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Doyle E, Dimmock MR, Lee KL, Thomas P, Bassed RB. Comparison of typical radiation doses and risks using an anthropomorphic 'bone fracture' phantom for commonly performed X-ray projections in a 5-year-old. J Med Radiat Sci 2024; 71:35-43. [PMID: 37602665 PMCID: PMC10920946 DOI: 10.1002/jmrs.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/05/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Diagnostic reference levels (DRLs) are typical dose levels for medical imaging examinations for groups of standard-sized patients or standard phantoms for broadly defined types of equipment used as a tool to aid optimisation of protection for medical exposures. Currently, there are no paediatric DRLs for conventional radiography (i.e. general X-rays) published in Australia. The aim of this study was to establish typical radiation doses and risks that are representative of those delivered for commonly performed X-ray projections for a 5-year-old/20 kg child using a 5-year-old anthropomorphic 'bone fracture' phantom in three dedicated paediatric radiology departments in Victoria. METHODS A total of 20 projection images were acquired for a standard 5-year-old/20 kg phantom using digital radiography X-ray equipment. The air kerma-area product (KAP) measured at each centre by a KAP metre, which was calibrated to a national primary standard, was considered to represent the median value for that centre for each X-ray projection. Organ doses and effective dose were estimated using PCXMC software, and risks of radiation-induced cancer and radiation-induced death were calculated based on the BEIR VII report. RESULTS The typical doses for the individual X-ray projections ranged from 3 mGy•cm2 to 86 mGy•cm2 , whilst the effective doses ranged from 0.00004 to 0.07 mSv. The radiation risks were 'minimal' to 'negligible'. CONCLUSION The estimation of typical radiation doses and associated risks for a 5-year-old/20 kg phantom study provides reference values for guidance and is a first step in assisting optimisation at other institutions until national DRLs, based on patient data from the clinical setting, are published.
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Affiliation(s)
- Edel Doyle
- Department of Forensic MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Matthew R Dimmock
- Department of Medical Imaging and Radiation SciencesMonash UniversityMelbourneVictoriaAustralia
- School of Allied Health ProfessionsKeele UniversityKeeleUK
| | - Kam L Lee
- Australian Radiation Protection and Nuclear Safety AgencyYallambieVictoriaAustralia
| | - Peter Thomas
- Australian Radiation Protection and Nuclear Safety AgencyYallambieVictoriaAustralia
| | - Richard B Bassed
- Department of Forensic MedicineMonash UniversityMelbourneVictoriaAustralia
- Victorian Institute of Forensic MedicineAcademic ProgramsMelbourneVictoriaAustralia
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Broadley L, Erskine B, Marshall E, Ewert K, Picker B. Optimising image quality in intravenous cerebral cone beam computed tomography. J Med Radiat Sci 2024; 71:26-34. [PMID: 37847044 PMCID: PMC10920929 DOI: 10.1002/jmrs.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION The efficacy of intravenous cerebral Cone Beam Computed Tomography (IV CBCT) is well established; however, image quality has only ever been authenticated by subjective evaluation. The aim of this study was to quantify the factors pertinent to achieving consistent and optimal image quality when performing IV CBCT. METHODS Between 1 March 2021 and 30 October 2022, 79 patients received IV CBCT. These candidates were divided into three main acquisition field size categories (22/32, 42 and 48 cm) according to the clinical indication. The images were analysed using both a quantitative assessment and a subjective evaluation. Here, a comparison of Hounsfield units (HUs), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and noise index was conducted for each study and compared relative to the acquisition field size. The subjective analysis was performed in a non-blinded fashion where the diagnostic value (DV) of the exam was determined according to a graded scale. A phantom analysis for each of the acquisition field sizes was conducted and modulation transfer function (MTF) graphed. RESULTS Significantly higher HU, SNR, CNR and lower noise indices were achieved with the 42-cm protocol than the 22/32 and 48-cm protocols. Here a greater DV was also reported. The MTF demonstrates marginally improved spatial resolution for the 22-cm protocol, but this is near equivocal for the 32-, 42 and 48-cm protocols. CONCLUSION The use of larger acquisition field sizes provides improved image quality when performing IV CBCT as an alternative to intra-arterial (IA) CBCT.
