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%.

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.

scholarly journals Effective doses from panoramic radiography and CBCT (cone beam CT) using dose area product (DAP) in dentistry

2014 ◽  
Vol 43 (5) ◽  
pp. 20130439 ◽  
Author(s):  
H S Shin ◽  
K C Nam ◽  
H Park ◽  
H U Choi ◽  
H Y Kim ◽  
...  
Keyword(s):  
Panoramic Radiography ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Dose Area Product ◽  
Effective Doses ◽  
Area Product

CONE BEAM CT IN DENTAL IMPLANT PLANNING: HOW CLOSE ARE PATIENT DOSIMETRY RESULTS WITH DATA FROM PHANTOM STUDIES FOUND IN LITERATURE?

2019 ◽  
Author(s):  
S Kottou ◽  
A Zapros ◽  
N Stefanopoulou ◽  
N Krompas ◽  
V Tsapaki
Keyword(s):  
Radiation Exposure ◽  
Low Cost ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Study Patient ◽  
Tube Voltage ◽  
Voxel Size ◽  
Phantom Studies ◽  
Area Product ◽  
Patient Radiation Exposure

Abstract Advantages of Cone Beam Computed Tomography (CBCT) include high-quality 3D imaging and reduced radiation exposure with relatively low cost. In this study, patient radiation exposure in CBCT implant planning dentistry was measured in terms of Kerma Area Product (KAP). Data were obtained from 217 CBCT scans on 168 individuals using a CS9300 Carestream system. Scans were made using 80–90 kVp, 4–5 mA, 8 and 13.3 s exposure time (depending on voxel size) and a fixed field of view (FOV) of 10 × 10 cm2 (medium). Mean KAP was estimated using two voxel sizes 180 × 180 × 180 μm3 and 200 × 200 × 200 μm3 and found to be 399 and 314 mGycm2, respectively. Corresponding KAP values found in literature ranged between 210 and 2140 mGycm2. Mean E was estimated using conversion coefficient factors found in literature, according to FOV size and tube voltage value and found to range between 24 and 161 μSv.

scholarly journals A review of dental cone-beam CT dose conversion coefficients

2020 ◽  
pp. 20200225
Author(s):  
Eugene Mah ◽  
E Russell Ritenour ◽  
Hai Yao
Keyword(s):  
Effective Dose ◽  
Cone Beam Ct ◽  
Field Of View ◽  
Cone Beam ◽  
Tube Voltage ◽  
Conversion Factors ◽  
Dose Area Product ◽  
Ct Dose ◽  
Conversion Coefficients ◽  
Area Product

Objective: The purpose of this study was to review the literature to examine the usage and magnitude of effective dose conversion factors (DCE) for dental cone beam CT (CBCT) scanners. Methods: A PubMed literature search for publications relating to radiation dosimetry in dental radiography was performed. Papers were included if they reported DCE, or reported ICRP 103 effective dose and dose-area product. 71 papers relating to dental CBCT dosimetry were found, of which eight reported effective dose conversion factors or provided enough information to calculate dose conversion factors. Scanner model, effective dose, dose-area product, tube voltage, field of view size and DCE were extracted from the papers for analysis. Results: DCE values ranged from 0.035 to 0.31 µSv/mGy-cm2 with a mean of 0.129 µSv/mGy-cm2 (SD = 0.056). When categorized into small (<100 cm2), medium (100–225 cm2) and large (>225 cm2) fields of view (FOV), linear fits to the effective dose and dose-area product yielded slopes of 0.129, 0.111 and 0.074 µSv/mGy-cm2 for small, medium and large FOVs respectively. Conclusion: The range of reported DCE values and spread with respect to field of view category suggests that DCE values that depend on FOV would provide more accurate effective dose estimates. Tube voltage was found to be a smaller factor in determining DCE. Reasonable values for DCE taking into account FOV size were obtained. There is considerable room for more work to be done to examine the behaviour of DCE with changes to patient age and dental CBCT imaging parameters.

