1
|
Becker von Rose A, Kobus K, Bohmann B, Lindquist-Lilljequist M, Eilenberg W, Kapalla M, Bassermann F, Reeps C, Eckstein HH, Neumayer C, Brostjan C, Roy J, von Heckel K, Hultgren R, Schwaiger BJ, Combs SE, Busch A, Schiller K. Radiation therapy for cancer is potentially associated with reduced growth of concomitant abdominal aortic aneurysm. Strahlenther Onkol 2024; 200:425-433. [PMID: 37676483 DOI: 10.1007/s00066-023-02135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Co-prevalence of abdominal aortic aneurysm (AAA) and cancer poses a unique challenge in medical care since both diseases and their respective therapies might interact. Recently, reduced AAA growth rates were observed in cancer patients that received radiation therapy (RT). The purpose of this study was to perform a fine-grained analysis of the effects of RT on AAA growth with respect to direct (infield) and out-of-field (outfield) radiation exposure, and radiation dose-dependency. METHODS A retrospective single-center analysis identified patients with AAA, cancer, and RT. Clinical data, radiation plans, and aneurysm diameters were analyzed. The total dose of radiation to each aneurysm was computed. AAA growth under infield and outfield exposure was compared to patients with AAA and cancer that did not receive RT (no-RT control) and to an external noncancer AAA reference cohort. RESULTS Between 2003 and 2020, a total of 38 AAA patients who had received well-documented RT for their malignancy were identified. AAA growth was considerably reduced for infield patients (n = 18) compared to outfield patients (n = 20), albeit not significantly (0.8 ± 1.0 vs. 1.3 ± 1.6 mm/year, p = 0.28). Overall, annual AAA growth in RT patients was lower compared to no-RT control patients (1.1 ± 1.5 vs. 1.8 ± 2.2 mm/year, p = 0.06) and significantly reduced compared to the reference cohort (1.1 ± 1.5 vs. 2.7 ± 2.1 mm/year, p < 0.001). The pattern of AAA growth reduction due to RT was corroborated in linear regression analyses correcting for initial AAA diameter. A further investigation with respect to dose-dependency of radiation effects on AAA growth, however, revealed no apparent association. CONCLUSION In this study, both infield and outfield radiation exposure were associated with reduced AAA growth. This finding warrants further investigation, both in a larger scale clinical cohort and on a molecular level.
Collapse
Affiliation(s)
- Aaron Becker von Rose
- III. Medical Department for Hematology and Oncology, University Hospital rechts der Isar, Technical University Munich, Munich, Germany.
| | - Kathrin Kobus
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Bianca Bohmann
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Moritz Lindquist-Lilljequist
- Stockholm Aneurysm Research Group (STAR), Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna and University Hospital Vienna, Vienna, Austria
| | - Marvin Kapalla
- Division of Vascular and Endovascular Surgery, Department for Visceral‑, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Florian Bassermann
- III. Medical Department for Hematology and Oncology, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral‑, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna and University Hospital Vienna, Vienna, Austria
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna and University Hospital Vienna, Vienna, Austria
| | - Joy Roy
- Stockholm Aneurysm Research Group (STAR), Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Rebecka Hultgren
- Stockholm Aneurysm Research Group (STAR), Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Benedikt J Schwaiger
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
- Division of Vascular and Endovascular Surgery, Department for Visceral‑, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Kilian Schiller
- Department of Radiation Oncology, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
| |
Collapse
|
2
|
Watabe T, Namba M, Yanagida S, Nakamura Y, Yamada T, Tatsuno S, Ri A, Yoshida S, Uyama K, Kinuya S, Tomiyama N, Hosono M. Manual on the proper use of the 211At-labeled PSMA ligand ([ 211At]PSMA-5) for clinical trials of targeted alpha therapy (1st edition). Ann Nucl Med 2024; 38:329-336. [PMID: 38548987 PMCID: PMC11016504 DOI: 10.1007/s12149-024-01916-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 04/15/2024]
Abstract
Recently, an astatine-labeled prostate-specific membrane antigen (PSMA) ligand ([211At]PSMA-5) has been developed for the targeted alpha therapy of patients with prostate cancer. This manual delineates its physicochemical characteristics to assist healthcare professionals in understanding the α-ray-emitting drug of [211At]PSMA-5 when administered to patients. The safety considerations regarding the handling and use of this drug in clinical trials are outlined, based on the proper usage manual of previous studies. The dose limits, as defined by the guidelines of the International Commission on Radiological Protection (ICRP) and the International Atomic Energy Agency (IAEA), are assessed for patients' caregivers and the general public. According to the calculations provided in this manual, clinical trials involving [211At]PSMA-5 can be safely conducted for these populations even if patients are released after its administration. Moreover, this manual provides comprehensive guidance on the handling of [211At]PSMA-5 for healthcare facilities, and compiles a list of precautionary measures to be distributed among patients and their caregivers. While this manual was created by a research team supported by Ministry of Health, Labour, and Welfare in Japan and approved by Japanese Society of Nuclear Medicine, its applicability extends to healthcare providers in other countries. This manual aims to facilitate conducting clinical trials using [211At]PSMA-5 in patients with prostate cancer.
Collapse
Affiliation(s)
- Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Masao Namba
- Japan Radioisotope Association, 2-28-45 Honkomagome, Bunkyo-ku, Tokyo, 113-0021, Japan
| | - Sachiko Yanagida
- Japan Radioisotope Association, 2-28-45 Honkomagome, Bunkyo-ku, Tokyo, 113-0021, Japan
| | - Yoshihide Nakamura
- Chiyoda Technol Corporation, 1-7-12 Yushima, Bunkyo-ku, Tokyo, 113-8681, Japan
| | - Takahiro Yamada
- Atomic Energy Research Institute, Kindai University, 3-4-1 Kowakae, Higashi, Osaka, 577-8502, Japan
| | - Saori Tatsuno
- Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Aritoshi Ri
- Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Shuhei Yoshida
- Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kumiko Uyama
- Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Seigo Kinuya
- Japanese Society of Nuclear Medicine, 3-1-17 Nishi-Azabu, Minato-ku, Tokyo, 106-0031, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Makoto Hosono
- Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| |
Collapse
|
3
|
Espinosa-Uribe AG, Fernández-Garza FA, Muñoz-Leija D, Vílchez-Cavazos JF, Quiroga-Garza A, Peña-Martínez VM, Elizondo-Omaña RE, Gutiérrez-de la O J. A comparison of three techniques for the osteosynthesis after minimal invasive osteotomies for hallux valgus. Int Orthop 2024:10.1007/s00264-024-06178-5. [PMID: 38589709 DOI: 10.1007/s00264-024-06178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Third and fourth-generation minimal invasive osteotomies (MIO) for the treatment of hallux valgus (HV) have become popular procedures worldwide with promising results due to the improvement in the fixation method. The tricortical cannulated screw placement remains a complex procedure that is technically challenging and requires a long skill learning curve with high radiation exposure mainly in the form of intensifier shots (IS) required for the MIO fixation. This study aims to compare the number of X-ray IS required using three different techniques for the cannulated guide placement. METHODS A retrospective cross-sectional observational and comparative study was conducted to assess the number of X-rays IS required for correct cannulated screw guide placement using three different techniques: traditional perforator, the drill and joystick, and K-wire first techniques. RESULTS A total of 53 MIS procedures from thirty-one patients in two different hospitals were included. IS X-rays were 155.1 ± 29.7 in the traditional technique (n = 14), 143.0 ± 43.2 in the drill and joystick technique (n = 22), and 85 ± 18.7 in the K-wires first technique (n = 17), p = < 0.001 using one-way ANOVA. CONCLUSIONS The K-wire first technique statistically significantly decreases X-ray IS numbers p ≤ 0.001. There were no statistically significant differences between the traditional (after osteotomy K-wire placement) and the drill and joystick techniques (p = 0.36).
Collapse
Affiliation(s)
- Abraham Guadalupe Espinosa-Uribe
- Human Anatomy Department, School of Medicine, Universidad Autónoma de Nuevo León, Avenida Francisco I. Madero y Gonzalitos S/N Colonia Mitras Centro, Monterrey, Nuevo León, 64460, México
| | - Fernando A Fernández-Garza
- Instituto de Seguridad Social de Trabajadores del Estado de Nuevo León (ISSSTELEON), Monterrey, Nuevo León, México
| | - David Muñoz-Leija
- Human Anatomy Department, School of Medicine, Universidad Autónoma de Nuevo León, Avenida Francisco I. Madero y Gonzalitos S/N Colonia Mitras Centro, Monterrey, Nuevo León, 64460, México.
| | - José Félix Vílchez-Cavazos
- Human Anatomy Department, School of Medicine, Universidad Autónoma de Nuevo León, Avenida Francisco I. Madero y Gonzalitos S/N Colonia Mitras Centro, Monterrey, Nuevo León, 64460, México
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, México
| | - Alejandro Quiroga-Garza
- Human Anatomy Department, School of Medicine, Universidad Autónoma de Nuevo León, Avenida Francisco I. Madero y Gonzalitos S/N Colonia Mitras Centro, Monterrey, Nuevo León, 64460, México
- Instituto Mexicano del Seguro Social, Hospital de Traumatología y Ortopedia #21, Monterrey, Nuevo León, México
| | - Víctor M Peña-Martínez
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, México
| | - Rodrigo E Elizondo-Omaña
- Human Anatomy Department, School of Medicine, Universidad Autónoma de Nuevo León, Avenida Francisco I. Madero y Gonzalitos S/N Colonia Mitras Centro, Monterrey, Nuevo León, 64460, México
| | - Jorge Gutiérrez-de la O
- Human Anatomy Department, School of Medicine, Universidad Autónoma de Nuevo León, Avenida Francisco I. Madero y Gonzalitos S/N Colonia Mitras Centro, Monterrey, Nuevo León, 64460, México
| |
Collapse
|
4
|
Tomonaga K, Ogami A, Ando H, Okubo T. Factors affecting the changes in body mass index among emergency workers at the Fukushima Daiichi Nuclear Power Plant. Ind Health 2024; 62:123-132. [PMID: 37821364 PMCID: PMC10995666 DOI: 10.2486/indhealth.2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
Understanding the effects of lifestyle and radiation on health is important for the health management of disaster recovery workers. International research has demonstrated the relationship between natural disasters and diseases. The lifestyle and working conditions following the Great East Japan Earthquake potentially increased the incidence of cardiovascular disease and obesity among affected individuals. The aim of this study was to analyze the body mass index (BMI) of 1,341 emergency workers who responded to the accident at the Fukushima Daiichi Nuclear Power Plant. The BMI of each emergency worker was measured immediately after the accident and compared with that measured at the initial survey conducted 5 yr later to determine the effect of lifestyle habits on BMI. Awareness of the frequency of eating out and caloric intake helped maintain their BMI, while evacuation contributed to the increase in BMI. Prevention of obesity, which can trigger or exacerbate certain health conditions, such as heat exhaustion, infection, and cerebro-cardiovascular disease, requires diet counseling, with a focus on maintaining adequate caloric intake; moreover, special consideration should be provided to evacuated workers.
Collapse
Affiliation(s)
- Kenta Tomonaga
- Research Center for Prevention from Radiation Hazards of Workers, National Institute of Occupational Safety and Health, Japan
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Akira Ogami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Hajime Ando
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Toshiteru Okubo
- Research Center for Prevention from Radiation Hazards of Workers, National Institute of Occupational Safety and Health, Japan
| |
Collapse
|
5
|
Toscan M, de Araújo BF, Martini JC, Ravazio R, de Souza VC. Our estimates of neonatal radiation exposure fall short of reality. Eur J Pediatr 2024; 183:1911-1916. [PMID: 38334796 DOI: 10.1007/s00431-024-05466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
The purpose of this study is to evaluate radiation exposure in newborns undergoing imaging tests during the first 30 days of neonatal intensive care unit (NICU) hospitalization. A retrospective cohort study was conducted from November 2018 to April 2019 with newborns admitted to the NICU. Thermoluminescent dosimeters (TLD-100™) measured radiation emitted during imaging exams over 1 month, with a comparison between measured and estimated radiation. The cohort exhibited a median gestational age of 33.0 (31.0, 37.0) weeks, a median birth weight of 1840 (1272, 2748) g, and a median length of stay of 25.5 (11.7, 55.0) days. Eighty-four patients underwent 314 imaging tests, with an estimated radiation dose (ERD) per patient of 0.116 mSv and a measured radiation dose (MDR) of 0.158 mSv. ERD consistently underestimated MDR, with a mean difference of -0.043 mSv (-0.049 to -0.036) in the Bland-Altman analysis. The regression equation was as follows: difference MRD - ERD = -1.7 × (mean (MRD + ERD)) + 0.056. The mean estimated radiation dose per exam was 0.030 mSv, and the chest X-rays accounted for 63.26% of total exams. The median number of radiographic incidences per patient was 2 (1, 4), with 5 patients undergoing three or more exams in a single day. CONCLUSION Radiation exposure in these newborns was underestimated, emphasizing the need for awareness regarding associated risks and strict criteria for requesting radiological exams. Lung ultrasound is a radiation-free and effective option in managing respiratory diseases in newborns, reducing the reliance on chest X-rays. WHAT IS KNOWN • Radiation used in diagnostic exams is not risk-free. • Radiation risk is much higher in small Infants due to the exposure area and the prolonged expectance of life. WHAT IS NEW • Radiation exposure is underestimated in the neonatal population. • The study found a mean radiation exposure in neonates about 5% of the mean annual dose in the general population.
Collapse
Affiliation(s)
- Michelle Toscan
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil.