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Affiliation(s)
| | | | | | - Kyle Ewert
- Alfred HospitalMelbourneVictoriaAustralia
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Lin CY, Cavanaugh NB, Subramani S, Singhal AK, Hanada S. Interpretation of chest fluoroscopy: the risk of misdiagnosing atelectasis as pneumothorax due to greyscale inversion. Anaesth Rep 2024; 12:e12307. [PMID: 38827818 PMCID: PMC11143383 DOI: 10.1002/anr3.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Anaesthetists may be required to work in hybrid theatres for procedures using fluoroscopic imaging. Adequate knowledge of fluoroscopic images allows prompt and effective emergency management of complications which arise during procedures. Here, we present a case of severe hypotension and hypoxia occurring shortly after induction of anaesthesia. Atelectasis was mistaken for a pneumothorax due to misinterpretation of fluoroscopic imaging, which demonstrated a dark pleural cavity peripheral to a partially collapsed left lung, leading to an incorrect diagnosis. This case highlights the importance of understanding greyscale inversion in fluoroscopy.
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Affiliation(s)
- C. Y. Lin
- Department of Anesthesiology and Perioperative CareSchool of Medicine, University of California, Irvine School of MedicineIrvineCAUSA
| | | | - S. Subramani
- Department of AnesthesiaUniversity of IowaIowa CityIAUSA
| | - A. K. Singhal
- Department of Cardiothoracic SurgeryUniversity of IowaIowa CityIAUSA
| | - S. Hanada
- Department of AnesthesiaUniversity of IowaIowa CityIAUSA
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Slave O, Mahomed N. An audit of patient radiation doses in interventional radiology at a South African hospital. SA J Radiol 2023; 27:2559. [PMID: 36756356 PMCID: PMC9900283 DOI: 10.4102/sajr.v27i1.2559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/11/2022] [Indexed: 02/04/2023] Open
Abstract
Background Interventional radiology (IR) is becoming more relevant in patient care and is associated with increased patient radiation exposure and radiation-induced adverse effects. Diagnostic reference levels (DRLs) are crucial for radiation control. There is a paucity of published DRLs for IR in South Africa and sub-Saharan Africa. Objectives This study aimed to determine local DRLs for fluoroscopically-guided IR procedures and compare the achieved DRLs with published local and international DRLs. Method Retrospective, descriptive, single-centre study. Kerma air product (KAP), reference point air kerma (Ka,r) and fluoroscopy time (FT) were collected for patients (12 years and older) who underwent IR procedures at a university hospital from 01 January 2019 to 31 December 2019. The 75th percentile of the distribution of each dose parameter (KAP, Ka,r and FT) per procedure was calculated and taken as the local diagnostic reference levels (LDRL). The established LDRLs were compared to published DRLs. Results A total of 564 cases were evaluated. The 13 most frequent procedures (with 15 or more cases) represented 86.1% (487/564). Percutaneous transhepatic biliary drainage was the most common procedure (n = 146, 25.9%). Diagnostic cerebral angiogram DRLs exceeded the published DRL data ranges for all parameters (DRL 209.3), and interventional cerebral angiogram exceeded published ranges (DRL 275). Uterine artery embolisation (UAE) exceeded these ranges for KAP and Ka,r. (KAP-954.9 Gy/cm2, Ka,r-2640.8 mGy). Conclusion The LDRLs for diagnostic cerebral angiogram, interventional cerebral angiogram and UAE exceeded published international DRL ranges. These procedures require radiation optimisation as recommended by the International Commission on Radiological Protection (ICRP). Contribution In addition to informing radiation protection practices at the level of the institution, the established LDRLs contribute towards Regional and National DRLs.
