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Di Maria S, Vedantham S, Vaz P. Breast dosimetry in alternative X-ray-based imaging modalities used in current clinical practices. Eur J Radiol 2022; 155:110509. [PMID: 36087425 PMCID: PMC9851082 DOI: 10.1016/j.ejrad.2022.110509] [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: 06/30/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023]
Abstract
In X-ray breast imaging, Digital Mammography (DM) and Digital Breast Tomosynthesis (DBT), are the standard and largely used techniques, both for diagnostic and screening purposes. Other techniques, such as dedicated Breast Computed Tomography (BCT) and Contrast Enhanced Mammography (CEM) have been developed as an alternative or a complementary technique to the established ones. The performance of these imaging techniques is being continuously assessed to improve the image quality and to reduce the radiation dose. These imaging modalities are predominantly used in the diagnostic setting to resolve incomplete or indeterminate findings detected with conventional screening examinations and could potentially be used either as an adjunct or as a primary screening tool in select populations, such as for women with dense breasts. The aim of this review is to describe the radiation dosimetry for these imaging techniques, and to compare the mean glandular dose with standard breast imaging modalities, such as DM and DBT.
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Affiliation(s)
- S Di Maria
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Campus Tecnológico e Nuclear, Estrada Nacional 10, km 139,7, 2695-066 Bobadela LRS, Portugal.
| | - S Vedantham
- Department of Medical Imaging, The University of Arizona, Tucson, AZ, USA; Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, USA
| | - P Vaz
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Campus Tecnológico e Nuclear, Estrada Nacional 10, km 139,7, 2695-066 Bobadela LRS, Portugal
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Thukral S, Salter A, Lancia S, Kahn S, Vedantham S. Abstract No. 154 Relationship between baseline clinical features of DVT and clinical outcomes with pharmacomechanical catheter-directed thrombolysis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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van der Marel K, Vedantham S, van der Bom IMJ, Howk M, Narain T, Ty K, Karellas A, Gounis MJ, Puri AS, Wakhloo AK. Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform. AJNR Am J Neuroradiol 2017; 38:442-449. [PMID: 28104643 DOI: 10.3174/ajnr.a5049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose-reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings. MATERIALS AND METHODS In this single-center, retrospective study, cumulative dose-area product inclusive of fluoroscopy, angiography, and 3D acquisitions for all neurovascular procedures performed during a 2-year period on the dose-reduction platform were compared with a reference platform. Key study features were the following: The neurointerventional radiologist could select the targeted dose reduction for each patient with the dose-reduction platform, and the statistical analyses included patient characteristics and the neurointerventional radiologist as covariates. The analyzed outcome measures were cumulative dose (kerma)-area product, fluoroscopy duration, and administered contrast volume. RESULTS A total of 1238 neurointerventional cases were included, of which 914 and 324 were performed on the reference and dose-reduction platforms, respectively. Over all diagnostic and neurointerventional procedures, the cumulative dose-area product was significantly reduced by 53.2% (mean reduction, 160.3 Gy × cm2; P < .0001), fluoroscopy duration was marginally significantly increased (mean increase, 5.2 minutes; P = .0491), and contrast volume was nonsignificantly increased (mean increase, 15.3 mL; P = .1616) with the dose-reduction platform. CONCLUSIONS A significant reduction in patient radiation dose is achievable during neurovascular procedures by using dose-reduction technology with a minimal impact on workflow.