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Breno Fauth de Araújo
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
| | - Júlio César Martini
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafaela Ravazio
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Programa de Pós Graduação em Ciências da Computação, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vandréa Carla de Souza
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
- Programa de Pós Graduação em Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
| |
Collapse
|
6
|
Wang X, Xu M, Zhu H, Ma L, Chen C, Jiang Q, Wu W, Hu D, Zhou W, Chen R, Gao L, Yu X, Wang L, Cai X, Liu H, Xia L. Phantom study of a self-shielded X-ray bone age assessment instrument against scattered radiation in children. Pediatr Radiol 2024; 54:646-652. [PMID: 38472490 DOI: 10.1007/s00247-024-05897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024]
Abstract
Hand-wrist radiography is the most common and accurate method for evaluating children's bone age. To reduce the scattered radiation of radiosensitive organs in bone age assessment, we designed a small X-ray instrument with radioprotection function by adding metal enclosure for X-ray shielding. We used a phantom operator to compare the scattered radiation doses received by sensitive organs under three different protection scenarios (proposed instrument, radiation personal protective equipment, no protection). The proposed instrument showed greater reduction in the mean dose of a single exposure compared with radiation personal protective equipment especially on the left side which was proximal to the X-ray machine (≥80.0% in eye and thyroid, ≥99.9% in breast and gonad). The proposed instrument provides a new pathway towards more convenient and efficient radioprotection.
Collapse
Affiliation(s)
- Xinhong Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengxi Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huayong Zhu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Linlin Ma
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Jiang
- Hangzhou Mednova Medical Technologies Co., Ltd, Hangzhou, China
| | - Weihong Wu
- Hangzhou Mednova Medical Technologies Co., Ltd, Hangzhou, China
| | - Daoxi Hu
- Department of Medical Imaging, Army 75 Group Military Hospital, Dali, China
| | - Wei Zhou
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, China
| | - Rongmin Chen
- S.M.U. Medical Equipment Test Co., Ltd, Guangzhou, China
| | - Lili Gao
- S.M.U. Medical Equipment Test Co., Ltd, Guangzhou, China
| | - Xiaoli Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijian Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxiao Cai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, UK.
| | - Ling Xia
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, 38 Zheda Road, Hangzhou, 310027, China.
| |
Collapse
|
7
|
Ramanan B, Pizano A, Solano A, Gonugunta AS, Timaran CH, Siah M, Baig S, Shih M, Guild JB, Kirkwood ML. The addition of a leaded arm sleeve to leaded aprons further decreases operator upper outer quadrant chest wall radiation dose during fluoroscopically guided interventions. J Vasc Surg 2024; 79:948-953. [PMID: 38040201 DOI: 10.1016/j.jvs.2023.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Breast cancer most commonly occurs in the upper outer quadrant (UOQ) chest wall (CW). The effectiveness of routine leaded aprons to protect this region of the body in interventionalists during fluoroscopically guided interventions (FGIs) is unknown. Given the high lifetime attributable risks of prolonged occupational exposure to ionizing radiation and the increasing number of practicing female vascular surgeons and interventionalists, we sought to determine if the use of a leaded arm shield would offer additional protection to the lateral CW and axilla in operators compared with routine leaded aprons. METHODS Effectiveness of leaded sleeves in attenuating radiation dose to the axilla and UOQ was evaluated in clinical practice and simulated scenarios. In the clinical setting, optically stimulated luminescence nanoDot detectors were placed at the UOQ lateral CW position, both over and under a standard leaded apron vest with and without the addition of an antimony/bismuth Enviro-Lite sleeve on two vascular surgeons performing FGIs. In the simulation, nanoDots were similarly placed on an anthropomorphic phantom positioned to represent a primary operator performing right femoral access. Fluorography was performed on 12-inch-thick acrylic scatter phantom at 80 kVp for an exposure of 3 Gy reference air kerma. Experiments were done with and without the sleeve. Paired Wilcoxon and χ2 tests were performed to identify the statistical significance of radiation attenuation. RESULTS Operator UOQ CW dose was measured during 61 FGIs: 33 cases (54%) with and 28 cases (46%) without the sleeve. Median procedure reference air kerma and fluoroscopy time was 180 mGy (interquartile range [IQR], 85-447 mGy) and 21 minutes (IQR, 11-39 minutes) when the sleeve was worn vs 100 mGy (IQR, 67-270 mGy) and 11 minutes (IQR, 6.3-25 minutes) without the sleeve. Radiation dose to the operator's UOQ was reduced by 96% (IQR, 85%-96%) when the sleeve was present and by 62% (IQR, 44%-82%; P < .001) without the sleeve. In the simulated setting, the sleeve reduced the radiation dose to the UOQ compared with the apron alone (96% vs 67%; P < .001). CONCLUSIONS Routine leaded aprons do attenuate the majority of UOQ chest wall radiation dose; however, the addition of a lead-equivalent sleeve further significantly reduces this dose. Because this area of the body has a high incidence of cancer formation, additional protection, especially to female interventionalists, seems prudent. Vascular surgeons should consider using a protective sleeve with their personal protective equipment when performing complex fluoroscopically guided procedures.
Collapse
Affiliation(s)
- Bala Ramanan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alejandro Pizano
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Amrit S Gonugunta
- University of Texas Southwestern Medical School, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey B Guild
- Division of Medical Physics, Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
8
|
Saad A, Mayne A, Pagkalos J, Ollivier M, Botchu R, Davis E, Sharma A. Comparative analysis of radiation exposure in robot-assisted total knee arthroplasty using popular robotic systems. J Robot Surg 2024; 18:120. [PMID: 38492073 DOI: 10.1007/s11701-024-01896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
Robotic-assisted TKA (RATKA) is a rapidly emerging technique that has been shown to improve precision and accuracy in implant alignment in TKA. Robotic-assisted TKA (RATKA) uses computer software to create a three-dimensional model of the patient's knee. Different types of preoperative imaging, including radiographs and CT scans, are used to create these models, each with varying levels of radiation exposure. This study aims to determine the radiation dose associated with each type of imaging used in RATKA, to inform patients of the potential risks. A retrospective search of our clinical radiology and arthroplasty database was conducted to identify 140 knees. The patients were divided into three groups based on the type of preoperative imaging they received: (1) CT image-based MAKO Protocol, (2) Antero-posterior long leg alignment films (LLAF), (3) standard AP, lateral, and skyline knee radiographs. The dose of CT imaging technique for each knee was measured using the dose-length product (DLP) with units of mGycm2, whereas the measurement for XRAY images was with the dose area product (DAP) with units of Gycm2. The mean radiation dose for patients in the CT (MAKO protocol) image-based group was 1135 mGy.cm2. The mean radiation dose for patients in the LLAF group was 3081 Gycm2. The mean radiation dose for patients undergoing knee AP/lateral and skyline radiographs was the lowest of the groups, averaging 4.43 Gycm2. Through an ANOVA and post hoc analysis, the results between groups was statistically significant. In this study, we found a significant difference in radiation exposure between standard knee radiographs, LLAF and CT imaging. Nonetheless, the radiation dose for all groups is still within acceptable safety limits.
Collapse
Affiliation(s)
- Ahmed Saad
- Royal Orthopaedic Hospital, Birmingham, UK.
| | | | | | | | | | | | | |
Collapse
|
9
|
MacNevin W, Chua M, Kraus MS, Keefe DT. Radiation exposure associated with computed tomography for pediatric urolithiasis evaluation: A scoping review of the literature. J Pediatr Urol 2024:S1477-5131(24)00155-4. [PMID: 38521719 DOI: 10.1016/j.jpurol.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Computed tomography (CT) imaging is used for assessment of pediatric urolithiasis in cases where ultrasound is inconclusive. The utility of CT imaging must be considered alongside the potential risks of radiation exposure in this patient population due to the increased risk of cancer development. The purpose of this review is to investigate the radiation exposure associated with standard-dose and low-dose computed tomography (CT) imaging for the assessment of pediatric urolithiasis. METHODS A scoping literature review over a 23 year period between 2000 and 2023 was conducted of all English-language studies reporting on the use of non-contrast CT imaging for assessment of pediatric urolithiasis. Patients that were specified as pediatric with age ≤20 years at time of intervention and undergoing standard-dose or low/ultra-low-dose CT were included. Low-dose and ultra-low-dose CT were defined as a radiation dose ≤3.0 mSv and ≤1.9 mSv, respectively. RESULTS A total of 8121 articles were identified and after screening, 6 articles representing 309 patients were included in this scoping review. Of the articles reviewed, standard non-contrast CT radiation doses for pediatric urolithiasis evaluation ranged from 2.9 to 5.5 mSv and low-dose CT radiation dose was reported to be 1.0-2.72 mSv. Only 2 studies directly evaluated low-dose CT imaging compared to standard-dose CT imaging for pediatric urolithiasis assessment. Radiation reduction approaches did not negatively impact urolithiasis detection or characterization in 2 studies reviewed. CONCLUSIONS CT radiation doses for suspected or known pediatric urolithiasis are underreported and vary greatly with underutilization of low-dose/ultra-dose protocols for pediatric urolithiasis especially in comparison to the adult population. Results from this scoping review support that low-dose CTprotocols for pediatric stone disease are feasible to reduce radiation exposure.
Collapse
Affiliation(s)
- Wyatt MacNevin
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, M5G 1E8, Canada
| | - Mareen Sarah Kraus
- Department of Diagnostic Radiology, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Daniel T Keefe
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada; Division of Pediatric Urology, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada.
| |
Collapse
|
10
|
Boto J, Vargas MI. A new modified technique of dynamic CT myelography to detect dural tears in spontaneous intracranial hypotension. J Neuroradiol 2024; 51:210-213. [PMID: 37499791 DOI: 10.1016/j.neurad.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
We propose a modified dynamic CT-myelography technique for patients with fast CSF leaks caused by ventral dural tears in order to reduce radiation exposure and complications. A fluoroscopy-guided lumbar puncture using an epidural anesthesia kit replaces a CT-guided lumbar puncture, and a smaller volume of less concentrated contrast media is used. This approach has advantages, including speeding up the procedure, reduced radiation exposure, and elimination of the risk of contrast injection into the epidural space.
Collapse
Affiliation(s)
- José Boto
- Division of Neuroradiology, Geneva University Hospital and Faculty of Medicine of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Maria Isabel Vargas
- Division of Neuroradiology, Geneva University Hospital and Faculty of Medicine of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| |
Collapse
|
11
|
Steiniger B, Fiebich M, Grimm MO, Malouhi A, Reichenbach JR, Scheithauer M, Teichgräber U, Franiel T. PAE planning: Radiation exposure and image quality of CT and CBCT. Eur J Radiol 2024; 172:111329. [PMID: 38278010 DOI: 10.1016/j.ejrad.2024.111329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE To determine accurate organ doses, effective doses, and image quality of computed tomography (CT) compared with cone beam CT (CBCT) for correct identification of prostatic arteries. METHOD A dual-energy CT scanner and a flat-panel angiography system were used. Dose measurements (gallbladder (g), intestine (i), bladder (b), prostate (p), testes (t), active bone marrow of pelvis (bmp) and femura (bmf)) were performed using an anthropomorphic phantom with 65 thermoluminescent dosimeters in the pelvis and abdomen region. For the calculation of the contrast-to-noise ratio (CNR) of the pelvic arteries, a patient whose weight and height were almost identical to those of the phantom was selected for each examination type. RESULTS The effective dose of CT was 2.7 mSv and that of CBCT was 21.8 mSv. Phantom organ doses were lower for CT than for CBCT in all organs except the testes (g: 1.2 mGy vs. 3.3 mGy, i: 5.8 mGy vs. 23.9 mGy, b: 6.9 mGy vs. 19.4 mGy, p: 6.4 mGy vs. 13.2 mGy, t: 4.7 mGy vs. 2.4 mGy, bmp: 5.1 mGy vs. 18.2 mGy, bmf: 3.3 mGy vs. 6.6 mGy). For human pelvic arteries, the CNR of CT was better than that of CBCT, with the exception of one prostate artery that showed stenosis on CT. Evaluation by experienced radiologists also confirmed the better detectability of prostate arteries on CT examination. CONCLUSIONS In our study preprocedural CT had lower organ doses and better image quality comparedd with CBCT and should be considered for the correct identification of prostatic arteries.
