida, Malta
| | - J Vassileva
- Technical University of Varna, Studentska str. 1, Varna 9010, Bulgaria
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Rehani M, Meghzifene A, Tsapaki V, Padovani R, Pipman Y, Lief E. WE-E-19A-01: Globalization of Medical Physics. Med Phys 2014. [DOI: 10.1118/1.4889429] [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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Ruggieri I, Bille Turc F, Padovani R. Expérience en neurologie libérale de la mise en place de la pompe à apomorphine dans la maladie de Parkinson. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.355] [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: 11/29/2022]
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Bosmans H, Bliznakova K, Padovani R, Christofides S, Van Peteghem N, Tsapaki V, Caruana C. Eutempe-RX: a new EC supported course for medical physics experts in radiology. Phys Med 2014. [DOI: 10.1016/j.ejmp.2014.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Piccaluga E, Simonetti I, Chiesa MR, Andreassi MG, Padovani R, Bernardi G, Cremonesi A, Guagliumi G, Picano E. Radiation awareness and safety practices in the cardiac catheterization laboratory: results of a survey among Italian cardiac cath lab workers. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3049] [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: 11/13/2022] Open
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Arandjic D, Bonutti F, Biasizzo E, Ciraj-Bjelac O, Floreani M, Giustizieri M, Iaiza F, Inkoom S, Tommasini G, Padovani R. Radiation doses in cerebral perfusion computed tomography: patient and phantom study. Radiat Prot Dosimetry 2013; 154:459-464. [PMID: 23060430 DOI: 10.1093/rpd/ncs260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to investigate radiation doses in cerebral perfusion computed tomography (CT) examination. As a part of routine patient monitoring, data were collected on patients in terms of the skin dose and CT dose index (CTDIvol) and dose-length product (DLP) values. For the estimation of the dose to the lens a phantom study was performed. Dose values for skin and lens were below the threshold for deterministic effects. The results were also compared with already published data. For better comparison, the effective dose was also estimated. The values collected on patients were in the ranges 230-680 mGy for CTDI and 2120-2740 mGy cm for DLP, while the skin dose and estimated effective dose were 340-800 mGy and 4.9-6.3 mSv, respectively. These values measured in the phantom study were similar, while the doses estimated to the lens were 53 and 51 mGy for the right and left lens, respectively.
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Affiliation(s)
- D Arandjic
- Vinca Institute of Nuclear Sciences, Radiation Protection Department, Belgrade, Serbia.
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Hand J, Bosmans H, Caruana C, Keevil S, Norris D, Padovani R, Speck O. The European Federation of Organisations for Medical Physics Policy Statement No 14: The role of the Medical Physicist in the management of safety within the magnetic resonance imaging environment: EFOMP recommendations. Phys Med 2013; 29:122-5. [DOI: 10.1016/j.ejmp.2012.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Malisan M, Spadaccini L, Moretti E, Negri A, Foti C, Padovani R. PO-0786: Retrospective assessment of the clinical impact of errors detected in patient specific IMRT QA: a validation study. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33092-9] [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]
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Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, Einstein AJ, Geiger B, Heintz P, Padovani R, Sim KH. ICRP PUBLICATION 120: Radiological protection in cardiology. Ann ICRP 2013; 42:1-125. [PMID: 23141687 DOI: 10.1016/j.icrp.2012.09.001] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff(1) in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission's published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy.