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Affiliation(s)
- K van der Marel
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - S Vedantham
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - M Howk
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - T Narain
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - K Ty
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A Karellas
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - M J Gounis
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A S Puri
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - A K Wakhloo
- From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
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Taschner CA, Vedantham S, de Vries J, Biondi A, Boogaarts J, Sakai N, Lylyk P, Szikora I, Meckel S, Urbach H, Kan P, Siekmann R, Bernardy J, Gounis MJ, Wakhloo AK. Surpass Flow Diverter for Treatment of Posterior Circulation Aneurysms. AJNR Am J Neuroradiol 2016; 38:582-589. [PMID: 28007769 DOI: 10.3174/ajnr.a5029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/11/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Flow diverters for the treatment of posterior circulation aneurysms remain controversial. We aimed to identify factors contributing to outcome measures in patients treated with the Surpass flow diverter for aneurysms in this location. MATERIALS AND METHODS We conducted an observational study of 53 patients who underwent flow-diverter treatment for posterior circulation aneurysms at 15 centers. Key outcome measures were mortality, complete aneurysm occlusion, and modified Rankin Scale score at follow-up. RESULTS At follow-up (median, 11.3 months; interquartile range, 5.9-12.7 months), 9 patients had died, resulting in an all-cause mortality rate of 17.3% (95% CI, 7%-27.6%); 7 deaths (14%) were directly related to the procedure and none occurred in patients with a baseline mRS score of zero. After adjusting for covariates, a baseline mRS of 3-5 was more significantly (P = .003) associated with a higher hazard ratio for death than a baseline mRS of 0-2 (hazard ratio, 17.11; 95% CI, 2.69-109.02). After adjusting for follow-up duration, a 1-point increase in the baseline mRS was significantly (P < .001) associated with higher values of mRS at follow-up (odds ratio, 2.93; 95% CI, 1.79-4.79). Follow-up angiography in 44 patients (median, 11.3 months; interquartile range, 5.9-12.7 months) showed complete aneurysm occlusion in 29 (66%; 95% CI, 50.1%-79.5%). CONCLUSIONS Clinical results of flow-diverter treatment of posterior circulation aneurysms depend very much on patient selection. In this study, poorer outcomes were related to the treatment of aneurysms in patients with higher baseline mRS scores. Angiographic results showed a high occlusion rate for this subset of complex aneurysms.
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Affiliation(s)
- C A Taschner
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | | | - J de Vries
- Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - A Biondi
- Department of Neuroradiology and Endovascular Therapy (A.B.), University of Besançon, Besançon, France
| | - J Boogaarts
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany.,Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - N Sakai
- Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - P Lylyk
- Department of Neurosurgery (P.L.), Equipo de Neurocirugía Endovascular Radiología Intervencionista, Buenos Aires, Argentina
| | - I Szikora
- National Institute of Neurosciences (I.S.), Budapest, Hungary
| | - S Meckel
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - H Urbach
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - P Kan
- Department of Neurosurgery (P.K.), Baylor College of Medicine, Houston, Texas
| | - R Siekmann
- Department of Neuroradiology (R.S.), Klinikum Kassel, Kassel, Germany
| | - J Bernardy
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - M J Gounis
- New England Center for Stroke Research (M.J.G.)
| | - A K Wakhloo
- Division of Neuroimaging and Intervention (A.K.W.), Departments of Radiology, Neurology, and Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts
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Marosfoi M, Langan E, Vedantham S, Clarençon F, King R, Wainwright J, Gounis M, Puri A. O-029 Acute Thrombus Formation on Flow Diverters Imaged In Vivo Using Optical Coherence Tomography. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vedantham S, Shrestha S, Shi L, Vijayaraghavan G, Karellas A. SU-D-206-06: Task-Specific Optimization of Scintillator Thickness for CMOS-Detector Based Cone-Beam Breast CT. Med Phys 2016. [DOI: 10.1118/1.4955660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shrestha S, Vedantham S, Karellas A. WE-DE-207B-08: Towards Standardization of X-Ray Filters in Digital Mammography-Enabled Breast Tomosynthesis Systems. Med Phys 2016. [DOI: 10.1118/1.4957868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shi L, Vedantham S, Karellas A, Zhu L. WE-DE-207B-10: Library-Based X-Ray Scatter Correction for Dedicated Cone-Beam Breast CT: Clinical Validation. Med Phys 2016. [DOI: 10.1118/1.4957870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vedantham S. WE-FG-207A-01: Introduction to Dedicated Breast CT - Early Studies. Med Phys 2016. [DOI: 10.1118/1.4957926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shrestha S, Vedantham S, Karellas A. MO-FG-CAMPUS-IeP1-01: Alternative K-Edge Filters for Low-Energy Image Acquisition in Contrast Enhanced Spectral Mammography. Med Phys 2016. [DOI: 10.1118/1.4957333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shi L, Vedantham S, Karellas A, Zhu L. WE-DE-207B-12: Scatter Correction for Dedicated Cone Beam Breast CT Based On a Forward Projection Model. Med Phys 2016. [DOI: 10.1118/1.4957872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gagne P, Tahara R, Fastabend C, Dzieciuchowicz L, Marston W, Vedantham S, Ting W, Iafrati M, Lugli M, Gasparis A, Black S, Thorpe P, Passman M. Venogram Versus Intravascular Ultrasound for Diagnosing and Treating Iliofemoral Vein Obstruction (VIDIO): Report From a Multicenter, Prospective Study of Iliofemoral Vein Interventions. J Vasc Surg Venous Lymphat Disord 2016. [DOI: 10.1016/j.jvsv.2015.