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Affiliation(s)
- Oneile Slave
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nasreen Mahomed
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Establishing diagnostic reference levels for pediatric fluoroscopic examinations in a tertiary hospital. Pediatr Radiol 2022; 52:1296-1305. [PMID: 35284948 DOI: 10.1007/s00247-022-05290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diagnostic reference levels (DRLs) identify unusually high patient radiation exposures and are required for dose optimisation. DRLs for pediatric fluoroscopic examinations are not widely determined in Australia. OBJECTIVE Our objectives were to establish DRLs for pediatric fluoroscopic examinations in a South Australian tertiary hospital and compare these to previously published data and to explore relationships between patient dose area product (DAP), age and fluoroscopy times. MATERIALS AND METHODS Dose data from 365 pediatric patients undergoing 5 fluoroscopic examinations were retrospectively collected for a 3-year period commencing January 2018 to develop local DRLs. Relationships between DAP, age and fluoroscopy time were explored using scatterplots, Spearman's correlation, and regression analyses. RESULTS Local DRLs were significantly lower than data published previously, possibly reflecting technological and procedural advancements. Each 1-year increase in patient age was associated with a 0.77 μGy·m2 increase in DAP for barium meal and follow-through studies (95% confidence interval [CI]=0.055, 1.48) (P=0.04), and a 1.37 μGy·m2 increase in DAP for barium swallow studies (95% CI=0.61, 2.12) (P<0.001). A low correlation was demonstrated between DAP and fluoroscopy time for micturating cystourethrography studies (r=0.35, 95% CI=0.15, 0.51, P<0.001) and barium meal and follow-through studies (r=0.37, 95% CI= -0.011, 0.65, P=0.05). Age and fluoroscopy time were not significantly related. CONCLUSION This study provides updated Australian pediatric fluoroscopic DRLs, with the intention of promoting a national database for benchmarking pediatric doses. The local DRLs can be used for dose comparisons and optimisation between facilities.
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Erdem O, Ay M, Yalcin A, Bilgic S, Sanlıdilek U, Amasyalı B, Sancak T, Olgar T. PATIENT AND STAFF DOSES FOR VARIOUS INTERVENTIONAL RADIOLOGY AND CARDIOLOGY EXAMINATIONS IN TURKEY. RADIATION PROTECTION DOSIMETRY 2022; 198:158-166. [PMID: 35165744 DOI: 10.1093/rpd/ncac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
This study aims to determine the radiation doses of patients and staff during different interventional radiology and cardiology examinations. Dose measurements for interventional radiology examinations were performed in Ibn-i Sina Hospital of Ankara University using Siemens Artis-Zee medical imaging system. Patient dose measurement was carried out for interventional cardiology examinations in Cardiology Department of TOBB-ETU University, Medical Faculty Hospital using Philips Allura Centron interventional X-ray system. Patient doses were obtained in terms of kerma area product (KAP) and cumulative air kerma (CAK) from KAP meter attached to the angiography system. Performance tests of the angiography system were performed before patient dose measurements. Staff dose measurements were carried out with thermoluminescence dosimeters (TLD-100) placed in certain areas on the staff. Patient dose measurements were performed for 15 different interventional radiology examinations on a total of 431 patients and for four different cardiology examinations on a total of 299 patients. Monte Carlo based PCXMC 2.0 program was used to calculate patient effective doses. Lower extremity arteriography was the most common examination with a mean KAP value of 30 Gy cm2 and mean effective dose value of 1.2 mSv for total number of 194 patients. Mean KAP values calculated for coronary angiography, percutaneous coronary intervention, electrophysiological procedures and radiofrequency cardiac ablation examinations were 62.8, 162.8, 16.7 and 70.6 Gy cm2, respectively. Radiologist, nurse and technician effective dose normalised to the unit KAP of patient dose were 0.15, 0.11 and 0.14 μSv Gy-1 cm-2. Similarly, cardiologist, nurse and technician effective dose normalised to the unit KAP of patient dose were 0.22, 0.15 and 0.09 μSv Gy-1 cm-2. Measured KAP and CAK values vary depending on the type and complexity of the examination. The measured staff doses during cardiac examinations were higher when compared with that measured for interventional radiology as expected.
