A prospective case control comparison of the ZeroGravity system versus a standard lead apron as radiation protection strategy in neuroendovascular procedures

2015 ◽  
Vol 8 (10) ◽  
pp. 1052-1055 ◽  
Author(s):  
Diogo C Haussen ◽  
Imramsjah Martijn John Van Der Bom ◽  
Raul G Nogueira
Keyword(s):  
Radiation Exposure ◽  
Radiation Protection ◽  
Protection System ◽  
Skin Dose ◽  
Lead Apron ◽  
Dose Area Product ◽  
Primary Operator ◽  
The Mean ◽  
Area Product ◽  
Peak Skin Dose

Background and purposeWe aimed to compare the performance of the ZeroGravity (ZG) system (radiation protection system composed by a suspended lead suit) against the use of standard protection (lead apron (LA), thyroid shield, lead eyeglasses, table skirts, and ceiling suspended shield) in neuroangiography procedures.Materials and methodsRadiation exposure data were prospectively collected in consecutive neuroendovascular procedures between December 2014 and February 2015. Operator No 1 was assigned to the use of an LA (plus lead glasses, thyroid shield, and a 1 mm hanging shield at the groin) while operator No 2 utilized the ZG system. Dosimeters were used to measure peak skin dose for the head, thyroid, and left foot.ResultsThe two operators performed a total of 122 procedures during the study period. The ZG operator was more commonly the primary operator compared with the LA operator (85% vs 71%; p=0.04). The mean anterior-posterior (AP), lateral, and cumulative dose area product (DAP) radiation exposure as well as the mean fluoroscopy time were not statistically different between the operators’ cases. The peak skin dose to the head of the operator with LA was 2.1 times higher (3380 vs 1600 μSv), while the thyroid was 13.9 (4460 vs 320 μSv), the mediastinum infinitely (520 vs 0 μSv), and the foot 3.3 times higher (4870 vs 1470 μSv) compared with the ZG operator, leading to an overall accumulated dose 4 times higher. The ratio of cumulative operator received dose/total cumulative DAP was 2.5 higher on the LA operator.ConclusionsThe ZG radiation protection system leads to substantially lower radiation exposure to the operator in neurointerventional procedures. However, substantial exposure may still occur at the level of the lens and thyroid to justify additional protection.

RADIATION DOSE TO PATIENTS IN CORONARY INTERVENTIONAL PROCEDURES: A SURVEY

2018 ◽  
Vol 184 (1) ◽  
pp. 1-4 ◽  
Author(s):  
A Brindhaban
Keyword(s):  
Interventional Procedures ◽  
Coronary Intervention ◽  
Skin Dose ◽  
Radiation Doses ◽  
Dose Area Product ◽  
Maximum Value ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Area Product ◽  
Peak Skin Dose

Abstract The objective of this study was to evaluate dose–area product (DAP) and peak skin dose (PSD) for coronary angiography (CA) and percutaneous coronary intervention (PCI). The DAP and PSD of 300 randomly selected patients who were referred to CA and/or PCI, over a period of 3 months were recorded and analyzed. The mean DAP of 32 Gy cm2 and mean PSD of 412 mGy for CA were lower than 118 Gy cm2 and 857 mGy, respectively, for PCI. The DAP range of 2–84 Gy cm2 for CA and 12–378 mGy for PCI were also established. The maximum value of PSD for PCI procedures reached above the 2 Gy threshold for erythema. However, these values are similar to those available in literature. Periodic surveys may be required to monitor and/or reduce radiation doses in coronary interventional procedures.

scholarly journals Patient Peak Skin Dose and Dose Area Product from Interventional Cardiology Procedures

2015 ◽  
Vol 04 (01) ◽  
pp. 7-12 ◽  
Author(s):  
Antar E. Aly ◽  
Ibrahim M. Duhaini ◽  
Samia M. Manaa ◽  
Sayed M. Tarique ◽  
Shehim E. Kuniyil ◽  
...  
Keyword(s):  
Interventional Cardiology ◽  
Skin Dose ◽  
Dose Area Product ◽  
Area Product ◽  
Peak Skin Dose

scholarly journals SPOT REGION OF INTEREST IMAGING: A NOVEL FUNCTIONALITY AIMED AT X-RAY DOSE REDUCTION IN NEUROINTERVENTIONAL PROCEDURES

2020 ◽  
Vol 188 (3) ◽  
pp. 322-331
Author(s):  
Ljubisa Borota ◽  
Andreas Patz
Keyword(s):  
Dose Reduction ◽  
Region Of Interest ◽  
Skin Dose ◽  
X Ray ◽  
Dose Area Product ◽  
Dose Saving ◽  
Area Product ◽  
Anatomical Area ◽  
Neurointerventional Procedures ◽  
Peak Skin Dose