Collapse
Affiliation(s)
- Beatrice Steiniger
- Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - Martin Fiebich
- Department LSE, Technische Hochschule Mittelhessen, Wiesenstraße 14, 35390 Gießen, Germany
| | - Marc-Oliver Grimm
- Clinic for Urology, University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Amer Malouhi
- Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Marcel Scheithauer
- Stabsstelle Strahlenschutz, University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Ulf Teichgräber
- Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Tobias Franiel
- Department of Diagnostic and Interventional Radiology, University Hospital, Am Klinikum 1, 07747 Jena, Germany
| |
Collapse
|
12
|
Sullivan MH, Yu L, Schueler BA, Nassr A, Guerin J, Milbrandt TA, Larson AN. Radiation exposure in navigated techniques for AIS: is there a difference between pre-operative CT and intraoperative CT? Spine Deform 2024; 12:349-356. [PMID: 37870680 DOI: 10.1007/s43390-023-00772-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/23/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Utilization of navigation improves pedicle screw accuracy in adolescent idiopathic scoliosis (AIS). Our center switched from intraoperative CT (ICT) to an optical navigation system that utilizes pre-operative CT (PCT). We aim to evaluate the radiation dose and operative time for low-dose ICT compared to standard and low-dose PCT used for optical navigation in AIS patients undergoing posterior spinal fusion. METHODS A single-center matched-control cohort study of 38 patients was conducted. Nineteen patients underwent ICT navigation (O-arm) and were matched by sex, age, and weight to 19 patients who underwent PCT for use with an optical-guided navigation (7D, Seaspine). A total of 418 levels were instrumented and reviewed. PCT was either a standard dose (N = 7) or a low dose (N = 12). The mean volume CT dose index, dose-length product, overall effective dose (ED), ED per level instrumented, and operative time per level were compared. RESULTS ED per level instrumented was 0.061 ± 0.029 mSv in low-dose PCT and 0.14 ± 0.05 mSv in low-dose ICT (p < 0.0001). ED per level instrumented was significantly higher in standard PCT (1.46 ± 0.39 vs. 0.14 ± 0.03 mSv; p < 0.0001). Mean operative time per level was 31 ± 7 min for ICT and 33 ± 3 min for PCT (p = 0.628). CONCLUSION Low-dose PCT resulted in 0.70 mSv exposure per case and 31 min per level, standard-dose was 16.95 mSv, while ICT resulted in 1.34-1.62 mSv and a similar operative time. Use of a standard-dose PCT involves radiation exposure about 9 times higher than ICT and 23 times higher than low-dose PCT per level instrumented. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Mikaela H Sullivan
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Julie Guerin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Todd A Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
13
|
Staniorski CJ, Paul A, Chaudhry R. Prospective assessment of entrance skin dose and targets for radiation reduction during abdominal plain films in pediatric urology patients. J Pediatr Urol 2024:S1477-5131(24)00139-6. [PMID: 38453616 DOI: 10.1016/j.jpurol.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Abdominal radiographs are frequently used for evaluation of bowel and bladder dysfunction in pediatric urology. However, the dose of radiation delivered with each study is estimated from machine settings as opposed to measurement of the true entrance skin dose. In addition, the correlation of radiographic constipation with patient symptoms has been questioned. OBJECTIVE To evaluate the practices for obtaining abdominal radiographs and the true entrance skin dose of radiation for each examination in order to identify targets for radiation reduction. STUDY DESIGN Pediatric urology patients were prospectively enrolled from June 2022 through June 2023. Dosimeters were attached to the navel to collect entrance skin doses from single view abdominal x-ray. Estimated doses were compared to measured entrance skin dose as well as patient characteristics. Exam parameters were evaluated to identify targets for radiation reduction. RESULTS A total of 75 patients were recruited for this study with a median age of 10.0 years (IQR 6-14). Most evaluations were done to assess for bowel and bladder dysfunction (68 exams, 91%). The protocol for exams was not standardized resulting in 27% of patients undergoing a medium or high dose strength and 55% undergoing 1 or more image. The median estimated dose was 0.63 mGy (IQR 0.3-1.2 mGy). The median measured dose was 0.77 mGy (IQR 0.31-2.01 mGy) which was significantly different than the estimations (p < 0.001). The estimated dose, measured dose and estimate error were all found to be positively correlated with patient characteristics including age and body mass index (See Figure). Increasing age and body mass index also showed a higher likelihood of increased dose strength and image acquisition. DISCUSSION The measured entrance skin dose of radiation is significantly higher than prior estimates. The measured dose but also the estimate error increased with patient age and size which is likely related to higher settings used for image acquisition as patients age. Standardized protocols using low dose settings and limiting image acquisition to the pelvis may reduce radiation exposure in children with bowel and bladder dysfunction while providing adequate diagnostic data. CONCLUSION Radiation dose for abdominal radiographs is higher than previously estimated. Older and larger children received higher doses which may be mediated by increased dose strength and image acquisition. Standardization of protocols could lower radiation exposure.
Collapse
Affiliation(s)
| | | | - Rajeev Chaudhry
- Department of Urology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
14
|
Rehm A, Linardatou Novak P, Newton A, Ngu AWT, Clegg R, Ashby E. Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques. Injury 2024; 55:111354. [PMID: 38246014 DOI: 10.1016/j.injury.2024.111354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Pinelopi Linardatou Novak
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ayla Newton
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Albert W T Ngu
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rachael Clegg
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Elizabeth Ashby
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
15
|
Peters J, Oswald D, Eiben C, Ramesmayer C, Abenhardt M, Sieberer M, Homberg R, Gross AJ, Herrmann TRW, Miernik A, Becker B, Lehrich K, Klein JT, Hatiboglu G, Lusuardi L, Netsch C. [Imaging in nephroureterolithasis]. Urologie 2024; 63:295-302. [PMID: 38376761 DOI: 10.1007/s00120-024-02297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/21/2024]
Abstract
In the acute diagnostics of a suspected nephroureterolithiasis, ultrasonography should be the examination modality of choice. In cases of suspected urolithiasis, unclear flank pain with fever or in cases of a solitary kidney, a noncontrast computed tomography (CT) scan should always subsequently be performed. If the sonography findings are inconclusive in pregnant women a magnetic resonance imaging (MRI) examination can be considered. If there are indications for urinary diversion, a retrograde imaging study should be performed as part of the urinary diversion. This or CT imaging is also suitable for preinterventional imaging before shock wave lithotripsy, percutaneous nephrolithotomy or ureteroscopy. Postinterventional imaging is not always necessary and sonography is often sufficient. In a conservative treatment approach an abdominal plain X‑ray can be used for follow-up assessment.
Collapse
Affiliation(s)
- Julia Peters
- Universitätsklinikum Salzburg, Salzburg, Österreich.
- , Müllner Hauptstr. 48, 5020, Salzburg, Österreich.
| | - David Oswald
- Universitätsklinikum Salzburg, Salzburg, Österreich
| | | | | | | | | | - Roland Homberg
- St.-Barbara-Klinik Hamm-Hessen, Hamm-Hessen, Deutschland
| | | | | | | | | | | | | | | | - Lukas Lusuardi
- Universitätsklinikum Salzburg, Salzburg, Österreich.
- , Müllner Hauptstr. 48, 5020, Salzburg, Österreich.
| | | |
Collapse
|
16
|
Kasashima K, Kitahara T, Nakajima Y, Hayase M, Uesaka D, Torikoshi S, Ezaka Y, Tajima K, Nishimura M. Transradial approach for coil embolization of a ruptured intracranial aneurysm during pregnancy to minimize fetal radiation exposure. Radiol Case Rep 2024; 19:1106-1109. [PMID: 38229607 PMCID: PMC10789927 DOI: 10.1016/j.radcr.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024] Open
Abstract
Endovascular treatment of aneurysmal subarachnoid hemorrhage during pregnancy involves a risk of intraoperative radiation exposure to the fetus. The transradial approach does not require fluoroscopy of the maternal abdominopelvic region, which reduces fetal radiation exposure. We report a case of a female at 21 gestation weeks who developed subarachnoid hemorrhage due to a ruptured right posterior communicating artery aneurysm. The patient underwent balloon-assisted coil embolization via the transradial approach, which achieved aneurysmal obliteration with minimal fetal radiation exposure and without puncture site complications. The patient was free from neurological sequelae. Further, the patient delivered a healthy newborn through an elective cesarean section at 37 gestation weeks without any complications. The transradial approach allows endovascular treatment of ruptured intracranial aneurysms during pregnancy, with minimal risks of fetal radiation exposure.
Collapse
Affiliation(s)
- Kazuhiro Kasashima
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| | - Takahiro Kitahara
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| | - Yusuke Nakajima
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| | - Makoto Hayase
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| | - Daisuke Uesaka
- Department of Radiology, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| | - Sadaharu Torikoshi
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| | - Yukie Ezaka
- Department of Obstetrics, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| | - Kimihisa Tajima
- Department of Obstetrics, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| | - Masaki Nishimura
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Tsukimi 2-4-1, Fukui 918-8501, Japan
| |
Collapse
|
17
|
Rockley M, Nana P, Rebet A, Fabre D, Haulon S. A procedural step analysis of radiation exposure in fenestrated endovascular aortic repair. J Vasc Surg 2024:S0741-5214(24)00309-4. [PMID: 38368998 DOI: 10.1016/j.jvs.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Radiation exposure during complex endovascular aortic repair may be associated with tangible adverse effects in patients and operators. This study aimed to identify the steps of highest radiation exposure during fenestrated endovascular aortic repair (FEVAR) and to investigate potential intraoperative factors affecting radiation exposure. METHODS Prospective data of 31 consecutive patients managed exclusively with four-fenestration endografts between March 1, 2020, and July 1, 2022 were retrospectively analyzed. Leveraging the conformity of the applied technique, every FEVAR operation was considered a combination of six overall stages composed of 28 standardized steps. Intraoperative parameters, including air kerma, dose area product, fluoroscopy time, and number of digital subtraction angiographies (DSAs) and average angulations were collected and analyzed for each step. RESULTS The mean procedure duration and fluoroscopy time was 140 minutes (standard deviation [SD], 32 minutes), and 40 minutes (SD, 9.1 minutes), respectively. The mean air kerma was 814 mGy (SD, 498 mGy), and the mean dose area product was 66.8 Gy cm2 (SD, 33 Gy cm2). The percentage of air kerma of the entire procedure was distributed throughout the following procedure stages: preparation (13.9%), main body (9.6%), target vessel cannulation (27.8%), stent deployment (29.1%), distal aortoiliac grafting (14.3%), and completion (5.3%). DSAs represented 23.0% of the total air kerma. Target vessel cannulation and stent deployment presented the highest mean lateral angulation (67 and 63 degrees, respectively). Using linear regression, each minute of continuous fluoroscopy added 18.9 mGy of air kerma (95% confidence interval, 17.6-20.2 mGy), and each DSA series added 21.1 mGy of air kerma (95% confidence interval, 17.9-24.3 mGy). Body mass index and lateral angulation were significantly associated with increased air kerma (P < .001). CONCLUSIONS Cannulation of target vessels and bridging stent deployment are the steps requiring the highest radiation exposure during FEVAR cases. Optimized operator protection during these steps is mandatory.
Collapse
Affiliation(s)
- Mark Rockley
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France; Division of Vascular Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Petroula Nana
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France
| | | | - Dominique Fabre
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France
| | - Stéphan Haulon
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France.
| |
Collapse
|
18
|
Larsson MEV, Jonasson PI, Apell PS, Kearney PP, Lundh CJ. Evaluation of novel radiation protection devices during radiologically guided interventions. CVIR Endovasc 2024; 7:18. [PMID: 38353904 PMCID: PMC10866844 DOI: 10.1186/s42155-024-00430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND In radiologically guided interventions, medical practitioners are subjected to radiation exposure, which may lead to radiation-induced diseases. In this study, novel radiation shields for the head and neck were evaluated for their potential to reduce radiation exposure. METHOD An anthropomorphic phantom was exposed on its left side to scattered radiation from beneath to simulate the exposure of an operator in a x-ray operating room. Thermoluminescent dosimeters (TLDs) were positioned at different depths in five slices in the phantom, measuring personal dose equivalent. Two different set up situations were evaluated: a head protector designed to reduce radiation in the upper section of the head; and a novel thyroid protector prototype extended in the front and on both sides, designed to reduce radiation in the lower and middle sections of the head. A standard thyroid collar prototype and a ceiling mounted lead glass shield were used as comparisons. Furthermore, the head protector was evaluated in a clinical study in which TLDs were positioned to measure scattered radiation exposure to the heads of operators during endovascular interventions. RESULTS The extended thyroid protector reduced the scattered radiation in the throat, chin, and ear slices. Some shielding effect was seen in the brain and skull slices. The head protector showed a shielding effect in the skull slice up to two cm depth where it covered the phantom head. As expected, the ceiling mounted lead glass shield reduced the scattered radiation in all measuring points. CONCLUSIONS A ceiling mounted lead glass shield is an effective radiation protection for the head, but in clinical practice, optimal positioning of a ceiling mounted lead shield may not always be possible, particularly during complex cases when radiation protection may be most relevant. Added protection using these novel guards may compliment the shielding effect of the ceiling mounted lead shield. The head protector stand-alone did not provide sufficient protection of the head. The extended thyroid protector stand-alone provided sufficient protection in the lower and middle sections of the head and neck.
Collapse
Affiliation(s)
- Maria E V Larsson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Pernilla I Jonasson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Petra S Apell
- Texray AB, Gothenburg, Sweden
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Peter P Kearney
- Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Charlotta J Lundh
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
19
|
Rahman MN, Javed M, Adnan G, Khan M, Nizar Z, Shah I. Differing radiation exposure in scrub technicians and rotating staff in Cardiac catheterization laboratory: occupation matters. Egypt Heart J 2024; 76:18. [PMID: 38334828 PMCID: PMC10858000 DOI: 10.1186/s43044-024-00448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Radiation exposure is a significant hazard associated with invasive Cardiology, with most studies based on primary operator exposure. This prospective, observational study aimed to find out over lead radiation exposure as effective dose acquired by non-physician staff comprising scrub technicians and rotating staff in the cath laboratory. Effective dose (ED) measured per procedure via Raysafe i2®dosimeter badges worn by both rotating staff and scrub technicians over lead aprons along with dose area product (DAP), fluoroscopy time (FT) and procedure time (PT) in minutes was collected prospectively over forty-six invasive Cardiology procedures. RESULTS This study shows that rotating staff acquire higher ED in comparison with their scrub technician colleagues in diagnostic, interventional and electrophysiology cases. However, a statistically significant difference in radiation exposure of both staff groups was demonstrated in diagnostic and interventional Cardiology procedures, with p values of 0.04 and 0.01, respectively. CONCLUSIONS These findings highlight occupational role and mobility around fluoroscopic sources as major factors in radiation exposure, which should be addressed within current radiation protection practices.
