scholarly journals Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site Experience

2017 ◽  
Vol 6 (3-4) ◽  
pp. 105-116 ◽  
Author(s):  
Ameer E. Hassan ◽  
Sophie Amelot
Keyword(s):  
Cerebral Angiography ◽  
Digital Subtraction ◽  
Patient Exposure ◽  
Flat Panel ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
Alara Principle ◽  
Area Product ◽  
Procedure Type ◽  
Neurointerventional Procedures

Background and Purpose: Per the ALARA principle, reducing the dose delivered to both patients and staff must be a priority for endovascular therapists, who should monitor their own practice. We evaluated patient exposure to radiation during common neurointerventions performed with a recent flat-panel detector angiographic system and compared our results with those of recently published studies. Methods: All consecutive patients who underwent a diagnostic cerebral angiography or intervention on 2 modern flat-panel detector angiographic biplane systems (Innova IGS 630, GE Healthcare, Chalfont St Giles, UK) from February to November 2015 were retrospectively analyzed. Dose-area product (DAP), cumulative air kerma (CAK) per plane, fluoroscopy time (FT), and total number of digital subtraction angiography (DSA) frames were collected, reported as median (interquartile range), and compared with the previously published literature. Results: A total of 755 consecutive cases were assessed in our institution during the study period, including 398 diagnostic cerebral angiographies and 357 interventions. The DAP (Gy × cm2), fontal and lateral CAK (Gy), FT (min), and total number of DSA frames were as follows: 43 (33-60), 0.26 (0.19-0.33), 0.09 (0.07-0.13), 5.6 (4.2-7.5), and 245 (193-314) for diagnostic cerebral angiographies, and 66 (41-110), 0.46 (0.25-0.80), 0.18 (0.10-0.30), 18.3 (9.1-30.2), and 281 (184-427) for interventions. Conclusion: Our diagnostic cerebral angiography group had a lower median and was in the 75th percentile of DAP and FT when compared with the published literature. For interventions, both DAP and number of DSA frames were significantly lower than the values reported in the literature, despite a higher FT. Subgroup analysis by procedure type also revealed a lower or comparable DAP.

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.

Therapeutic angiographic procedures: differences in dose area product between analog image intensifier and digital flat panel detector

2015 ◽  
Vol 57 (5) ◽  
pp. 587-594 ◽  
Author(s):  
Daniel Spira ◽  
Sebastian Kirchner ◽  
Gunnar Blumenstock ◽  
Klaus Herz ◽  
Dominik Ketelsen ◽  
...  
Keyword(s):  
Image Intensifier ◽  
Flat Panel ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
Area Product

Analysis of Patients’ X-ray Exposure in 146 Percutaneous Radiologic Gastrostomies

2017 ◽  
Vol 189 (09) ◽  
pp. 820-827 ◽  
Author(s):  
Tim-Ole Petersen ◽  
Martin Reinhardt ◽  
Jochen Fuchs ◽  
Dieter Gosch ◽  
Alexey Surov ◽  
...  
Keyword(s):  
Cone Beam Ct ◽  
Image Intensifier ◽  
Flat Panel ◽  
Flat Detector ◽  
Dose Length Product ◽  
X Ray ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
Significant Prolongation ◽  
Area Product

Purpose Analysis of patient´s X-ray exposure during percutaneous radiologic gastrostomies (PRG) in a larger population. Materials and Methods Data of primary successful PRG-procedures, performed between 2004 and 2015 in 146 patients, were analyzed regarding the exposition to X-ray. Dose-area-product (DAP), dose-length-product (DLP) respectively, and fluoroscopy time (FT) were correlated with the used x-ray systems (Flatpanel Detector (FD) vs. Image Itensifier (BV)) and the necessity for periprocedural placement of a nasogastric tube. Additionally, the effective X-ray dose for PRG placement using fluoroscopy (DL), computed tomography (CT), and cone beam CT (CBCT) was estimated using a conversion factor. Results The median DFP of PRG-placements under fluoroscopy was 163 cGy*cm2 (flat panel detector systems: 155 cGy*cm2; X-ray image intensifier: 175 cGy*cm2). The median DLZ was 2.2 min. Intraprocedural placement of a naso- or orogastric probe (n = 68) resulted in a significant prolongation of the median DLZ to 2.5 min versus 2 min in patients with an already existing probe. In addition, dose values were analyzed in smaller samples of patients in which the PRG was placed under CBCT (n = 7, median DFP = 2635 cGy*cm2), or using CT (n = 4, median DLP = 657 mGy*cm). Estimates of the median DFP and DLP showed effective doses of 0.3 mSv for DL-assisted placements (flat panel detector 0.3 mSv, X-ray image converter 0.4 mSv), 7.9 mSv using a CBCT – flat detector, and 9.9 mSv using CT. This corresponds to a factor 26 of DL versus CBCT, or a factor 33 of DL versus CT. Conclusion In order to minimize X-ray exposure during PRG-procedures for patients and staff, fluoroscopically-guided interventions should employ flat detector systems with short transmittance sequences in low dose mode and with slow image frequency. Series recordings can be dispensed with. The intraprocedural placement of a naso- or orogastric probe significantly extends FT, but has little effect on the overall dose of the intervention. Due to the significantly higher X-ray exposure, the use of a CBCT as well as PRG-placements using CT should be limited to clinically absolutely necessary exceptions with strict indication. Key Points  Citation Format

