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Yoshida M, Niwa M, Takahashi Y, Kuratani Y. [Effect of Reducing Fluoroscopy Pulse Rates on Visibility of Devices and Radiation Dose in Percutaneous Coronary Intervention]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:519-529. [PMID: 38569842 DOI: 10.6009/jjrt.2024-1396] [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] [Indexed: 04/05/2024]
Abstract
The goal of our study was to clarify the effect of low pulse rate fluoroscopy applying in percutaneous coronary intervention (PCI) on devices' visibility and radiation dose. Four types of fluoroscopy conditions combined with two pulse rates (7.5 and 15 pulses/s) and two types of adaptive temporal filters (ATFs) (weak and strong) were used. Samples for visibility evaluation were acquired with moving phantom and devices such as stent, balloon, and guidewire. Trailing artifacts and the visibility of stent were evaluated by Scheffe's method of paired comparisons. Incident air kerma (Ka,r) and kerma area product (PKA) in the clinic were obtained under two fluoroscopic pulse rate conditions (7.5 and 15 pulses/s). As a result, in 7.5 pulses/s fluoroscopy, trailing artifacts were decreased by using weak ATF with the median value of PKA and Ka,r reduced by about 50%, but stent visibility was decreased compared to 15 pulses/s. Therefore, a combination of 7.5 pulses/s fluoroscopy and suitable ATF can bring dose reduction with avoiding trailing artifacts, but dose per pulse should be adjusted to maintain the stent visibility.
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Shindo R, Ohno S, Yamamoto K, Konta S, Inaba Y, Suzuki M, Zuguchi M, Chida K. Comparison of shielding effects of over-glasses-type and regular eyewear in terms of occupational eye dose reduction. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:023501. [PMID: 38701771 DOI: 10.1088/1361-6498/ad4714] [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: 01/17/2024] [Accepted: 05/03/2024] [Indexed: 05/05/2024]
Abstract
Given the new recommendations for occupational eye lens doses, various lead glasses have been used to reduce irradiation of interventional radiologists. However, the protection afforded by lead glasses over prescription glasses (thus over-glasses-type eyewear) has not been considered in detail. We used a phantom to compare the protective effects of such eyewear and regular eyewear of 0.07 mm lead-equivalent thickness. The shielding rates behind the eyewear and on the surface of the left eye of an anthropomorphic phantom were calculated. The left eye of the phantom was irradiated at various angles and the shielding effects were evaluated. We measured the radiation dose to the left side of the phantom using RPLDs attached to the left eye and to the surface/back of the left eyewear. Over-glasses-type eyewear afforded good protection against x-rays from the left and below; the average shielding rates on the surface of the left eye ranged from 0.70-0.72. In clinical settings, scattered radiation is incident on physicians' eyes from the left and below, and through any gap in lead glasses. Over-glasses-type eyewear afforded better protection than regular eyewear of the same lead-equivalent thickness at the irradiation angles of concern in clinical settings. Although clinical evaluation is needed, we suggest over-glasses-type Pb eyewear even for physicians who do not wear prescription glasses.
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Affiliation(s)
- Ryota Shindo
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Saya Ohno
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Keisuke Yamamoto
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Satoe Konta
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Yohei Inaba
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4 Aoba, Sendai 980-8579, Japan
| | - Masatoshi Suzuki
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4 Aoba, Sendai 980-8579, Japan
| | - Masayuki Zuguchi
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4 Aoba, Sendai 980-8579, Japan
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Miller DL, Balter S. NCRP commentary no. 33-recommendations for stratification of equipment use and radiation safety training for fluoroscopy. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:023001. [PMID: 38636477 DOI: 10.1088/1361-6498/ad4042] [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: 01/09/2024] [Accepted: 04/18/2024] [Indexed: 04/20/2024]
Abstract
National Council on Radiation Protection and Measurements Commentary No. 33 'Recommendations for Stratification of Equipment Use and Radiation Safety Training for Fluoroscopy' defines an evidence-based, radiation risk classification for fluoroscopically guided procedures (FGPs), provides radiation-related recommendations for the types of fluoroscopes suitable for each class of procedure, and indicates the extent and content of training that ought to be provided to different categories of facility staff who might enter a room where fluoroscopy is or may be performed. For FGP, radiation risk is defined by the type and likelihood of radiation hazards that could be incurred by a patient undergoing a FGP. The Commentary also defines six training groups of facility staff based on their role in the fluoroscopy room. The training groups are based on a combination of job descriptions and the procedures in which these individuals might be involved. The Commentary recommends the extent and content of training that should be provided to each of these training groups. It also provides recommendations on training formats, training frequency, and methods for demonstrating that the learner has acquired the necessary knowledge.
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Affiliation(s)
- Donald L Miller
- U.S. Food and Drug Administration, Silver Spring, MD, United States of America
| | - Stephen Balter
- Columbia University, New York, NY, United States of America
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Aly A, Tsapaki V, Ahmed AZ, Own A, Patro S, Al Naemi H, Kharita MH. Clinical diagnostic reference levels in neuroradiology based on clinical indication. RADIATION PROTECTION DOSIMETRY 2024:ncae113. [PMID: 38702851 DOI: 10.1093/rpd/ncae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/27/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
This study focuses on patient radiation exposure in interventional neuroradiology (INR) procedures, a field that has advanced significantly since its inception in the 1980s. INR employs minimally invasive techniques to treat complex cerebrovascular diseases in the head, neck, and spine. The study establishes diagnostic reference levels (DRLs) for three clinical indications (CIs): stroke (S), brain aneurysms (ANs), and brain arteriovenous malformation (AVM). Data from 209 adult patients were analyzed, and DRLs were determined in terms of various dosimetric and technical quantities. For stroke, the established DRLs median values were found to be 78 Gy cm2, 378 mGy, 118 mGy, 12 min, 442 images, and 15 runs. Similarly, DRLs for brain AN are 85 Gy cm2, 611 mGy, 95.5 mGy, 19.5, 717 images, and 26 runs. For brain AVM, the DRL's are 180 Gy cm2, 1144 mGy, 537 mGy, 36 min, 1375 images, and 31 runs. Notably, this study is unique in reporting DRLs for specific CIs within INR procedures, providing valuable insights for optimizing patient safety and radiation exposure management.
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Affiliation(s)
- Antar Aly
- Medical Physics Section, Hamad Medical Corporation, Doha 3050, Qatar
- Radiology Department, Weill Cornell Medicine, Doha 24144, Qatar
| | - Virginia Tsapaki
- Medical Physics Department, Konstantopoulio Hospital, 142 33 Nea Ionia, Athens, Greece
| | | | - Ahmed Own
- Neurosurgery Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Satya Patro
- Neurosurgery Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Huda Al Naemi
- Radiology Department, Weill Cornell Medicine, Doha 24144, Qatar
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Hachiya K, Chida K, Matsuda Y. [Radiation Dose Reduction through the Optimization of Mask Images in Cerebral Angiography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:365-373. [PMID: 38382990 DOI: 10.6009/jjrt.2024-1386] [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] [Indexed: 02/23/2024]
Abstract
PURPOSE To verify the effectiveness of optimizing the number of mask images in DSA for radiation dose reduction during cerebral angiography. METHODS A total of 60 angiography sessions in 2 times for 30 patients performed by the same operator were included in this study. In order to compare the effects of optimization to change the injection delay time of DSA from 1 s to the shortest possible time, the number of mask images, the number of imaging frames, and radiation doses between sessions were compared and analyzed retrospectively. RESULTS In one DSA run, the number of mask images was decreased from 6 (5-7) to 3 (2-3) frames (p<0.01)/57.1% (median [IQR]/reduction rate), the number of imaging frames was decreased from 34 (32-36) to 32 (29-34) frames (p<0.01)/7.9%, and the radiation dose was decreased from 33 (23-47) to 30 (21-40) mGy (p<0.01)/8.3%. In magnification angiography, the reductions rate was significantly increased. In one angiography session, the number of mask images was decreased from 45 (35-72) to 19 (16-34) frames (p<0.01)/54.6%, the number of imaging frames was decreased from 242 (199-385) to 211 (181-346) frames (p<0.01)/8.3%, the radiation dose of DSA was decreased from 295 (190-341) to 242 (167-305) mGy (p<0.01)/11.6%, and the total radiation dose was decreased from 369 (259-418) to 328 (248-394) mGy (p<0.01)/7.5%. CONCLUSION Using the shortest possible injection delay time for the number of mask image optimization was an effective radiation dose reduction method.
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Affiliation(s)
- Kota Hachiya
- Department of Radiology, Yamagata City Hospital Saiseikan
- Department of Radiological Examination and Technology, Tohoku University Graduate School of Medicine
| | - Koichi Chida
- Department of Radiological Examination and Technology, Tohoku University Graduate School of Medicine
- Disaster Medical Radiology, Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University
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Ayyagari R, Rahman SZ, Grizzard K, Mustafa A, Staib LH, Makkia RS, Bhatia S, Bilhim T, Carnevale FC, Davis C, Fischman A, Isaacson A, McClure T, McWilliams J, Nutting C, Richardson A, Salem R, Sapoval M, Yu H. Multicenter Quantification of Radiation Exposure and Associated Risks for Prostatic Artery Embolization in 1476 Patients. Radiology 2024; 310:e231877. [PMID: 38441098 DOI: 10.1148/radiol.231877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Background Prostatic artery embolization (PAE) is a safe, minimally invasive angiographic procedure that effectively treats benign prostatic hyperplasia; however, PAE-related patient radiation exposure and associated risks are not completely understood. Purpose To quantify radiation dose and assess radiation-related adverse events in patients who underwent PAE at multiple centers. Materials and Methods This retrospective study included patients undergoing PAE for any indication performed by experienced operators at 10 high-volume international centers from January 2014 to May 2021. Patient characteristics, procedural and radiation dose data, and radiation-related adverse events were collected. Procedural radiation effective doses were calculated by multiplying kerma-area product values by an established conversion factor for abdominopelvic fluoroscopy-guided procedures. Relationships between cumulative air kerma (CAK) or effective dose and patient body mass index (BMI), fluoroscopy time, or radiation field area were assessed with linear regression. Differences in radiation dose stemming from radiopaque prostheses or fluoroscopy unit type were assessed using two-sample t tests and Wilcoxon rank sum tests. Results A total of 1476 patients (mean age, 69.9 years ± 9.0 [SD]) were included, of whom 1345 (91.1%) and 131 (8.9%) underwent the procedure with fixed interventional or mobile fluoroscopy units, respectively. Median procedure effective dose was 17.8 mSv for fixed interventional units and 12.3 mSv for mobile units. CAK and effective dose both correlated positively with BMI (R2 = 0.15 and 0.17; P < .001) and fluoroscopy time (R2 = 0.16 and 0.08; P < .001). No radiation-related 90-day adverse events were reported. Patients with radiopaque implants versus those without implants had higher median CAK (1452 mGy [range, 900-2685 mGy] vs 1177 mGy [range, 700-1959 mGy], respectively; P = .01). Median effective dose was lower for mobile than for fixed interventional systems (12.3 mSv [range, 8.5-22.0 mSv] vs 20.4 mSv [range, 13.8-30.6 mSv], respectively; P < .001). Conclusion Patients who underwent PAE performed with fixed interventional or mobile fluoroscopy units were exposed to a median effective radiation dose of 17.8 mSv or 12.3 mSv, respectively. No radiation-related adverse events at 90 days were reported. © RSNA, 2024 See also the editorial by Mahesh in this issue.