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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van der Marel K, Vedantham S, van der Bom I, Howk M, Narain T, Gounis M, Puri A, Wakhloo A. E-101 reduced patient radiation exposure during diagnostic and interventional x-ray angiography with novel imaging platform. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vedantham S. TU-EF-207-05: Dedicated Cone-beam Breast CT. Med Phys 2015. [DOI: 10.1118/1.4925705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vedantham S, Shi L, Karellas A, O'Connell A. MO-F-CAMPUS-I-01: Accuracy of Radiologists Interpretation of Mammographic Breast Density. Med Phys 2015. [DOI: 10.1118/1.4925452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Advances in image-guided, catheter-based interventions have shown great potential to improve outcomes in patients with venous thromboembolism. Catheter-directed thrombolysis has been shown in one randomized controlled trial to reduce the risk of post-thrombotic syndrome in patients with acute lower extremity deep vein thrombosis; data from a larger national institute of health trial are expected in early 2017. The use of catheter-directed thrombolysis is also being increasingly considered for patients with submassive or massive pulmonary embolism. Preliminary studies suggest that endovascular stent placement and ablative therapies may be used to reduce symptoms and improve quality of life in severely affected patients with established post-thrombotic syndrome. In this article, we summarize the risks and benefits of endovascular venous thromboembolism therapies as currently understood, highlight clinical situations where their benefit may outweigh risks, and describe ongoing and upcoming pivotal research initiatives with multidisciplinary participation.
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Affiliation(s)
- S Vedantham
- Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Shrestha S, Vedantham S, Karellas A, Bellazzini R, Spandre G, Brez A. WE-G-204-03: Photon-Counting Hexagonal Pixel Array CdTe Detector: Optimal Resampling to Square Pixels. Med Phys 2015. [DOI: 10.1118/1.4926087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shi L, Vedantham S, Karellas A. WE-EF-207-06: Dedicated Cone-Beam Breast CT with Laterally-Shifted Detector: Monte Carlo Evaluation of X-Ray Scatter Distribution and Scatter-To-Primary Ratio. Med Phys 2015. [DOI: 10.1118/1.4926013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shi L, Vedantham S, Michaelsen K, Krishnaswamy V, Shenoy A, Pogue B, Karellas A, Paulsen K. SU-E-I-54: Volumetric Breast Density: Comparison of Estimates From Tomosynthesis Reconstructions with Mammography. Med Phys 2014. [DOI: 10.1118/1.4888004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Konate S, Vedantham S, Shi L, Karellas A. SU-E-I-01: Radiation Dose Reduction and Image Quality Evaluation of Coronal Truncated Projections in Cone-Beam Dedicated Breast CT. Med Phys 2013. [DOI: 10.1118/1.4814101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vedantham S, Shi L, Karellas A. WE-G-103-04: X-Ray Scatter in Differential Phase-Contrast Breast Imaging Using Gratings-Based Interferometer. Med Phys 2013. [DOI: 10.1118/1.4815664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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van der Bom IMJ, Hou SY, Puri AS, Spilberg G, Ruijters D, van de Haar P, Carelsen B, Vedantham S, Gounis MJ, Wakhloo AK. Reduction of coil mass artifacts in high-resolution flat detector conebeam CT of cerebral stent-assisted coiling. AJNR Am J Neuroradiol 2013; 34:2163-70. [PMID: 23721899 DOI: 10.3174/ajnr.a3561] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Developments in flat panel angiographic C-arm systems have enabled visualization of both the neurovascular stents and host arteries in great detail, providing complementary spatial information in addition to conventional DSA. However, the visibility of these structures may be impeded by artifacts generated by adjacent radio-attenuating objects. We report on the use of a metal artifact reduction algorithm for high-resolution contrast-enhanced conebeam CT for follow-up imaging of stent-assisted coil embolization. MATERIALS AND METHODS Contrast-enhanced conebeam CT data were acquired in 25 patients who underwent stent-assisted coiling. Reconstructions were generated with and without metal artifact reduction and were reviewed by 3 experienced neuroradiologists by use of a 3-point scale. RESULTS With metal artifact reduction, the observers agreed that the visibility had improved by at least 1 point on the scoring scale in >40% of the cases (κ = 0.6) and that the streak artifact was not obscuring surrounding structures in 64% of all cases (κ = 0.6). Metal artifact reduction improved the image quality, which allowed for visibility sufficient for evaluation in 65% of the cases, and was preferred over no metal artifact reduction in 92% (κ = 0.9). Significantly higher scores were given with metal artifact reduction (P < .0001). CONCLUSIONS Although metal artifact reduction is not capable of fully removing artifacts caused by implants with high x-ray absorption, we have shown that the image quality of contrast-enhanced conebeam CT data are improved drastically. The impact of the artifacts on the visibility varied between cases, and yet the overall visibility of the contrast-enhanced conebeam CT with metal artifact reduction improved in most the cases.