Collapse
Affiliation(s)
- Muhammad Nasir Rahman
- 1Department of Medicine, Section of Cardiology, Aga Khan University Hospital, National Stadium Road, Karachi, Pakistan.
| | - Maleeha Javed
- Aga Khan University Hospital, National Stadium road, Karachi, Sindh, Pakistan
| | - Ghufran Adnan
- Wazirabad Institute of Cardiology, Wazirabad, Pakistan
| | - Maria Khan
- Wazirabad Institute of Cardiology, Wazirabad, Pakistan
| | - Zeenat Nizar
- Section of Cardiology, Department of Medicine, Aga Khan University Hospital, National Stadium Road, Karachi, Pakistan
| | - Izat Shah
- Section of Cardiology, Department of Medicine, Aga Khan University Hospital, National Stadium Road, Karachi, Pakistan
| |
Collapse
|
20
|
Ulanowski A, Ban N, Ozasa K, Rühm W, Semones E, Shavers M, Vaillant L. Time-integrated radiation risk metrics and interpopulation variability of survival. Z Med Phys 2024; 34:64-82. [PMID: 37669888 PMCID: PMC10919971 DOI: 10.1016/j.zemedi.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
Task Group 115 of the International Commission on Radiological Protection is focusing on mission-related exposures to space radiation and concomitant health risks for space crew members including, among others, risk of cancer development. Uncertainties in cumulative radiation risk estimates come from the stochastic nature of the considered health outcome (i.e., cancer), uncertainties of statistical inference and model parameters, unknown secular trends used for projections of population statistics and unknown variability of survival properties between individuals or population groups. The variability of survival is usually ignored when dealing with large groups, which can be assumed well represented by the statistical data for the contemporary general population, either in a specific country or world averaged. Space crew members differ in many aspects from individuals represented by the general population, including, for example, their lifestyle and health status, nutrition, medical care, training and education. The individuality of response to radiation and lifespan is explored in this modelling study. Task Group 115 is currently evaluating applicability and robustness of various risk metrics for quantification of radiation-attributed risks of cancer for space crew members. This paper demonstrates the impact of interpopulation variability of survival curves on values and uncertainty of the estimates of the time-integrated radiation risk of cancer.
Collapse
Affiliation(s)
- Alexander Ulanowski
- International Atomic Energy Agency, IAEA Laboratories, Friedensstrasse 1, A-2444 Seibersdorf, Austria.
| | - Nobuhiko Ban
- Nuclear Regulation Authority, 1-9-9 Roppongi, Minato-ku, Tokyo 106-8450, Japan
| | - Kotaro Ozasa
- Health Management Center, Kyoto Prefectural University of Medicine, Kyoto 602-8566 Japan
| | - Werner Rühm
- Federal Office for Radiation Protection, Ingolstädter Landstraße 1, 85764 Oberschleißheim, Germany
| | - Edward Semones
- NASA Space Radiation Analysis Group, Johnson Space Center, Houston, TX, USA
| | - Mark Shavers
- KBR Human Health and Performance, NASA Johnson Space Center, Houston, TX, USA
| | - Ludovic Vaillant
- Centre d'étude sur l'Evaluation de la Protection dans le domaine Nucléaire, 28 rue de la Redoute, 92260 Fontenay aux Roses, France
| |
Collapse
|
21
|
McAleese T, Price A, Ryan AG, Rowan FE. A standardised communication tool reduces radiation exposure associated with intraoperative fluoroscopy. Ir J Med Sci 2024; 193:257-263. [PMID: 37450259 PMCID: PMC10808702 DOI: 10.1007/s11845-023-03442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The widespread use of intraoperative fluoroscopy in orthopaedic procedures has revolutionised surgical practice. However, there are risks associated with using ionising radiation. Efforts to reduce radiation exposure include low-dose imaging protocols and lead protective equipment. Current communication during fluoroscopic procedures can be inefficient and lead to excessive radiation exposure for patients and staff. AIMS This study aims to implement a communication tool with standardised commands to reduce radiation exposure in an Irish orthopaedic department. METHODS Radiation exposure was evaluated using dose-area product (DAP) measured in uGy/m2. A control group was recorded before implementing the communication tool. Training sessions were conducted and posters of the standardised commands were displayed. Feedback was collected from surgeons and radiographers via surveys. Statistical analysis was performed to compare pre- and post-intervention groups. RESULTS A total of 673 surgical cases were included over 6 months. The post-intervention group showed a mean reduction in radiation exposure from 59.8 to 36.4 uGy/m2 (p < 0.011). Subset analyses revealed reduced radiation exposure for ORIF of the distal radius, ankle, humerus, and phalanges. Surgeons and radiographers recognised the need for improved communication and expressed willingness to learn the new tool. CONCLUSIONS Implementation of a standardised communication tool effectively reduced patient and staff radiation exposure. It was also believed to have a positive effect on theatre staff morale. Incorporating a universal language tool into training programmes could be beneficial. Surgeons and radiographers provided several suggestions to improve the effectiveness and implementation of this tool into other units.
Collapse
Affiliation(s)
- Timothy McAleese
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, X91ER8E, Ireland.
| | - Alexander Price
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, X91ER8E, Ireland
| | - Anthony G Ryan
- Department of Radiology, University Hospital Waterford, Waterford, X91ER8E, Ireland
| | - Fiachra E Rowan
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, X91ER8E, Ireland
| |
Collapse
|
22
|
Slongo T, Stranzinger E. [Imaging in pediatric traumatology and orthopedics]. Oper Orthop Traumatol 2024; 36:56-72. [PMID: 38319324 PMCID: PMC10861404 DOI: 10.1007/s00064-023-00839-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 02/07/2024]
Abstract
Conventional or digital radiography is still the basis of imaging diagnostics of the skeletal system in pediatric patients. It is considered the gold standard for diagnosis, treatment selection, and follow-up. In addition, procedures such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and also nuclear medicine techniques can and should be used. It is advantageous to use trained radiology technicians who are familiar with the handling of children in X‑ray diagnostics. If there is no dedicated pediatric radiology department, it is recommended to follow the guidelines from radiology societies (as low as reasonably achievable [ALARA]) and radiation protection commissions. The present article describes how state-of-the-art tools such as dose monitoring systems and software-controlled image processing and also postprocessing can be used. The article provides information on how the various modalities can be optimally used in order to achieve the best result, i.e., diagnosis, with the least possible effort and burden for the child.
Collapse
Affiliation(s)
- Theddy Slongo
- Kinderorthopädie / Kindertraumatologie, Medizinbereich Kinder und Jugendliche, Universitätsklinik für Kinderchirurgie, Juli-von-Jenner-Haus, Freiburgstr. 15, 3010, Bern, Schweiz.
| | - Enno Stranzinger
- Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie (DIPR), Inselspital, Universitätsspital Bern, Anna-Seiler-Haus, Freiburgstr. 20, 3010, Bern, Schweiz
| |
Collapse
|
23
|
Alvandi M, Narimani Javid R, Shaghaghi Z, Farzipour S, Nosrati S. An In-depth Analysis of the Adverse Effects of Ionizing Radiation Exposure on Cardiac Catheterization Staffs. Curr Radiopharm 2024; 17:CRP-EPUB-137931. [PMID: 38314600 DOI: 10.2174/0118744710283181231229112417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
Diagnostic and interventional angiograms are instrumental in the multidisciplinary approach to CAD management, enabling accurate diagnosis and effective targeted treatments that significantly enhance patient care and cardiovascular outcomes. However, cath lab staff, including interventional cardiologists, is consistently exposed to ionizing radiation, which poses inherent health risks. Radiation exposure in the cath lab primarily results from the use of fluoroscopy and cineangiography during diagnostic and interventional procedures. Understanding these risks and implementing effective radiation protection measurements are imperative to ensure the well-being of healthcare professionals while delivering high-quality cardiac care. Prolonged and repeated exposure can lead to both deterministic and stochastic effects. Deterministic effects, such as skin erythema and tissue damage, are more likely to occur at high radiation doses. Interventional cardiologists and staff may experience these effects when safety measures are not rigorously followed. In fact, while ionizing radiation is essential in the practice of radiation cardiology ward, cath lab staff faces inherent risks from radiation exposure. Stochastic effects, on the other hand, are characterized by a probabilistic relationship between radiation exposure and the likelihood of harm. These effects include the increased risk of cancer, particularly for those with long-term exposure. Interventional cardiologists, due to their frequent presence in the cath lab, face a higher lifetime cumulative radiation dose, potentially elevating their cancer risk. Protective measures, including the use of lead aprons, thyroid shields, and radiation monitoring devices, play a crucial role in reducing radiation exposure for cath lab personnel. Adherence to strict dose optimization protocols, such as minimizing fluoroscopy time and maximizing distance from the radiation source, is also essential in mitigating these risks. Ongoing research and advancements in radiation safety technology are essential in further for minimizing the adverse effects of ionizing radiation in the cath lab.
Collapse
Affiliation(s)
- Maryam Alvandi
- Cardiovascular Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Zahra Shaghaghi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Sahar Nosrati
- Institute of Nuclear Chemistry and Technology, Dorodna 16 Str, 03-195, Warsaw, Poland
| |
Collapse
|
24
|
Striano BM, Crawford AM, Verhofste BP, Hresko AM, Hedequist DJ, Schoenfeld AJ, Simpson AK. Intraoperative navigation increases the projected lifetime cancer risk in patients undergoing surgery for adolescent idiopathic scoliosis. Spine J 2024:S1529-9430(24)00018-4. [PMID: 38262498 DOI: 10.1016/j.spinee.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) is a common condition, often requiring surgical correction. Computed tomography (CT) based navigation technologies, which rely on ionizing radiation, are increasingly being utilized for surgical treatment. Although this population is highly vulnerable to radiation, given their age and female predominance, there is little available information elucidating modeled iatrogenic cancer risk. PURPOSE To model lifetime cancer risk associated with the use of intraoperative CT-based navigation for surgical treatment of AIS. STUDY DESIGN/SETTING This retrospective cross-sectional study took place in a quaternary care academic pediatric hospital in the United States. PATIENT SAMPLE Adolescents aged 10-18 who underwent posterior spinal fusion for a diagnosis of AIS between July 2014 and December 2019. OUTCOMES MEASURES Effective radiation dose and projected lifetime cancer risk associated with intraoperative doses of ionizing radiation. METHODS Clinical and radiographic parameters were abstracted, including total radiation dose during surgery from flat plate radiographs, fluoroscopy, and intraoperative CT scans. Multivariable regression analysis was used to assess differences in radiation exposure between patients treated with conventional radiography versus intraoperative navigation. Radiation exposure was translated into lifetime cancer risk using well-established algorithms. RESULTS In total, 245 patients were included, 119 of whom were treated with navigation. The cohort was 82.9% female and 14.4 years of age. The median radiation exposure (in millisieverts, mSv) for fluoroscopy, radiography, and navigation was 0.05, 4.14, and 8.19 mSv, respectively. When accounting for clinical and radiographic differences, patients treated with intraoperative navigation received 8.18 mSv more radiation (95%CI: 7.22-9.15, p<.001). This increase in radiation projects to 0.90 iatrogenic malignancies per 1,000 patients (95%CI 0.79-1.01). CONCLUSIONS Ours is the first work to define cancer risk in the setting of radiation exposure for navigated AIS surgery. We project that intraoperative navigation will generate approximately one iatrogenic malignancy for every 1,000 patients treated. Given that spine surgery for AIS is common and occurs in the context of a multitude of other radiation sources, these data highlight the need for radiation budgeting protocols and continued development of lower radiation dose technologies. LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Bram P Verhofste
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Andrew M Hresko
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
25
|
Chen R, Joo EH, Baas C, Hartman J, Amasyali AS, Shete K, Belle JD, Ritchie C, Baldwin EA, Okhunov Z, Farkouh A, Baldwin DD. Reducing hand radiation during renal access for percutaneous nephrolithotomy: a comparison of radiation reduction techniques. Urolithiasis 2024; 52:27. [PMID: 38217570 PMCID: PMC10787896 DOI: 10.1007/s00240-023-01510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/16/2023] [Indexed: 01/15/2024]
Abstract
Percutaneous nephrolithotomy confers the highest radiation to the urologist's hands compared to other urologic procedures. This study compares radiation exposure to the surgeon's hand and patient's body when utilizing three different techniques for needle insertion during renal access. Simulated percutaneous renal access was performed using a cadaveric patient and separate cadaveric forearm representing the surgeon's hand. Three different needle-holding techniques were compared: conventional glove (control), a radiation-attenuating glove, and a novel needle holder. Five 300-s fluoroscopy trials were performed per treatment arm. The primary outcome was radiation dose (mSv) to the surgeon's hand. The secondary outcome was radiation dose to the patient. One-way ANOVA and Tukey's B post-hoc tests were performed with p < 0.05 considered significant. Compared to the control (3.92 mSv), both the radiation-attenuating glove (2.48 mSv) and the needle holder (1.37 mSv) reduced hand radiation exposure (p < 0.001). The needle holder reduced hand radiation compared to the radiation-attenuating glove (p < 0.001). The radiation-attenuating glove resulted in greater radiation produced by the C-arm compared to the needle holder (83.49 vs 69.22 mGy; p = 0.019). Patient radiation exposure was significantly higher with the radiation-attenuating glove compared to the needle holder (8.43 vs 7.03 mSv; p = 0.027). Though radiation-attenuating gloves decreased hand radiation dose by 37%, this came at the price of a 3% increase in patient exposure. In contrast, the needle holder reduced exposure to both the surgeon's hand by 65% and the patient by 14%. Thus, a well-designed low-density needle holder could optimize radiation safety for both surgeon and patient.