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Affiliation(s)
- Raj Ayyagari
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Saumik Z Rahman
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Kevin Grizzard
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Adel Mustafa
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Lawrence H Staib
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Rasha S Makkia
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Shivank Bhatia
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Tiago Bilhim
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Francisco C Carnevale
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Clifford Davis
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Aaron Fischman
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Ari Isaacson
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Timothy McClure
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Justin McWilliams
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Charles Nutting
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Andrew Richardson
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Riad Salem
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Marc Sapoval
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Hyeon Yu
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
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Rakemaa L, Aho PS, Tulamo R, Laine MT, Laukontaus SJ, Hakovirta H, Venermo M. Ultrasound Surveillance is Feasible After Endovascular Aneurysm Repair. Ann Vasc Surg 2024; 100:223-232. [PMID: 37926137 DOI: 10.1016/j.avsg.2023.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Surveillance after endovascular aneurysm repair (EVAR) is traditionally done with computed tomography angiography (CTA) scans that exposes patient to radiation, nephrotoxic contrast media, and potentially increased risk for cancer. Ultrasound (US) is less labor intensive and expensive and might thus provide a good alternative for CTA surveillance. The aim of this study was to evaluate in real-life patient cohorts whether US is able to detect post-EVAR aneurysm-related complications similarly to CTA. METHODS This retrospective study compared the outcome of consecutive patients who underwent EVAR for intact abdominal aortic aneurysm and were surveilled solely by CTA (CTA-only cohort, n = 168) in 2000-2010 or by combined CTA and US (CTA/US cohort, n = 300) in 2011-2016, as a standard surveillance protocol in the department of vascular surgery, Helsinki University Hospital. The CTA-only patients were imaged at 1, 3, and 12 months and annually thereafter. The CTA/US patients were imaged with CTA at 3 and 12 months, US at 6 months and annually thereafter. If there were suspicion of >5 mm aneurysm growth, CTA scan was performed. The patients were reviewed for imaging data, reinterventions, aneurysm ruptures, and death until December 2018. The 2 groups were compared for secondary rupture, aneurysm-related and cancer-related death, reintervention related to abdominal aortic aneurysm, and maximum aneurysm diameter increase ≥5 mm. The mean follow-up in the CTA-only cohort was 67 months and in CTA/US cohort 43 months. RESULTS The 2 cohorts were alike for basic characteristics and for the mean aneurysm diameter. The total number of CT scans for detecting aneurysm was 84.1/100 patient years in the CTA-only cohort compared to 74.5/100 patient years for US/CTA cohort. Forty percent of patients under combined CTA/US surveillance received 1 or more additional CTA scans. The 2 cohorts did not differ for 1-year, 5-year and 8-year freedom from aneurysm related death, secondary sac rupture, nor the incidence of rupture preventing interventions. CONCLUSIONS Based on the follow-up data of this real-life cohort of 468 patients, combined surveillance with US and additional CTA either per protocol or due to suspicion of aneurysm-related complications had comparable outcome with sole CTA-surveillance. Thus, US can be considered a reasonable alternative for the CTA. However, our study showed also that the need of additional CTAs due to suspicion of endoleak or aneurysm nonrelated reasons is substantial.
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Affiliation(s)
- Lotta Rakemaa
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Pekka S Aho
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Riikka Tulamo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Matti T Laine
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Sani J Laukontaus
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Harri Hakovirta
- Department of Vascular Surgery, University of Turku and Turku University Hospital, Turku, Varsinais-Suomi, Finland; Department of Surgery, Satasairaala Hospital, Pori, Satakunta, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland.
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8
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Maeda T, Hayashi H, Ando M, Kobayashi D, Nishigami R, Asahara T, Goto S, Lee C, Yamashita K, Higashino K, Konishi T, Murakami S, Maki M. Performance of elastic x-ray shield made by embedding Bi 2 O 3 particles in porous polyurethane. Med Phys 2024; 51:1061-1073. [PMID: 38103261 DOI: 10.1002/mp.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Many healthcare institutions have guidelines concerning the usage of protective procedures, and various x-ray shields have been used to reduce unwanted radiation exposure to medical staff and patients when using x-rays. Most x-ray shields are in the form of sheets and lack elasticity, which limits their effectiveness in shielding areas with movement, such as the thyroid. To overcome this limitation, we have developed an innovative elastic x-ray shield. PURPOSE The purpose of this study is to explain the methodology for developing and evaluating a novel elastic x-ray shield with sufficient x-ray shielding ability. Furthermore, valuable knowledge and evaluation indices are derived to assess our shield's performance. METHODS Our x-ray shield was developed through a process of embedding Bi2 O3 particles into porous polyurethane. Porous polyurethane with a thickness of 10 mm was dipped into a solution of water, metal particles, and chemical agents. Then, it was air-dried to fix the metal particles in the porous polyurethane. Thirteen investigational x-ray shields were fabricated, in which Bi2 O3 particles at various mass thicknesses (ranging from 585 to 2493 g/m2 ) were embedded. To determine the performance of the shielding material, three criteria were evaluated: (1) Dose Reduction Factor (D R F $DRF$ ), measured using inverse broad beam geometry; (2) uniformity, evaluated from the standard deviation (S D $SD$ ) of the x-ray image obtained using a clinical x-ray imaging detector; and (3) elasticity, evaluated by a compression test. RESULTS The elastic shield with small pores, containing 1200 g/m2 of the metal element (Bi), exhibited a well-balanced performance. TheD R F $DRF$ was approximately 80% for 70 kV diagnostic x-rays. This shield's elasticity was -0.62 N/mm, a loss of only 30% when compared to porous polyurethane without metal. Although the non-uniformity of the x-ray shield leads to poor shielding ability, it was found that the decrease in the shielding ability can be limited to a maximum of 6% when the shield is manufactured so that theS D $SD$ of the x-ray image of the shield is less than 10%. CONCLUSIONS It was verified that an elastic x-ray shield that offers an appropriate reduction in radiation exposure can be produced by embedding Bi2 O3 particles into porous polyurethane. Our findings can lead to the development of novel x-ray shielding products that can reduce the physical and mental stress on users.
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Affiliation(s)
- Tatsuya Maeda
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroaki Hayashi
- College of Medical, Pharmaceutical and Health Sciences, Kanazawa, Ishikawa, Japan
| | - Miku Ando
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daiki Kobayashi
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Rina Nishigami
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takashi Asahara
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Okayama University Hospital, Kitaku, Okayama, Japan
| | - Sota Goto
- Faculty of Health Sciences, Kobe Tokiwa University, Kobe, Hyogo, Japan
| | - Cheonghae Lee
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, School of Medicine, Tokushima University, Tokushima, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopedics and Rehabilitation, Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
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Ishii H, Chida K, Inaba Y, Abe K, Onodera S, Zuguchi M. Fundamental study on diagnostic reference level quantities for endoscopic retrograde cholangiopancreatography using a C-arm fluoroscopy system. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:041510. [PMID: 37939385 DOI: 10.1088/1361-6498/ad0a9d] [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: 08/18/2023] [Accepted: 11/08/2023] [Indexed: 11/10/2023]
Abstract
The diagnostic reference level (DRL) is an effective tool for optimising protection in medical exposures to patients. However regarding air kerma at the patient entrance reference point (Ka,r), one of the DRL quantities for endoscopic retrograde cholangiopancreatography (ERCP), manufacturers use a variety of the International Electrotechnical Commission and their own specific definitions of the reference point. The research question for this study was whetherKa,ris appropriate as a DRL quantity for ERCP. The purpose of this study was to evaluate the difference betweenKa,rand air kerma incident on the patient's skin surface (Ka,e) at the different height of the patient couch for a C-arm system. Fluoroscopy and radiography were performed using a C-arm system (Ultimax-i, Canon Medical Systems, Japan) and a over-couch tube system (CUREVISTA Open, Fujifilm Healthcare, Japan).Ka,ewas measured by an ion chamber placed on the entrance surface of the phantom. Kerma-area product (PKA) andKa,rwere measured by a built-inPKAmeter and displayed on the fluoroscopy system.Ka,edecreased whileKa,rincreased as the patient couch moved away from the focal spot. The uncertainty of theKa,e/Ka,rratio due to the different height of the patient couch was estimated to be 75%-94%.Ka,rmay not accurately representKa,e.PKAwas a robust DRL quantity that was independent of the patient couch height. We cautioned against optimising patient doses in ERCP with DRLs set in terms ofKa,rwithout considering the patient couch height of the C-arm system. Therefore, we recommend thatKa,ris an inappropriate DRL quantity in ERCP using the C-arm system.
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Affiliation(s)
- Hiroki Ishii
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
- Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai 980-8572, Japan
| | - Yohei Inaba
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
- Division of Disaster Medical Science, International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai 980-8572, Japan
| | - Keisuke Abe
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Shu Onodera
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Masayuki Zuguchi
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
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Nagamoto K, Kawachino T, Suetsugu Y, Saruwatari H, Nihei SI, Kunugita N. Eye lens dose in spine surgeons during myelography procedures: a dosimetry study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:041509. [PMID: 37944177 DOI: 10.1088/1361-6498/ad0b3a] [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: 07/16/2023] [Accepted: 11/09/2023] [Indexed: 11/12/2023]
Abstract
To determine the eye lens dose (3 mm dose equivalent [Hp(3)]) received by spine surgeons during myelography and evaluate the effectiveness of radiation-protective glasses and x-ray tube system positioning in reducing radiation exposure. This study included spine surgeons who performed myelography using over- or under-table x-ray tube systems. Hp(3) was measured for each examination using a radio-photoluminescence glass dosimeter (GD-352M) mounted on radiation-protective glass. This study identified significantly high Hp(3) levels, especially in the right eye lens in spinal surgeons. The median Hp(3) values in the right eye were 524 (391-719) and 58 (42-83)μSv/examination for over- and under-table x-ray tube systems, respectively. Further, Hp(3)AK, which was obtained by dividing the cumulative air kerma from Hp(3), was 8.09 (6.69-10.21) and 5.11 (4.06-6.31)μSv mGy-1for the over- and under-table x-ray tube systems, respectively. Implementing radiation-protective glasses resulted in dose reduction rates of 54% (50%-57%) and 54% (51%-60%) for the over- and under-table x-ray tube systems, respectively. The use of radiation protection glasses significantly reduced the radiation dose in the eye lens during myelography, with the most effective measures being the combination of using radiation protection glasses and an under-table x-ray tube system.
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Affiliation(s)
- Keisuke Nagamoto
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Tomonori Kawachino
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Yoshiki Suetsugu
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Hiromi Saruwatari
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Shun-Ichi Nihei
- Department of Emergency and Intensive Care Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Naoki Kunugita
- Department of Occupational and Community Health Nursing School of Health Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
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11
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Raso AL, Lopes R, Leyton F, Neves E, Ribeiro EJ, Vasconcelos V, Nogueira MS. Applicability of 'Toolkit for Safety Assessment' tool to interventional radiology using probabilistic risk assessment techniques. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:031519. [PMID: 37714146 DOI: 10.1088/1361-6498/acfa0a] [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: 06/14/2023] [Accepted: 09/15/2023] [Indexed: 09/17/2023]
Abstract
Interventional radiology brings extensive benefits to patients. Nevertheless, certain procedures may result in high doses of radiation, leading to health risks to occupationally exposed individuals (OEIs). Therefore, a more comprehensive risk analysis is essential to ensuring safety and minimising radiation exposures for all OEIs. The Toolkit for Safety Assessment (TOKSA) tool performs risk assessments based on the concepts described in 'General Safety Requirements' Part 3 (Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards) and Part 4 (Safety Assessment for Facilities and Activities). This tool was developed based on the 'Ibero-American Forum of Radiological and Nuclear Regulatory Agencies' risk models and can promote the use of the risk assessment processes by OEIs. The aim of this study was to experimentally analyse the applicability of the TOKSA tool in interventional radiology with the use/support of probabilistic risk assessment techniques. The results were used to reduce the risks associated with a hemodynamics room in a hospital in Belo Horizonte, Brazil.