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Affiliation(s)
- I M J van der Bom
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
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Vedantham S, Shi L, Karellas A, O'Connell A. TU-E-217BCD-05: Dedicated Breast CT: Skin Thickness Measurements in a Diagnostic Population. Med Phys 2012; 39:3914-3915. [DOI: 10.1118/1.4735977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- S Vedantham
- University of Massachusetts Medical School, Worcester, MA.,University of Rochester Medical Center, Rochester, NY
| | - L Shi
- University of Massachusetts Medical School, Worcester, MA.,University of Rochester Medical Center, Rochester, NY
| | - A Karellas
- University of Massachusetts Medical School, Worcester, MA.,University of Rochester Medical Center, Rochester, NY
| | - A O'Connell
- University of Massachusetts Medical School, Worcester, MA.,University of Rochester Medical Center, Rochester, NY
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Vedantham S, Karellas A. SU-E-I-61: Phantom Design for Phase Contrast Breast Imaging. Med Phys 2012; 39:3638-3639. [DOI: 10.1118/1.4734777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vedantham S, Gounis M, Wakhloo A, Karellas A. SU-E-I-97: A Protocol for Attenuation Characterization of Neurovascular Devices under Fluoroscopic Conditions. Med Phys 2011. [DOI: 10.1118/1.3611671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Karellas A, Vedantham S. WE-C-201C-01: Perspective on the Developing Modalities for Breast Cancer Imaging. Med Phys 2010. [DOI: 10.1118/1.3469382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vedantham S, Karellas A. TH-D-201B-02: Modeling the Performance Characteristics of a “Dual-Side” Read Computed Radiography System for Mammography. Med Phys 2010. [DOI: 10.1118/1.3469561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vedantham S, Gounis M, van der Bom M, Karellas A, Wakhloo A. SU-GG-I-181: Noise Characterization of a Clinical Flat-Panel Cone-Beam Computed Tomography (CBCT) System. Med Phys 2010. [DOI: 10.1118/1.3468217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Dewdney S, Benn T, Rimel B, Saad N, Gao F, Vedantham S, Picus D, Massad L, Mutch DG, Zighelboim I. Effect of anticoagulation after inferior vena cava filter placement in gynecologic oncology patients on survival. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kahn SR, Partsch H, Vedantham S, Prandoni P, Kearon C. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost 2009; 7:879-83. [PMID: 19175497 DOI: 10.1111/j.1538-7836.2009.03294.x] [Citation(s) in RCA: 319] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
SUMMARY The post-thrombotic syndrome (PTS) is increasingly recognized to be a common and important complication of deep venous thrombosis (DVT). Because there is no 'gold standard' objective test to establish its presence, PTS is diagnosed primarily on the basis of the presence of typical symptoms and clinical signs in a limb that was affected by DVT. As a wide variety of definitions of PTS have been used by researchers, it is difficult to compare data across studies and to formally combine data in meta-analyses. In a step towards standardization of the measurement of PTS in clinical studies, available scales and evidence to support their utility to diagnose PTS and to classify its severity were reviewed and discussed at the Control of Anticoagulation Subcommittee of the International Society on Thrombosis and Haemostasis (Vienna, July 2008).