Collapse
Affiliation(s)
- Ricky Chen
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Eun Hye Joo
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Catalina Baas
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - John Hartman
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Kanha Shete
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Joshua D Belle
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Cayde Ritchie
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Elizabeth A Baldwin
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Zhamshid Okhunov
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Ala'a Farkouh
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA.
| |
Collapse
|
26
|
Fragoso Costa P, Shi K, Holm S, Vidal-Sicart S, Kracmerova T, Tosi G, Grimm J, Visvikis D, Knapp WH, Gnanasegaran G, van Leeuwen FWB. Surgical radioguidance with beta-emitting radionuclides; challenges and possibilities: A position paper by the EANM. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-023-06560-2. [PMID: 38189911 DOI: 10.1007/s00259-023-06560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
Radioguidance that makes use of β-emitting radionuclides is gaining in popularity and could have potential to strengthen the range of existing radioguidance techniques. While there is a strong tendency to develop new PET radiotracers, due to favorable imaging characteristics and the success of theranostics research, there are practical challenges that need to be overcome when considering use of β-emitters for surgical radioguidance. In this position paper, the EANM identifies the possibilities and challenges that relate to the successful implementation of β-emitters in surgical guidance, covering aspects related to instrumentation, radiation protection, and modes of implementation.
Collapse
Affiliation(s)
- Pedro Fragoso Costa
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Essen, Germany.
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Computer Aided Medical Procedures and Augmented Reality, Institute of Informatics I16, Technical University of Munich, Munich, Germany
| | - Soren Holm
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Tereza Kracmerova
- Department of Medical Physics, Motol University Hospital, Prague, Czech Republic
| | - Giovanni Tosi
- Department of Medical Physics, Ospedale U. Parini, Aosta, Italy
| | - Jan Grimm
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Wolfram H Knapp
- Department of Nuclear Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gopinath Gnanasegaran
- Institute of Nuclear Medicine, University College London Hospital, Tower 5, 235 Euston Road, London, NW1 2BU, UK
- Royal Free London NHS Foundation Trust Hospital, London, UK
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
27
|
Li X, Yang K, Marschall TA, Rehani MM, Liu B. Neurointerventions on two generations of angiography systems: Recent systems reduce radiation exposure by half. Phys Med 2024; 117:103180. [PMID: 38042063 DOI: 10.1016/j.ejmp.2023.103180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/05/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023] Open
Abstract
PURPOSE Fluoroscopically-guided neurointervention may be associated with prolonged procedure time and substantial radiation exposure to the patient and staff. This study sought to examine technological features affecting the potential radiation exposure reduction of new angiography systems, compared to older systems, for neurointerventional procedures. METHODS Consecutive neurointerventional patients (2020-2022) were retrospectively analyzed. The air kerma at the reference point (Ka,r) and kerma-area product (KAP) were compared between Artis icono and Artis zee (Siemens) using statistical analyses (two-tailed t tests), where P < 0.05 is considered significant. X-ray tube potential and copper filtration were examined. Tests with an anthropomorphic phantom (Sun Nuclear) on Artis icono were conducted and entrance skin exposure and x-ray spectral half value layer were measured. Effective spectral filtration was characterized by x-ray spectral modeling. RESULTS The number of procedures was 1158 [median (range) age, 59 (7-95) years] on Artis zee and 1087 [60 (1-95) years] on Artis icono, without significant difference in age (p = 0.059) between cohorts. Ka,r was 925.4 (890.6-960.1) mGy [mean (95 % CI)] and KAP was 119.8 (115-124.5) Gy∙cm2 on Artis zee. The measures were 48-50 % lower on Artis icono, 440.5 (411.7-469.4) mGy (Ka,r) and 59.5 (55.4-63.6) Gy∙cm2 (KAP); while the difference in fluoroscopic time between the two generations of angiography systems was insignificant (p = 0.55). CONCLUSIONS The newer angiography system, with updated hardware and software, was found to result in half the radiation exposure compared to older technology of the same manufacturer, even though fluoroscopic time was similar.
Collapse
Affiliation(s)
- Xinhua Li
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Kai Yang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Theodore A Marschall
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Bob Liu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
28
|
Kammer B, Stahl R, Seidenbusch MC, Schneider KO. [Voiding cystourethrography : Indications, fluoroscopy technique and radiation protection]. Radiologie (Heidelb) 2024; 64:54-64. [PMID: 38155326 DOI: 10.1007/s00117-023-01256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Voiding cystourethrography continues to be the gold standard in the diagnostics of a wide range of diseases of the urinary tract in children. MATERIAL AND METHODS Indications, implementation of voiding cystourethrography in terms of preparation, materials used, dealing with the child and the parents as well as the standardized examination technique are presented. In particular, the technical aspects of fluoroscopy devices and criteria for good image quality are discussed. Case studies are used to illustrate the problems of frequent urological diseases. DISCUSSION The three standard examinations for the detection of vesicoureteral reflux (VUR), radionuclide cystography, contrast-enhanced voiding urosonography and voiding cystourethrography are compared. Their potential for detecting VUR and additional urological pathologies is discussed in detail. Furthermore, the optimized examination technique of voiding cystourethrography is presented. The applicability of the current dose reference values of the German Federal Office for Radiation Protection (BfS) in the daily routine is discussed and the feasibility of the dose reference values is explained.
Collapse
Affiliation(s)
- B Kammer
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Lindwurmstr. 4, 80337, München, Deutschland.
| | - R Stahl
- Institut für Diagnostische und Interventionelle Neuroradiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | | | - K O Schneider
- Medizinische Fakultät der LMU München, 80336, München, Deutschland
| |
Collapse
|
29
|
Inami K, Tsutsumi S, Hashizume A, Yoshida K, Sugiyama N, Ueno H, Ishii H. De novo meningiomas and cavernous malformations developing after coil embolization for dural arteriovenous fistula. Radiol Case Rep 2024; 19:172-177. [PMID: 37954678 PMCID: PMC10637871 DOI: 10.1016/j.radcr.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023] Open
Abstract
A 25-year-old woman presented with exophthalmos. With the diagnosis of dural arteriovenous fistula of the transverse sinus, the patient underwent coil embolization. Fifteen years later, she sustained visual disturbance due to de novo tuberculum sellae meningioma that was resected. Surveillance magnetic resonance imaging (MRI) performed at the age of 42 years detected tumor recurrence and small, apparent meningioma in the cerebral convexity. The patient underwent the second tumor resection at the age of 46 years. The histological appearance was consistent with meningothelial meningioma. In addition, surveillance MRI at the age of 43 years detected de novo cerebral and cerebellar cavernous malformations (CMs). These CMs showed repeat hemorrhages on MRI but remained asymptomatic during the next 38 months. De novo meningiomas and CMs may develop in association with radiation exposure during endovascular therapy. Sufficiently long-term follow-up is recommended after endovascular therapy for monitoring secondary pathologies.
Collapse
Affiliation(s)
- Kasumi Inami
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akane Hashizume
- Department of Pathology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Kohei Yoshida
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Natsuki Sugiyama
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hideaki Ueno
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| |
Collapse
|
30
|
Demircioğlu A, Bos D, Demircioğlu E, Qaadan S, Glasmachers T, Bruder O, Umutlu L, Nassenstein K. Deep learning-based scan range optimization can reduce radiation exposure in coronary CT angiography. Eur Radiol 2024; 34:411-421. [PMID: 37552254 DOI: 10.1007/s00330-023-09971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/24/2023] [Accepted: 05/28/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Cardiac computed tomography (CT) is essential in diagnosing coronary heart disease. However, a disadvantage is the associated radiation exposure to the patient which depends in part on the scan range. This study aimed to develop a deep neural network to optimize the delimitation of scan ranges in CT localizers to reduce the radiation dose. METHODS On a retrospective training cohort of 1507 CT localizers randomly selected from calcium scoring and angiography scans and acquired between 2010 and 2017, optimized scan ranges were delimited by two radiologists in consensus. A neural network was trained to reproduce the scan ranges and was tested on two randomly selected and independent validation cohorts: an internal cohort of 233 CT localizers (January 2018-June 2020) and an external cohort from a nearby hospital of 298 CT localizers (July 2020-December 2020). Localizers where a bypass surgery was visible were excluded. The effective radiation dose to the patient was simulated using a Monte Carlo simulation. Scan ranges of radiographers, radiologists, and the network were compared using an equivalence test; likewise, the reduction in effective dose was tested using a superior test. RESULTS The network replicated the radiologists' scan ranges with a Dice score of 96.5 ± 0.02 (p < 0.001, indicating equivalence). The generated scan ranges resulted in an effective dose reduction of 10.0% (p = 0.002) in the internal cohort and 12.6% (p < 0.001) in the external cohort compared to the scan ranges delimited by radiographers in clinical routine. CONCLUSIONS Automatic delimitation of the scan range can result in a radiation dose reduction to the patient. CLINICAL RELEVANCE STATEMENT Fully automated delimitation of the scan range using a deep neural network enables a significant reduction in radiation exposure during CT coronary angiography compared to manual examination planning. It can also reduce the workload of the radiographers. KEY POINTS • Scan range delimitation for coronary computed tomography angiography could be performed with high accuracy by a deep neural network. • Automated scan ranges showed a high agreement of 96.5% with the scan ranges of radiologists. • Using a Monte Carlo simulation, automated scan ranges reduced the effective dose to the patient by up to 12.6% (0.9 mSv) compared to the scan ranges of radiographers in clinical routine.
Collapse
Affiliation(s)
- Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ender Demircioğlu
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, 45147, Essen, Germany
| | - Sahar Qaadan
- Department of Mechatronics and Artificial Intelligence Engineering, German Jordanian University, Madaba, JO-11180, Jordan
| | - Tobias Glasmachers
- Faculty of Computer Science, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, 45138, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| |
Collapse
|
31
|
Popic JM, Urso L, Michalik B. Assessing the exposure situations with naturally occurring radioactive materials across European countries by means of the e-NORM survey. Sci Total Environ 2023; 905:167065. [PMID: 37714339 DOI: 10.1016/j.scitotenv.2023.167065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023]
Abstract
Despite the EU states being under the umbrella of the European Directive 2013/59/Euratom, a certain degree of heterogeneity may be noticed in the implementation of EU recommendations concerning regulation and handling of NORM into national legislation and practice. This is mainly a result of the still existing incomplete international knowledge about different phenomena related to NORM. Therefore, the attempt to advance the understanding of the behaviour and exposure of NORM is at the core of the European RadoNorm project. Within this context, an international survey on NORM has been prepared. The goals of the survey were to gather information and data from European countries that will contribute making an updated and/or new (a) systematic overview of NORM exposure situations and their analysis with respect to different radiation protection aspects, (b) knowledge about applied radioecological models in a variety of NORM exposure situations to improve evaluation of possible exposure doses and risk for population and workers, as well as of environmental risk, and (c) overview of overall mitigation measures applied in NORM involving industries, and possible remediation activities applied at NORM affected legacy sites. The survey is built upon an extended list of NORM-involving industries and processes, covers general aspects of NORM, presence of multi-stressors, as well as practical procedures applied in management and regulation, also in the context of a circular economy. The survey responses were obtained from 19 countries. An analysis of survey responses proved that NORM control is still a complex issue for many countries, and the recently-introduced regulatory solutions require further interpretation for developing procedures and good practices. The present work provides a detailed analysis of the survey responses with respect to regulation, management and investigation of NORM.
Collapse
Affiliation(s)
- Jelena Mrdakovic Popic
- Norwegian Radiation and Nuclear Safety Authority (DSA), Grini Næringspark 13, 1861 Østerås, Norway.
| | - Laura Urso
- German Federal Office for Radiation Protection (BfS), Ingolstaedter Landstr. 1, 85764 Oberschleissheim, Germany
| | - Boguslaw Michalik
- Silesian Centre for Environmental Radioactivity, Central Mining Institute (GIG), Plac Gwarków 1, 4-166 Katowice, Poland
| |
Collapse
|
32
|
Lokesh, Jana M, Naranje P, Bhalla AS, Kabra SK, Hadda V, Gupta AK. MDCT and MRI in Bronchiectasis in Older Children and Young Adults - A Non-Inferiority Trial. Indian J Pediatr 2023:10.1007/s12098-023-04921-1. [PMID: 38051445 DOI: 10.1007/s12098-023-04921-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES To compare and evaluate the usefulness of magnetic resonance imaging (MRI) with computed tomography (CT) in bronchiectasis; to compare MRI and CT scores with pulmonary function tests (PFT) and to evaluate the role of Diffusion-weighted imaging (DWI) in bronchiectasis. METHODS In this prospective study, 25 patients between 7-21 y of age with a clinical/radiological diagnosis of bronchiectasis underwent MDCT and MRI chest. MRI and CT scoring was performed using modified Bhalla-Helbich's score by two independent radiologists for all parameters. A final consensus score was recorded. The overall image quality of different MRI sequences to identify pathologies was also assessed. Appropriate statistical tests were used for inter-observer agreements, and correlation amongst CT and MRI; as well as CT, MRI and PFT. RESULTS Strong agreement (ICC 0.80-0.95) between CT and MRI was seen for extent and severity of bronchiectasis, number of bullae, sacculation/abscess, emphysema, collapse/ consolidation, mucus plugging, and mosaic perfusion. Overall CT and MRI scores had perfect concordance (ICC 0.978). Statistically significant (p-value <0.01) intra-observer and inter-observer agreement for all CT and MRI score parameters were seen. A strong negative correlation was seen between total CT and MRI severity scores and forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow (FEF) 25-75%. DWI MR, with an apparent diffusion coefficient (ADC) cut-off of 1.62 × 10-3 mm3/s had a sensitivity of 70% and specificity of 75% in detecting true mucus plugs. CONCLUSIONS MRI with DWI can be considered as a radiation-free alternative in the diagnostic algorithm for assessment of lung changes in bronchiectasis, especially in follow-up.