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Affiliation(s)
- A L Raso
- Laboratory of Radioprotection Applied to Mammography-LARAM/Center for the Development of Nuclear Technology (CDTN), Belo Horizonte, MG, Brazil
| | - R Lopes
- National Commission of Nuclear Safety and Safeguards (CNSNS), Mexico City, Mexico
| | - F Leyton
- Personal Dosimetry Laboratory- LABODOP/University of Tarapaca, Arica, Chile
| | - E Neves
- SEMPER Hospital, Belo Horizonte, MG, Brazil
| | - E J Ribeiro
- Laboratory of Radioprotection Applied to Mammography-LARAM/Center for the Development of Nuclear Technology (CDTN), Belo Horizonte, MG, Brazil
| | - V Vasconcelos
- Laboratory of Radioprotection Applied to Mammography-LARAM/Center for the Development of Nuclear Technology (CDTN), Belo Horizonte, MG, Brazil
| | - M S Nogueira
- Laboratory of Radioprotection Applied to Mammography-LARAM/Center for the Development of Nuclear Technology (CDTN), Belo Horizonte, MG, Brazil
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Aristizabal AM, Gutiérrez JA, Ramirez E, Mejía-Quiñones V, Ubeda C, Mosquera WF, Mosquera W. Diagnostic Reference Levels in Interventional Pediatric Cardiology: Two-Year Experience in a Tertiary Referral Hospital in Latin America. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1588. [PMID: 37892251 PMCID: PMC10605529 DOI: 10.3390/children10101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 10/29/2023]
Abstract
The goal of the present study was to propose the first local diagnostic reference levels (DRLs) for interventional pediatric cardiology procedures in a large hospital in Colombia. The data collection period was from April 2020 to July 2022. The local DRLs were calculated as the 3rd quartile of patient-dose distributions for the kerma-area product (Pka) values. The sample of collected clinical procedures (255) was divided into diagnostic and therapeutic procedures and grouped into five weight and five age bands. The Pka differences found between diagnostic and therapeutic procedures were statistically significant in all weight and age bands, except for the 1-5-year age group. The local DRLs for weight bands were 3.82 Gy·cm2 (<5 kg), 7.39 Gy·cm2 (5-<15 kg), 19.72 Gy·cm2 (15-<30 kg), 28.99 Gy·cm2 (30-<50 kg), and 81.71 Gy·cm2 (50-<80 kg), respectively. For age bands, the DRLs were 3.97 Gy·cm2 (<1 y), 9.94 Gy·cm2 (1-<5 y), 20.82 Gy·cm2 (5-<10 y), 58.00 Gy·cm2 (10-<16 y), and 31.56 Gy·cm2 (<16 y), respectively. In conclusion, when comparing our results with other existing DRL values, we found that they are similar to other centers and thus there is scope to continue optimizing the radiation dose values. This will contribute to establishing national DRLs for Colombia in the near future.
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Affiliation(s)
- Ana M. Aristizabal
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
| | - Jaiber A. Gutiérrez
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
| | - Emmanuel Ramirez
- Oficina de Física Médica & Protección Radiológica, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia;
| | - Valentina Mejía-Quiñones
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia
| | - Carlos Ubeda
- Diagnóstico por Imagen, Laboratorio de Dosimetría Personal (LABODOP), Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica 1020000, Chile;
| | - Walter Fernando Mosquera
- Servicio de Hospitalización, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia;
| | - Walter Mosquera
- Servicio de Cardiología Pediátrica, Departamento Materno Infantil, Fundación Valle del Lili, Cra. 98 No. 18–49, Cali 760032, Colombia; (J.A.G.); (W.M.)
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia;
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Park DJ, Marianayagam NJ, Yener U, Tayag A, Ustrzynski L, Emrich SC, Pollom E, Soltys S, Meola A, Chang SD. Practical Guideline for Prevention of Patchy Hair Loss following CyberKnife Stereotactic Radiosurgery for Calvarial or Scalp Tumors: Retrospective Analysis of a Single Institution Experience. Stereotact Funct Neurosurg 2023; 101:319-325. [PMID: 37699370 DOI: 10.1159/000533555] [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: 07/01/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Patchy alopecia is a common adverse effect of stereotactic radiosurgery (SRS) on the calvarium and/or scalp, yet no guidelines exist for its prevention. This study aims to investigate the incidence and outcomes of patchy alopecia following SRS for patients with calvarial or scalp lesions and establish preventive guidelines. METHODS The study included 20 patients who underwent CyberKnife SRS for calvarial or scalp lesions, resulting in a total of 30 treated lesions. SRS was administered as a single fraction for 8 lesions and hypofractionated for 22 lesions. The median SRS target volume was 9.85 cc (range: 0.81-110.7 cc), and the median prescription dose was 27 Gy (range: 16-40 Gy), delivered in 1-5 fractions (median: 3). The median follow-up was 15 months. RESULTS Among the 30 treated lesions, 11 led to patchy alopecia, while 19 did not. All cases of alopecia resolved within 12 months, and no patients experienced other adverse radiation effects. Lesions resulting in alopecia exhibited significantly higher biologically effective dose (BED) and single-fraction equivalent dose (SFED) on the overlying scalp compared to those without alopecia. Patients with BED and SFED exceeding 60 Gy and 20 Gy, respectively, were 9.3 times more likely to experience patchy alopecia than those with lower doses. The 1-year local tumor control rate for the treated lesions was 93.3%. Chemotherapy was administered for 26 lesions, with 11 lesions receiving radiosensitizing agents. However, no statistically significant difference was found. CONCLUSION In summary, SRS is a safe and effective treatment for patients with calvarial/scalp masses regarding patchy alopecia near the treated area. Limiting the BED under 60 Gy and SFED under 20 Gy for the overlying scalp can help prevent patchy alopecia during SRS treatment of the calvarial/scalp mass. Clinicians can use this information to inform patients about the risk of alopecia and the contributing factors.
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Affiliation(s)
- David J Park
- Department of Neurosurgery, Stanford, California, USA,
| | | | - Ulas Yener
- Department of Neurosurgery, Stanford, California, USA
| | - Armine Tayag
- Department of Neurosurgery, Stanford, California, USA
| | | | - Sara C Emrich
- Department of Neurosurgery, Stanford, California, USA
| | - Erqi Pollom
- Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Scott Soltys
- Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford, California, USA
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Sas N, Lacroix JB, Dedieu V, Boyer L. Optimized radiological alert thresholds based on device-dosimetric information to predict peak skin dose between 2 and 4 Gy during vascular fluoroscopically guided intervention. Eur Radiol 2023; 33:5707-5716. [PMID: 36932215 DOI: 10.1007/s00330-023-09538-8] [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: 05/18/2022] [Revised: 12/22/2022] [Accepted: 02/06/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To provide radiologists and physicists with methodological tools to improve patient management after vascular fluoroscopically guided intervention (FGI) by providing optimized thresholds (OT) values that could be used as a surrogate to the thresholds classically proposed by the National Council on Radiation Protection (NCRP) or could be useful to adapt their own substantial radiation dose levels (SRDL) values. METHODS PSD of 2000-4000 mGy after FGI were calculated for 258 patients with dedicated software. Overall, the kerma and KAP 3D-ROC curves were used to assess the sensitivity (SEN) and specificity (SPE) of NCRP thresholds and OT for each PSD. Kiviat diagram and density curves were plotted for the best SEN/SPE pair of 3D-ROC curves and compared to the NCRP thresholds. RESULTS OT for both kerma and KAP generating the best SEN/SPE couple for PSD of 2000-4000 mGy were obtained. The SEN/SPE couple of each OT was always better than that obtained using NCRP ones. The best OT among all those calculated providing the highest SEN/SPE values for kerma (3020.5 mGy) and KAP (741.02 Gy.cm2) were obtained when PSD was equal to 3300 mGy. CONCLUSIONS We have calculated OT in terms of kerma and KAP based on 3D-ROC curves analysis and peak skin dose calculations that can be obtained to better predict high skin dose. The use of OT that predicted PSD greater than 3000 mGy is likely to improve patient follow-up. The methodology developed in this work could be adapted to other institutions in order to better define their own SRDL. KEY POINTS • Optimized dose thresholds in terms of kerma and KAP based on 3D-ROC curves analysis and peak skin dose calculations between 2000 and 4000 mGy can be obtained to better predict high skin dose. • Patients receiving a peak skin dose between 2000 and 4000 mGy have their follow-up enhanced by using the optimized thresholds instead of the NCRP thresholds. • The best-optimized thresholds, corresponding to 3020.5 mGy and 741.02 Gy.cm2 for kerma and KAP respectively can be used instead of NRCP ones to trigger patient follow-up after fluoroscopically guided vascular interventions.
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Affiliation(s)
- Nicolas Sas
- Department of Medical Physics, Jean Perrin Comprehensive Cancer Center, 63000, Clermont-Ferrand, France.
- Clermont-Ferrand University, UMR 1240 INSERM IMoST, 63000, Clermont-Ferrand, France.
| | - Jean-Baptiste Lacroix
- Department of Medical Physics, Jean Perrin Comprehensive Cancer Center, 63000, Clermont-Ferrand, France
- Clermont-Ferrand University, UMR 1240 INSERM IMoST, 63000, Clermont-Ferrand, France
| | - Véronique Dedieu
- Department of Medical Physics, Jean Perrin Comprehensive Cancer Center, 63000, Clermont-Ferrand, France
- Clermont-Ferrand University, UMR 1240 INSERM IMoST, 63000, Clermont-Ferrand, France
| | - Louis Boyer
- Pôle Interhospitalier d'Imagerie Diagnostique Et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France
- TGI Institut Pascal, UMR 6602, UCA/CNRS/SIGMA, Aubière, France
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15
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Suyama Y, Soga S, Mikoshi A, Hokari R, Shinmoto H, Tomita K. Initial experience of coaxial percutaneous liver biopsy with tract embolization using N-Butyl cyanoacrylate. Scand J Gastroenterol 2023; 58:1317-1320. [PMID: 37272082 DOI: 10.1080/00365521.2023.2219800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/22/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Bleeding occurs after liver biopsy in up to 10.9% cases, and patients with impaired hemostasis or ascites are considered to have absolute or relative contraindications. N-butyl cyanoacrylate enables immediate hemostasis, even in lethal situations. Therefore, percutaneous liver biopsy combined with tract embolization using N-butyl cyanoacrylate is expected to enable safe biopsy, even in patients for whom conventional biopsy is contraindicated. Here we describe our initial experience with coaxial percutaneous biopsy with tract embolization using N-butyl cyanoacrylate. MATERIALS AND METHODS Eighty-six patients who underwent tract embolization using N-butyl cyanoacrylate between October 2014 and July 2020, including 21 patients who had absolute or relative contraindications for liver biopsy, were retrospectively analyzed. Tract embolization using N-butyl cyanoacrylate comprised two steps: (1) liver biopsy with a biopsy needle inserted via a coaxial introducer needle and (2) embolization of the puncture route by injecting N-butyl cyanoacrylate via the coaxial needle. RESULTS No complications occurred in any patient. The mean number of biopsies per patient was 3.30 (range, 1-7). Histologically adequate samples were acquired in all cases, and pathological diagnoses were obtained. The mean time required for tract embolization was 52.8 s (range, 6-132 s). The mean peak skin dose was 9.97 mGy (range, 2-68 mGy), which is far below the 3-Gy threshold dose for temporary erythema. CONCLUSIONS This proposed technique may be a promising and straightforward alternative to improve the management of patients with severe liver disease by allowing safer biopsy, including patients for whom conventional liver biopsy is contraindicated.
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Affiliation(s)
- Yohsuke Suyama
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Shigeyoshi Soga
- Department of Radiology, National Defense Medical College, Saitama, Japan
- Department of Radiology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Ayako Mikoshi
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Ryota Hokari
- Department of Gastroenterology and Hepatology, National Defense Medical College, Saitama, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Kengo Tomita
- Department of Gastroenterology and Hepatology, National Defense Medical College, Saitama, Japan
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16
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Ma Y, Guo L, Fang L, Hou D, Chen R, Wang X, Mao X, Zhao Z, Chen Y. Assessment of radiation doses and DNA damage in pediatric patients undergoing interventional procedures for vascular anomalies. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2023; 889:503653. [PMID: 37491112 DOI: 10.1016/j.mrgentox.2023.503653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/07/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023]
Abstract
Interventional procedures (IPs) have been widely used to treat vascular anomalies (VA) in recent years. However, patients are exposed to low-dose X-ray ionizing radiation (IR) during these fluoroscopy-guided IPs. We collected clinical information and IR doses during IPs and measured biomarkers including γ-H2AX, chromosome aberrations (CA), and micronuclei (MN), which underpin radiation-induced DNA damage, from 74 pediatric patients before and after IPs. For the 74 children, the range of dose-area product (DAP) values was from 1.2 to 1754.6 Gy∙cm2, with a median value of 27.1 Gy∙cm2. DAP values were significantly higher in children with lesions in the head and neck than in the limbs and trunk; the age and weight of children revealed a strong positive correlation with DAP values. The treated patients as a group demonstrated an increase in all three endpoints relative to baseline following IPs. Children with vascular tumors have a higher risk of dicentric chromosome + centric ring (dic+r) and cytokinesis-block micronucleus (CBMN) after IPs than children with vascular malformations. The younger the patient, the greater the risk of CA after IPs. Moreover, rogue cells (RCs) were found in five children (approximately 10%) after IPs, and the rates of dic+r and CBMN were significantly higher than those of other children (Z = -3.576, p < 0.001). These results suggest that there may be some children with VA who are particularly sensitive to IR, but more data and more in-depth experiments will be needed to verify this in the future.