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Affiliation(s)
- Onur Erdem
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Musa Ay
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Asena Yalcin
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Sadık Bilgic
- Ankara University, Faculty of Medicine, Department of Radiology, 06100 Ankara, Turkey
| | - Umman Sanlıdilek
- Ankara University, Faculty of Medicine, Department of Radiology, 06100 Ankara, Turkey
| | - Basri Amasyalı
- TOBB University of Economics and Technology Hospital, Department of Cardiology, 06510 Ankara, Turkey
| | - Tanzer Sancak
- TOBB University of Economics and Technology Hospital, Department of Radiology, 06510 Ankara, Turkey
| | - Turan Olgar
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
- Ankara University, Faculty of Engineering, Department of Physics Engineering, 06100 Ankara, Turkey
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Tristram J, Steuwe A, Kröpil F, Thomas C, Rubbert C, Antoch G, Boos J. Typical doses and typical values for fluoroscopic diagnostic and interventional procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021510. [PMID: 35130526 DOI: 10.1088/1361-6498/ac5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
To implement typical doses (TD) and typical values (TV) for fluoroscopic diagnostic and interventional procedures. A total of 3811 fluoroscopic procedures performed within 34 months on three devices were included in this retrospective study. Dose-, patient- and procedure-related information were extracted using the institutional dose management system (DMS). TD/TV were defined as median dose and calculated for the five most frequent procedures per device for dose area product (DAP), cumulative air kerma (CAK) and fluoroscopy time (FT). National diagnostic reference levels and other single facility studies were compared to our results. Additionally, the five procedures with the highest doses of each device were analysed. To evaluate the data coverage of the DMS compared to the picture archiving and communication system (PACS), procedure lists were extracted from the PACS and compared to the procedure information extracted from the DMS. TD/TV for 15 procedures were implemented. Among all devices, TD for DAP ranged between 0.6 Gycm2for port catheter control (n= 64) and 145.9 Gycm2for transarterial chemoembolisation (n= 84). TD for CAK ranged between 5 mGy for port catheter control and 1397 mGy for aneurysm treatment (n= 129) and TV for FT ranged between 0.3 min for upper cavography (n= 67) and 51.4 min for aneurysm treatment. TD for DAP and CAK were lower or within the range of other single facility studies. The five procedures with the highest median DAP per device were identified, 6 of 15 procedures were also found to be among the most frequent procedures. Data coverage of the DMS compared to the PACS ranged between 71% (device 2, stroke treatment) and 78% (device 1, lower limb angiography) for the most common procedure per device. Thus, in 22%-29% of cases dose data of the performed procedure was not transferred into the DMS. We implemented TD/TV for fluoroscopic diagnostic and interventional procedures which enable a comprehensive dose analysis and comparison with previously published values.
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Affiliation(s)
- Juliana Tristram
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Andrea Steuwe
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Feride Kröpil
- Medical Faculty, Department of Surgery, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Christoph Thomas
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Christian Rubbert
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Johannes Boos
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
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Poor practice and governance in Lebanese national diagnostic reference levels of adult head and body computed tomography: A nationwide study. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2021.109888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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González-Ruíz A, Ou-Saada I, Isidro-Ortega FJ, Sánchez-Mendoza HI. Local dose reference levels during transarterial chemoembolization procedure. Appl Radiat Isot 2021; 178:109982. [PMID: 34655924 DOI: 10.1016/j.apradiso.2021.109982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
The aim of this study was to develop local diagnostic reference levels (LDRL) during Transarterial chemoembolization (TACE). This cross-sectional study reports radiation dose indicators of 108 patients in a Mexican hospital, obtained over a period of 35 months. Kerma-area product (PKA), air-kerma at the reference point (Ka, r), and descriptive statistical analysis were examined according to sociodemographic characteristics of the sample patients. The LDRL obtained were then compared to a similar international framework. The present study contributes to the establishment of a TACE LDRL and identifies significant correlations among radiology factors and dosimetric quantities obtained.