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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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Dumas R, Padovani R, Richieri R, Lançon C. Stimulation magnétique transcrânienne répétée dans la prise en charge des épisodes dépressifs majeurs : facteurs prédictifs de réponse thérapeutique. Encephale 2012; 38:360-8. [DOI: 10.1016/j.encep.2011.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 05/13/2011] [Indexed: 01/18/2023]
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Varatharaj C, Moretti E, Manickam R, Padovani R. SU-E-T-366: Patient Specific IMRT Pre-Treatment Verification Using a Commercial Portal Dosimetry Software. Med Phys 2012. [DOI: 10.1118/1.4735453] [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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Negri A, Michelutti D, Padovani R, Moretti E. SU-E-J-130: Study of the Image Quality Degradation in Phase-Based 4DCT Imaging for Radiation Oncology. Med Phys 2012; 39:3682. [PMID: 28518911 DOI: 10.1118/1.4734966] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Four-dimensional computed tomography (4DCT) integrated into radiation imaging system is a useful tool for accurate targeting. 4DCT has the ability to minimize breathing related artefacts compared to conventional CT but irregular breathing and large tumour motion may cause inappropriate reconstruction. Our aim is to estimate the image quality degradation of 4DCT and to assess the clinical consequences. METHODS The performance of the respiratory gating system of the multi-slice CT-simulator Brilliance Big Bore was evaluated employing one-dimensional moving phantom. The binning algorithm was phased-based. 4DCT scans of the test-phantom were acquired applying periodic motion patterns characterized by amplitude and frequency spanning a clinically range and also irregular waveforms simulating realistic breathing cycles. The internal spherical objects of the moving phantom were contoured using semiautomatic segmentation for evaluating uncertainties in volume delineation and motion amplitude calculation. Motion amplitude was determined by a specially written MATLAB program. Afterwards we investigated the influence of the image distortions on the targeting and the consequences of the related uncertainties on the calculated dose distribution of the tumour and the lungs in a group of five lung-cancer patients. RESULTS The results obtained with the phantom show that 4DCT imaging is still affected by distortions due to residual motion. The inaccuracies are mainly related to the amplitude (R2=0.99, R2=0.97 for 20 mm-dia sphere and 10 mm-dia sphere, respectively) and to the oscillation frequency (R2=0.87 for 20 mm-dia sphere, R2=0.96 for 10 mm-dia sphere) of simulated respiratory cycle and can cause both underestimation and overestimation of the real tumour motion amplitude with an average difference between real and calculated amplitude of about 10%. CONCLUSIONS The resulting inaccuracies on the internal tumour volume delineated do not have significant clinical consequences on lung doses but they could be important on tumour dose distribution if they imply underestimation of the real tumour motion.
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Negri A, Michelutti D, Padovani R, Moretti E. PD-0081 INVESTIGATION OF THE IMAGE QUALITY DEGRADATION IN PHASE-BASED 4DCT DATA AND ITS CLINICAL CONSEQUENCES. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70420-6] [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: 11/29/2022]
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Boyer L, Aghababian V, Richieri R, Loundou A, Padovani R, Simeoni MC, Auquier P, Lançon C. Insight into illness, neurocognition and quality of life in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:271-6. [PMID: 22019603 DOI: 10.1016/j.pnpbp.2011.10.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [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: 08/11/2011] [Revised: 10/06/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess the impact of insight into illness on self-reported quality of life (QoL) for patients with schizophrenia. METHODS This cross-sectional study was conducted in the psychiatric department of a French public university teaching hospital. The data collected included socio-demographic information, clinical characteristics, medications, cognitive performance assessments, insight into illness, and the S-QoL 18. A multivariate analysis using multiple linear regressions was performed to determine variables potentially associated with QoL levels. RESULTS One hundred and thirteen outpatients with stable schizophrenia were enrolled in our study. Significant associations were found between QoL and socio-demographic characteristics: a higher QoL was associated with marital status (in couple) and employment. Concerning insight into illness, lower QoL levels were associated with better awareness of the mental disorder, whereas higher QoL levels were associated with better awareness of positive and negative symptoms. Elementary neuropsychological measures were not statistically associated with QoL. CONCLUSION Insight into illness, marital status and employment were the most important features associated with QoL, whereas there was no evidence that elementary neurocognition directly influenced QoL. The different facets of insight into illness should be considered to guide the development of specific interventions intended to improve QoL. Moreover, this study highlights the need for clinicians to pay more attention to the personal impact of schizophrenia, especially upon family life and work.
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Affiliation(s)
- L Boyer
- Aix-Marseille Univ, EA 3279 Research Unit, 13385 Marseille, France.