Abstract Aim of the study: The aim of this study was to describe a new functionality aimed at X-ray dose reduction, referred to as spot region of interest (Spot ROI) and to compare it with existing dose-saving functionalities, spot fluoroscopy (Spot F), and conventional collimation (CC). Material and methods: Dose area product, air kerma, and peak skin dose were measured for Spot ROI, Spot F, and CC in three different fields of view (FOVs) 20 × 20 cm, 15 × 15 cm, and 11 × 11 cm using an anthropomorphic head phantom RS-230T. The exposure sequence was 5 min of pulsed fluoroscopy (7.5 pulses per s) followed by 7× digital subtraction angiography (DSA) runs with 30 frames per DSA acquisition (3 fps × 10 s). The collimation in Spot F and CC was adjusted such that the size of the anatomical area exposed was as large as the Spot ROI area in each FOV. Results: The results for all FOVs were the following: for the fluoroscopy, all measured parameters for Spot ROI and Spot F were lower than corresponding values for CC. For DSA and DSA plus fluoroscopy, all measured parameters for Spot ROI were lower than corresponding parameters for Spot F and CC. Conclusion: Spot ROI is a promising dose-saving technology that can be applied in fluoroscopy and acquisition. The biggest benefit of Spot ROI is its ability to keep the entire FOV information always visible.

scholarly journals Comparison of Radiation Exposure of the Surgeon in Minimally Invasive Treatment of Osteoporotic Vertebral Fractures – Radiofrequency Kyphoplasty versus Balloon Kyphoplasty with Cement Delivery Systems (CDS)

2019 ◽  
Vol 192 (01) ◽  
pp. 59-64
Author(s):  
Steffen Reißberg ◽  
Lina Lüdeke ◽  
Michael Fritsch
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Radiation Protection ◽  
Balloon Kyphoplasty ◽  
Delivery Systems ◽  
Working Time ◽  
Minimally Invasive Treatment ◽  
Invasive Treatment ◽  
Dose Area Product ◽  
Area Product

The aim of the present study was to compare the radiation exposure of the surgeon when using two different kyphoplasty systems for the minimally invasive treatment of osteoporotic vertebral body fractures. There was a preliminary investigation study by a Belgian working group from the ORAMED project (2010), which served as the basis and showed a dose reduction for the surgeon when using a balloon kyphoplasty system with cement delivery systems (CDS). Materials and Methods A bipedicular balloon kyphoplasty system (Medtronic GmbH) with CDS and a unipedicular radiofrequency kyphoplasty system (StabiliT, DFine Europe GmbH) were used in solitary fractures in the thoracolumbar junction in 20 patients each. The patient groups were relatively homogeneous with a mean age of 76.9 years for balloon kyphoplasty and 75 years for radiofrequency kyphoplasty. As expected, the proportion of woman was higher in both groups. The mean BMI value was higher in the radiofrequency kyphoplasty group, and the patient with the highest BMI was also in this group. The workflows were defined in three steps. The working time and the fluoroscopic time were measured in the individual work steps and the dose was measured over all work steps by TLD chips (thermoluminescence detector) on the forehead, on the X-ray apron, on both wrists and on the left ankle. The dose area product was registered for the entire procedure. Results In step 2, the main differences were found in working time and fluoroscopy time in transit. The difference was due to the bipedicular puncture for balloon kyphoplasty and the change of the working cannula, while only a unipedicular puncture was needed in radiofrequency kyphoplasty. The total fluoroscopy time over all procedures was three times longer than in balloon kyphoplasty and this was also reflected in the dose area product, which was more than twice that. The measured surface doses for the lenses were four times higher in balloon kyphoplasty. For the left wrist, the values for balloon kyphoplasty were about 8 times higher. Conclusion Overall, from a radiophysical perspective, the use of a unipedicular kyphoplasty system must be recommended. Should balloon kyphoplasty be used for medical reasons, all radiation protection products (lead gloves, lead glass, radiation protection goggles and CDS) should be used, the surface doses for both hands must be detected by a ring dosimeter and the lens dose must be recorded and documented by a TLD on the radiation protection goggles. Key Points: Citation Format

Comparison of a Suspended Radiation Protection System versus Standard Lead Apron for Radiation Exposure of a Simulated Interventionalist

2011 ◽  
Vol 22 (4) ◽  
pp. 437-442 ◽  
Author(s):  
Daniel A. Marichal ◽  
Temoor Anwar ◽  
David Kirsch ◽  
Jessica Clements ◽  
Luke Carlson ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Radiation Protection ◽  
Protection System ◽  
Lead Apron ◽  
System Versus ◽  
Standard Lead

Radiation exposure during TACE procedures using additional cone-beam CT (CBCT) for guidance: safety and precautions

