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Greffier J, Dabli D, Kammoun T, Goupil J, Berny L, Touimi Benjelloun G, Beregi JP, Frandon J. Retrospective Analysis of Doses Delivered during Embolization Procedures over the Last 10 Years. J Pers Med 2022; 12:jpm12101701. [PMID: 36294840 PMCID: PMC9605272 DOI: 10.3390/jpm12101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/31/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
Background: This study aimed to retrospectively analyze dosimetric indicators recorded since 2012 for thoracic, abdominal or pelvic embolizations to evaluate the contribution of new tools and technologies in dose reduction. Methods: Dosimetric indicators (dose area product (DAP) and air kerma (AK)) from 1449 embolizations were retrospectively reviewed from August 2012 to March 2022. A total of 1089 embolizations were performed in an older fixed C-Arm system (A1), 222 in a newer fixed C-Arm system (A2) and 138 in a 4DCT system (A3). The embolization procedures were gathered to compare A1, A2 and A3. Results: DAP were significantly lower with A2 compared to A1 for all procedures (median −50% ± 5%, p < 0.05), except for uterine elective embolizations and gonadal vein embolization. The DAP values were significantly lower with A3 than with A1 (p < 0.001). CT scan was used for guidance in 90% of embolization procedures. Conclusions: The last C-Arm technology allowed a median reduction of 50% of the X-ray dose. The implementation of a CT scan inside the IR room allowed for more precise 3D-guidance with no increase of the dose delivered.
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Affiliation(s)
- Joël Greffier
- IMAGINE UR UM 103, Department of Medical Imaging, Montpellier University, Nîmes University Hospital, 30029 Nîmes, France
- Department of Medical Physics, Nîmes University Hospital, 30029 Nîmes, France
- Correspondence: ; Tel.: +33-466-683-309
| | - Djamel Dabli
- IMAGINE UR UM 103, Department of Medical Imaging, Montpellier University, Nîmes University Hospital, 30029 Nîmes, France
- Department of Medical Physics, Nîmes University Hospital, 30029 Nîmes, France
| | - Tarek Kammoun
- IMAGINE UR UM 103, Department of Medical Imaging, Montpellier University, Nîmes University Hospital, 30029 Nîmes, France
| | - Jean Goupil
- IMAGINE UR UM 103, Department of Medical Imaging, Montpellier University, Nîmes University Hospital, 30029 Nîmes, France
| | - Laure Berny
- IMAGINE UR UM 103, Department of Medical Imaging, Montpellier University, Nîmes University Hospital, 30029 Nîmes, France
| | - Ghizlane Touimi Benjelloun
- IMAGINE UR UM 103, Department of Medical Imaging, Montpellier University, Nîmes University Hospital, 30029 Nîmes, France
| | - Jean-Paul Beregi
- IMAGINE UR UM 103, Department of Medical Imaging, Montpellier University, Nîmes University Hospital, 30029 Nîmes, France
| | - Julien Frandon
- IMAGINE UR UM 103, Department of Medical Imaging, Montpellier University, Nîmes University Hospital, 30029 Nîmes, France
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Werncke T, Meine TC, Hinrichs JB, Maschke SK, Becker LS, Brüsch I, Rumpel R, Wacker FK, Meyer BC. Tantalum-specific contrast-to-noise ratio or conventional detector dose-driven exposure control in angiography: radiation dose and image quality evaluation in a porcine model. Eur Radiol Exp 2022; 6:24. [PMID: 35578057 PMCID: PMC9110612 DOI: 10.1186/s41747-022-00275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this animal study was to compare the fluoroscopic image quality (IQ) and radiation dose between a tantalum (Ta)-specific contrast-to-noise ratio-driven exposure control (Ta-CEC) and a detector dose-driven exposure control (DEC) in abdominal angiography. Methods Nine angiography scenarios were created in seven anaesthetised pigs using Ta-based embolisation material during percutaneous liver and kidney intervention. Fluoroscopic images were acquired using three DEC protocols with different dose levels and Ta-CEC protocols with different IQ levels, sampled in small steps. Polymethyl-methacrylate and aluminium plates were used to simulate attenuation of three water equivalent thicknesses (WET). Three blinded readers evaluated the IQ of DEC and dose equivalent Ta images and selected the Ta-IQ equivalent image corresponding to the DEC image. Results Interobserver agreement for the IQ assessment was 0.43 for DEC, 0.56 for Ta-CEC and for the assessment of incident air kerma at the interventional reference point (Ka,r) for the Ta-IQ equivalent image 0.73. The average IQ of the dose equivalent Ta images was superior compared to the DEC images (p < 0.001) and also for every WET (26, 31, or 36 cm) and dose level (p ≤ 0.022). The average Ka,r for the Ta-IQ equivalent images was 59 ± 16% (mean ± standard deviation) lower compared to the DEC images (p < 0.001). Conclusions Compared to DEC, Ta-CEC significantly improved the fluoroscopic depiction of Ta, while maintaining the Ka,r. Alternatively, the Ka,r can be significantly reduced by using Ta-CEC instead of DEC, while maintaining equivalent IQ.