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Padovani R, Le Heron J, Cruz-Suarez R, Duran A, Lefaure C, Miller DL, Sim HK, Vano E, Rehani M, Czarwinski R. International project on individual monitoring and radiation exposure levels in interventional cardiology. Radiat Prot Dosimetry 2011; 144:437-441. [PMID: 21051431 DOI: 10.1093/rpd/ncq326] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Within the Information System on Occupational Exposure in Medicine, Industry and Research (ISEMIR), a new International Atomic Energy Agency initiative, a Working Group on interventional cardiology, aims to assess staff radiation protection (RP) levels and to propose an international database of occupational exposures. A survey of regulatory bodies (RBs) has provided information at the country level on RP practice in interventional cardiology (IC). Concerning requirements for wearing personal dosemeters, only 57 % of the RB specifies the number and position of dosemeters for staff monitoring. Less than 40 % of the RBs could provide occupational doses. Reported annual median effective dose values (often <0.5 mSv) were lower than expected considering validated data from facility-specific studies, indicating that compliance with continuous individual monitoring is often not achieved in IC. A true assessment of annual personnel doses in IC will never be realised unless a knowledge of monitoring compliance is incorporated into the analysis.
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Affiliation(s)
- R Padovani
- Medical Physics Department, University Hospital, Udine, Italy
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Pratesi A, Ginestroni A, Padovani R, Mascalchi M. An unusual cause of cord compression: synovial cyst of the thoracic spine. BMJ Case Rep 2009; 2009:bcr2007127134. [PMID: 21687302 DOI: 10.1136/bcr.2007.127134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- A Pratesi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Pratesi A, Ginestroni A, Padovani R, Mascalchi M. Neurological picture. An unusual cause of cord compression: synovial cyst of the thoracic spine. J Neurol Neurosurg Psychiatry 2008; 79:947. [PMID: 18645216 DOI: 10.1136/jnnp.2007.127134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A Pratesi
- Department of Clinical Physiopathology, Radiodiagnostic Section, University of Florence, Florence, Italy
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Bonutti F, Cattaruzzi E, Cragnolini E, Floreani M, Foti C, Malisan MR, Moretti E, Geatti O, Padovani R. Count-rate analysis from clinical scans in PET with LSO detectors. Radiat Prot Dosimetry 2008; 129:288-290. [PMID: 18440959 DOI: 10.1093/rpd/ncn153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
The purpose of optimising the acquisition parameters in positron emission tomography is to improve the quality of the diagnostic images. Optimisation can be done by maximising the noise equivalent count rate (NECR) that in turn depends on the coincidence rate. For each bed position the scanner records coincidences and singles rates. For each patient, the true, random and scattered coincidences as functions of the single count rate(s) are determined by fitting the NEMA (National Electrical Manufacturers Association) 70 cm phantom count rate curves to measured clinical points. This enables analytical calculation of the personalised PNECR [pseudo NECR(s)] curve, linked to the NECR curve. For central bed positions, missing activity of approximately 70% is estimated to get maximum PNECR (PNECR(max)), but the improvement in terms of signal-toz-noise ratio would be approximately 15%. The correlation between patient weight and PNECR(max) is also estimated to determine the optimal scan duration of a single bed position as a function of patient weight at the same PNEC. Normalising the counts at PNECR(max) for the 70 kg patient, the bed duration for a 90 kg patient should be 230 s, which is approximately 30% longer. Although the analysis indicates that the fast scanner electronics allow using higher administered activities, this would involve poor improvement in terms of NECR. Instead, attending to higher bed duration for heavier patients may be more useful.
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Affiliation(s)
- F Bonutti
- Medical Physics Department, University Hospital, Udine, Italy.