Collapse
Affiliation(s)
- Lokesh
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sushil K Kabra
- Department of Pediatric Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Vijay Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Arun Kumar Gupta
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| |
Collapse
|
33
|
Pannenbecker P, Huflage H, Grunz JP, Gruschwitz P, Patzer TS, Weng AM, Heidenreich JF, Bley TA, Petritsch B. Photon-counting CT for diagnosis of acute pulmonary embolism: potential for contrast medium and radiation dose reduction. Eur Radiol 2023; 33:7830-7839. [PMID: 37311805 PMCID: PMC10598187 DOI: 10.1007/s00330-023-09777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the image quality of an ultra-low contrast medium and radiation dose CT pulmonary angiography (CTPA) protocol for the diagnosis of acute pulmonary embolism using a clinical photon-counting detector (PCD) CT system and compare its performance to a dual-energy-(DE)-CTPA protocol on a conventional energy-integrating detector (EID) CT system. METHODS Sixty-four patients either underwent CTPA with the novel scan protocol on the PCD-CT scanner (32 patients, 25 mL, CTDIvol 2.5 mGy·cm) or conventional DE-CTPA on a third-generation dual-source EID-CT (32 patients, 50 mL, CTDIvol 5.1 mGy·cm). Pulmonary artery CT attenuation, signal-to-noise ratio, and contrast-to-noise-ratio were assessed as objective criteria of image quality, while subjective ratings of four radiologists were compared at 60 keV using virtual monoenergetic imaging and polychromatic standard reconstructions. Interrater reliability was determined by means of the intraclass correlation coefficient (ICC). Effective dose was compared between patient cohorts. RESULTS Subjective image quality was deemed superior by all four reviewers for 60-keV PCD scans (excellent or good ratings in 93.8% of PCD vs. 84.4% of 60 keV EID scans, ICC = 0.72). No examinations on either system were considered "non-diagnostic." Objective image quality parameters were significantly higher in the EID group (mostly p < 0.001), both in the polychromatic reconstructions and at 60 keV. The ED (1.4 vs. 3.3 mSv) was significantly lower in the PCD cohort (p < 0.001). CONCLUSIONS PCD-CTPA allows for considerable reduction of contrast medium and radiation dose in the diagnosis of acute pulmonary embolism, while maintaining good to excellent image quality compared to conventional EID-CTPA. CLINICAL RELEVANCE STATEMENT Clinical PCD-CT allows for spectral assessment of pulmonary vasculature with high scan speed, which is beneficial in patients with suspected pulmonary embolism, frequently presenting with dyspnea. Simultaneously PCD-CT enables substantial reduction of contrast medium and radiation dose. KEY POINTS • The clinical photon-counting detector CT scanner used in this study allows for high-pitch multi-energy acquisitions. • Photon-counting computed tomography allows for considerable reduction of contrast medium and radiation dose in the diagnosis of acute pulmonary embolism. • Subjective image quality was rated best for 60-keV photon-counting scans.
Collapse
Affiliation(s)
- Pauline Pannenbecker
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany.
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Theresa S Patzer
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany
| |
Collapse
|
34
|
Grünwald L, Histing T, Springer F, Keller G. MRI-based torsion measurement of the lower limb is a reliable and valid alternative for CT measurement: a prospective study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4903-4909. [PMID: 37589766 PMCID: PMC10598136 DOI: 10.1007/s00167-023-07533-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The aim of this study was to compare MRI-based torsion measurements of the lower limb to a well-established CT-based assessment in a prospective inter- and intraindividual approach. METHODS A total of 26 patients (age 28.8 years ± 11.0) were enrolled beginning in January 2021 until August 2022. Inclusion criteria were the clinical indication for torsion measurement of the lower limb. CT and MRI imaging were performed with a standard operating procedure, to ensure that all patients were examined in a standardized position. The examinations were planned on a coronal scout view based on prominent anatomical landmarks. Femoral and tibial torsion were measured individually. Torsion measurements were analysed twice: immediately after examination and after 3 weeks. Subsequently, intra-rater and parallel test reliability was calculated accordingly. RESULTS High significant results for CT and MRI measurements for both tibia (MRI: r = 0.961; p ≤ 0.001; CT: r = 0.963; p ≤ 0.001) and femur (MRI: r = 0.980; p ≤ 0.001; CT: r = 0.979; p ≤ 0.001) were obtained by calculated intra-rater reliability, showing that measurements were highly consistent for MRI and CT, respectively. Parallel test reliability for time point 1 as well as time point 2 was also highly significant and ranged from r = 0.947 to r = 0.972 (all with p ≤ 0.001, respectively) for both tibia and femur, showing a high concordance between the two measurements. CONCLUSION Measurement of tibial as well as femoral torsion was comparable for CT and MRI measurement. Therefore, this study supports MRI measurement as an equivalent alternative for CT measurement concerning torsional malalignment to reduce exposure to radiation. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Leonard Grünwald
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076, Tübingen, Germany.
| | - Tina Histing
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076, Tübingen, Germany
| | - Fabian Springer
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Gabriel Keller
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| |
Collapse
|
35
|
Zhai X, Li B, Chen K, Chen Z, Shao J, Chen K, Xu Q, Meng D, Fei Q, Jiang L, Bai Y, Li M. Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review. Orthop Surg 2023; 15:2872-2880. [PMID: 37735987 PMCID: PMC10622289 DOI: 10.1111/os.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Improving accuracy and safety of pedicle screw placement is of great clinical importance. Electronic conductivity device (ECD) can be a promising technique with features of affordability, portability, and real-time detection capabilities. This study aimed to validate the safety and effectiveness of a modified ECD. METHODS The ECD underwent a modification where six lamps of various colors, and it was utilized in a prospectively multicenter randomized controlled clinical trial involving 96 patients across three hospitals from June 2018 to December 2018. The trial incorporated a self-control randomization with an equal distribution of left or right side of vertebral pedicle among two groups: the free-hand group and the ECD group. A total of 496 pedicle screws were inserted, with 248 inserted in each group. The primary outcomes focused on the accuracy of pedicle screw placement and the frequency of intraoperative X-rays. Meanwhile, the secondary indicator measured the time required for pedicle screw placement. Results were presented as means ± SD. Paired samples t-test and χ2 -test were used for comparison. Furthermore, an updated review was conducted, which included studies published from 2006 onwards. RESULTS Baseline patient characteristics were recorded. The primary accuracy outcome revealed a 96.77% accuracy rate in the ECD group, compared to a 95.16% accuracy rate in the free-hand group, with no significant differences noted. In contrast, ECD demonstrated a significant reduction in radiation exposure frequency when compared to the free-hand group (1.11 ± 0.32 vs. 1.30 ± 0.53; p < 0.001), resulting in a 14.6% reduction. Moreover, ECD displayed a decrease of 30.38% in insertion time (70.88 ± 30.51 vs. 101.82 ± 54.00 s; p < 0.001). According to the results of the 21 studies, ECD has been utilized in various areas of the spine such as the atlas, thoracic and lumbar spine, as well as sacral 2-alar-iliac. The accuracy of ECD ranged from 85% to 100%. CONCLUSION The prospectively randomized trial and the review indicate that the use of ECD presents a secure and precise approach to the placement of pedicle screws, with the added benefit of reducing both procedure time and radiation exposure.
Collapse
Affiliation(s)
- Xiao Zhai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Bo Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ziqiang Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Jie Shao
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Qintong Xu
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Dehua Meng
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Qinming Fei
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Leisheng Jiang
- Spine Center, Xinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yushu Bai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ming Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| |
Collapse
|
36
|
Amir I, Eguchi Y, Saotome K, Ogawa S, Kojima Y, Tamaki T, Tsubokura M. The "GU-GU-RU" project to eliminate discrimination related to the health effects of the Fukushima nuclear accident. BMC Public Health 2023; 23:2050. [PMID: 37858066 PMCID: PMC10588131 DOI: 10.1186/s12889-023-16883-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Although 12 years have passed since Great East Japan Earthquake and following Fukushima nuclear accident, approximately 40% of Japanese citizen still believe that the current radiation exposure in Fukushima residents will likely/ very likely to cause genetic effects of radiation. This incorrect understanding could continue unexpected discrimination and prejudice towards those from Fukushima now and in the future. In order to provide updated knowledge and eliminate rumors related to radiation, Japanese Ministry of the Environment has launched "GU-GU-RU" project in 2021 with consisting of five sections. OBJECTIVE (1) To discuss the objectives and effects of the "GU-GU-RU" project (results after the first year), (2) to present administrative measures that may be effective in the long-term to prevent unjustified discrimination and prejudice, and (3) to eliminate rumors in the event of future large-scale disasters, including radiation disasters. METHODS We showed the contents of each sections carried out under the project and observed the result of first-year activities in each section. RESULTS Among the programs, the "Radiation College" has steadily produced positive results, with nearly 1,300 students participating and 50 students sharing their thoughts and ideas. In addition, the project has adopted strategies such as creating and broadcasting a TV program and collaborations with manga, which are expected to have a significant impact on society. CONCLUSIONS Compared to previous efforts on disseminating information related to health effect of radiation exposure, the "GU-GU-RU" project has taken a different approach in providing primary data of radiation and its health effects, which could become a better understanding of health effects of radiation for the general public, in order to eliminate rumors that may lead unjustified discrimination and prejudice.
Collapse
Affiliation(s)
- Isamu Amir
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima-city, 960-1295, Fukushima, Japan.
| | - Yuichiro Eguchi
- Loco-Medical General Institute, 1178-1 Kanada, Mikatsuki-cho, Ogi-city, 845-0032, Saga, Japan
| | - Kousaku Saotome
- Department of Radiological Sciences, Fukushima Medical University School of Health Sciences, 10-6 Sakae-machi, 960-8516, Fukushima-city, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima-city, 960-1295, Fukushima, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima-city, 960-1295, Fukushima, Japan
| | - Tomoaki Tamaki
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima-city, 960-1295, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima-city, 960-1295, Fukushima, Japan
| |
Collapse
|
37
|
Nouchi S, Yoshida H, Miki Y, Tezuka Y, Ogawa R, Ogura I. Accuracy of non-contact semiconductor X-ray analyzer for quality assurance in intraoral radiography: a comparison with ionization chamber dosimeter. Oral Radiol 2023; 39:766-770. [PMID: 37318742 DOI: 10.1007/s11282-023-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/09/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The aim of the present study was to evaluate the accuracy of a non-contact semiconductor X-ray analyzer for quality assurance in intraoral radiography, especially a comparison with an ionization chamber dosimeter. METHODS Intraoral radiography was performed with intraoral X-ray unit using the dental protocol at our hospital: tube voltage, 70 kV; tube current, 7 mA. Accuracy of dose and half-value layer (HVL) measurements was analyzed with a non-contact semiconductor X-ray analyzer and an ionization chamber dosimeter. Stability of the semiconductor sensor, effect of scattered radiation, and comparison of measured HVL between the ionization chamber and the semiconductor sensor were analyzed in this study. RESULTS The values with the semiconductor sensor were tube voltage: 70.3 ± 0.2 kVp (degree of variability: 0.28%), dose: 454.1 ± 12.3 μGy (degree of variability: 2.7%), and HVL: 1.91 ± 0.02 mmAl (degree of variability: 1.0%). With collimator, the dose with the semiconductor sensor and the ionization chamber decreased by 2.3 μ Gy and 5.2 μ Gy, respectively. The measured HVL of the semiconductor dosimeter was more than that of ionization chamber, and the semiconductor dosimeter was less than ionization chamber in variation of between without and with collimator. CONCLUSION This study indicated the accuracy of a non-contact semiconductor X-ray analyzer for quality assurance in intraoral radiography, especially a comparison with an ionization chamber dosimeter. The semiconductor sensor can be useful for quality assurance in intraoral radiography.
Collapse
Affiliation(s)
- Shun Nouchi
- Radiology, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-Cho, Chuo-Ku, Niigata, Niigata, 951-8580, Japan
| | - Hidenori Yoshida
- Department of Radiological Technology, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, Niigata, 950-3198, Japan
| | - Yusaku Miki
- Radiology, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-Cho, Chuo-Ku, Niigata, Niigata, 951-8580, Japan
| | - Yasuhito Tezuka
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-Cho, Chuo-Ku, Niigata, Niigata, 951-8580, Japan
| | - Ruri Ogawa
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-Cho, Chuo-Ku, Niigata, Niigata, 951-8580, Japan
| | - Ichiro Ogura
- Radiology, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-Cho, Chuo-Ku, Niigata, Niigata, 951-8580, Japan.