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Affiliation(s)
- Ya Ma
- School of Preventive Medicine Sciences (Institute of Radiation Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), No. 6699 Qingdao Road, Jinan 250117, PR China
| | - Lei Guo
- Jinan Children's Hospital, No. 23976 Jingshi Road, Jinan 250022, PR China
| | - Lianying Fang
- School of Preventive Medicine Sciences (Institute of Radiation Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), No. 6699 Qingdao Road, Jinan 250117, PR China
| | - Dianjun Hou
- School of Preventive Medicine Sciences (Institute of Radiation Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), No. 6699 Qingdao Road, Jinan 250117, PR China
| | - Rui Chen
- School of Preventive Medicine Sciences (Institute of Radiation Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), No. 6699 Qingdao Road, Jinan 250117, PR China
| | - Xiaoshan Wang
- School of Preventive Medicine Sciences (Institute of Radiation Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), No. 6699 Qingdao Road, Jinan 250117, PR China
| | - Xuesong Mao
- School of Preventive Medicine Sciences (Institute of Radiation Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), No. 6699 Qingdao Road, Jinan 250117, PR China
| | - Zihan Zhao
- High School Attached to Shandong Normal University, No. 3 Shanshi North Street, Jinan 250014, PR China
| | - Yingmin Chen
- School of Preventive Medicine Sciences (Institute of Radiation Medicine), Shandong First Medical University (Shandong Academy of Medical Sciences), No. 6699 Qingdao Road, Jinan 250117, PR China.
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17
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Martinez Del Carmen DT, Saldaña Gutierrez P, Vila Coll R, Iborra Ortega E. Radiation Exposure in Endovascular Surgery According to Complexity: Protocol for a Prospective Observational Study. Methods Protoc 2023; 6:mps6030049. [PMID: 37218909 DOI: 10.3390/mps6030049] [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: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
In the past decades, we have witnessed tremendous developments in endovascular surgery. Nowadays, highly complex procedures are performed by minimally invasive means. A key point is equipment improvement. Modern C-arms provide advanced imaging capabilities, facilitating endovascular navigation with an adequate open surgical environment. Nevertheless, radiation exposure remains an issue of concern. This study aims to analyze radiation used during endovascular procedures according to complexity, comparing a mobile X-ray system with a hybrid room (fixed X-ray system). This is an observational and prospective study based on a cohort of non-randomized patients treated by endovascular procedures in a Vascular Surgery department using two imaging systems. The study is planned for a 3-year duration with a recruitment period of 30 months (beginning 20 July 2021) and a 1-month follow-up period for each patient. This is the first prospective study designed to describe the radiation dose according to the complexity of the procedure. Another strength of this study is that radiologic variables are obtained directly from the C-arm and no additional measurements are required for feasibility benefit. The results from this study will help us determine the level of radiation in different endovascular procedures, in view of their complexity.
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Affiliation(s)
| | - Pablo Saldaña Gutierrez
- Medical Physics and Radiological Protection Department, Institut Català d'Oncologia|Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ramon Vila Coll
- Angiology and Vascular Surgery Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Iborra Ortega
- Angiology and Vascular Surgery Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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18
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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19
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Jafari A, Mousavi SH, Mohsenizadeh SA, Khoshfetrat M, Arefizadeh R. Investigation of the Efficiency and Quality of Lightweight Gowns with Multi-Layered Nanoparticles Compositions of Bismuth, Tungsten, Barium, and Copper. J Biomed Phys Eng 2023; 13:55-64. [PMID: 36818007 PMCID: PMC9923238 DOI: 10.31661/jbpe.v0i0.2209-1540] [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: 09/19/2022] [Accepted: 10/17/2022] [Indexed: 02/03/2023]
Abstract
Background Radiation protection plays a key role in medicine, due to the considerable usage of radiation in diagnosis and treatment. The protection against radiation exposure with inappropriate equipment is concerning. Objective The current study aimed to investigate the efficiency and quality of the radiation protection gowns with multi-layered nanoparticles compositions of Bismuth, Tungsten, Barium, and Copper, and light non-lead commercial gowns in angiography departments for approval of the manufacturers' declarations and improve the quality of gowns. Material and Methods In this case study, physicians, physician assistants, radiology technologists, and nurses were asked to wear two commercial and proposed gowns in the angiography departments. Dosimetry of personnel was conducted using a Thermoluminescent Dosimeter (TLD) (GR-200), and the radiation dose received by personnel was compared in both cases. The participants were asked to fill out a questionnaire about the quality and comfort of two radiation protection gowns. Results However, both gowns provide the necessary radiation protection; the multi-layer proposed gown has better radiation protection than the commercial sample (2 to 14 percent reduction in effective dose). The proposed gown has higher flexibility and efficiency than the commercial sample due to the use of nanoparticles and multi-layers (2.3 percent increase in personnel satisfaction according to the questionnaires). Conclusion However, the multi-layer gown containing nanoparticles of Bismuth, Tungsten, Barium, and Copper has no significant difference from the non-lead commercial sample in terms of radiation protection, it has higher flexibility and comfort with more satisfaction for the personnel.
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Affiliation(s)
- Alireza Jafari
- Student Research Committee, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Mousavi
- Department of Cardiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | | | - Mehran Khoshfetrat
- Department of Cardiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Arefizadeh
- Department of Cardiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
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20
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Loose R, Lell M. [Information, informed consent, and communication with patients]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:95-98. [PMID: 36536121 DOI: 10.1007/s00117-022-01098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
The transposition of EU Directive 2013/59/Euratom into German law requires that patients be informed about the radiation risk of radiological procedures. Such information is not the same as a medical informed consent about immediate risks associated with the procedure, such as deterministic radiation damage, risks of contrast media, or complications. The sole use of X‑rays in diagnostic procedures therefore requires no informed consent in most cases.
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Affiliation(s)
- R Loose
- Institut für Medizinische Physik, Klinikum Nürnberg, Prof. Ernst Nathan Str. 1, 90419, Nürnberg, Deutschland.
| | - M Lell
- Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Nürnberg, Deutschland
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21
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O'Connor U, Walsh C, Gorman D, O'Reilly G, Martin Z, Madhavan P, Murphy RT, Szirt R, Almén A, Andersson M, Camp A, Garcia V, Duch MA, Ginjaume M, Abdelrahman M, Lombardo P, Vanhavere F. Feasibility study of computational occupational dosimetry: evaluating a proof-of-concept in an endovascular and interventional cardiology setting. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:041501. [PMID: 36130583 DOI: 10.1088/1361-6498/ac9394] [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: 05/17/2022] [Accepted: 09/21/2022] [Indexed: 06/15/2023]
Abstract
Individual monitoring of radiation workers is essential to ensure compliance with legal dose limits and to ensure that doses are As Low As Reasonably Achievable. However, large uncertainties still exist in personal dosimetry and there are issues with compliance and incorrect wearing of dosimeters. The objective of the PODIUM (Personal Online Dosimetry Using Computational Methods) project was to improve personal dosimetry by an innovative approach: the development of an online dosimetry application based on computer simulations without the use of physical dosimeters. Occupational doses were calculated based on the use of camera tracking devices, flexible individualised phantoms and data from the radiation source. When combined with fast Monte Carlo simulation codes, the aim was to perform personal dosimetry in real-time. A key component of the PODIUM project was to assess and validate the methodology in interventional radiology workplaces where improvements in dosimetry are needed. This paper describes the feasibility of implementing the PODIUM approach in a clinical setting. Validation was carried out using dosimeters worn by Vascular Surgeons and Interventional Cardiologists during patient procedures at a hospital in Ireland. Our preliminary results from this feasibility study show acceptable differences of the order of 40% between calculated and measured staff doses, in terms of the personal dose equivalent quantity Hp(10), however there is a greater deviation for more complex cases and improvements are needed. The challenges of using the system in busy interventional rooms have informed the future needs and applicability of PODIUM. The availability of an online personal dosimetry application has the potential to overcome problems that arise from the use of current dosimeters. In addition, it should increase awareness of radiation protection among staff. Some limitations remain and a second phase of development would be required to bring the PODIUM method into operation in a hospital setting. However, an early prototype system has been tested in a clinical setting and the results from this two-year proof-of-concept PODIUM project are very promising for future development.
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Affiliation(s)
- U O'Connor
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
| | - C Walsh
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - D Gorman
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - G O'Reilly
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin, Ireland
| | - Z Martin
- Department of Vascular Surgery, St James's Hospital, Dublin, Ireland
| | - P Madhavan
- Department of Vascular Surgery, St James's Hospital, Dublin, Ireland
| | - R T Murphy
- Department of Cardiology, St James's Hospital, Dublin, Ireland
| | - R Szirt
- Department of Cardiology, St James's Hospital, Dublin, Ireland
| | - A Almén
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - M Andersson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - A Camp
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - V Garcia
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - M A Duch
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - M Ginjaume
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - M Abdelrahman
- Belgian Nuclear Research Center, Boeretang, Mol, Belgium
| | - P Lombardo
- Belgian Nuclear Research Center, Boeretang, Mol, Belgium
| | - F Vanhavere
- Belgian Nuclear Research Center, Boeretang, Mol, Belgium
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22
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Ubeda C, Vano E, Perez MD, Jímenez P, Ramirez R, Nader A, Miranda P, Azcurra P, Damsky J, Capdevila S, Oliveira M, Albuquerque J, Bocamino R, Schelin H, Yagui A, Aguirre D, Riquelme N, Cardenas L, Álvarez A, Mosquera W, Arias F, Gutierrez R, De la Mora R, Rivera T, Zapata J, Araujo P, Chiesa P. Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:031513. [PMID: 35940166 DOI: 10.1088/1361-6498/ac87b7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm2for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm2for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm2for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm2for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.
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Affiliation(s)
- C Ubeda
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - E Vano
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - M D Perez
- World Health Organization (WHO), Geneva, Switzerland
| | - P Jímenez
- Pan American Health Organization (PAHO), Washington, DC, United States of America
| | - R Ramirez
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - A Nader
- International Atomic Energy Agency (IAEA), Vienna, Austria
| | - P Miranda
- Luis Calvo Mackenna's Hospital, AntonioVaras 360, Santiago, Chile
| | - P Azcurra
- Hemodynamic Service, Italian Hospital, Buenos Aires, Argentina
| | - J Damsky
- Hemodynamic Service, Pedro de Elizalde Children's Hospital, Buenos Aires, Argentina
| | - S Capdevila
- Hemodynamic Service, Santísima Trinidad Children's Hospital, Córdova, Argentina
| | - M Oliveira
- Department of Health Technology and Biology, Federal Institute of Bahia, Salvador, Brazil
| | - J Albuquerque
- University Hospital of the Federal University of Maranhão, San Luis, Brasil
| | - R Bocamino
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brasil
| | - H Schelin
- Pequeno Príncipe Hospital, Curitiba, Brasil
| | - A Yagui
- Pequeno Príncipe Hospital, Curitiba, Brasil
| | - D Aguirre
- Hemodynamic Service, Roberto del Rio Children's, Santiago, Chile
| | - N Riquelme
- Hemodynamic Service, Roberto del Rio Children's, Santiago, Chile
| | - L Cardenas
- Hemodynamic Service, Santa Maria Clinic, Santiago, Chile
| | - A Álvarez
- Hemodynamic Service, Santa Maria Clinic, Santiago, Chile
| | - W Mosquera
- Valle del Lili Foundation University Hospital ICESI, Cali, Colombia
| | - F Arias
- National Children's Hospital, San José, Costa Rica
| | - R Gutierrez
- National Children's Hospital, San José, Costa Rica
| | - R De la Mora
- National Directorate of Environmental Health, Ministry of Public Health, Havana, Cuba
| | - T Rivera
- Center for Research in Applied Sciences and Advanced Technology Legaria, IPN, Ciudad de México, Mexico
| | - J Zapata
- National Institute of Child Health St. Borja, Lima, Peru
| | - P Araujo
- National Cardiovascular Institute, Lima, Peru
| | - P Chiesa
- Children's Cardiology Institute, Montevideo, Uruguay
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23
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Local diagnostic reference levels in diagnostic and therapeutic pediatric cardiology at a specialist pediatric hospital in South Africa. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2022. [DOI: 10.2478/pjmpe-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Introduction: Children may be at a higher risk of experiencing the detrimental effects of ionizing radiation arising from medical radiation imaging. Dose optimisation is therefore recommended to provide assurance that their exposure is as low as reasonably achievable. To this end, periodic assessment of dose levels and establishment of Local Diagnostic Reference Levels (LDRLs) in medical facilities is necessary. There is a general paucity in the literature of data pertaining to dose levels in pediatric interventional radiology. This study establishes LDRLs in diagnostic and therapeutic heart catheterization procedures at a specialist pediatric hospital in a resource constrained country.