2018 ◽  
Vol 59 (11) ◽  
pp. 1277-1284 ◽  
Author(s):  
M Jonczyk ◽  
F Collettini ◽  
D Geisel ◽  
D Schnapauff ◽  
G Böning ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Digital Subtraction ◽  
Dose Area Product ◽  
Additional Radiation ◽  
Ethiodized Oil ◽  
The Mean ◽  
Area Product ◽  
Spearman’S Correlation

Background During transarterial chemoembolization (TACE), cone-beam computed tomography (CBCT) can be used for tumor and feeding vessel detection as well as postembolization CT imaging. However, there will be additional radiation exposure from CBCT. Purpose To evaluate the additional dose raised through CBCT-assisted guidance in comparison to TACE procedures guided with pulsed digital subtraction angiography (DSA) alone. Material and Methods In 70 of 140 consecutive patients undergoing TACE for liver cancer, CBCT was used to facilitate the TACE. Cumulative dose area product (DAP), cumulative kerma(air), DAP values of DSA, total and cine specific fluoroscopy times (FT) of 1375 DSA runs, and DAP of 91 CBCTs were recorded and analyzed using Spearman's correlation, Mann–Whitney U-test, and Kruskal–Wallis test. P values < 0.05 were considered significant. Results Additional CBCT increased DAP by 2% ( P = 0.737), kerma(air) by 24.6% ( P = 0.206), and FT by 0.02% ( P = 0.453). Subgroup analysis revealed that postembolization CBCT for detection of ethiodized oil deposits added more DAP to the procedure. Performing CBCT-assisted TACE, DSA until first CBCT contributed about 38% to the total DAP. Guidance CBCT acquisitions conduced to 6% of the procedure's DAP. Additional DSA for guidance after CBCT acquisition required approximately 46% of the mean DAP. The last DSA run for documentation purposes contributed about 10% of the DAP. Conclusion CBCT adds radiation exposure in TACE. However, the capability of CBCT to detect vessels and overlay in real-time during fluoroscopy facilitates TACE with resultant reduction of DAPs up to 46%.

Surgeon’s radiation exposure during percutaneous vertebroplasty

2006 ◽  
Vol 4 (2) ◽  
pp. 106-109 ◽  
Author(s):  
Michael Synowitz ◽  
Juergen Kiwit
Keyword(s):  
Radiation Exposure ◽  
Percutaneous Vertebroplasty ◽  
Prospective Trial ◽  
Reduction Rate ◽  
Dose Area Product ◽  
Left Hand ◽  
Right Hand ◽  
The Mean ◽  
Area Product ◽  
The Right

Object In this study the authors evaluated levels of radiation exposure to surgeons’ protected and unprotected hands during fluoroscopically assisted vertebroplasty. Methods The amount of radiation administered to 30 patients during 41 procedures in a controlled prospective trial over 6 months was assessed, comparing radiation exposure to the right and left hands in two neurosurgeons. Effective skin doses were evaluated using thermoluminescent finger dosimeters (ring dosimeters). The ratios of finger dosimeter exposure were compared between the glove-protected and unprotected left hands of two surgeons and both unprotected right hands. In addition, dose-area product (DAP) and fluoroscopy times were recorded in all patients. The mean treatment-effective dose to the surgeons’ hands was 0.49 ± 0.4 mSv in the glove-protected left hand and 1.81 ± 1.31 mSv in the unprotected left hand (p < 0.05). The mean effective hand doses were 0.59 ± 0.55 mSv in the unprotected right hand of the glove-protected surgeon and 0.62 ± 0.55 mSv in the unprotected right hand of the control surgeon. The total corresponding fluoroscopy time was 38.55 minutes for the protected surgeon and 41.23 minutes for the unprotected one (p > 0.05). Lead glove shielding resulted in a radiation dose reduction of 75%. The total DAP for all procedures was 256,496 mGy/cm2 and 221,408 mGy/cm2 (p >0.05) for the protected and unprotected surgeons, respectively. Conclusions This study emphasizes the importance of surgeons wearing lead glove protection on their leading hands during percutaneous vertebroplasty procedures and demonstrates a 75% reduction rate of exposure to radiation.

scholarly journals Primary operator radiation dose in the cardiac catheter laboratory

2020 ◽  
Vol 93 (1112) ◽  
pp. 20200018
Author(s):  
James A Crowhurst ◽  
Mark Whitby ◽  
Nicholas Aroney ◽  
Rustem Dautov ◽  
Darren Walters ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Protection ◽  
Reference Level ◽  
Protection Measures ◽  
Dose Area Product ◽  
Primary Operator ◽  
Significant Difference ◽  
Operator Dose ◽  
The Individual ◽  
Area Product