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Radiation dose reduction during adrenal vein sampling using a new angiographic imaging technology. Sci Rep 2022; 12:6067. [PMID: 35414704 PMCID: PMC9005500 DOI: 10.1038/s41598-022-09984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
To compare the patient radiation doses during angiographic selective adrenal vein sampling (AVS) before and after an imaging technology upgrade. In this retrospective single-center-study, cumulative air kerma (AK), cumulative dose area product (DAP), fluoroscopy time and contrast agent dosage were recorded from 70 patients during AVS. 35 procedures were performed before and 35 after an imaging processing technology upgrade. Mean values were calculated and compared using an unpaired student’s t-test. DSA image quality was assessed independently by two blinded readers using a four-point Likert scale (1 = poor; 4 = excellent) and compared using Wilcoxon signed-rank test. After the technology upgrade we observed a significant reduction of 35% in AK (1.7 ± 0.7 vs. 1.1 ± 0.7 Gy, p = 0.01) and a significant reduction of 28% in DAP (235.1 ± 113 vs. 170.1 ± 94 Gy*cm2, p = 0.01) in comparison to procedures before the upgrade. There were no significant differences between the number of exposure frames (143 ± 86 vs. 132 ± 61 frames, p = 0.53), fluoroscopy time (42 ± 23 vs. 36 ± 18 min, p = 0.22), or the amount of contrast medium used (179.5 ± 84 vs. 198.1 ± 109 ml, p = 0.41). There was also no significant difference regarding image quality (3 (2–4) vs. 3 (2–4), p = 0.67). The angiographic imaging technology upgrade significantly decreases the radiation dose during adrenal vein sampling without increasing time of fluoroscopy or contrast volume and without compromising image quality.
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Werncke T, Kemling M, Tashenov S, Hinrichs JB, Meine TC, Maschke SK, Kyriakou Y, Wacker FK, Meyer BC. Comparison of a contrast-to-noise ratio-driven exposure control and a regular detector dose-driven exposure control in abdominal imaging in a clinical angiography system. Med Phys 2021; 48:7641-7656. [PMID: 34651705 DOI: 10.1002/mp.15288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 05/28/2021] [Accepted: 09/20/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The first purpose of this phantom study was to verify whether a contrast-to-noise ratio (CNR)-driven exposure control (CEC) can maintain target CNR in angiography more precisely compared to a conventional detector dose-driven exposure control (DEC). The second purpose was to estimate the difference between incident air kerma produced by CEC and DEC when both exposure controls reach the same CNR. METHODS A standardized 3D-printed phantom with an iron foil and a cavity, filled with iodinated contrast material, was developed to measure CNR using different image acquisition settings. This phantom was placed into a stack of polymethylmethacrylate and aluminum plates, simulating a patient equivalent thickness (PET) of 2.5-40 cm. Images were acquired using fluoroscopy and digital radiography modes with CEC using one image quality level and four image quality gradients and DEC having three different detector dose levels. The spatial frequency weighted CNR and incident air kerma were determined. The differences in incident air kerma between DEC and CEC were estimated. RESULTS When using DEC, CNR decreased continuously with increasing attenuation, while CEC within physical limits maintained a predefined CNR level. Furthermore, CEC could be parameterized to deliver the CNR as a predefined function of PET. To provide a given CNR level, CEC used equal or lower air kerma than DEC. The mean estimated incident air kerma of CEC compared to DEC was between 3% (PET 20 cm) and 40% (PET 27.5 cm) lower in fluoroscopy and between 1% (PET 20 cm) and 55% (PET 2.5 cm) lower in digital radiography while maintaining CNR. CONCLUSION Within physical and legislative limits, the CEC allows for a flexible adjustment of the CNR as a function of PET. Thus, the CEC enables task-dependent examination protocols with predefined image quality in order to easier achieve the as low as reasonably achievable principle. CEC required equal or lower incident air kerma than DEC to provide similar CNR, which allows for a substantial reduction of skin radiation dose in these situations.