Development and evaluation of a digital subtraction angiography system using a large-area flat panel detector

2003 ◽  
Author(s):  
Shigeyuki Ikeda ◽  
Katsumi Suzuki ◽  
Ken Ishikawa ◽  
Richard E. Colbeth ◽  
Chris Webb ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Large Area ◽  
Flat Panel ◽  
Flat Panel Detector

Impact of digital imaging on radiation doses to the patient during X-ray examination of the urinary tract

2005 ◽  
Vol 46 (6) ◽  
pp. 657-661 ◽  
Author(s):  
B. Sjöholm ◽  
H. Geijer ◽  
J. Persliden
Keyword(s):  
Dose Reduction ◽  
Intravenous Urography ◽  
Radiation Doses ◽  
Flat Panel ◽  
Storage Phosphor ◽  
X Ray ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
Before And After ◽  
Phosphor Plates

Purpose: To compare radiation doses given to patients undergoing IVU (intravenous urography) before and after digitalization of our X-ray department. Material and Methods: IVU examinations were monitored with dose area product meters before and after the X-ray department changed to digital techniques. The first step was a change from film-screen to storage phosphor plates, while the second step involved changing to a flat panel detector. Forty-two patients were included for the film-screen situation, 69 when using the storage phosphor plates, and 70 using the flat panel detector. Results: A dose reduction from 41.8 Gycm2 to 31.5 Gycm2 was achieved with the first step when the film-screen system was replaced with storage phosphor plates. A further reduction to 12.1 Gycm2 was achieved using the flat panel detector. Conclusion: The introduction of the flat panel detectors made a considerable dose reduction possible.

Analysis of radiation doses incurred during diagnostic cerebral angiography after the implementation of dose reduction strategies

2016 ◽  
Vol 9 (4) ◽  
pp. 384-388 ◽  
Author(s):  
Tanja Schneider ◽  
Emily Wyse ◽  
Monica S Pearl
Keyword(s):  
Radiation Dose ◽  
Dose Reduction ◽  
Cerebral Angiography ◽  
Pediatric Patients ◽  
Radiation Doses ◽  
Digital Subtraction ◽  
Air Kerma ◽  
Reduction Strategies ◽  
Technical Modifications ◽  
Area Product

BackgroundOne goal of increasing awareness of radiation dose is to encourage personal and technical modifications in order to reduce the radiation exposure of patients and staff.ObjectiveTo analyze the radiation doses incurred during diagnostic cerebral angiography and the angiographic techniques practiced over a 4-year period, in order to demonstrate the effectiveness of implementing radiation dose reduction strategies.MethodsA retrospective review of the first 50 consecutive adult and pediatric patients undergoing diagnostic cerebral angiography each year from 2010 to 2013 was performed. Angiograms and procedure examination protocols were reviewed for patient age, gender, diagnosis, angiography techniques, fluoroscopy time, reference point air kerma (Ka,r in mGy), and kerma-area product (PKA in μGym2).ResultsFrom January 2010 to June 2013, a total of 231 diagnostic cerebral angiograms were reviewed (200 adults, 31 children). Adult patients were aged from 19 to 94 years and included 77 men and 123 women. Pediatric patients were aged from 2 to 18 years and comprised 11 boys and 20 girls. Median Ka,r and PKA significantly decreased from 2010 to 2013 in adults (1867 mGy; 21 231 µGym2 vs 653 mGy; 7860 µGym2) and children (644 mGy; 6495 µGym2 vs138 mGy; 1465 µGym2), (p<0.001).ConclusionsIncreased awareness and implementation of dose reduction strategies resulted in decreased radiation doses for diagnostic cerebral angiography both in adult and pediatric patients. The use of lower and variable digital subtraction angiography frame rates and tailored examinations contributed significantly to the reduced radiation doses observed during diagnostic cerebral angiography.

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 Monitoring Radiation Doses during Diagnostic and Therapeutic Neurointerventional Procedures: Multicenter Study for Establishment of Reference Levels

2021 ◽  
Author(s):  
Yon-Kwon Ihn ◽  
Bum-soo Kim ◽  
Hae Woong Jeong ◽  
Sang Hyun Suh ◽  
Yoo Dong Won ◽  
...  
Keyword(s):  
Cerebral Angiography ◽  
Interventional Neuroradiology ◽  
Reference Level ◽  
Radiation Doses ◽  
Large Variability ◽  
Dose Area Product ◽  
Stroke Thrombolysis ◽  
Neurointerventional Procedures ◽  
Aneurysm Coiling ◽  
Significant Factors

Purpose: To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL).Materials and Methods: Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution.Results: Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm<sup>2</sup>, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm<sup>2</sup>, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm<sup>2</sup>, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm<sup>2</sup>, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group.Conclusion: Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm<sup>2</sup>) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.

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