Material and methods: Dose indicators from actual patient procedures were collected from the archive and analyzed retrospectively to determine the median, 25th, and 75th percentiles of the total Air Kerma Area Product (KAP), Cumulative Air Kerma (CAK), total Fluoroscopy Time (FT), and a total number of Cine Images (CI) of selected interventional procedures. The dose indicators were also age-stratified into five age groups defined by the International Commission on Radiation Protection publication 135. The results were compared to values available from similar studies in the literature to benchmark our dose levels. Local Dose Reference Levels were set as the 75th percentile values.
Results: For diagnostic procedures (n = 80), the 75th percentiles of KAP, CAK, FT, and CI were 4.0 Gy·cm2, 31.5 mGy, 14.3 min, and 315 frames, respectively and 3.2 Gy·cm2, 30.5 mGy, 17.5 min, and 606 frames, respectively for therapeutic procedures (n = 143).
Conclusions: The LDRLs from this study did not vary significantly from those published in the literature, suggesting that practices at our center were comparable to international norms. Regular reviews of the LDRLs must be conducted to check that the dose levels do not deviate considerably.
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Komemushi A, Takashima S, Nagai A, Usui M, Fukuda M, Nakatani M, Ono Y, Maruyama T, Kariya S, Utsunomiya K, Tanigawa N. Practical Radiation Protection for Interventional Radiologist. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2022; 7:54-57. [PMID: 36196386 PMCID: PMC9527100 DOI: 10.22575/interventionalradiology.2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 06/16/2023]
Abstract
As per the International Commission on Radiological Protection 2010 recommendation, it was stated that "interventional radiologists performing difficult procedures with high workloads may be exposed to high doses" and that education and training of medical staffs in radiation exposure is "an urgent priority." There are many reports on the textbook aspects of radiation protection, but reports on the practical aspects of radiation protection have remained to be scarce. Various methods of reducing radiation exposure are described as "useful" or "can be reduced," but the priority of these methods and the "extent" to which they contribute to reducing radiation exposure are not clear. Thus, in this article, we will look into the protection of interventional radiologist from radiation exposure in a practical way, giving priority to clarity rather than academic accuracy.
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Affiliation(s)
| | | | - Atsushi Nagai
- Department of Radiology, Kansai Medical University, Japan
| | - Masakatsu Usui
- Department of Radiology, Kansai Medical University, Japan
| | | | | | - Yasuyuki Ono
- Department of Radiology, Kansai Medical University, Japan
| | | | - Shuji Kariya
- Department of Radiology, Kansai Medical University, Japan
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25
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Chida K. What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel? Radiol Phys Technol 2022; 15:101-115. [PMID: 35608759 DOI: 10.1007/s12194-022-00660-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
Protection against occupational radiation exposure in clinical settings is important. This paper clarifies the present status of medical occupational exposure protection and possible additional safety measures. Radiation injuries, such as cataracts, have been reported in physicians and staff who perform interventional radiology (IVR), thus, it is important that they use shielding devices (e.g., lead glasses and ceiling-suspended shields). Currently, there is no single perfect radiation shield; combinations of radiation shields are required. Radiological medical workers must be appropriately educated in terms of reducing radiation exposure among both patients and staff. They also need to be aware of the various methods available for estimating/reducing patient dose and occupational exposure. When the optimizing the dose to the patient, such as eliminating a patient dose that is higher than necessary, is applied, exposure of radiological medical workers also decreases without any loss of diagnostic benefit. Thus, decreasing the patient dose also reduces occupational exposure. We propose a novel four-point policy for protecting medical staff from radiation: patient dose Optimization, Distance, Shielding, and Time (pdO-DST). Patient dose optimization means that the patient never receives a higher dose than is necessary, which also reduces the dose received by the staff. The patient dose must be optimized: shielding is critical, but it is only one component of protection from radiation used in medical procedures. Here, we review the radiation protection/reduction basics for radiological medical workers, especially for IVR staff.
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Affiliation(s)
- Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, 980-8575, Japan. .,Division of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai, 980-8572, Japan.
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26
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Kozuma K, Chikamori T, Hashimoto J, Honye J, Ikeda T, Ishiwata S, Kato M, Kondo H, Matsubara K, Matsumoto K, Matsumoto N, Motoyama S, Obunai K, Sakamoto H, Soejima K, Suzuki S, Abe K, Amano H, Hioki H, Iimori T, Kawai H, Kosuge H, Nakama T, Suzuki Y, Takeda K, Ueda A, Yamashita T, Hirao K, Kimura T, Nagai R, Nakamura M, Shimizu W, Tamaki N. JCS 2021 Guideline on Radiation Safety in Cardiology. Circ J 2022; 86:1148-1203. [DOI: 10.1253/circj.cj-21-0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ken Kozuma
- Division of Cardiology, Teikyo University Hospital
| | | | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine
| | - Junko Honye
- Department of Cardiology, Kikuna Memorial Hospital
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | - Mamoru Kato
- Department of Radiology, Akita Cerebrospinal and Cardiovascular Center
| | | | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Kazuma Matsumoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | | | | | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital
| | - Shigeru Suzuki
- Department of Radiology, Totsuka Kyouritsu Daini Hospital
| | - Koichiro Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University
| | - Hideo Amano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | | | - Hideki Kawai
- Department of Cardiology, Fujita Health University
| | | | | | | | | | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | | | - Kenzo Hirao
- Division of Cardiovascular Medicine, AOI Universal Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Ryozo Nagai
- Department of Cardiovascular Medicine, Jichi Medical University
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine
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27
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Vano E, Loose R, Frija G, Paulo G, Efstathopoulos E, Granata C, Corridori R, Torresin A, Andersson JS, Tsapaki V, Ammon J, Hoeschen C. Notifications and alerts in patient dose values for computed tomography and fluoroscopy-guided interventional procedures. Eur Radiol 2022; 32:5525-5531. [PMID: 35294584 PMCID: PMC9279248 DOI: 10.1007/s00330-022-08675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/04/2022]
Abstract
The terms "notifications" and "alerts" for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to help in optimisation for CT and for fluoroscopy-guided interventional procedures as well as in the analysis of unintended and accidental medical exposures. The paper also includes cautions in setting the alert values and discusses the benefits of using patient dose management systems for the alerts, their registry and follow-up, and the differences between notifications, alerts, and trigger levels for individual procedures and the terms used for the collective approach, such as diagnostic reference levels. KEY POINTS: • Notifications and alerts on patient dose values for computed tomography (CT) and fluoroscopy-guided interventional procedures (FGIP) allow to improve radiation safety and contribute to the avoidance of radiation injuries and unintended and accidental exposures. • Alerts may be established before the imaging procedures (as in CT) or during and after the procedures as for FGIP. • Dose management systems should include notifications and alerts and their registry for the hospital quality programmes.
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Affiliation(s)
- Eliseo Vano
- Radiology Department, Complutense University, 28040, Madrid, Spain.
| | - Reinhard Loose
- Institute of Medical Physics, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Guy Frija
- Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal
| | - Efstathios Efstathopoulos
- Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Claudio Granata
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Virginia Tsapaki
- Medical Physics, Konstantopoulio General Hospital, Nea Ionia, Greece
| | - Josefin Ammon
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Christoph Hoeschen
- Institut Für Medizintechnik, Otto-Von-Guericke Universität, Magdeburg, Germany
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28
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Occupational eye dose correlation with neck dose and patient-related quantities in interventional cardiology procedures. Radiol Phys Technol 2022; 15:54-62. [DOI: 10.1007/s12194-022-00650-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
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29
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Abstract
There has been a rapid development in the field of interventional radiology over recent years, and this has led to a rapid increase in the number of interventional radiology procedures being performed. There is, however, a growing concern regarding radiation exposure to the patients and the operators during these procedures. In this article, we review the basics of radiation exposure, radiation protection techniques, radiation protection tools available to interventional radiologists, and radiation protection during pregnancy.
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Affiliation(s)
- Tushar Garg
- Department of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Apurva Shrigiriwar
- Department of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
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30
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First local diagnostic reference levels for fluoroscopically guided cardiac procedures in adult patients in Chile. NUCLEAR TECHNOLOGY AND RADIATION PROTECTION 2022. [DOI: 10.2298/ntrp2201084u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The goal of this study was to generate the first values of local diagnostic
reference levels for a range of fluoroscopically guided cardiac diagnostic
and therapeutic procedures in adult patients in Chile and to compare
radiation dose levels with others presented in the literature. The
dosimetric data collection period was conducted over the whole of 2020. The
local diagnostic reference levels were calculated as the 75th percentile
of patient dose data distributions for kerma area-product values. The sample
of collected clinical procedures (480) was divided into diagnostic and
therapeutic procedures. The kerma area-product differences found between
diagnostic and therapeutic procedures were statistically significant. The
local diagnostic reference levels were 81.6 Gy cm2 and 166.9 Gycm2 for
fluoroscopically guided cardiac diagnostic and therapeutic procedures,
respectively. A comparison of our results with results found in the
literature for the last 10 years, showed that there are no published papers
for hospitals in Latin America and the Caribbean. It becomes urgent to be
able to carry out more research of this type, given that the health
reality between countries on different continents is very different. While
in some the establishment of diagnostic reference levels is a legal obligation, in others it is a matter of good or bad will.
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31
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Fujibayashi S, Murata K, Shimizu T, Otsuki B, Masamoto K, Shimizu Y, Matsuda S. An Observational Survey of Nail and Skin of Spine Surgeons-Possible Damage by Occupational Ionizing Radiation Exposure. Spine Surg Relat Res 2021; 5:359-364. [PMID: 34966861 PMCID: PMC8668220 DOI: 10.22603/ssrr.2020-0204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Orthopedic surgeons are exposed to ionizing radiation daily. With the increase in the number of minimally invasive surgery performed under X-ray fluoroscopy, radiation exposure to unprotected fingers will increase. Although the effect of high dose radiation exposure is known, the long-term effect of exposure to low doses is unclear. This study aims to investigate damage to the nail and skin on the thumbs of spine surgeons via occupational ionizing radiation exposure. Methods Forty male spine surgeons (group S) and 40 males of the same age group who were not exposed to radiation (controls; group C) were included. Using a scoring system, we evaluated the damage to the fingernail and skin of the bilateral thumb. Scoring was based on fingernail pigmentation (melanonychia), fingernail crack, and periungual dermatitis status. We investigated the number of examinations and operations under radiation exposure in the last 3 months. Results Group S had 17.83 (3-28) years of surgeon experience. In group S, the dominant side scored significantly higher than the non-dominant side; however, there was no dominant vs. non-dominant difference in group C. Only the dominant side had a significantly higher score in group S than in group C. In group S, surgeon experience and the score of the dominant side were significantly correlated; however, for the non-dominant side of group S and both thumbs of group C, no correlation was observed. The kappa coefficients for fingernail pigmentation, fingernail crack, and periungual dermatitis status were 0.458, 0.248, and 0.612, respectively. The average number of examinations and operations under radiation exposure was 11.89 ± 9.04 (0-30) and 26.34 ± 14.67 (1-63), respectively. Conclusions The dominant side in group S had a significantly higher score than the non-dominant side in group S and the dominant side in group C, suggesting the possibility of radiation damage to the dominant side in group S.