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Affiliation(s)
- Abraham González-Ruíz
- Universidad Autónoma del Estado de México, Paseo Tollocan S/N, Toluca, Estado de México, 50180, México
| | - Imane Ou-Saada
- Laboratory of High Energy Physics, Modelling and Simulations Faculty of Sciences Rabat, Mohammed V University, 4 Avenue Ibn Battouta B.P. 1014, Rabat, Morocco
| | - Frank Jhonatan Isidro-Ortega
- División de Estudios de Posgrado e Investigación, Instituto Tecnológico de Toluca, Metepec, 52149, Estado de México, México
| | - Helen's Irais Sánchez-Mendoza
- Instituto Nacional de Salud Pública, Fray Pedro de Gante 12, Belisario Domínguez Secc 16, Tlalpan, 14080, Ciudad de México, México.
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Malan L, Pitcher RD, da Silva M, Breuninger S, Groenewald W. Diagnostic reference levels for fluoroscopically guided procedures in a South African tertiary hospital. Acta Radiol 2021; 62:807-814. [PMID: 32640888 DOI: 10.1177/0284185120938371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burgeoning usage and complexity of fluoroscopically guided procedures (FGPs) contribute to extended examination times and increased risk of adverse radiation effects. Diagnostic reference levels (DRLs) play a pivotal role in dose optimization. There are limited DRL data for FGPs in low- and middle-income countries (LMICs). PURPOSE To determine local DRLs (LDRLs) for common FGPs in the South African (SA) context and compare these with published international data. MATERIAL AND METHODS A three-year, retrospective study of the 15 most frequently performed FGPs at a SA institution. For each procedure, the 50th and 75th percentiles of kerma area product (KAP), reference point air kerma (Ka,r), and fluoroscopy time data were derived. Published international FGP DRL data were collated and compared with the 75th percentiles of local institutional dosage parameters. RESULTS The commonest FGPs were aorto-bifemoral diagnostic angiography (n = 590), aorto-bifemoral interventional angiography (n = 287), nephrostomy (n = 265), and bronchial arterial embolization (BAE) (n = 208). Selective abdominal vessel interventional angiography (KAP = 170 Gy . cm2; Ka,r = 877 mGy) recorded the highest LDRL dosages; BAE was the longest procedure (LDRL = 38 min). Nephrostomies achieved the lowest LDRLs across all parameters (KAP = 10 Gy . cm2; Ka,r = 63 mGy, fluoroscopy time = 4.3 min). All Tygerberg Hospital LDRLs with comprehensive comparable data were within or below published ranges. CONCLUSION This study advances international radiation protection initiatives, addresses the paucity of LMIC DRL data, demonstrates broad alignment of Tygerberg Hospital FGP practice with international norms and highlights areas for optimization of institutional practice.
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Affiliation(s)
- Leon Malan
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Richard D Pitcher
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Michelle da Silva
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Sharlene Breuninger
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Wilhelm Groenewald
- Division of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape, South Africa
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Peter Y, Speelman A, Daries V. Measurement of the average radiation dose to the local skin and thyroid gland during intracranial aneurysm coil embolization. Radiography (Lond) 2021; 27:255-259. [DOI: 10.1016/j.radi.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/07/2023]
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Investigating the parameters that affect the radiation exposure and establishing typical values based on procedure complexity for cerebral angiography and brain aneurysm embolization. Neuroradiology 2020; 63:787-794. [PMID: 33057746 DOI: 10.1007/s00234-020-02580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to investigate the parameters that affect the radiation exposure and to establish typical values (TV) based on procedure complexity for cerebral angiography (CA) and brain aneurysm embolization (BAE). METHODS Clinical parameters and exposure data were retrospectively reviewed for 348 examinations performed between March 2016 and December 2019 at a single specialized neuroradiology center. TV were derived as the median value of the distribution of exposure parameters such as total air kerma area product (PKA,T), air kerma at the patient entrance reference point, fluoroscopy time, and number of frames. A statistical analysis was conducted to investigate the exposure variability with patient's gender, number of treated vessels during CA and patient gender, aneurysm location and dimension, and treatment strategies during BAE. RESULTS Patient gender was associated with a significant increase in the exposure level for both CA and BAE. For CA, TV were in term of PKA,T of 52 Gycm2 for male vs. 28 Gycm2 for female patients. For BAE, these were 113 Gycm2 for male vs. 75 Gycm2 for female patients. Exposure levels increased significantly with the number of treated vessels in CA. TV were 20 Gycm2 for one vessel vs. 77 Gycm2 for 5-6 vessels CA. For BAE, aneurysm location was also a key factor that affects the patient exposure. TV were 55 Gycm2 for aneurysms grouped in location 1 vs. 105 Gycm2 for those grouped in location 2. CONCLUSION Male gender, number of treated vessels, and aneurysm location are key parameters affecting patient exposure during CA and BAE procedures.