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Jankowski J, Domienik J, Papierz S, Padovani R, Vano E, Faulkner K. An international calibration of Kerma-Area Product meters for patient dose optimisation study. Radiat Prot Dosimetry 2008; 129:328-332. [PMID: 18319283 DOI: 10.1093/rpd/ncn018] [Citation(s) in RCA: 2] [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
The results of international calibration of Kerma Area Product (KAP) meters for European SENTINEL survey on patient dose optimisation of cardiac and interventional radiology practice are presented. Twelve countries were involved in the study. An investigation was conduced on 25 KAP meters fitted to undercouch X-ray tubes; 13 KAP meters were installed on cardiac units and the remaining 12 on interventional ones. The simplified calibration method has been applied, consisting of KAP estimation by multiplying the air kerma at the centre of the X-ray field by the irradiated area. The obtained values of calibration factors range from 0.4 to 0.9 and from 0.4 to 0.8 for KAP meters installed on cardiac and interventional units, respectively. They account also for table and mattress attenuation. For air kerma assessment, measurements with thermoluminescent dosemeters have been applied and when possible compared against an additional reference dosemeter. As the result of the investigation, the importance of calibration of KAP meters in clinical conditions that include mattress and table attenuation has been recognised.
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Affiliation(s)
- J Jankowski
- Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland.
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Abstract
Health-care expenditure on radiological equipment in Europe is a growing fraction of the gross domestic product for all member states. This increase in expenditure has been driven by technical developments in equipment design, matched by the introduction of novel clinical practices, examinations and procedures. The radiation protection implications of these developments have to be assessed. The SENTINEL co-ordination action covered radiation protection, safety and related issues that arise from these technical and clinical developments. SENTINEL covered 90% of patient examinations in European Radiology, 60% of the collective dose from medical sources and approximately 50% of the collective dose to European citizens from man-made sources. The SENTINEL co-ordination actions 'main' objective was to address the safety and efficacy issues which are common to all digital diagnostic imaging systems, including nuclear medicine. High-dose procedures and sensitive groups (such as children) were covered by the project. Specifically, the co-ordination action aimed: (1) to establish both physical and clinical image quality criteria and link the two, (2) to undertake a series of dosimetry studies to establish the reference levels for new procedures and (3) to develop good practice guidelines for radiation protection in digital imaging and produce training material.
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Affiliation(s)
- K Faulkner
- Unit 9 Kingfisher Way, Silverlink Business Park, Wallsend, NE28 9ND, UK.
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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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Malisan MR, Padovani R, Faulkner K, Malone JF, Vaño E, Jankowski J, Kosunen A. Proposal for a patient database on cardiac interventional exposures for epidemiological studies. Radiat Prot Dosimetry 2008; 129:96-99. [PMID: 18287190 DOI: 10.1093/rpd/ncn036] [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
Relatively high organ doses absorbed by patients in interventional cardiology suggest the opportunity to define these patients as a cohort to be followed forward in time in an epidemiological study of the cancer risks associated with exposure to low-dose ionising radiation. In this paper, the UNSCEAR 2000 Report risk estimates for the most exposed organs/tissues in cardiac interventional procedures are reviewed, as well as the critical features of such an epidemiological study that is anticipated to have an intrinsically low statistical power because of the low levels of risk and possible confounding factors. To overcome these limitations, data collected in different institutions can be combined provided that a common design and conduct are used for dose assessment. A minimum dataset to be collected on a patient basis is proposed that can be implemented routinely in most facilities. This data should be linked to the local patient information system in order to retrieve all the exposures of a given patient.