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 Dose indices in dental cone beam CT and correlation with dose–area product

2013 ◽  
Vol 42 (5) ◽  
pp. 20120362 ◽  
Author(s):  
K Araki ◽  
S Patil ◽  
A Endo ◽  
T Okano
Keyword(s):  
Cone Beam Ct ◽  
Cone Beam ◽  
Dose Area Product ◽  
Area Product

scholarly journals Fusion Imaging Significantly Reduces Contrast and Radiation Exposure During Standard EVAR

2019 ◽  
pp. 1-5
Author(s):  
Susanne Anton ◽  
J. Barkhausen ◽  
M. Wiedner ◽  
E. Stahlberg ◽  
Janpeter Goltz ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Fusion Imaging ◽  
Standard Group ◽  
Digital Subtraction ◽  
Hypogastric Artery ◽  
Median Dose ◽  
Dose Area Product ◽  
Contrast Volume ◽  
Area Product ◽  
Few Data

Background: Standard endovascular aortic repair (EVAR) is frequently performed with few data regarding utilization of 2D-3D fusion imaging (FI). Purpose: To evaluate a) feasibility and safety of 2D-3D FI to guide limb deployment during EVAR and b) efficacy of this technique compared to standard use of digital subtraction angiography (DSA) for guidance. Materials and Methods: Iliac limb deployment by guidance of 2D-3D FI (FUSION group, n=22 limbs) during EVAR was compared to (STANDARD group, n=23 limbs). Retrospectively, we analyzed feasibility (success-rate) and safety (patency of hypogastric artery; type Ib/III endoleak) of FI for limb deployment (FUSION group). Total contrast (ml) and median dose area product (mGy*cm2) per group to visualize the iliac bifurcation were compared. Results: In the FUSION group, limb deployment was performed in 19/22 limbs (86.4%) and all hypogastric arteries were patent at the end of the procedure. Median volumes of contrast per bifurcation were 13.0 ml (RANGE 13–13ml) in the STANDARD and 2.2ml (RANGE 0–13ml) in the FUSION group (p=0.002); median dose area products per bifurcation were 11951mGy*cm2 and 2593.1mGy*cm2 (p=0.001), respectively. Conclusion: Fusion imaging for guidance of limb deployment during standard EVAR is safe and feasible in the majority of procedures and can significantly reduce contrast volume and radiation exposure even if compared with optimal preparation by predicting optimal C-arm positions. Therefore, FI should be used whenever possible

Estimation of the radiation dose for dental spectral cone-beam CT

2020 ◽  
pp. 20200372
Author(s):  
Kaan Orhan ◽  
Ruben Pauwels ◽  
Yi Chen ◽  
Dandan Song ◽  
Reinhilde Jacobs
Keyword(s):  
Radiation Dose ◽  
Effective Dose ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Dose Area Product ◽  
Ion Chamber ◽  
Effective Doses ◽  
Artefact Reduction ◽  
Area Product ◽  
Dose Measurements

Objectives: The purpose of this study was to estimate the radiation dose for a dental spectral cone-beam CT (SCBCT) unit at different scanning parameters. Methods: Radiation dose measurements were performed for a commercially available dental SCBCT. Scans were obtained at different exposure times and fields of view (FOV), both for non-spectral (25 × 18 cm, 14 × 18 cm, 14 × 12 cm, 9 × 9 cm, 6 × 6 cm) and spectral modes (14 × 18 cm, 14 × 12 cm, 9 × 9 cm, 6 × 6 cm) with the tube voltage alternating between 80 and 110 kV for spectral mode, and fixed at 110 kV for non-spectral mode. An ion chamber was used for air kerma and dose area product (DAP) measurements. The effective dose was estimated based on the mAs using previously published logarithmic curves for CBCT units with a similar X-ray spectrum. Results: The adult effective dose, in non-spectral mode, was 44-269µSv for small FOVs, 131-336µSv for the medium FOV, and 163-476µSv for the large FOV. In spectral mode, the estimated adult effective doses were 96-206µSv for small, 299µSv for medium and 372µSv for large FOV protocols. Pediatric effective doses were estimated to be 75% higher than corresponding adult doses. Conclusion: SCBCT showed comparable doses with other CBCT devices, but DAP values were generally above currently published DRLs. Spectral imaging might allow for artefact reduction at comparable dose levels, which should be assessed in further image quality studies at both a technical and diagnostic level.

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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