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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Nocum DJ, Robinson J, Liang E, Thompson N, Reed W. The factors contributing to the total radiation exposure of patients during uterine artery embolisation. J Med Radiat Sci 2019; 66:200-211. [PMID: 31332961 PMCID: PMC6745357 DOI: 10.1002/jmrs.347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/22/2022] Open
Abstract
Uterine artery embolisation (UAE) is an interventional angiography procedure for the treatment of symptomatic fibroids and/or adenomyosis in women. UAE is a less invasive and non-surgical alternative to hysterectomy or myomectomy. However, ionising radiation is used for both fluoroscopic and angiographic image guidance to visualise and access the uterine arteries for embolisation and treatment of these benign conditions. Identifying the contributors and implementing dose reduction techniques are particularly important as UAE patients are usually of child-bearing age. The purpose of this review was to examine the progression of literature on radiation exposure measurements and identifying the factors contributing to the total radiation exposure of female patients undergoing UAE. A Medline, ProQuest Central, ScienceDirect and Scopus database search from 2000 to 2018 was performed and forty articles were deemed acceptable for review following the inclusion and exclusion criteria set. UAE is a viable alternative to hysterectomy and myomectomy, as the reviewed literature demonstrated that the reported radiation exposure doses appear to be below the threshold for any deterministic radiation risks. The total radiation exposure of UAE patients is affected independently by multiple patient, operator expertise and technique, angiographic imaging and x-ray unit variables. Uterus preservation can be attained post-UAE with dose reduction and optimisation, however, a longitudinal study on UAE patients and their risk of radiation-induced deterministic and/or stochastic effects is recommended.
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Affiliation(s)
- Don J. Nocum
- San Radiology & Nuclear MedicineSydney Adventist HospitalWahroongaNew South WalesAustralia
| | - John Robinson
- Faculty of Health Sciences, School of Medical Radiation SciencesUniversity of SydneyCumberlandNew South WalesAustralia
| | - Eisen Liang
- Faculty of Medicine and Health Adventist Hospital Clinical SchoolUniversity of SydneyWahroongaNew South WalesAustralia
| | - Nadine Thompson
- San Radiology & Nuclear MedicineSydney Adventist HospitalWahroongaNew South WalesAustralia
- Faculty of Medicine and Health Adventist Hospital Clinical SchoolUniversity of SydneyWahroongaNew South WalesAustralia
| | - Warren Reed
- Faculty of Health Sciences, School of Medical Radiation SciencesUniversity of SydneyCumberlandNew South WalesAustralia
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Ngaile J, Msaki P, Kazema R. Monte Carlo based estimation of organ and effective doses to patients undergoing hysterosalpingography and retrograde urethrography fluoroscopy procedures. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hadjiconstanti AC, Messaris GAT, Thomopoulos KC, Panayiotakis GS. Patient Radiation Doses in Therapeutic Endoscopic Retrograde Cholangiopancreatography in Patras and the Key Role of the Operator. RADIATION PROTECTION DOSIMETRY 2017; 177:243-249. [PMID: 28419374 DOI: 10.1093/rpd/ncx037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
The patient radiation doses, in conjunction with the operator experience, in therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, performed in our hospital, were obtained. Ninety-six patients participated in the study and were divided into 3 groups, based on the operator experience. The dosemetric indices, fluoroscopy time (FT), cumulative dose (Ka,r) and air kerma-area product (PKA), were collected. For the total and weight banding group the third quartile values of the distribution of FT, Ka,r and PKA were 2.90 and 2.92 min, 6.89 and 6.93 mGy and 1.84 and 1.85 Gycm2, respectively, and were comparative or significantly lower than the corresponding values previously reported. Taking as a criterion the operator, the differences in the patient radiation doses were statistically significant, with the highest dose recorded for the operator of the lowest experience degree. The values obtained could contribute in establishing local and national diagnostic reference levels and in optimising ERCP procedure.