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Affiliation(s)
- S R Kahn
- Division of Internal Medicine, Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montréal, QC, Canada.
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Abstract
Objectives Understand the potential consequences of deep vein thrombosis (DVT) in patients undergoing superficial venous interventions, the proper way to assess DVT risk in patients with superficial venous disease and the appropriate management of patients stratified by risk level. Methods Review of published literature Results Because DVT can have major long-term consequences, DVT risk should be assessed as a routine part of the preprocedure evaluation of venous disease. Chronic venous disease may have multiple contributing factors amenable to treatment in both the superficial and deep venous systems. Conclusion Superficial venous interventions should be deferred in patients at particularly high risk for DVT, but may be performed with appropriate countermeasures for DVT prophylaxis in patients at moderate risk.
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Affiliation(s)
- S Vedantham
- Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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Suryanarayanan S, Sechopoulos I, Vedantham S, Karellas A. SU-FF-I-97: Feasibility of Low Dose X-Ray Contrast Enhanced Digital Mammography with Gold Nanoparticles. Med Phys 2007. [DOI: 10.1118/1.2760474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vedantham S, Suryanarayanan S, Sechopoulos I, Karellas A. TH-C-L100F-10: Monte Carlo Coupled Modeling of a Computed Radiography System. Med Phys 2007. [DOI: 10.1118/1.2761637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sechopoulos I, Suryanarayanan S, Vedantham S, D'Orsi CJ, Karellas A. WE-E-L100J-05: Radiation Dose to Tissues From Mammography. Med Phys 2007. [DOI: 10.1118/1.2761580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sechopoulos I, Vedantham S, Suryanarayanan S, Karellas A. SU-FF-I-12: Validation of Geant4's Predictions On X-Ray Scatter and Glandular Dose in Pendant-Geometry Cone-Beam Breast CT. Med Phys 2006. [DOI: 10.1118/1.2240250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sechopoulos I, Suryanarayanan S, Vedantham S, Karellas A. SU-DD-A4-05: Characterization of X-Ray Scatter and Glandular Dose in Digital Tomosynthesis for Breast Imaging Using Monte Carlo Simulations. Med Phys 2006. [DOI: 10.1118/1.2240153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Suryanarayanan S, Vedantham S, Sechopoulos I, Karellas A. WE-E-330D-03: Feasibility of High-Resolution Contrast Enhanced Digital Mammography. Med Phys 2006. [DOI: 10.1118/1.2241793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vedantham S, Karellas A, Suryanarayanan S. Attenuation characteristics of fiberoptic plates for digital mammography and other X-ray imaging applications. J Xray Sci Technol 2003; 11:219-230. [PMID: 22388292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Spatially coherent fiberoptic plates are important components of some charge-coupled device (CCD)-based x-ray imaging systems. These plates efficiently transmit scintillations from the phosphor, and also filter out x-rays not absorbed by the phosphor, thus protecting the CCD from direct x-ray interaction. The thickness of the fiberoptic plate and the CCD package present a significant challenge in the design of a digital x-ray cassette capable of insertion into the existing film-screen cassette holders of digital mammography systems. This study was performed with an aim to optimize fiberoptic plate thickness. Attenuation measurements were performed on nine fiberoptic plates varying in material composition that exhibit desirable optical characteristics such as good coupling efficiency. Mammographic spectra from a clinical mammographic system and an Americium-241 (Am-241) source (59.54 KeV) were used. The spectra were recorded with a high-resolution cadmium zinc telluride (CZT)-based spectrometer and corrected for dead time and pile-up. The linear attenuation coefficients varied by a factor of 3 in the set of tested fiberoptic plates at both mammographic energies and 59.54 keV. Our results suggest that a 3-mm thick high-absorption plate might provide adequate for shielding at mammographic energies. A thickness of 2-mm is feasible for mammographic applications with further optimization of the fiberoptic plate composition by incorporating non-scintillating, high-atomic number material. This would allow more space for cooling components of the cassette and for a more compact device, which is critical for clinical implementation of the technology.