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Affiliation(s)
- Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Masamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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32
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Sakamoto H, Moritake T, Sun L, Kobayashi I, Kawauchi S, Abe T, Tsukamoto A, Morimoto Y, Daida H, Matsumaru Y. Monitoring and Protection against Radiation Dose to Eyes of Operators Performing Neuroendovascular Procedures: A Nationwide Study in Japan. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:354-360. [PMID: 37502341 PMCID: PMC10370920 DOI: 10.5797/jnet.oa.2021-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/25/2021] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To meet the new standard of the annual dose limit for the eye lens recommended by the International Commission on Radiation Protection, radiation doses of neuroendovascular procedures in Japanese institutions were investigated. METHODS Radiation doses to operators involved in 304 neuroendovascular procedures at 30 Japanese institutions were prospectively surveyed. The institutions recruited at an annual meeting of the Japanese Society for Neuroendovascular Therapy participated voluntarily. A maximum of 10 wireless dosimeters were attached to the radiation protection (RP) goggles, the ceiling-mounted RP shielding screen, and the operators' forehead and neck over the protective clothing. Doses recorded inside the goggles were defined as eye lens doses for operators who wore RP goggles, while doses to the forehead were defined as eye lens doses for those who did not. The shielding effect rates of the protection devices were calculated, and statistical analysis was performed for the comparison of radiation doses. RESULTS From 296 analyzed cases, mean eye lens radiation doses per procedure were 0.088 mGy for the left eye and 0.041 mGy for the right eye. For the left eye, that dose without RP equipment was 0.176 mGy and that with RP goggles plus an RP shielding screen was 0.034 mGy. Four parameters, including left eye dose, air kerma at the patient entrance reference point, fluoroscopic time, and the total number of frames, were assessed for five types of neurovascular procedures. Of them, transarterial embolization for dural arteriovenous fistula was associated with the highest eye lens dose at 0.138 mGy. The shielding effect rates of protection goggles were 60% for the left and 55% for the right RP goggle. The mean doses to the inner and outer surfaces of the RP shielding screen were 0.831 mGy and 0.040 mGy, respectively, amounting to a shielding effect rate of 95%. CONCLUSION To meet the new standard, both RP goggles and RP shielding screens are strongly recommended to be used effectively. Without proper use of radiological protection devices, the number of neuroendovascular procedures that one operator performs per year will be limited under the new guideline.
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Affiliation(s)
- Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Takashi Moritake
- Department of National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Chiba, Japan
| | - Lue Sun
- Health and Medical Research Institute, Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan
| | - Ikuo Kobayashi
- Research Institute of Nuclear Engineering, University of Fukui, Tsuruga, Fukui, Japan
- Nagase Landauer Ltd., Tsukuba, Ibaraki, Japan
| | | | - Toshi Abe
- Department of Radiobiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | | | - Yuh Morimoto
- Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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33
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Li S. Theoretical derivation and clinical dose-response quantification of a unified multi-activation (UMA) model of cell survival from a logistic equation. BJR Open 2021; 3:20210040. [PMID: 34877459 PMCID: PMC8611684 DOI: 10.1259/bjro.20210040] [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: 06/18/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To theoretically derive a unified multiactivation (UMA) model of cell survival after ionising radiation that can accurately assess doses and responses in radiotherapy and X-ray imaging. METHODS A unified formula with only two parameters in fitting of a cell survival curve (CSC) is first derived from an assumption that radiation-activated cell death pathways compose the first- and second-order reaction kinetics. A logit linear regression of CSC data is used for precise determination of the two model parameters. Intrinsic radiosensitivity, biologically effective dose (BED), equivalent dose to the traditional 2 Gy fractions (EQD2), tumour control probability, normal-tissue complication probability, BED50 and steepness (Γ50) at 50% of tumour control probability (or normal-tissue complication probability) are analytical functions of the model and treatment (or imaging) parameters. RESULTS The UMA model has almost perfectly fit typical CSCs over the entire dose range with R2≥0.99. Estimated quantities for stereotactic body radiotherapy of early stage lung cancer and the skin reactions from X-ray imaging agree with clinical results. CONCLUSION The proposed UMA model has theoretically resolved the catastrophes of the zero slope at zero dose for multiple target model and the bending curve at high dose for the linear quadratic model. More importantly, it analytically predicts dose-responses to various dose-fraction schemes in radiotherapy and to low dose X-ray imaging based on these preclinical CSCs. ADVANCES IN KNOWLEDGE The discovery of a unified formula of CSC over the entire dose range may reveal a common mechanism of the first- and second-order reaction kinetics among multiple CD pathways activated by ionising radiation at various dose levels.
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Affiliation(s)
- Shidong Li
- Department of Radiation Oncology, Temple University Hospital, Philadelphia, PA, USA
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34
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Ihn YK, Kim BS, Jeong HW, Suh SH, Won YD, Lee YJ, Kim DJ, Jeon P, Ryu CW, Suh SI, Choi DS, Choi SS, Kim SH, Byun JS, Rho J, Song Y, Jeong WS, Hong N, Baik SH, Park JJ, Lim SM, Kim JJ, Yoon W. Monitoring Radiation Doses during Diagnostic and Therapeutic Neurointerventional Procedures: Multicenter Study for Establishment of Reference Levels. Neurointervention 2021; 16:240-251. [PMID: 34695909 PMCID: PMC8561028 DOI: 10.5469/neuroint.2021.00437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/18/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL). MATERIALS AND METHODS Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution. RESULTS Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm2, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm2, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm2, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm2, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group. CONCLUSION Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm2) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.
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Affiliation(s)
- Yon-Kwon Ihn
- Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Yoo Dong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Young-Jun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Severance Hospital, Yonsei Unviersity College of Medicine, Seoul, Korea
| | - Pyong Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Sang Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Jieun Rho
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yunsun Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sang Jeong
- Department of Radiology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Noah Hong
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Jung-Jae Kim
- Department of Neurosurgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
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Ichikawa N, Fukuda A, Hayashi T, Matsubara K. Effect of equalization filters on measurements with kerma-area product meter in a cardiovascular angiography system. J Appl Clin Med Phys 2021; 22:177-185. [PMID: 34610646 PMCID: PMC8664145 DOI: 10.1002/acm2.13444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose This study aimed to evaluate the effect of equalization filters (EFs) on the kerma‐area product (KAPQKM) and incident air‐kerma (Ka,i,QKM) using a kerma‐area product (KAP) meter. In addition, potential underestimations of the Ka,i,QKM values by EFs were identified. Materials and methods A portable flat‐panel detector (FPD) was placed to measure the X‐ray beam area (A) and EFs dimension at patient entrance reference point (PERP). Afterward, a 6‐cm3 external ionization chamber was placed to measure incident air‐kerma (Ka,i,Qext) at PERP instead of the portable FPD. KAP reading and Ka,i,Qext were simultaneously measured at several X‐ray beam qualities with and without EFs. The X‐ray beam quality correction factor by KAP meter (kQ,Q0KM) was calculated by A, Ka,i,Qext and KAP reading to acquire the KAPQKM and Ka,i,QKM. Upon completion of the measurements, KAPQKM, Ka,i,QKM, and Ka,i,Qext were plotted as functions of tube potential, spectral filter, and EFs dimension. Moreover, Ka,i,QKM/Ka,i,Qext values were calculated to evaluate the Ka,i,QKM underestimation. Results The kQ,Q0KM values increased with an increase in the X‐ray tube potential and spectral filter, and the maximum kQ,Q0KM was 1.18. KAPQKM and Ka,i,QKM decreased as functions of EFs dimension, whereas Ka,i,Qext was almost constant. Ka,i,QKM/Ka,i,Qext decreased with an increase in EFs dimension but increased with an increase in tube potential and spectral filter, and the range was 0.55–1.01. Conclusions Ka,i,QKM value was up to approximately two times lower than the Ka,i,Qext values by EFs. When using the Ka,i,QKM value, the potential Ka,i,QKM underestimation with EFs should be considered.
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Affiliation(s)
- Nao Ichikawa
- Faculty of Health Science, Department of Radiological Technology, Kobe Tokiwa University, Hyogo, Japan
| | - Atsushi Fukuda
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Takuma Hayashi
- Department of Radiation Oncology, Shiga General Hospital, Shiga, Japan
| | - Kosuke Matsubara
- Faculty of Health Sciences, Department of Quantum Medical Technology, Kanazawa University, Ishikawa, Japan
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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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Wong JHD, Zaili Z, Abdul Malik R, Bustam AZ, Saad M, Jamaris S, Mosiun JA, Mohd Taib NA, Ung NM, See M. Evaluation of skin dose and skin toxicity in patients undergoing intraoperative radiotherapy for early breast cancer. J Appl Clin Med Phys 2021; 22:139-147. [PMID: 34254425 PMCID: PMC8364274 DOI: 10.1002/acm2.13338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE This study aims to evaluate in vivo skin dose delivered by intraoperative radiotherapy (IORT) and determine the factors associated with an increased risk of radiation-induced skin toxicity. METHODOLOGY A total of 21 breast cancer patients who underwent breast-conserving surgery and IORT, either as IORT alone or IORT boost plus external beam radiotherapy (EBRT), were recruited in this prospective study. EBT3 film was calibrated in water and used to measure skin dose during IORT at concentric circles of 5 mm and 40 mm away from the applicator. For patients who also had EBRT, the maximum skin dose was estimated using the radiotherapy treatment planning system. Mid-term skin toxicities were evaluated at 3 and 6 months post-IORT. RESULTS The average skin dose at 5 mm and 40 mm away from the applicator was 3.07 ± 0.82 Gy and 0.99 ± 0.28 Gy, respectively. Patients treated with IORT boost plus EBRT received an additional skin dose of 41.07 ± 1.57 Gy from the EBRT component. At 3 months post-IORT, 86% of patients showed no evidence of skin toxicity. However, the number of patients suffering from skin toxicity increased from 15% to 38% at 6 months post-IORT. We found no association between the IORT alone or with the IORT boost plus EBRT and skin toxicity. Older age was associated with increased risk of skin toxicities. A mathematical model was derived to predict skin dose. CONCLUSION EBT3 film is a suitable dosimeter for in vivo skin dosimetry in IORT, providing patient-specific skin doses. Both IORT alone and IORT boost techniques resulted in similar skin toxicity rates.
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Affiliation(s)
- Jeannie Hsiu Ding Wong
- Department of Biomedical ImagingFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Zainor Zaili
- Department of Biomedical ImagingFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Rozita Abdul Malik
- Clinical Oncology UnitFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Anita Zarina Bustam
- Clinical Oncology UnitFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Marniza Saad
- Clinical Oncology UnitFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Suniza Jamaris
- Breast Surgery UnitDepartment of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
- Department of Surgery, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Joanne Aisha Mosiun
- Department of Surgery, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Nur Aishah Mohd Taib
- Breast Surgery UnitDepartment of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Ngie Min Ung
- Clinical Oncology UnitFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Mee‐Hoong See
- Breast Surgery UnitDepartment of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
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Roh Y, Kim J, Park H, Kim J, Ryu D, Chun K, Seo J, Lee B, Cho B, Yoon Y. Effect of Exposure Angulation on the Occupational Radiation Exposure during Cardiac Angiography: Simulation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158097. [PMID: 34360390 PMCID: PMC8345727 DOI: 10.3390/ijerph18158097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
Cardiac angiography to visualize the cardiac coronary artery for lesions causes a lot of radiation exposure dose to the interventional cardiologist. We evaluated the occupational radiation exposure to the interventional cardiologist based on changes to the angle of the X-ray tube used in cardiac angiography and calculated the conversion factor for effective dose in this study. To evaluate the occupational radiation exposure resulting from scattered radiation to interventional cardiologists, organ doses for eyeball, thyroid, and heart were calculated using Monte Carlo simulation with korean typical man(KTMAN) phantom at the left anterior oblique (LAO)30/cranial (CRAN)30, CRAN40, right anterior oblique (RAO)30/CRAN30, RAO30/caudal(CAUD)20, CAUD39, LAO40/CAUD35, and LAO40 positions in the femoral and the radial artery puncture. In this study, analysis of the different angles showed the highest radiation exposure on LAO30/CRAN30 and CRAN40 position, which were 150.65% and 135.3%, respectively, compared to AP angles. Therefore, to reduce occupational dose for interventional cardiologists, it is recommended that radiation protection, such as using radiation shield and personal protective equipment (PPE), be used at LAO30/CRAN30 and CRAN40 angulation, and the conversion factor for calculating the organ dose received by the interventional cardiologists based on patient dose can be applied for improved occupational dose management.
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Affiliation(s)
- Younghoon Roh
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Jungsu Kim
- Department of Radiologic-Technology, Daegu Health College, 15, Yeongsong-ro, Buk-gu, Daegu 41453, Korea;
| | - Hyemin Park
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Jungmin Kim
- Department of Health and Safety Convergence Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.R.); (H.P.); (J.K.)
| | - Dongryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Kwangjin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Jeonghun Seo
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Bongki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
| | - Byungryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Kangwon National University, Baengnyeong-ro 156, Chuncheon-si 24289, Korea; (D.R.); (K.C.); (J.S.); (B.L.)
- Correspondence: (B.C.); (Y.Y.)
| | - Yongsu Yoon
- Department of Radiological Science, Dongseo University, 47 Jurye-ro, Sasang-gu, Busan 47011, Korea
- Correspondence: (B.C.); (Y.Y.)