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Affiliation(s)
- Thomas Werncke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Marius Kemling
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Stanislav Tashenov
- Advanced Therapies, Cancer Therapy, Define, Siemens Healthcare GmbH, Forchheim, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Timo C Meine
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Yiannis Kyriakou
- Customer Services, Education, Education Architecture & Design, Siemens Healthcare GmbH, Forchheim, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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El-Diasty MT, Olfat AA, Mufti AS, Alqurashi AR, Alghamdi MJ. Patients' Radiation Shielding in Interventional Radiology Settings: A Systematic Review. Cureus 2021; 13:e16870. [PMID: 34513445 PMCID: PMC8412000 DOI: 10.7759/cureus.16870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
As a result of the increasing risk of developing radiation-related complications, many approaches aimed at reducing this risk and enhancing the outcomes of the patient, doctor or device operator have been developed. In this systematic review, we aim to discuss previous investigations that studied patient shielding or protection within the context of selected interventional radiology procedures. We included original studies that used Ka,r, and PKA for the assessment of the outcomes of two procedures: transjugular intrahepatic portosystemic shunt creation (TIPS) and hepatic arterial chemoembolization (HAE). A thorough search strategy was conducted on relevant databases to identify all relevant studies. We included 13 investigations, including 12 cross-sectional studies and one randomized controlled trial. Significant diversity was found among all these studies in terms of the used modalities, which made them hard to compare. However, almost all studies agreed that using novel imaging and interventional modalities is useful when obtaining better outcomes and reducing patient radiation exposure. The use of ultrasound-guided procedures and providing adequate lead curtains has also been recommended by the identified studies in order to minimize the frequency of radiation exposure. The reported Ka,r, and PKA were also variable between studies and were discussed within this study. Our findings indicate that unified guidelines for patient radiation shielding should be urgently investigated.
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Affiliation(s)
| | - Ahmed A Olfat
- Department of Radiology, King Abdullah Medical City, Mecca, SAU
| | - Ahmad S Mufti
- Department of Radiology, King Abdullah Medical City, Mecca, SAU
| | - Ahmed R Alqurashi
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, SAU
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Paulo G, Bartal G, Vano E. Radiation Dose of Patients in Fluoroscopically Guided Interventions: an Update. Cardiovasc Intervent Radiol 2020; 44:842-848. [PMID: 33034703 DOI: 10.1007/s00270-020-02667-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
The benefits of fluoroscopically guided interventional procedures are significant and have established new standards in the clinical management of many diseases. Despite the benefits, it is known that they come with known risks, such as the exposure to ionizing radiation. To minimize such risks, it is crucial that the health professionals involved in the procedures have a common understanding of the concepts related to radiation protection, such as dose descriptors, diagnostic reference levels and typical dose values. An update about these concepts will be presented with the objective to raise awareness amongst health professionals and contribute to the increase in knowledge, skills and competences in radiation protection in fluoroscopically guided interventional procedures.
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Affiliation(s)
- Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal.
| | | | - Eliseo Vano
- Radiology Department, Complutense University, Madrid, Spain
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Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization. Invest Radiol 2019; 54:153-159. [DOI: 10.1097/rli.0000000000000519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Thomaere E, Dehairs M, Laenen A, Mehrsima A, Timmerman D, Cornelissen S, Op de Beeck K, Bosmans H, Maleux G. A new imaging technology to reduce the radiation dose during uterine fibroid embolization. Acta Radiol 2018; 59:1446-1450. [PMID: 29486598 DOI: 10.1177/0284185118760064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Uterine fibroid embolization (UFE) is a minimally invasive imaging-guided treatment using radiation exposure. PURPOSE To compare the patients' radiation exposure during UFE before and after introduction of a new X-ray imaging platform. MATERIAL AND METHODS Forty-one patients were enrolled in a prospective, comparative two-arm project before and after introduction of a new X-ray imaging platform with reduced dose settings, i.e. novel real-time image processing techniques (AlluraClarity). Demographic, pre-interventional imaging, and procedural data, including dose area product (DAP) and estimated organ dose on the ovaries and uterus, were recorded and angiographic quality of overall procedure was assessed. RESULTS There were no significant differences in demographic characteristics and preoperative fibroid and uterine volumes in the two groups. The new imaging platform led to a significant reduction in mean total DAP (102 vs. 438 Gy.cm2; P < 0.001), mean fluoroscopy DAP (32 vs. 138 Gy.cm2; P < 0.001), mean acquisition DAP (70 vs. 300 Gy.cm2; P < 0.001), and acquisition DAP estimated organ dose in ovaries (42 vs. 118 mGy; P < 0.001) and uterus (40 vs. 118 mGy, P < 0.001), without impairment of the procedure and angiographic image quality. CONCLUSION A substantial 77% reduction of DAP values and 64% and 66% reduction in organ dose on ovaries and uterus, respectively, was demonstrated with the new imaging platform, while maintaining optimal imaging quality and efficacy.
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Affiliation(s)
- Eveline Thomaere
- Department of Radiology, University Hospitals Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Michiel Dehairs
- Department of Radiology, Section of Medical Physics, University Hospitals Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven and University Hasselt, Leuven, Belgium
| | | | - Dirk Timmerman
- Department of Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Sandra Cornelissen
- Department of Radiology, Section of Interventional Radiology, University Hospitals Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Katya Op de Beeck
- Department of Radiology, University Hospitals Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Hilde Bosmans
- Department of Radiology, Section of Medical Physics, University Hospitals Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, Section of Interventional Radiology, University Hospitals Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
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