CT fluoroscopy guidance versus conventional CT guidance for percutaneous pulmonary nodule biopsy- a comparison of patient radiation exposure, procedural time, and complication rates

2014 ◽  
Vol 25 (3) ◽  
pp. S202-S203 ◽  
Author(s):  
S. Black ◽  
A. Peterson
Keyword(s):  
Radiation Exposure ◽  
Pulmonary Nodule ◽  
Ct Guidance ◽  
Complication Rates ◽  
Ct Fluoroscopy ◽  
Procedural Time ◽  
Patient Radiation Exposure ◽  
Conventional Ct ◽  
Fluoroscopy Guidance

3D mapping versus cardiac computed tomography guided cryoballoon ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Varnavas ◽  
K De Schouwer ◽  
JP Abugattas ◽  
M Wolf ◽  
Y De Greef ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Radiation Exposure ◽  
Cardiac Computed Tomography ◽  
Fluoroscopy Time ◽  
Cryoballoon Ablation ◽  
3D Mapping ◽  
Procedural Time ◽  
The Mean ◽  
Patient Radiation Exposure

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac computed tomography (CCT) is an essential tool for an efficient ablation for atrial fibrillation. 3D mapping guided ablation could also deliver sufficient results in the setting of cryoballoon ablation (CBA) with additional advantages regarding total patient radiation exposure, fluoroscopy and procedural time. Purpose To compare the 3D mapping with the Achieve® catheter versus the CCT on the procedural characteristics and acute outcome during CBA. Methods Consecutive patients who underwent CBA with the second-generation cryoballoon (CB) were retrospectively enrolled from a single centre registry. Baseline and procedural characteristics of patients with pre-procedural CCT (CT-Group) were compared to those with peri-procedural 3D mapping (Ensite PrecisionTM ) with the 1st generation Achieve® catheter (3D-Group). Results A total of 696 patients were enrolled, 327 (47%) in the CT-Group and 369 (53%) in the 3D-Group. Baseline characteristics were comparable between the two groups. Similar pulmonary vein (PV) anatomical variations were identified in both groups and all PVs were acutely isolated. The mean CB temperature (T) at 60s, the nadir T, the time to PV isolation, the T of isolation and the mean thaw time did not differ significantly. However, the total procedural and fluoroscopy time were significantly shorter as well as the dose area product was significantly less  in the 3D-Group. Conclusion 3D mapping guided CBA using the Achieve® catheter is associated with significantly shorter fluoroscopy and procedural time and less patient radiation exposure. The anatomical acquisition of the PVs and the acute ablation outcome is non inferior to the CCT guided CBA. Procedural characteristics CT-Group n = 327 3D- Groupn = 369 p-value Paroxysmal AF 214 244 0.87 Total procedure time (min) 73.3 ± 23.1 65.1 ± 18.9 < 0.01 Fluoroscopy time (min) 14.9 ± 7.7 12.6 ± 7 0.02 DAP (Gy·cm2) 5924 ± 4991 4890 ± 3790 0.04 LCPV 37 41 1.00 RMPV 20 21 0.87 Mean T at 60s(oC) -41.9 ± 8.5 -40.6 ± 10.7 0.10 Mean nadir T(oC) -49.5 ± 6.4 -48.4 ± 7.8 0.18 Mean PVI time(s) 42.4 ± 26.3 38.1 ± 24.3 0.11 Mean PVI temperature(oC) -33.4 ± 11.6 -31.1 ± 22 0.16 Mean thaws time(s) 51.5 ± 20.5 51.8 ± 20.3 0.85

scholarly journals A minimally fluoroscopic approach in AVNRT ablation reduces radiation exposure and number of RF applications without compromising safety, effectiveness and procedural time

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Kasbari ◽  
B Robaye ◽  
F Dormal ◽  
E Ballant ◽  
B Collet ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Conventional Group ◽  
Complication Rates ◽  
Reduce Radiation Exposure ◽  
Acute Success ◽  
Procedural Time ◽  
Rf Applications ◽  
Safety Effectiveness ◽  
Mapping Systems