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-Cho, Chuo-Ku, Niigata, Niigata, 951-8580, Japan.
| |
Collapse
|
38
|
İğrek S, Şahbat Y, Akgülle AH, Erol B. Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques. Injury 2023; 54:110962. [PMID: 37544117 DOI: 10.1016/j.injury.2023.110962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION In the surgical treatment of supracondylar humeral fractures (SHF), the surgeon has to stand right next to the fluoroscopy device, so it is very important to know how to use it in the most appropriate way to reduce radiation exposure. The aim of this study was to investigate the effect of using C-arm in uniplanar (inverted) and biplanar (standard-horizontal) configurations on (1) the radiation exposure to the surgeon, and (2) surgical time and fluoroscopy exposure time. MATERIAL AND METHODS This prospective randomised study was conducted on 20 patients who underwent fluoroscopy during closed reduction and percutaneous pinning for a SHF. In the first configuration, the C-arm was inverted and the image intensifier was used as a surgical table. In the second configuration, the C-arm was used biplanar. The operations were performed by 5 surgeons, with each surgeon using each method only twice. During the operation, to find a value closed to direct radiation exposure measurement was made by attaching a dosimeter to the wrist and scatter radiation exposure was measured by attaching a dosimeter to the neck and waist of the surgeons. The operation time and fluoroscopy exposure time were determined. RESULTS The duration of operations performed with the biplanar C-arm position and the fluoroscopy exposure time in operations performed with the uniplanar method were found to be statistically significantly longer (p = 0.001). The measurements on the dosimeter worn on the neck of surgeons were found to be statistically significantly higher while using the uniplanar C-arm configuration (p = 0.001). There was no statistically significant difference between the dosimeter measurements on the wrists and waists of the surgeons and the C-arm configurations (p = 0.820; p = 0.185). CONCLUSIONS Although the use of biplanar C-arm has no effect on radiation exposure to the surgeon's wrist, the most important advantages are that the neck area is exposed to less radiation and it shortens the fluoroscopy time so the use of a biplanar C-arm can be recommended. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Servet İğrek
- Department of Orthopaedics and Traumatology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Şahbat
- Erzurum Regional Training and Research Hospital, Department of Orthopaedics and Traumatology, Erzurum, Turkey.
| | - Ahmet Hamdi Akgülle
- Department of Orthopaedics and Traumatology, Marmara University School of Medicine, Marmara University, Istanbul, Turkey
| | - Bülent Erol
- Department of Orthopaedics and Traumatology, Marmara University School of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
39
|
Laranjo Tinoco C, Coutinho A, Cardoso A, Araújo AS, Matos R, Anacleto S, Mota P. Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study. Actas Urol Esp 2023; 47:535-542. [PMID: 37207987 DOI: 10.1016/j.acuroe.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. MATERIAL AND METHODS Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. RESULTS A total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%, p=.127) or postoperative complication rate (35.0% vs 31.5%, p=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR 0.991; 95% IC 0.407-2.411; p=.983), when adjusted for procedure type, stone size and stone number. CONCLUSION URS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.
Collapse
Affiliation(s)
| | - A Coutinho
- Urology Department, Hospital de Braga, Braga, Portugal
| | - A Cardoso
- Urology Department, Hospital de Braga, Braga, Portugal
| | - A S Araújo
- Urology Department, Hospital de Braga, Braga, Portugal
| | - R Matos
- Urology Department, Hospital de Braga, Braga, Portugal
| | - S Anacleto
- Urology Department, Hospital de Braga, Braga, Portugal
| | - P Mota
- Urology Department, Hospital de Braga, Braga, Portugal; School of Medicine, University of Minho, Braga, Portugal; Centro Clínico Académico (2CA-Braga), Braga, Portugal
| |
Collapse
|
40
|
Beisemann N, Gierse J, Mandelka E, Hassel F, Grützner PA, Franke J, Vetter SY. Radiation exposure for pedicle screw placement with three different navigation system and imaging combinations in a sawbone model. BMC Musculoskelet Disord 2023; 24:752. [PMID: 37742007 PMCID: PMC10517448 DOI: 10.1186/s12891-023-06880-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Studies have shown that pedicle screw placement using navigation can potentially reduce radiation exposure of surgical personnel compared to conventional methods. Spinal navigation is based on an interaction of a navigation software and 3D imaging. The 3D image data can be acquired using different imaging modalities such as iCT and CBCT. These imaging modalities vary regarding acquisition technique and field of view. The current literature varies greatly in study design, in form of dose registration, as well as navigation systems and imaging modalities analyzed. Therefore, the aim of this study was a standardized comparison of three navigation and imaging system combinations in an experimental setting in an artificial spine model. METHODS In this experimental study dorsal instrumentation of the thoracolumbar spine was performed using three imaging/navigation system combinations. The system combinations applied were the iCT/Curve, cCBCT/Pulse and oCBCT/StealthStation. Referencing scans were obtained with each imaging modality and served as basis for the respective navigation system. In each group 10 artificial spine models received bilateral dorsal instrumentation from T11-S1. 2 referencing and control scans were acquired with the CBCTs, since their field of view could only depict up to five vertebrae in one scan. The field of view of the iCT enabled the depiction of T11-S1 in one scan. After instrumentation the region of interest was scanned again for evaluation of the screw position, therefore only one referencing and one control scan were obtained. Two dose meters were installed in a spine bed ventral of L1 and S1. The dose measurements in each location and in total were analyzed for each system combination. Time demand regarding screw placement was also assessed for all system combinations. RESULTS The mean radiation dose in the iCT group measured 1,6 ± 1,1 mGy. In the cCBCT group the mean was 3,6 ± 0,3 mGy and in the oCBCT group 10,3 ± 5,7 mGy were measured. The analysis of variance (ANOVA) showed a significant (p < 0.0001) difference between the three groups. The multiple comparisions by the Kruskall-Wallis test showed no significant difference for the comparison of iCT and cCBCT (p1 = 0,13). Significant differences were found for the direct comparison of iCT and oCBCT (p2 < 0,0001), as well as cCBCT and oCBCT (p3 = 0,02). Statistical analysis showed that significantly (iCT vs. oCBCT p = 0,0434; cCBCT vs. oCBCT p = 0,0083) less time was needed for oCBCT based navigated pedicle screw placement compared to the other system combinations (iCT vs. cCBCT p = 0,871). CONCLUSION Under standardized conditions oCBCT navigation demanded twice as much radiation as the cCBCT for the same number of scans, while the radiation exposure measured for the iCT and cCBCT for one scan was comparable. Yet, time effort was significantly less for oCBCT based navigation. However, for transferability into clinical practice additional studies should follow evaluating parameters regarding feasibility and clinical outcome under standardized conditions.
Collapse
Affiliation(s)
- Nils Beisemann
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Jula Gierse
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Eric Mandelka
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Frank Hassel
- Department of Spine Surgery, Loretto Hospital, Mercystrasse 6, 79100, Freiburg Im Breisgau, Germany
| | - Paul A Grützner
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Sven Y Vetter
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), BG Klinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
| |
Collapse
|
41
|
Bhatt MC, Singhal M, Pilania RK, Bansal SC, Khandelwal N, Gupta P, Singh S. Radiation dose analysis of computed tomography coronary angiography in Children with Kawasaki disease. World J Clin Pediatr 2023; 12:230-236. [PMID: 37753492 PMCID: PMC10518747 DOI: 10.5409/wjcp.v12.i4.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND There is evolving role of computed tomography coronary angiography (CTCA) in non-invasive evaluation of coronary artery abnormalities in children with Kawasaki disease (KD). Despite this, there is lack of data on radiation dose in this group of children undergoing CTCA. AIM To audit the radiation dose of CTCA in children with KD. METHODS Study (December 2013-February 2018) was performed on dual source CT scanner using adaptive prospective electrocardiography-triggering. The dose length product (DLP in milligray-centimeters-mGy.cm) was recorded. Effective radiation dose (millisieverts-mSv) was calculated by applying appropriate age adjusted conversion factors as per recommendations of International Commission on Radiological Protection. Radiation dose was compared across the groups (0-1, 1-5, 5-10, and > 10 years). RESULTS Eighty-five children (71 boys, 14 girls) with KD underwent CTCA. The median age was 5 years (range, 2 mo-11 years). Median DLP and effective dose was 21 mGy.cm, interquartile ranges (IQR) = 15 (13, 28) and 0.83 mSv, IQR = 0.33 (0.68, 1.01) respectively. Mean DLP increased significantly across the age groups. Mean effective dose in infants (0.63 mSv) was significantly lower than the other age groups (1-5 years 0.85 mSv, 5-10 years 1.04 mSv, and > 10 years 1.38 mSv) (P < 0.05). There was no significant difference in the effective dose between the other groups of children. All the CTCA studies were of diagnostic quality. No child required a repeat examination. CONCLUSION CTCA is feasible with submillisievert radiation dose in most children with KD. Thus, CTCA has the potential to be an important adjunctive imaging modality in children with KD.
Collapse
Affiliation(s)
- Mahesh Chandra Bhatt
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subhash Chand Bansal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| |
Collapse
|
42
|
Forbrig R, Ozpeynirci Y, Fischer TD, Trumm CG, Liebig T, Stahl R. Radiation Dose and Fluoroscopy Time of Extracranial Carotid Artery Stenting : Elective vs. Emergency Treatment Including Combined Mechanical Thrombectomy in Tandem Occlusion. Clin Neuroradiol 2023; 33:843-853. [PMID: 37261451 PMCID: PMC10449680 DOI: 10.1007/s00062-023-01288-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/24/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Fluoroscopically guided endovascular carotid artery stenting (CAS) of extracranial carotid stenosis (ECS) is a reasonable alternative to carotid endarterectomy in selected patients. Diagnostic reference levels (DRL) for this common neurointervention have not yet been defined and respective literature data are sparse. We provide detailed dosimetrics for useful expansion of the DRL catalogue. METHODS A retrospective single-center study of patients undergoing CAS between 2013 and 2021. We analyzed dose area product (DAP) and fluoroscopy time considering the following parameters: indications for CAS, semielective/elective versus emergency including additional mechanical thrombectomy (MT) in extracranial/intracranial tandem occlusion, etiology of ECS (atherosclerotic vs. radiation-induced), periprocedural features, e.g., number of applied stents, percutaneous transluminal angioplasty (PTA) and MT maneuvers, and dose protocol. Local DRL was defined as 75% percentile of the DAP distribution. RESULTS A total of 102 patients were included (semielective/elective CAS n = 75, emergency CAS n = 8, CAS + MT n = 19). Total median DAP was 78.2 Gy cm2 (DRL 117 Gy cm2). Lowest and highest median dosimetry values were documented for semielective/elective CAS and CAS + MT (DAP 49.1 vs. 146.8 Gy cm2, fluoroscopy time 27.1 vs. 43.8 min; p < 0.005), respectively. Dosimetrics were significantly lower in patients undergoing 0-1 PTA maneuvers compared to ≥ 2 maneuvers (p < 0.05). Etiology of ECS, number of stents and MT maneuvers had no significant impact on dosimetry values (p > 0.05). A low-dose protocol yielded a 33% reduction of DAP. CONCLUSION This CAS study suggests novel local DRLs for both elective and emergency cases with or without intracranial MT. A dedicated low-dose protocol was suitable for substantial reduction of radiation dose.
Collapse
Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas David Fischer
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph G. Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Stahl
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| |
Collapse
|
43
|
Montorsi P, Galli S, Teruzzi G, Gili S, Trabattoni D. The 'Trawl Fishing' Technique: A Quick Engagement of the Left Common Carotid Artery With the Simmons Catheter During Carotid Artery Stenting From the Right Radial Approach. Cardiovasc Revasc Med 2023; 54:57-60. [PMID: 37085354 DOI: 10.1016/j.carrev.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Transradial approach for carotid artery stenting (TRCAS) is an established technique in specific anatomies potentially associated with high periprocedural event rate from femoral catheterization. The engagement of left common carotid artery originating from the aortic arch is the most challenging scenario requiring specific catheters and techniques. METHODS Among 542 consecutive TRCAS 66 had left, non-bovine carotid stenosis as the target vessel. We retrospectively compared the feasibility, safety, efficacy, fluoroscopy time and radiation exposure of two different techniques, the standard (ST) and the 'trawl-fishing' (TFT), to engage the LCCA with the 5F, 125 cm-long Simmons-2 catheter. RESULTS The ST was initially used in 20 patients with a technical success of 85 % (17/20). In the following 46 patients, the TFT was successfully tested first as bailout after ST failure in 12 cases and as first option in the remaining 34 patients. Full technical success was obtained in all patients at the first attempt. No MACCEs or vascular complications occurred in all patients. Fluoroscopy time and radiation exposure were significantly lower with the TFT vs. ST (p < 0.001). CONCLUSIONS TFT represents a definite improvement in the technique of LCCA engagement during TRCAS.
Collapse
Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy.
| | | | | | | | | |
Collapse
|
44
|
Dieckmeyer M, Sollmann N, Kupfer K, Löffler MT, Paprottka KJ, Kirschke JS, Baum T. Computed Tomography of the Head : A Systematic Review on Acquisition and Reconstruction Techniques to Reduce Radiation Dose. Clin Neuroradiol 2023; 33:591-610. [PMID: 36862232 PMCID: PMC10449676 DOI: 10.1007/s00062-023-01271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023]
Abstract
In 1971, the first computed tomography (CT) scan was performed on a patient's brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New technological developments, broader availability, and the clinical success of CT led to a steady growth in examination numbers. Most frequent indications for non-contrast CT (NCCT) of the head include the assessment of ischemia and stroke, intracranial hemorrhage and trauma, while CT angiography (CTA) has become the standard for first-line cerebrovascular evaluation; however, resulting improvements in patient management and clinical outcomes come at the cost of radiation exposure, increasing the risk for secondary morbidity. Therefore, radiation dose optimization should always be part of technical advancements in CT imaging but how can the dose be optimized? What dose reduction can be achieved without compromising diagnostic value, and what is the potential of the upcoming technologies artificial intelligence and photon counting CT? In this article, we look for answers to these questions by reviewing dose reduction techniques with respect to the major clinical indications of NCCT and CTA of the head, including a brief perspective on what to expect from current and future developments in CT technology with respect to radiation dose optimization.