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Affiliation(s)
- M R Malisan
- Medical Physics Department, University Hospital, Udine, 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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Vano E, Järvinen H, Kosunen A, Bly R, Malone J, Dowling A, Larkin A, Padovani R, Bosmans H, Dragusin O, Jaschke W, Torbica P, Back C, Schreiner A, Bokou C, Kottou S, Tsapaki V, Jankowski J, Papierz S, Domienik J, Werduch A, Nikodemova D, Salat D, Kepler K, Bor MD, Vassileva J, Borisova R, Pellet S, Corbett RH. Patient dose in interventional radiology: a European survey. Radiat Prot Dosimetry 2008; 129:39-45. [PMID: 18287189 DOI: 10.1093/rpd/ncn024] [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: 05/25/2023]
Abstract
Patient doses for a few common fluoroscopy-guided procedures in interventional radiology (IR) (excluding cardiology) were collected from a few radiological departments in 13 European countries. The major aim was to evaluate patient doses for the basis of the reference levels. In total, data for 20 procedures for about 1300 patients were collected. There were many-fold variations in the number of IR equipment and procedures per population, in the entrance dose rates, and in the patient dose data (total dose area product or DAP, fluoroscopy time and number of frames). There was no clear correlation between the total DAP and entrance dose rate, or between the total DAP and fluoroscopy time, indicating that a number of parameters affect the differences. Because of the limited number of patients, preliminary reference levels were proposed only for a few procedures. There is a need to improve the optimisation of IR procedures and their definitions and grouping, in order to account for their different complexities.
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Affiliation(s)
- E Vano
- Radiology Department, Ciudad Universitaria, Complutense University, Madrid, Spain
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Muhogora WE, Devetti A, Padovani R, Msaki P, Bonutti F. Application of European protocol in the evaluation of contrast-to-noise ratio and mean glandular dose for two digital mammography systems. Radiat Prot Dosimetry 2008; 129:231-236. [PMID: 18283065 DOI: 10.1093/rpd/ncn023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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 performance of two digital mammography systems, Agfa CR75 and CRMM3 computed radiography (CR) and IMS Giotto MD direct digital radiography (DR), was assessed by applying a method recommended in the European protocol for quality control in mammography screening. The contrast-to-noise ratio (CNR) and mean glandular dose (MGD) values were measured and contrast detail (CD) analysis was performed. The CNRs for system CR were 21.9, 12.9, 9.5, 8.8, 7.4, 5.5 and 4.4 for 2, 3, 4, 4.5, 5, 6 and 7-cm polymenthylmethacrylate (PMMA) thickness, respectively. The respective CNRs for system DR were 10.4, 8.8, 6.3, 7.3, 7.2, 6.4 and 6.54. For the same phantom thickness sequence, the MGDs were 0.7, 1.1, 1.3, 1.6, 1.9, 2.5 and 3.4 mGy for system CR, whereas they were 0.7, 1.2, 1.1, 1.3, 1.8, 3.5 and 3.9 mGy for system DR. The CNR and MGD results satisfactorily correlate with CD analysis results. The MGD values compare well with the values recommended in the European protocol. Despite being simple, CNR and MGD can provide an effective system for performance assessment and constancy checks for related optimisations.
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Affiliation(s)
- W E Muhogora
- Medical Physics, Ospedale Universitario, 15 33100 Udine, 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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Tsapaki V, Padovani R, Vano E, Schreiner A, Molfetas M, Neofotistou V, Kottou S. Commissioning and constancy protocols for digital angiographic units. Radiat Prot Dosimetry 2008; 129:258-260. [PMID: 18245790 DOI: 10.1093/rpd/ncn016] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
During the European Concerted Action SENTINEL 'Safety and Efficacy for New Techniques and Imaging using New Equipment to Support European Legislation', protocols for commissioning and constancy tests for dynamic digital flat detectors angiography units have been developed in order to harmonise practice among the European counties. The commissioning protocol includes measurements on X-ray tube and generator, patient and detector radiation dose and image quality. The constancy protocol is based on the dose and image quality measurements. The commissioning protocol was tested by SENTINEL partners who expressed an interest in checking their dynamic digital systems using this protocol. The results of basic tests are reported.