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Affiliation(s)
- S Vedantham
- Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, USA
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Suryanarayanan S, Karellas A, Vedantham S, Baker SP, Glick SJ, D'Orsi CJ, Webber RL. Evaluation of linear and nonlinear tomosynthetic reconstruction methods in digital mammography. Acad Radiol 2001; 8:219-24. [PMID: 11249085 DOI: 10.1016/s1076-6332(03)80530-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to comparatively evaluate digital planar mammography and both linear and nonlinear tomosynthetic reconstruction methods. MATERIALS AND METHODS A "disk" (ie, target) identification study was conducted to compare planar and reconstruction methods. Projective data using a composite phantom with circular disks were acquired in both planar and tomographic modes by using a full-field, digital mammographic system. Two-dimensional projections were reconstructed with both linear (ie, backprojection) and nonlinear (ie, maximization and minimization) tuned-aperture computed tomographic (TACT) methods to produce three-dimensional data sets. Four board-certified radiologists and one 4th-year radiology resident participated as observers. All images were compared by these observers in terms of the number of disks identified. RESULTS Significant differences (P < .05, Bonferroni adjusted) were observed between all reconstruction and planar methods. No significant difference, however, was observed between the planar methods, and only a marginally significant difference (P < .054, Bonferroni adjusted) was observed between TACT-backprojection and TACT-minimization. CONCLUSION A combination of linear and nonlinear reconstruction schemes may have potential implications in terms of enhancing image visualization to provide radiologists with valuable diagnostic information.
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Affiliation(s)
- S Suryanarayanan
- Department of Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester 01655, USA
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Abstract
RATIONALE AND OBJECTIVES The authors performed this study to investigate the potential applicability of tomosynthesis to digital mammography. Four methods of tomosynthesis-tuned aperture computed tomography (TACT)-backprojection, TACT-iterative restoration, iterative reconstruction with expectation maximization, and Bayesian smoothing-were compared to planar mammography and analyzed in terms of their contrast-detail characteristics. Specific comparisons between the tomosynthesis methods were not attempted in this study. MATERIALS AND METHODS A full-field, amorphous, silicon-based, flat-panel digital mammographic system was used to obtain planar and tomosynthesis projection images. A composite tomosynthesis phantom with a centrally located contrast-detail insert was used as the object of interest. The total exposure for multiple views with tomosynthesis was always equal to or less than that for the planar technique. Algorithms were used to reconstruct the object from the acquired projections. RESULTS Threshold contrast characteristics with all tomosynthesis reconstruction methods were significantly better than those with planar mammography, even when planar mammography was performed at more than twice the exposure level. Reduction of out-of-plane structural components was observed in all the tomosynthesis methods analyzed. CONCLUSION The contrast-detail trends of all the tomosynthesis methods analyzed in this study were better than those of planar mammography. Further optimization of the algorithms could lead to better image reconstruction, which would improve visualization of valuable diagnostic information.
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Affiliation(s)
- S Suryanarayanan
- Department of Radiology, University of Massachusetts Medical School-UMass Memorial Medical Center, Worcester 01655, USA
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Vedantham S, Karellas A, Suryanarayanan S, D'Orsi CJ, Hendrick RE. Breast imaging using an amorphous silicon-based full-field digital mammographic system: stability of a clinical prototype. J Digit Imaging 2000; 13:191-9. [PMID: 11110258 PMCID: PMC3453066 DOI: 10.1007/bf03168394] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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] [Indexed: 11/29/2022] Open
Abstract
An amorphous silicon-based full-breast imager for digital mammography was evaluated for detector stability over a period of 1 year. This imager uses a structured CsI:TI scintillator coupled to an amorphous silicon layer with a 100-micron pixel pitch and read out by special purpose electronics. The stability of the system was characterized using the following quantifiable metrics: conversion factor (mean number of electrons generated per incident x-ray), presampling modulation transfer function (MTF), detector linearity and sensitivity, detector signal-to-noise ratio (SNR), and American College of Radiology (ACR) accreditation phantom scores. Qualitative metrics such as flat field uniformity, geometric distortion, and Society of Motion Picture and Television Engineers (SMPTE) test pattern image quality were also used to study the stability of the system. Observations made over this 1-year period indicated that the maximum variation from the average of the measurements were less than 0.5% for conversion factor, 3% for presampling MTF over all spatial frequencies, 5% for signal response, linearity and sensitivity, 12% for SNR over seven locations for all 3 target-filter combinations, and 0% for ACR accreditation phantom scores. ACR mammographic accreditation phantom images indicated the ability to resolve 5 fibers, 4 speck groups, and 5 masses at a mean glandular dose of 1.23 mGy. The SMPTE pattern image quality test for the display monitors used for image viewing indicated ability to discern all contrast steps and ability to distinguish line-pair images at the center and corners of the image. No bleeding effects were observed in the image. Flat field uniformity for all 3 target-filter combinations displayed no artifacts such as gridlines, bad detector rows or columns, horizontal or vertical streaks, or bad pixels. Wire mesh screen images indicated uniform resolution and no geometric distortion.