Objectives: Radiation from cardiac angiography procedures is harmful to patients and the staff performing them. This study sought to investigate operator radiation dose for a range of procedures and different operators in order to investigate trends and optimise dose. Methods: Real-time dosemeters (RTDs) were worn by operators for angiography procedures for 3 years. Dose–area product (DAP) and RTD were collected. RTD was normalised to DAP (RTD/DAP) to compare radiation dose and radiation protection measures. Comparisons were made across procedure categories and individual operators. Results: In 7626 procedures, median and 75th percentile levels were established for operator dose for 8 procedure categories. There was a significant difference in all operator dose measures and DAP across procedure categories (p<0.001). DAP, RTD, and RTD/DAP were significantly different across 22 individual operators (p<0.001). Conclusion: DAP was significantly different across procedure categories and a higher RTD was seen with higher DAP. RTD/DAP can demonstrate radiation protection effectiveness and identified differences between procedures and individual operators with this measure. Procedures and individuals were identified where further optimisation of radiation protection measures may be beneficial. A reference level for operator dose can be created and audited against on a regular basis. Advances in knowledge: This study demonstrates that operator dose can be easily and routinely measured on a case by case basis to investigate dose trends for different procedures. Normalising the operator dose to DAP demonstrates radiation protection effectiveness for the individual operator which can then be optimised as part of an ongoing audit program.

scholarly journals Radioprotection during interventional cardiology procedures

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Noval-Morillas ◽  
D Canadas-Pruano ◽  
E Izaga ◽  
A Gutierrez-Barrios
Keyword(s):  
Radiation Exposure ◽  
Radiation Protection ◽  
Real World ◽  
Interventional Procedures ◽  
Interventional Cardiology ◽  
Dose Area Product ◽  
Reduce Radiation Exposure ◽  
Funding Sources ◽  
Different Types ◽  
Area Product

Abstract Background The use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and the medical staff. Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has demonstrated to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real-world procedures. Methods and results In this non-randomized all-comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n=59) and the non-RPC group (n=60). No significant changes in patients and procedures characteristics, average contrast volume, air kerma (AK), dose area-product (PDA) and fluoroscopy time between both groups were apparent. In RPC group, the first operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures. Conclusions Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real-world setting. FUNDunding Acknowledgement Type of funding sources: None.

Noninvasive patient tracker mask for spinal 3D navigation: does the required large-volume 3D scan involve a considerably increased radiation exposure?

2020 ◽  
Vol 33 (6) ◽  
pp. 838-844
Author(s):  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
Christoph Scholz ◽  
Florian Volz ◽  
Marc Hohenhaus ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Image Data ◽  
3D Image ◽  
Flat Panel ◽  
3D Navigation ◽  
Data Set ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
3D Scan ◽  
Area Product

OBJECTIVEIntraoperative 3D imaging and navigation is increasingly used for minimally invasive spine surgery. A novel, noninvasive patient tracker that is adhered as a mask on the skin for 3D navigation necessitates a larger intraoperative 3D image set for appropriate referencing. This enlarged 3D image data set can be acquired by a state-of-the-art 3D C-arm device that is equipped with a large flat-panel detector. However, the presumably associated higher radiation exposure to the patient has essentially not yet been investigated and is therefore the objective of this study.METHODSPatients were retrospectively included if a thoracolumbar 3D scan was performed intraoperatively between 2016 and 2019 using a 3D C-arm with a large 30 × 30–cm flat-panel detector (3D scan volume 4096 cm3) or a 3D C-arm with a smaller 20 × 20–cm flat-panel detector (3D scan volume 2097 cm3), and the dose area product was available for the 3D scan. Additionally, the fluoroscopy time and the number of fluoroscopic images per 3D scan, as well as the BMI of the patients, were recorded.RESULTSThe authors compared 62 intraoperative thoracolumbar 3D scans using the 3D C-arm with a large flat-panel detector and 12 3D scans using the 3D C-arm with a small flat-panel detector. Overall, the 3D C-arm with a large flat-panel detector required more fluoroscopic images per scan (mean 389.0 ± 8.4 vs 117.0 ± 4.6, p < 0.0001), leading to a significantly higher dose area product (mean 1028.6 ± 767.9 vs 457.1 ± 118.9 cGy × cm2, p = 0.0044).CONCLUSIONSThe novel, noninvasive patient tracker mask facilitates intraoperative 3D navigation while eliminating the need for an additional skin incision with detachment of the autochthonous muscles. However, the use of this patient tracker mask requires a larger intraoperative 3D image data set for accurate registration, resulting in a 2.25 times higher radiation exposure to the patient. The use of the patient tracker mask should thus be based on an individual decision, especially taking into considering the radiation exposure and extent of instrumentation.

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