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Affiliation(s)
- V Tsapaki
- Medical Physics Department, Konstantopoulio Agia Olga Hospital, Athens, Greece
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Balter S, Miller DL, Vano E, Ortiz Lopez P, Bernardi G, Cotelo E, Faulkner K, Nowotny R, Padovani R, Ramirez A. A pilot study exploring the possibility of establishing guidance levels in x-ray directed interventional procedures. Med Phys 2008; 35:673-80. [DOI: 10.1118/1.2829868] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [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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Balter S, Bernardi G, Cotelo E, Faulkner K, Miller DL, Nowotny R, Ortiz Lopez P, Padovani R, Ramirez A, Vano E. TU-E-330D-05: Potential Radiation Guidance Levels for Invasive Cardiology. Med Phys 2006. [DOI: 10.1118/1.2241616] [Citation(s) in RCA: 3] [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: 11/07/2022] Open
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Targher G, Bertolini L, Padovani R, Poli F, Scala L, Tessari R, Zenari L, Falezza G. Increased prevalence of cardiovascular disease in Type 2 diabetic patients with non-alcoholic fatty liver disease. Diabet Med 2006; 23:403-9. [PMID: 16620269 DOI: 10.1111/j.1464-5491.2006.01817.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS To estimate the prevalence of cardiovascular disease (CVD) in Type 2 diabetic patients with and without non-alcoholic fatty liver disease (NAFLD), and to assess whether NAFLD is independently related to prevalent CVD. METHODS We studied 400 Type 2 diabetic patients with NAFLD and 400 diabetic patients without NAFLD who were matched for age and sex. Main outcome measures were prevalent CVD (as ascertained by medical history, physical examination, electrocardiogram and echo-Doppler scanning of carotid and lower limb arteries), NAFLD (by ultrasonography) and presence of the metabolic syndrome (MetS) as defined by the World Health Organization or Adult Treatment Panel III criteria. RESULTS The prevalences of coronary (23.0 vs. 15.5%), cerebrovascular (17.2 vs. 10.2%) and peripheral (12.8 vs. 7.0%) vascular disease were significantly increased in those with NAFLD as compared with those without NAFLD (P < 0.001), with no differences between sexes. The MetS (by any criteria) and all its individual components were more frequent in NAFLD patients (P < 0.001). In logistic regression analysis, male sex, age, smoking history and MetS were independently related to prevalent CVD, whereas NAFLD was not. CONCLUSIONS The prevalence of CVD is increased in patients with Type 2 diabetes and NAFLD in association with an increased prevalence of MetS as compared with diabetic patients without NAFLD. Follow-up studies are necessary to determine whether this higher prevalence of CVD among diabetic patients with NAFLD affects long-term mortality.
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Affiliation(s)
- G Targher
- Division of Internal Medicine, Sacro Cuore Hospital, Negrar (VR), Italy.
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Targher G, Bertolini L, Padovani R, Poli F, Scala L, Zenari L, Zoppini G, Falezza G. Non-alcoholic fatty liver disease is associated with carotid artery wall thickness in diet-controlled type 2 diabetic patients. J Endocrinol Invest 2006; 29:55-60. [PMID: 16553034 DOI: 10.1007/bf03349177] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is closely associated with several metabolic syndrome (MetS) features. We assessed whether NAFLD is significantly associated with carotid artery intima-media thickness (IMT), as a marker of subclinical atherosclerosis, and whether such association is independent of classical cardiovascular risk factors and MetS features. We studied 100 diet-controlled Type 2 diabetic patients with ultrasonographically diagnosed NAFLD and 100 diabetic patients without NAFLD who were comparable for age and sex. Main outcome measures were carotid IMT (by ultrasonography), classical risk factors, insulin resistance [as estimated by homeostasis model assessment (HOMA)-IR] and MetS (as defined by the Adult Treatment Panel III criteria). NAFLD patients had a markedly greater carotid IMT (1.24 +/- 0.13 vs 0.95 +/- 0.11 mm; p < 0.001) than those without the condition. The MetS and all its clinical traits were more highly prevalent in those with NAFLD (p < 0.001). Adjustment for age, sex, smoking history, diabetes duration, glycosylated hemoglobin, LDL cholesterol, liver enzymes and microalbuminuria did not really affect the significant differences in carotid IMT that were observed between the groups. Further adjustment for the MetS also had little impact, but additional adjustment for HOMA-IR score consistently attenuated any statistical significance (p = 0.28). In multivariate regression analysis, HOMA-IR score along with age and MetS (principally raised blood pressure values) were independently related to carotid IMT, whereas NAFLD was not. In conclusion, these results suggest that among diet-controlled Type 2 diabetic individuals the significant increase of carotid IMT in the presence of NAFLD is largely explained by HOMA-estimated insulin resistance.