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Affiliation(s)
- S Vedantham
- Department of Radiology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester 01655, USA
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Goodwin SC, Yoon HC, Wong GC, Bonilla SM, Vedantham S, Arora LC. Percutaneous delivery of a heparin-impregnated collagen stent-graft in a porcine model of atherosclerotic disease. Invest Radiol 2000; 35:420-5. [PMID: 10901103 DOI: 10.1097/00004424-200007000-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To develop collagen stent-grafts impregnated with heparin to improve the biocompatibility of endovascular stents and to design a percutaneous delivery system for graft deployment in a swine model. METHODS Heparin-impregnated collagen stent-grafts were deployed, and follow-up angiograms were obtained every 15 minutes for 90 minutes to assess acute thromboses and again at 2 and 4 weeks afterward to assess patency. If stenosis or occlusion was detected at the 2-week evaluation, guidewire passage across the lesion was attempted and angioplasty was performed. If stenosis or occlusion was present at the 4-week evaluation, only guidewire passage was attempted; thereafter, the animals were killed and the stent-grafts were harvested and reviewed by a vascular pathologist. RESULTS Group A represents a feasibility study to optimize the deployment method applied in groups B and C. Fifteen of 17 stent-grafts were successfully deployed using this method. In group B, 89% of grafts were successfully deployed; 12% were patent at 2 weeks and none at 4 weeks. In group C, a 10-minute inflation time was added to the deployment procedure; 88% of grafts were successfully deployed and 28% were patent at 2 weeks and 14% at 4 weeks. Extensive luminal thrombosis and myointimal hyperplasia were present in every case. CONCLUSIONS A method was developed for percutaneous implantation of collagen stent-grafts into peripheral vessels. The heparin-impregnated grafts did not prevent vessel restenosis. Modification of the graft-processing technique may improve patency.
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Affiliation(s)
- S C Goodwin
- Department of Radiological Sciences, University of California, Los Angeles Medical Center, 90095, USA
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Vedantham S, Goodwin SC, McLucas B, Lee M, Perrella R, Forno AE, DeLeon M. Uterine artery embolization for fibroids: considerations in patient selection and clinical follow-up. Medscape Womens Health 1999; 4:2. [PMID: 10629068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Goodwin SC, McLucas B, Lee M, Chen G, Perrella R, Vedantham S, Muir S, Lai A, Sayre JW, DeLeon M. Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 1999; 10:1159-65. [PMID: 10527191 DOI: 10.1016/s1051-0443(99)70213-7] [Citation(s) in RCA: 354] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The authors review their midterm experience with uterine artery embolization for the treatment of uterine fibroids. MATERIALS AND METHODS Sixty patients were referred for permanent polyvinyl alcohol (PVA) foam particle uterine artery embolization during an 18-month period. Detailed clinical follow-up and ultrasound follow-up were obtained. RESULTS Bleeding was a presenting symptom in 56 patients and pain was a presenting symptom in 47 patients. All patients underwent a technically successful embolization. One of the patients underwent unilateral embolization. Fifty-nine patients underwent bilateral embolization. Of all patients undergoing bilateral embolization, at last follow-up (mean, 16.3 months), 81% had their uterus and had moderate or better improvement in their symptoms. Ninety-two percent of these patients also had reductions in uterine and dominant fibroid volumes. Overall, the mean uterine and dominant fibroid volume reduction were 42.8% and 48.8%, respectively (mean follow-up, 10.2 months). One infectious complication that necessitated hysterectomy occurred. CONCLUSION Uterine artery embolization for the treatment of uterine fibroids is a minimally invasive technique with low complication rates and very good clinical efficacy.
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Affiliation(s)
- S C Goodwin
- Department of Radiological Sciences, UCLA Medical Center, Los Angeles, California, USA.
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