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Hadid-Beurrier L, Dabli D, Royer B, Demonchy M, Le Roy J. Diagnostic reference levels during fluoroscopically guided interventions using mobile C-arms in operating rooms: A national multicentric survey. Phys Med 2021; 86:91-97. [PMID: 34062338 DOI: 10.1016/j.ejmp.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To establish diagnostic reference levels (DRLs) and achievable levels (ALs) for the most common fluoroscopically guided interventions (FGIs) performed in operating rooms using mobile C-arm equipment. METHODS A national survey was performed in 57 centers in France. Anonymous data from 6817 patients undergoing FGIs were prospectively collected over a period of 7 months. DRLs (third quartile of the distribution) and ALs (median of the distribution) were determined for each type of intervention in terms of kerma area product (KAP) and fluoroscopy time (FT). RESULTS DRLs and ALs were proposed for 31 procedure types related to seven surgical specialties: orthopedics (n = 9), urology (n = 3), vascular (n = 6), cardiology (n = 5), neurosurgery (n = 3), gastrointestinal (n = 3), and multi-specialty (n = 2). DRLs in terms of KAP ranged from 0.1 Gy·cm2 for hallux valgus to 78 Gy·cm2 for abdominal aortic aneurysm endovascular repair. A factor of 155 was obtained between the FTs for a herniated lumbar disk (0.2 min) and an abdominal aortic aneurysm endovascular repair (31 min). The highest variations were obtained within orthopedic procedures in terms of KAP (ratio 122) and within gastrointestinal procedures in terms of FT (ratio 9). Overall, the FGIs associated with the highest radiation exposure (KAP > 10 Gy·cm2) were found in the cardiology, vascular, and gastrointestinal specialties. CONCLUSIONS DRLs and ALs are suggested for a wide range of FGIs performed in operating rooms using a mobile C-arm. We aim at providing a practical optimization tool for medical physicists and surgeons.
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Affiliation(s)
- Lama Hadid-Beurrier
- Department of Medical Physics and Radiation Protection, APHP, Lariboisière Hospital, Paris University, Paris, France.
| | - Djamel Dabli
- Department of Medical Imaging, CHU Nîmes, Montpellier University, Medical Imaging Group Nîmes, EA 2415, France
| | - Brice Royer
- Department of Medical Physics, C2i santé, Maxéville, France
| | - Mathilde Demonchy
- Department of Medical Physics, Fréjus-Saint-Raphaël hospital, Fréjus, France
| | - Julien Le Roy
- Department of Medical Physics, Montpellier University Hospital, Montpellier, France
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Miller DL, Kakar S, Jiang L, Spelic DC, Burk L. The U.S. food and drug administration's role in improving radiation dose management for medical x-ray imaging devices. Br J Radiol 2021; 94:20210373. [PMID: 33989043 DOI: 10.1259/bjr.20210373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The U.S. Food and Drug Administration (FDA) has been concerned with minimizing the unnecessary radiation exposure of people for half a century. Manufacturers of medical X-ray imaging devices are important partners in this effort. Medical X-ray imaging devices are regulated under both FDA's electronic product regulations and FDA's medical device regulations. FDA also publishes guidance documents that represent FDA's current thinking on a topic and provide a suggested or recommended approach to meet the requirements of a regulation or statute. FDA encourages manufacturers to develop medical devices that conform to voluntary consensus standards. Use of these standards is a central element of FDA's system to ensure that all medical devices marketed in the U.S. meet safety and effectiveness requirements. FDA staff participate actively in the development and maintenance of these standards, often advancing or introducing new safety and dose management requirements. Use of voluntary consensus standards reduces the amount of time necessary to evaluate a premarket submission and reduces the burden on manufacturers. FDA interacts with industry and other stakeholders through meetings with industry groups, public meetings, public communications, and through the development of voluntary consensus standards. In these interactions, FDA staff introduce new concepts for improving the safety of these devices and provide support for similar initiatives from professional organizations. FDA works with all stakeholders to achieve its mission of protecting and promoting the public health.
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Affiliation(s)
- Donald L Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
| | - Smita Kakar
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
| | - Lu Jiang
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
| | - David C Spelic
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
| | - Laurel Burk
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring, MD, USA
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Hayashi S, Takenaka M, Kogure H, Yakushijin T, Maruyama H, Hori Y, Yoshio T, Ikezawa K, Takagi T, Asai S, Matsunaga K, Matsumoto K, Tsumura H, Yamaguchi S, Sumiyoshi T, Nagaike K, Tamaru Y, Hara K, Fujisawa T, Oda I, Ohnita K, Kato M, Nebiki H, Mikami T, Nishihara A, Egawa S, Minami R, Hosono M, Nishida T. A questionnaire survey on radiation protection among 282 medical staff from 26 endoscopy-fluoroscopy departments in Japan. DEN OPEN 2021; 1:e5. [PMID: 35310150 PMCID: PMC8828237 DOI: 10.1002/deo2.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/11/2021] [Accepted: 01/30/2021] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND AIMS It is essential for endoscopists, technologists, and nurses to understand radiation protection. However, protective equipment usage is still low, and there is little awareness of radiation protection in practice. METHODS We conducted a questionnaire survey on radiation protection from January to February 2020. The participants were medical staff, including medical doctors, nurses, and radiological and endoscopy technician in endoscopy-fluoroscopy departments. The questionnaire included 14 multiple-choice questions divided among three parts: background, equipment, and knowledge. RESULTS We surveyed a total of 282 subjects from 26 institutions. There were 168 medical doctors (60%), 90 nurses (32%), and 24 technologists (9%). Although almost all staff members (99%) always wore a lead apron, only a few wore a thyroid collar (32%) and lead glasses (21%). The rate of wearing a radiation dosimeter was insufficient (69%), especially among doctors (52%). A few subjects knew the radiation exposure dose of each procedure (15%), and slightly over half had attended lectures on radiation protection (64%) and knew about the three principles of radiation protection (59%). Protection adherence did not differ by years of experience, knowledge of fluoroscopy, awareness of radiation exposure doses, or attendance at basic lectures on radiation protection. However, medical doctors who were aware of the radiation exposure dose of each procedure were significantly more likely to wear dosimeters than those who were not (p = 0.0008). CONCLUSION Medical staff in endoscopy departments in Japan do not have enough radiation protection equipment or education.
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Affiliation(s)
- Shiro Hayashi
- Department of Gastroenterology and Internal MedicineHayashi ClinicOsakaJapan
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Mamoru Takenaka
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Hirofumi Kogure
- Department of GastroenterologyThe University of TokyoTokyoJapan
| | - Takayuki Yakushijin
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Hirotsugu Maruyama
- Department of GastroenterologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Yasuki Hori
- Department of Gastroenterology and MetabolismNagoya City University HospitalAichiJapan
| | - Toshiyuki Yoshio
- Department of GastroenterologyCancer Institute HospitalTokyoJapan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Tadayuki Takagi
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Satoshi Asai
- Department of GastroenterologyTane General HospitalOsakaJapan
| | - Kazuhiro Matsunaga
- Department of GastroenterologyIshikawa Prefectural Central HospitalIshikawaJapan
| | - Kengo Matsumoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Hidetaka Tsumura
- Department of Grastroenterological OncologyHyogo Cancer CenterHyogoJapan
| | - Shinjiro Yamaguchi
- Department of Gastroenterology and HepatologyKansai Rosai HospitalHyogoJapan
| | | | - Koji Nagaike
- Department of Gastroenterology and HepatologySuita Municipal HospitalOsakaJapan
| | - Yuzuru Tamaru
- Department of GastroenterologyKure Medical Center and Chugoku Cancer CenterHiroshimaJapan
| | - Kazuo Hara
- Department of GastroenterologyAichi Cancer CenterAichiJapan
| | | | - Ichiro Oda
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Ken Ohnita
- Department of Gastroenterology and HepatologyShunkaikai Inoue HospitalNagasakiJapan
| | - Motohiko Kato
- Department of GastroenterologyKeio University School of MedicineTokyoJapan
| | - Hiroko Nebiki
- Department of GastroenterologyOsaka City General HospitalOsakaJapan
| | - Tatsuya Mikami
- Division of EndoscopyHirosaki University HospitalAomoriJapan
| | | | - Satoshi Egawa
- Department of GastroenterologyOsaka Police HospitalOsakaJapan
| | - Ryuki Minami
- Department of GastroenterologyTenri HospitalNaraJapan
| | - Makoto Hosono
- Department of RadiologyKindai University Faculty of MedicineOsakaJapan
| | - Tsutomu Nishida
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
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Nakatake C, Araki F. Energy response of radiophotoluminescent glass dosimeter for diagnostic kilovoltage x-ray beams. Phys Med 2021; 82:144-149. [PMID: 33611051 DOI: 10.1016/j.ejmp.2021.01.076] [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: 10/22/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE This study aimed to investigate the energy response of a radiophotoluminescent glass dosimeter (RGD) for diagnostic kilovoltage x-ray beams by Monte Carlo (MC) calculations and measurements. METHODS The uniformity and reproducibility of GD-352M (with Sn filter) and GD-302M (no filter) were tested with 45 RGDs in free air. Subsequently, the RGD response was obtained as a function of an Al-HVL using the parameter, quality index (QI), which is defined as the ratio of the effective energy (keV) to the maximum energy (keV) of the photons. The x-ray fluence spectra with QI of 0.4, 0.5, and 0.6 were set for tube voltages of 50 ~ 137.6 kVp. The RGD response was calculated in free air using the MC method and verified by the air kerma, Kair, measured using an ionization chamber. RESULTS The uniformity and reproducibility of the 45 RGDs were ± 2.3% and ± 2.7% for GD-352M and ± 0.7% and ± 1.6% for GD-302M at the one standard deviation level, respectively. The calculated RGD response was 0.965 to 1.062 at Al-HVL 2.73 mm or more for GD-352M and varied from 3.9 to 2.8 for GD-302M. Both RGD responses exhibited a good correlation with the Al-HVL for the given QI. Kair measured by RGDs for each beam quality with a QI of 0.5 was in the range of -5%~0.8% for GD-352M and -1.8%~3% for GD-302M, relative to the chamber measurements. CONCLUSIONS The RGD response was indicated as a function of the Al-HVL for the given QI, and it presented a good correlation with the Al-HVL.
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Affiliation(s)
- Chihiro Nakatake
- Graduate School of Health Sciences, Kumamoto University, 4-24-1, Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan
| | - Fujio Araki
- Department of Health Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1, Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan.
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Phillips GS, Freret ME, Friedman DN, Trelles S, Kukoyi O, Freites-Martinez A, Unger RH, Disa JJ, Wexler LH, Tinkle CL, Mechalakos JG, Dusza SW, Beal K, Wolden SL, Lacouture ME. Assessment and Treatment Outcomes of Persistent Radiation-Induced Alopecia in Patients With Cancer. JAMA Dermatol 2021; 156:963-972. [PMID: 32756880 DOI: 10.1001/jamadermatol.2020.2127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described. Objective To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. Design, Setting, and Participants A retrospective cohort study of patients from January 1, 2011, to January 30, 2019, was conducted at 2 large tertiary care hospitals and comprehensive cancer centers. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA. Main Outcomes and Measures The clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. Results Of the 71 patients included (median [range] age, 27 [4-75] years; 51 female [72%]), 64 (90%) had a CNS tumor and 7 (10%) had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients (56%), with localized (29 of 54 [54%]), diffuse (13 of 54 [24%]), or mixed (12 of 54 [22%]) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (odds ratio [OR], 1.15; 95% CI, 1.04-1.28) and proton irradiation (OR, 5.7; 95% CI, 1.05-30.8) were associated with greater alopecia severity (P < .001), and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7-39.6 Gy). Predominant trichoscopic features included white patches (16 of 28 [57%]); in 15 patients, hair-shaft caliber negatively correlated with scalp dose (correlation coefficient, -0.624; P = .01). The association between hair density and scalp radiation dose was not statistically significant (-0.381; P = .16). Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% (median follow-up, 61 [interquartile range, 21-105] weeks); 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction. Conclusions and Relevance Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.