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency ablation (RF) of atrioventricular nodal reentry tachycardia (AVNRT) using conventional fluoroscopy is associated with a significant radiation exposure to both patients and operators. 3D electro-anatomical mapping systems (EAMS) can reduce radiation exposure, but specific clinical studies on their use in AVNRT ablation still lack. Purpose The aim of this study was to determine if EAMS use in AVNRT ablation can reduce radiation exposure and to analyse its effects on clinical and procedural outcomes. Methods We selected 277 patients who underwent AVNRT RF ablation in a single center in Belgium between July 2015 and November 2019 and performed a retrospective analysis of 136 and 141 patients who respectively and consecutively underwent AVNRT ablation with a conventional fluoroscopic approach (Conventional group) and a minimally fluoroscopic approach using a 3D electro-anatomical mapping system to guide the procedure (Minimal fluoroscopy group). Conventional fluoroscopy was used in both groups to confirm AVNRT induction to avoid costs related to the use of EAMS catheters in case of non-induction.  We compared radiation dose, acute success/complication rates, procedural time and the number/time of RF applications in both groups. Results Radiation dose in the minimal fluoroscopy group was significantly lower compared to the conventional group (1179 vs. 2686 mgray.cm2, p < 0,0001) and fluoroscopic time was shorter (2,5 vs. 8,6 minutes, p < 0,0001). Procedural time (70 vs. 69 min, p = NS) and acute success rate (99% vs. 98%, p = NS) were not significantly different in the minimal fluoroscopy group compared to the conventional group, and no complications were observed in both groups. The number of RF applications was significantly lower when EAMS was used (6,2 ± 4,8 vs. 8,6 ± 7,6 RF application, p = 0,01) while the RF application time was not significantly different (56,8 ± 51,2 1 vs. 65,3 ± 86 seconds, p = NS). Conclusion AVNRT catheter ablation using a minimally fluoroscopic approach with 3D electro-anatomical mapping systems reduces radiation exposure without compromising safety, effectiveness and procedural time. EAMS use is associated with a reduction in the number of RF applications suggesting a higher precision and stability of ablation catheters during RF application.

scholarly journals C-Arm Cone-Beam CT Virtual Navigation Versus Conventional CT Guidance in the Transthoracic Lung Biopsy: A Case-Control Study

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 115
Author(s):  
Lian Yang ◽  
Yue Wang ◽  
Lin Li ◽  
Dehan Liu ◽  
Xin Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Biopsy ◽  
Cone Beam ◽  
Ct Guidance ◽  
Complication Rates ◽  
Virtual Navigation ◽  
Ct Guided ◽  
Significant Difference ◽  
Lung Biopsies ◽  
Conventional Ct

C-arm cone-beam computed tomography (CBCT) virtual navigation-guided lung biopsy has been developed in the last decade as an alternative to conventional CT-guided lung biopsy. This study aims to compare the biopsy accuracy and safety between these two techniques and explores the risk factors of biopsy-related complications. A total of 217 consecutive patients undergoing conventional CT- or C-arm CBCT virtual navigation-guided lung biopsy from 1 June 2018 to 31 December 2019 in this single-center were retrospectively reviewed. Multiple factors (e.g., prior emphysema, lesion size, etc.) were compared between two biopsy techniques. The risk factors of complications were explored by using logistic regression. The patients’ median age and male-to-female ratio were 63 years and 2.1:1, respectively. Eighty-two (82) patients (37.8%) underwent conventional CT-guided biopsies, and the other 135 patients (62.2%) C-arm CBCT virtual navigation-guided biopsies. Compared with patients undergoing C-arm CBCT virtual navigation-guided lung biopsies, patients undergoing conventional CT-guided lung biopsies showed higher needle repositioning rate, longer operation time, and higher effective dose of X-ray (52.4% vs. 6.7%, 25 min vs. 15 min, and 13.4 mSv vs. 7.6 mSv, respectively; p < 0.001, each). In total, the accurate biopsy was achieved in 215 of 217 patients (99.1%), without a significant difference between the two biopsy techniques (p = 1.000). The overall complication rates, including pneumothorax and pulmonary hemorrhage/hemoptysis, are 26.3% (57/217), with most minor complications (56/57, 98.2%). The needle repositioning was the only independent risk factor of complications with an odds ratio of 6.169 (p < 0.001). In conclusion, the C-arm CBCT virtual navigation is better in percutaneous lung biopsy than conventional CT guidance, facilitating needle positioning and reducing radiation exposure. Needle repositioning should be avoided because it brings about more biopsy-related complications.