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Affiliation(s)
- G Targher
- Department of Internal Medicine, "Sacro Cuore" Hospital, Negrar (VR), Italy.
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Targher G, Bertolini L, Padovani R, Rodella S, Zenari L, Cigolini M, Falezza G, Arcaro G. We-P12:293 Associations between carotid artery wall thickness and liver histology in patients with non-alcoholic fatty liver disease. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81646-6] [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]
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Abstract
Interventional radiology contributes a significant proportion of the collective dose of the population from medical exposures. Interventional radiology procedures are usually fluoroscopy-guided diagnostic and therapeutic interventions. When complex procedures are performed or procedures are repeated for the same patient, high-radiation dose levels can occur because procedures often require long fluoroscopy times and require high-quality images. For all of these reasons, dosimetric evaluations in interventional radiology are widely increasing. Patient dosimetry methods currently used in interventional radiology may be divided into three categories according to dosimetry purpose: (I) dosimetry for stochastic risk evaluation, (II) dosimetry for quality assurance and (III) dosimetry to prevent the deterministic effects of radiation. A short description of dosimetric methods used in interventional cardiology practice and relevant published dosimetric data are reported.
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Affiliation(s)
- R Padovani
- Medical Physics Institute, S. Maria della Misericordia Hospital, Udine, Italy.
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47
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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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Padovani R, Bernardi G, Quai E, Signor M, Toh HS, Morocutti G, Spedicato L. Retrospective evaluation of occurrence of skin injuries in interventional cardiac procedures. Radiat Prot Dosimetry 2005; 117:247-50. [PMID: 16461491 DOI: 10.1093/rpd/nci757] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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 cardiology procedures can involve high doses to patients and, in particular, to patients' skin, the tissue at greatest risk of deterministic injuries. The evaluation of skin dose from interventional procedures is recommended, but difficult because of the amount of different X-ray fields and projections used in a procedure. For this reason, a retrospective follow-up study has been developed to identify skin injuries in patients submitted to one or more cardiac interventions in the Udine hospital between 1998 and 2002. Seventy-eight patients with a cumulative dose-area product >300 Gy cm2 were selected from 3332 patients, who underwent 5039 procedures. In this group the maximum skin dose was 6.7 Gy. The clinical follow-up, performed using the LENT-SOMA methodology, has not detected skin injuries and this result allows a frequency to be estimated for skin injuries in patients undergoing repeated cardiac procedures of <3 x 10(-4) in our centre.
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Affiliation(s)
- R Padovani
- Medical Physics Institute, S. Maria della Misericordia Hospital, 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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Bernardi G, Padovani R, Spedicato L, Desmet W, Malisan MR, Giannuleas JD, Neofotistou E, Manginas A, Olivari Z, Cosgrave J, Alfonso F, Bosmans H, Dowling A, Vano E. Image quality criteria in cardiology. Radiat Prot Dosimetry 2005; 117:102-6. [PMID: 16461497 DOI: 10.1093/rpd/nci750] [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: 05/06/2023]
Abstract
Image quality evaluation plays a key role in the process of optimisation in radiological procedures. Image quality criteria for cardiac cine-angiography were recently agreed as part of a European Research Project, and a scoring system based on these criteria has been developed to allow an 'objective' measurement of the quality of cardiac angiograms. Two studies aimed at the evaluation of the methodology have been completed, demonstrating that the method can be applied to cardiac images and translated into a scoring system that yields reproducible data. Based on the results of these studies, quality criteria have been further reviewed by DIMOND III panel and the updated version is presented in this paper.
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Affiliation(s)
- G Bernardi
- Unità Operativa di Cardiologia, Az. Osp. S. Maria della Misericordia, Piazzale della Misericordia, 15, 33100 Udine, Italy.
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