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Affiliation(s)
- Gregory S Phillips
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Morgan E Freret
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Sabrina Trelles
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oluwaseun Kukoyi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Dermatology Service, Hospital Ruber Juan Bravo and Universidad Europea, Madrid, Spain
| | - Robin H Unger
- Department of Dermatology, Mount Sinai Medical Center, New York, New York
| | - Joseph J Disa
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher L Tinkle
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James G Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Animal Experiment of a Novel Neurointerventional Surgical Robotic System with Master-Slave Mode. Appl Bionics Biomech 2021; 2021:8836268. [PMID: 33574888 PMCID: PMC7864736 DOI: 10.1155/2021/8836268] [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: 09/14/2020] [Revised: 11/29/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
In order to inspect and improve the system performance of the neuro-interventional surgical robot and its effectiveness and safety in clinical applications, we conducted ten animal experiments using this robotic system. Cerebral angiography was performed on ten experimental animals, and various mechanical performance indicators, operating time, X-ray radiation dosage to the experimental animals and the experimenter, and arterial damage in the experimental animals were recorded when the robotic system completed cerebral angiography. The results show that the robotic system can successfully complete the cerebral angiography surgery, and the mechanical performance is up to standard. The operating time is almost the same as the physician's operating time. And the mean X-ray radiation dosage received by the experimental animals and experimenter was 0.893 Gy and 0.0859 mSv, respectively. There were no complications associated with damage to the vascular endothelium. The robotic system can basically complete the relevant assessment indicators, and its system performance, effectiveness, and safety in clinical applications meet the standards, basically meeting the requirements of clinical applications of neurointerventional surgery.
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Radiation exposure in cryoballoon ablation compared to radiofrequency ablation with three-dimensional electroanatomic mapping in atrial fibrillation patients. Herzschrittmacherther Elektrophysiol 2021; 32:99-107. [PMID: 33443590 DOI: 10.1007/s00399-020-00738-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: 11/20/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Catheter ablation for atrial fibrillation (AF) has become an established treatment to control symptoms. AF ablation either by cryoballoon or radiofrequency using three-dimensional (3D) electroanatomical mapping exposes patients and medical staff to increased doses of radiation. AIM To compare radiation exposure in patients during cryoballoon ablation compared to 3D electro-anatomic mapping catheter ablation in AF patients. METHODS A total of 30 patients referred for AF ablation underwent full history taking, 12-lead ECG, echocardiogram, and pulmonary vein isolation either by 3D mapping system or cryoballoon. Procedure duration and fluoroscopy time were collected and analyzed. Radiation exposure was measured using thermoluminescent dosimeters placed at different sites related to patients and medical staff. RESULT The procedural time was statistically significantly longer with 3D mapping compared to cryoballoon but showed no significant difference regarding fluoroscopy time. There was a significantly higher radiation skin dose at the right scapular area in the cryoballoon ablation group, in addition to higher peak skin dose compared to the 3D mapping ablation group. There was no statistically significant correlation between peak skin doses and fluoroscopy duration but a statistically significant correlation between peak skin dose and usage of high frame rate and the high dose area product. CONCLUSION Cryoballoon ablation was found to be associated with higher peak skin radiation doses especially in the right scapular area. Knowing dose area product and peak skin dose is more important than fluoroscopy time alone.
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Tanaka T, Matsubara K, Kobayashi S. Evaluation of peak skin dose during percutaneous coronary intervention procedures: relationship with fluoroscopic pulse rate and target vessel. Radiol Phys Technol 2021; 14:34-40. [PMID: 33403510 DOI: 10.1007/s12194-020-00599-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/14/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022]
Abstract
This study aimed to evaluate the relationship between the peak skin dose (PSD) associated with radiation skin injury and the fluoroscopic pulse rate or target vessel during percutaneous coronary intervention (PCI) procedures. We consecutively included 213 patients who underwent PCI procedures. The fluoroscopic time (FT), total number of cine frames, reference air kerma (RAK), and PSD were compared between the two types of fluoroscopic pulse rates (10 and 7.5 pulses/s) and among target vessels. The total number of X-ray tube angulations for each target vessel was also investigated. The median FT was 21.5 min in the 10 pulses/s group and 19.4 min in the 7.5 pulses/s group (p = 0.068, Wilcoxon rank sum test). The median PSD in the 10 pulses/s group was 749 mGy, which was significantly higher than that in the 7.5 pulses/s group (549 mGy) (p < 0.001). The median RAK in the right coronary artery (RCA) was equivalent to that in the left anterior descending artery. However, among the target vessels, the median PSD tended to be the highest in the RCA. There was a difference in the X-ray tube angulation used depending on the target vessel. PCI in the RCA used the left anterior oblique angle more frequently than PCI in the other vessels and tended to use only one angulation. The calculated PSD was related to the target vessel of the PCI procedure, and it was also closely related to the X-ray tube angulation.
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Affiliation(s)
- Takuro Tanaka
- Department of Clinical Radiology, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
- Department of Quantum Medical Technology, Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan.
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
| | - Satoshi Kobayashi
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
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Vano E, Sanchez Casanueva R, Fernandez Soto JM, Bartal G. Challenges in Occupational Dosimetry for Interventional Radiologists. Cardiovasc Intervent Radiol 2021; 44:866-870. [PMID: 33388873 DOI: 10.1007/s00270-020-02725-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
This review presents the challenges met by interventional radiologists in occupational dosimetry. The issues mentioned are derived from the recommendations of the International Commission on Radiological Protection, the CIRSE guidelines on "Occupational radiation protection in interventional radiology" and the requirements of the European directive on Basic Safety Standards. The criteria for a proper use of personal dosimeters and the need to introduce optimization actions in some cases are set out in this review. The pros and cons of the electronic real-time dosimeters are outlined and the potential pitfalls associated with the use of personal dosimeters summarized. The electronic dosimeters, together with the appropriate software, allow an active optimization of the interventional procedures.
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Affiliation(s)
- E Vano
- Radiology Department, Faculty of Medicine, Complutense University, E-28040, Madrid, Spain. .,IdISSC and Medical Physics Service, Hospital Clínico San Carlos, Martin Lagos s.n., E-28040, Madrid, Spain.
| | - R Sanchez Casanueva
- Radiology Department, Faculty of Medicine, Complutense University, E-28040, Madrid, Spain.,IdISSC and Medical Physics Service, Hospital Clínico San Carlos, Martin Lagos s.n., E-28040, Madrid, Spain
| | - J M Fernandez Soto
- Radiology Department, Faculty of Medicine, Complutense University, E-28040, Madrid, Spain
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Roser P, Birkhold A, Preuhs A, Ochs P, Stepina E, Strobel N, Kowarschik M, Fahrig R, Maier A. XDose: toward online cross-validation of experimental and computational X-ray dose estimation. Int J Comput Assist Radiol Surg 2021; 16:1-10. [PMID: 33274400 PMCID: PMC7822800 DOI: 10.1007/s11548-020-02298-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE As the spectrum of X-ray procedures has increased both for diagnostic and for interventional cases, more attention is paid to X-ray dose management. While the medical benefit to the patient outweighs the risk of radiation injuries in almost all cases, reproducible studies on organ dose values help to plan preventive measures helping both patient as well as staff. Dose studies are either carried out retrospectively, experimentally using anthropomorphic phantoms, or computationally. When performed experimentally, it is helpful to combine them with simulations validating the measurements. In this paper, we show how such a dose simulation method, carried out together with actual X-ray experiments, can be realized to obtain reliable organ dose values efficiently. METHODS A Monte Carlo simulation technique was developed combining down-sampling and super-resolution techniques for accelerated processing accompanying X-ray dose measurements. The target volume is down-sampled using the statistical mode first. The estimated dose distribution is then up-sampled using guided filtering and the high-resolution target volume as guidance image. Second, we present a comparison of dose estimates calculated with our Monte Carlo code experimentally obtained values for an anthropomorphic phantom using metal oxide semiconductor field effect transistor dosimeters. RESULTS We reconstructed high-resolution dose distributions from coarse ones (down-sampling factor 2 to 16) with error rates ranging from 1.62 % to 4.91 %. Using down-sampled target volumes further reduced the computation time by 30 % to 60 %. Comparison of measured results to simulated dose values demonstrated high agreement with an average percentage error of under [Formula: see text] for all measurement points. CONCLUSIONS Our results indicate that Monte Carlo methods can be accelerated hardware-independently and still yield reliable results. This facilitates empirical dose studies that make use of online Monte Carlo simulations to easily cross-validate dose estimates on-site.
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Affiliation(s)
- Philipp Roser
- Pattern Recognition Lab, Friedrich-Alexander Universität Erlangen-Nürnberg, 91058, Erlangen, Germany.
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg, 91052, Erlangen, Germany.
| | - Annette Birkhold
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Alexander Preuhs
- Pattern Recognition Lab, Friedrich-Alexander Universität Erlangen-Nürnberg, 91058, Erlangen, Germany
| | - Philipp Ochs
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Elizaveta Stepina
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Norbert Strobel
- Institute of Medical Engineering Schweinfurt, University of Applied Sciences Würzburg-Schweinfurt, 97421, Schweinfurt, Germany
| | - Markus Kowarschik
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Rebecca Fahrig
- Innovation, Advanced Therapies, Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander Universität Erlangen-Nürnberg, 91058, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg, 91052, Erlangen, Germany
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Burman S, Das A, Mahajan C, Rath GP. Radiation Concerns for the Neuroanesthesiologists. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2020. [DOI: 10.1055/s-0040-1715354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractWith the advent of minimally invasive neurosurgical techniques and rapid innovations in the field of neurointervention, there has been a sharp rise in diagnostic and therapeutic modalities requiring radiation exposure. Neuroanesthesiologists are currently involved in various procedures inside as well as outside the operating room (OR) like intensive care units, interventional suites, and gamma knife units. The ambit expands from short-lasting diagnostic scans to lengthy therapeutic procedures performed under fluoroscopic guidance. Hence, a modern-day neuroanesthesiologist has to bear the brunt of the radiation exposure in both inside and outside the OR. However, obliviousness and nonadherence to the relevant radiation safety measures are still prevalent. Radiation protection and safety are topics that need to be discussed with new vigor in the light of current practice.
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Affiliation(s)
- Sourav Burman
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abanti Das
- Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Girija P. Rath
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Hayashi S, Nishida T, Kuriki S, Chang LS, Aochi K, Meren E, Sakamoto T, Tomita R, Higaki Y, Osugi N, Sugimoto A, Takahashi K, Mukai K, Matsumoto K, Nakamatsu D, Yamamoto M, Fukui K, Takenaka M, Hosono M, Inada M. Radiation exposure dose of fluoroscopy-guided gastrointestinal procedures: A single-center retrospective study. Endosc Int Open 2020; 8:E1872-E1877. [PMID: 33269323 PMCID: PMC7695514 DOI: 10.1055/a-1287-9066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Fluoroscopy-guided gastrointestinal procedures (FGPs) are increasingly common. However, the radiation exposure (RE) to patients undergoing FGPs is still unclear. We examined the actual RE of FGPs. Patients and methods This retrospective, single-center cohort study included consecutive FGPs, including endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), enteral stenting, balloon-assisted enteroscopy, tube placement, endoscopic injection sclerotherapy (EIS), esophageal balloon dilatation and repositioning for sigmoid volvulus, from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm 2 ), and fluoroscopy time (FT, min) for each procedure. Results In total, 3831 patients were enrolled. Overall, 2778 ERCPs were performed. The median AK, DAP, and FT were as follows: ERCP: 109 mGy, 13.3 Gycm 2 and 10.0 min; self-expandable enteral stenting (SEMS): 62 mGy, 12.4 Gycm 2 and 10.4 min; tube placement: 40 mGy, 13.8 Gycm 2 and 11.1 min; balloon-assisted enteroscopy: 43 mGy, 22.4 Gycm 2 and 18.2 min; EUS cyst drainage (EUS-CD): 96 mGy, 18.3 Gycm 2 and 10.4 min; EIS: 36 mGy, 8.1 Gycm 2 and 4.4 min; esophageal balloon dilatation: 9 mGy, 2.2 Gycm 2 and 1.8 min; and repositioning for sigmoid volvulus: 7 mGy, 4.7 Gycm 2 and 1.6 min. Conclusion This large series reporting actual RE doses of various FGPs could serve as a reference for future prospective studies.
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Affiliation(s)
- Shiro Hayashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
- Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Osaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Shinji Kuriki
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Li-sa Chang
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kazuki Aochi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Emi Meren
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Tatsuya Sakamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Ryo Tomita
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yu Higaki
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Naoto Osugi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Aya Sugimoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kei Takahashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kaori Mukai
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masahi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Koji Fukui
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masami Inada
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
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