Reducing Patient Radiation Exposure From CT Fluoroscopy–Guided Lumbar Spine Pain Injections by Targeting the Planning CT

2016 ◽  
Vol 206 (2) ◽  
pp. 390-394 ◽  
Author(s):  
Timothy J. Amrhein ◽  
J. Scott Schauberger ◽  
Peter G. Kranz ◽  
Jenny K. Hoang
Keyword(s):  
Lumbar Spine ◽  
Radiation Exposure ◽  
Ct Fluoroscopy ◽  
Spine Pain ◽  
Patient Radiation Exposure ◽  
Planning Ct

scholarly journals Preoperative versus intraoperative image-guided localization of multiple ipsilateral lung nodules

2019 ◽  
Author(s):  
Yin-Kai Chao ◽  
Hsin-Yueh Fang ◽  
Kuang-Tse Pan ◽  
Chih-Tsung Wen ◽  
Ming-Ju Hsieh
Keyword(s):  
Radiation Exposure ◽  
General Anaesthesia ◽  
Cone Beam Ct ◽  
Operating Time ◽  
Pulmonary Nodules ◽  
Complication Rates ◽  
Navigation Systems ◽  
Ct Guided ◽  
Preoperative Ct ◽  
Procedural Time

Abstract OBJECTIVES Computed tomography (CT)-guided localization of multiple ipsilateral pulmonary nodules remains challenging. Hybrid operating rooms equipped with cone-beam CT and laser navigation systems have the potential for improving clinical workflows and patient outcomes. METHODS Patients with multiple ipsilateral pulmonary nodules requiring localization were divided according to the localization method [preoperative CT-guided (POCT group) localization versus intraoperative CT-guided (IOCT group) localization]. The 2 groups were compared in terms of procedural efficacy, safety and radiation exposure. RESULTS Patients in the IOCT (n = 12) and POCT (n = 42) groups did not differ in terms of demographic and tumour characteristics. Moreover, the success and complication rates were similar. Notably, the IOCT approach allowed multiple nodules to be almost simultaneously localized—resulting in a shorter procedural time [mean difference (MD) −15.83 min, 95% confidence interval (CI) −7.97 to −23.69 min] and lower radiation exposure (MD −15.59 mSv, 95% CI −7.76 to −23.42 mSv) compared with the POCT approach. However, the total time under general anaesthesia was significantly longer in the IOCT group (MD 34.96 min, 95% CI 1.48–68.42 min), despite a similar operating time. The excess time under anaesthesia in the IOCT group can be attributed not only to the procedure per se but also to a longer surgical preparation time (MD 21.63 min, 95% CI 10.07–33.19 min). CONCLUSIONS Compared with the POCT approach, IOCT-guided localization performed in a hybrid operating room is associated with a shorter procedural time and less radiation exposure, albeit at the expense of an increased time under general anaesthesia.

Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with “ALARA” principles profoundly lowers total dose

2014 ◽  
Vol 25 (5) ◽  
pp. 963-968 ◽  
Author(s):  
Robert H. Pass ◽  
Gregory G. Gates ◽  
Laura A. Gellis ◽  
Lynn Nappo ◽  
Scott R. Ceresnak
Keyword(s):  
Radiation Exposure ◽  
Supraventricular Tachycardia ◽  
Group Versus ◽  
Group 14 ◽  
Dose Area Product ◽  
Patient Demographics ◽  
Acute Success ◽  
Procedural Time ◽  
Area Product ◽  
Patient Radiation Exposure

AbstractBackground: “ALARA – As Low As Reasonably Achievable” protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose. Methods: From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2–3 frames/second), low fluoro dose/frame (6–18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with “fast anatomical mapping” (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols. Results: A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical–fluoroscopy technique. Conclusions: Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.

scholarly journals Navigated iliac screw placement may reduce radiation and OR time in lumbopelvic fixation of unstable complex sacral fractures

2021 ◽  
Author(s):  
M. F. Hoffmann ◽  
E. Yilmaz ◽  
D. C. Norvel ◽  
T. A. Schildhauer
Keyword(s):  
Radiation Exposure ◽  
Operative Time ◽  
Pelvic Ring ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Lumbopelvic Fixation ◽  
Navigation Group ◽  
Iliac Screws ◽  
Iliac Screw

Abstract Purpose Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views. The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates. Methods Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated. Results Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures. Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm2; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing. Conclusion For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

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