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Affiliation(s)
| | - Gerasimos A T Messaris
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
| | | | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
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17
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Saukko E, Henner A, Nieminen MT, Ahonen SM. THE ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVELS IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A PRACTICAL TOOL FOR THE OPTIMISATION AND FOR QUALITY ASSURANCE MANAGEMENT. RADIATION PROTECTION DOSIMETRY 2017; 173:338-344. [PMID: 26932805 DOI: 10.1093/rpd/ncw018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
Fluoroscopic procedures are an area of special concern in relation to radiation protection. The aim of this study was to describe the current level of patient radiation doses in endoscopic retrograde cholangiopancreatography (ERCP) collected from a single centre, as well as to establish and review local diagnostic reference levels (DRLs) in ERCP. A total of 100 patients' radiation doses in ERCP were recorded, and the third-quartile method was adopted to establish local DRLs for ERCP. The mean dose area product (DAP) was 2.05 Gy cm2, fluoroscopy time (FT) 1.7 min and the number of images was 3. The proposed local DRLs for ERCP were 3.00 Gy cm2 and 3.0 min. Local DRLs were reviewed in a sample of 25 patients 5 y after they had been established. In reviewing data, the averages of DAP and FT were below the local DRLs. Local DRLs help in the optimisation process of fluoroscopic procedures and guides to a good clinical practice.
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Affiliation(s)
- E Saukko
- Turku University Hospital, The Medical Imaging Centre of Southwest Finland, Kiinamyllynkatu 4-8, PO Box 52, 20521 Turku, Finland
| | - A Henner
- Oulu University of Applied Sciences, School of Health and Social Care, Kiviharjuntie 8, 90220 Oulu, Finland
| | - M T Nieminen
- University of Oulu, Research Unit of Medical Imaging, Physics and Technology, PO Box 5000, 90014 Oulu, Finland
- Oulu University Hospital, Department of Diagnostic Radiology, PO Box 50, 90029 Oulu, Finland
| | - S-M Ahonen
- University of Oulu, Research Unit of Nursing Science and Health Management, PO Box 5000, 90014 Oulu, Finland
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18
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Brady Z. Radiation dose in fluoroscopy: Experience does matter. J Med Imaging Radiat Oncol 2016; 60:457-8. [DOI: 10.1111/1754-9485.12485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Zoe Brady
- Department of Radiology; Alfred Health; Prahran Victoria Australia
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19
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Bibbo G, Balman D, Linke R. Diagnostic reference levels for common paediatric fluoroscopic examinations performed at a dedicated paediatric Australian hospital. J Med Imaging Radiat Oncol 2016; 60:469-74. [DOI: 10.1111/1754-9485.12478] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/30/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Giovanni Bibbo
- SA Medical Imaging; Women's and Children's Hospital; North Adelaide South Australia Australia
| | - Debbie Balman
- SA Medical Imaging; Women's and Children's Hospital; North Adelaide South Australia Australia
| | - Rebecca Linke
- SA Medical Imaging; Women's and Children's Hospital; North Adelaide South Australia Australia
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