Collapse
Affiliation(s)
- Michael Dieckmeyer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Karina Kupfer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Karolin J. Paprottka
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
45
|
Sener TE, Tanidir Y, Ketenci S, Kutukoglu U, Dorucu D, Cayir H, Pietropaolo A, Emiliani E, Somani B. Radiation exposure during different percutaneous renal puncture techniques: A YAU endourology & urolithiasis study. Investig Clin Urol 2023; 64:474-479. [PMID: 37668203 PMCID: PMC10482668 DOI: 10.4111/icu.20220395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/05/2023] [Accepted: 06/07/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE Radiation exposure is affected by C-arm fluoroscopy device positioning during percutaneous renal puncture. Our aim was to compare the exposure of surgeon's lens, hand and chest with a fluoroscopy protocol replicated in different C-arm positions. MATERIALS AND METHODS A standardized fluoroscopy protocol was created using water-equivalent solid phantoms to replicate a surgeon and patient. 111 mGy radiation (360 s) was applied in standard fluoroscopy mode (91 kVp, 2.7 mA/mAs). Dosimeters were placed on lens, chest and hand of surgeon and patient phantom models. 7 different C-arm positions were created: 0°, mediolateral (ML) +90°, ML -90°, ML +30°, ML -15°, craniocaudal (CC) +30°, CC +15°. Measurements were evaluated separately for different positions. RESULTS The highest radiation exposure was measured on patient dosimeter (2.97 mSv). The highest exposure on surgeon was recorded on finger dosimeter in all C-arm positions; highest dose was recorded in ML +90° position (2.88 mSv). In finger dosimeters, lowest exposure was recorded in 0° position (0.51 mSv). The lowest exposure of all positions was measured in chest dosimeter in ML -90° position (0.24 mSv). CONCLUSIONS In positions where X-ray generator of the C-arm was facing towards the surgeon, radiation exposure measured in all dosimeters was higher compared to positions where the generator was facing away. The hand radiation exposure in all positions was higher than chest and lens. Special care must be taken to avoid facing the X-ray generator tube and hands should be as well-protected as chest and eyes with special protective gear.
Collapse
Affiliation(s)
- Tarik Emre Sener
- Department of Urology, Marmara University, School of Medicine, Istanbul, Türkiye
- Young Academic Urologists, Endourology and Urolithiasis Working Party, European Association of Urology, Arnhem, Netherlands.
| | - Yiloren Tanidir
- Department of Urology, Marmara University, School of Medicine, Istanbul, Türkiye
| | - Serap Ketenci
- Department of Radiation Oncology, Unit of Radiation Health, Marmara University Pendik Training and Research Hospital, Istanbul, Türkiye
| | - Umut Kutukoglu
- Department of Urology, Marmara University, School of Medicine, Istanbul, Türkiye
| | - Dogancan Dorucu
- Department of Urology, Marmara University, School of Medicine, Istanbul, Türkiye
| | - Huseyin Cayir
- Department of Radiology, Unit of Radiation Health, Marmara University Pendik Training and Research Hospital, Istanbul, Türkiye
| | - Amelia Pietropaolo
- Young Academic Urologists, Endourology and Urolithiasis Working Party, European Association of Urology, Arnhem, Netherlands
- Department of Urology, NHS Foundation Trust, Southampton University Hospital, Southampton, UK
| | - Esteban Emiliani
- Young Academic Urologists, Endourology and Urolithiasis Working Party, European Association of Urology, Arnhem, Netherlands
- Department of Urology, Fundación Puigvert. Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Bhaskar Somani
- Department of Urology, NHS Foundation Trust, Southampton University Hospital, Southampton, UK
- European Association of Urology Section of Uro-Technology, Arnhem, Netherlands
- European Association of Urology Section of Urolithiasis (EULIS), Arnhem, Netherlands
- European School of Urology (ESU), Arnhem, Netherlands
| |
Collapse
|
46
|
Lawson McLean A. Biplane fluoroscopy in spinal cord stimulation procedures. Neurochirurgie 2023; 69:101475. [PMID: 37544167 DOI: 10.1016/j.neuchi.2023.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Affiliation(s)
- A Lawson McLean
- Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
| |
Collapse
|
47
|
Adeliño R, Malaczynska-Rajpold K, Perrotta L, Manninger M, Vanduynhoven P, Nesti M, Goanță EV, Waldmann V, Pavlovic N, Farkowski MM, Guerra JM, Penela D, Boveda S, Chun JKR. Occupational radiation exposure of electrophysiology staff with reproductive potential and during pregnancy: an EHRA survey. Europace 2023; 25:euad216. [PMID: 37498147 PMCID: PMC10401324 DOI: 10.1093/europace/euad216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS Electrophysiology (EP) is a growing field in cardiology, with an increasing involvement of young people. Nevertheless, concerns about radiation exposure and its impact on reproduction and pregnancy may discourage the choice of an EP career. The study is aimed at investigating the level of awareness and main sources of concern about the effects of radiation on reproductive potential and pregnancy, exploring the safety measures adopted in different EP labs, and verifying the adherence to the current guidelines. METHODS AND RESULTS An online survey was conducted using the European Heart Rhythm Association (EHRA) infrastructure from April to June 2022. A total of 252 EP personnel (42% women) participated, from 50 countries and different professional roles. Most participants expressed concerns regarding the effects of radiation on reproductive capacity (67.1%) and offspring diseases (68.2%). Only 37.9% of participants were aware of the EHRA 2017 consensus document about occupational radiation exposure. Most participants (80.9%) considered that occupational radiation during pregnancy is not safe. EP female staff were not allowed to work in the EP lab during pregnancy in 48.1% of cases. Zero-fluoroscopy was the preferred choice to continue working in the EP lab during pregnancy. CONCLUSION EP staff, including both men and women, have concerns about the effects of radiation on reproductive capacity. Despite the recommendations issued by international bodies, implementation of the policies regarding pregnancy and occupational radiation exposure is heterogeneous. Zero-fluoroscopy is the preferred approach to ensure safety during pregnancy in the EP lab.
Collapse
Affiliation(s)
- Raquel Adeliño
- Arrhythmia Unit, Cardiology Department, Vall d’Hebron University Hospital, Pg. de la Vall d'Hebron 119, 08035 Barcelona, Spain
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076, 31300 Toulouse, France
| | | | - Laura Perrotta
- Arrhythmia Unit, Department of Cardiothoracovascular Medicine, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria
| | - Philippe Vanduynhoven
- Department of Cardiology, Arrhythmia Clinic, Algemeen Stedelijk Ziekenhuis Aalst, Merestraat 80, 9300 Aalst, Belgium
| | - Martina Nesti
- Arrhythmia Unit, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, 56124 Pisa, Italy
| | - Emilia-Violeta Goanță
- Cardiology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 2 Eftimie Murgu 2, Timisoara 300041, Romania
| | - Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, 20 Rue Leblanc, 75015 Paris, France
| | - Nikola Pavlovic
- Department of Cardiology, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí, 89, 08025 Barcelona, Spain
- Universidad Autonoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, Vilana nº 12, 08022 Barcelona, Spain
| | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076, 31300 Toulouse, France
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Im Prüfling 23, 60389 Frankfurt am Main, Germany
| |
Collapse
|
48
|
Nowicka Z, Tomasik B, Kozono D, Stawiski K, Johnson T, Haas-Kogan D, Ussowicz M, Chowdhury D, Fendler W. Serum miRNA-based signature indicates radiation exposure and dose in humans: A multicenter diagnostic biomarker study. Radiother Oncol 2023; 185:109731. [PMID: 37301262 DOI: 10.1016/j.radonc.2023.109731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Mouse and non-human primate models showed that serum miRNAs may be used to predict the biological impact of radiation doses. We hypothesized that these results can be translated to humans treated with total body irradiation (TBI), and that miRNAs may be used as clinically feasible biodosimeters. METHODS To test this hypothesis, serial serum samples were obtained from 25 patients (pediatric and adults) who underwent allogeneic stem-cell transplantation and profiled for miRNA expression using next-generation sequencing. miRNAs with diagnostic potential were quantified with qPCR and used to build logistic regression models with lasso penalty to reduce overfitting, identifying samples drawn from patients who underwent total body irradiation to a potentially lethal dose. RESULTS Differential expression results were consistent with previous studies in mice and non-human primates. miRNAs with detectable expression in this and two prior animal sets allowed for distinction of the irradiated from non-irradiated samples in mice, macaques and humans, validating the miRNAs as radiation-responsive through evolutionarily conserved transcriptional regulation mechanisms. Finally, we created a model based on the expression of miR-150-5p, miR-30b-5p and miR-320c normalized to two references and adjusted for patient age with an AUC of 0.9 (95%CI:0.83-0.97) for identifying samples drawn after irradiation; a separate model differentiating between high and low radiation dose achieved AUC of 0.85 (95%CI: 0.74-0.96). CONCLUSIONS We conclude that serum miRNAs reflect radiation exposure and dose for humans undergoing TBI and may be used as functional biodosimeters for precise identification of people exposed to clinically significant radiation doses.
Collapse
Affiliation(s)
- Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland
| | - Bartłomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - David Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Konrad Stawiski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland
| | - Thomas Johnson
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marek Ussowicz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Poland
| | - Dipanjan Chowdhury
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| |
Collapse
|
49
|
Sugawara R, Watanabe H, Taki N, Onuma S, Kikkawa I, Takeshita K. Radiation exposure in pediatric patients with early onset scoliosis: A longitudinal single-center study. J Orthop Sci 2023:S0949-2658(23)00197-5. [PMID: 37507317 DOI: 10.1016/j.jos.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND There is no consensus regarding the acceptable level of medical radiation exposure in patients with early-onset scoliosis. This study aimed to quantify radiation exposure in these patients and investigate factors associated with high exposure. METHODS Patients with early-onset scoliosis who received care for their spine deformity and other comorbidities in our institution were retrospectively reviewed. Cumulative radiation exposure and total number of imaging studies were recorded. Patients with ≥30 mSv exposure were classified as high exposure and analyzed to clarify factors associated with high exposure. RESULTS Thirty-five patients were included for analysis. The etiology of scoliosis was idiopathic in 8 patients, congenital in 7, syndromic in 8, and neuromuscular in 12. Fifteen patients underwent 19 spinal surgeries. The types of operation performed were definitive fusion (n = 12), vertebrectomy for hemivertebra (n = 2), growing rod (n = 1), lengthening (n = 3), and revision/partial implant removal (n = 1). The mean cumulative radiation dose was 22.3 mSv (range, 2.5-94.5 mSv). Spine radiography and computed tomography combined accounted for 15.0 mSv (range, 2.4-52.5 mSv, 67.3% of the mean cumulative dose). The mean radiation dose was significantly higher in patients who underwent spinal surgery than in those who did not (31.2 mSv vs. 15.6 mSv). The high-exposure group comprised 10 patients (1 idiopathic, 1 congenital, 5 syndromic, and 3 neuromuscular scoliosis) and 8 underwent 11 spinal operations. Among 8 patients who underwent spinal surgery, the cumulative radiation dose for spine was ≥30 mSv and spine computed tomography was performed an average of 4.0 times. CONCLUSIONS Nearly one-third of patients with early-onset scoliosis and half of patients who underwent spinal surgery had >30 mSv radiation exposure due to multiple computed tomography. Medical radiation exposure and associated cancer risk should be considered when treating these patients.
Collapse
Affiliation(s)
- Ryo Sugawara
- Department of Orthopedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hideaki Watanabe
- Department of Pediatric Orthopedics, Jichi Children's Medical Center, Tochigi. 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naoya Taki
- Department of Pediatric Orthopedics, Jichi Children's Medical Center, Tochigi. 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Saki Onuma
- Department of Pediatric Orthopedics, Jichi Children's Medical Center, Tochigi. 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ichiro Kikkawa
- Department of Orthopedic Surgery, Nasu Central Hospital, 1453 Shimoishigami, Otawara, Tochigi, 324-0036, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| |
Collapse
|
50
|
Steinl G, Grabski D, Fleming M, Levin D, McGahren E, McCullough W, Gander J. Implementation of ultrasound and fast magnetic resonance imaging pathway reduces computed tomography utilization in children with suspected appendicitis. Pediatr Surg Int 2023; 39:238. [PMID: 37486585 DOI: 10.1007/s00383-023-05521-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Computed tomography (CT) is still used in the imaging diagnosis of acute appendicitis in children at many hospitals. We implemented an ultrasound (US) and fast magnetic resonance imaging (MRI) pathway for suspected appendicitis at our institution with the goal of reducing radiation exposure in children. METHODS All children (< 18 years old) who underwent appendectomy between January 2011 and July 2021 were reviewed. Data were collected on all imaging studies performed. In December 2015, we initiated an imaging pathway for suspected acute appendicitis. US was the initial imaging study, and a rapid protocol MRI was performed if US was equivocal. Those could not tolerate MRI underwent CT. We evaluated the difference in percentage of patients who underwent CT before and after pathway initiation. RESULTS 554 patients who underwent appendectomy did not have prior imaging studies on presentation to our hospital and were included in analysis. After initiating the pathway, the use of abdominal US increased from 87% (220 of 254) to 97% (291 of 300, p < 0.0001) and the use of MRI increased by 100% (0 MRIs pre-protocol, 90 of 300 patients post-protocol, p < 0.0001). CT utilization decreased significantly from 32% (82 of 254) to 2% (6 of 300, p < 0.0001). CONCLUSION Embracing a new US and rapid MRI pathway to evaluate pediatric patients with suspected acute appendicitis resulted in significant reduction in CT utilization and therefore radiation exposure.
Collapse
Affiliation(s)
- Gabrielle Steinl
- Department of Surgery, University of Virginia, Charlottesville, USA
| | - David Grabski
- Department of Surgery, University of Virginia, Charlottesville, USA
| | - Mark Fleming
- Department of Surgery, University of Virginia, Charlottesville, USA
| | - Daniel Levin
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, University of Virginia, 1215 Lee St., Charlottesville, VA, 22904, USA
| | - Eugene McGahren
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, University of Virginia, 1215 Lee St., Charlottesville, VA, 22904, USA
| | - William McCullough
- Department of Radiology, Santa Clara Homestead Medical Center, Santa Clara, CA, USA
| | - Jeffrey Gander
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, University of Virginia, 1215 Lee St., Charlottesville, VA, 22904, USA.
| |
Collapse
|