Radiation exposure in 101 non-coronary fluoroscopically guided interventional procedures: reference levels of air kerma at the reference point and air kerma-area product

2021 ◽  
Author(s):  
Xinhua Li ◽  
Joshua Adam Hirsch ◽  
Madan M. Rehani ◽  
Kai Yang ◽  
Theodore Alan Marschall ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Reference Point ◽  
Interventional Procedures ◽  
Tertiary Care ◽  
Radiology Department ◽  
Care Hospital ◽  
Reference Levels ◽  
Air Kerma ◽  
Fluoroscopic Time ◽  
Area Product

Objectives: To present the median value and 75th percentile of air kerma at the reference point (Ka,r), air kerma-area product (KAP), and fluoroscopic time for a large number of fluoroscopically-guided interventional (FGI) procedures. Methods: This retrospective study included the consecutive non-coronary FGI procedures from a Radiology department between May 2016 and October 2018 at a large tertiary care hospital in the U.S. An in-house developed, semi-automated software, integrated with a dictation system, was used to record patient examination information, including Ka,r, KAP and fluoroscopic time. The included patient procedures were categorized into procedure types. A software package R (version 3.5.1, R Foundation) was used to calculate procedure-specific quartiles of radiation exposure. Results: Based on analysis of 24,911 FGI cases, median value and 75th percentile are presented for each of Ka,r, KAP and fluoroscopic time for 101 procedures that can act as benchmark for comparison for dose optimization studies. Conclusion: This study provides reference levels (50th and 75th percentiles) for a comprehensive list of FGI procedures, reflecting an overall picture of the latest FGI studies for diagnosis, targeted minimally invasive intervention, and therapeutic treatment. Advances in knowledge: This study provides reference levels (50th and 75th percentiles) for the largest number of fluoroscopically-guided interventional procedures reported to-date (101 procedures), in terms of air kerma at the reference point, air kerma-area product, and fluoroscopic time, among which these quartiles for ≥50 procedures are presented for the first time.

Radiation exposure in transcatheter patent ductus arteriosus closure: time to tune?

2018 ◽  
Vol 28 (5) ◽  
pp. 653-660 ◽  
Author(s):  
Olivier Villemain ◽  
Sophie Malekzadeh-Milani ◽  
Fidelio Sitefane ◽  
Meriem Mostefa-Kara ◽  
Younes Boudjemline
Keyword(s):  
Patent Ductus Arteriosus ◽  
Radiation Exposure ◽  
Ductus Arteriosus ◽  
Frame Rate ◽  
Radiation Doses ◽  
Dose Area Product ◽  
Air Kerma ◽  
Fluoroscopic Time ◽  
Area Product ◽  
Patent Ductus

AbstractObjectivesThe aims of this study were to describe radiation level at our institution during transcatheter patent ductus arteriosus occlusion and to evaluate the components contributing to radiation exposure.BackgroundTranscatheter occlusion relying on X-ray imaging has become the treatment of choice for patients with patent ductus arteriosus. Interventionists now work hard to minimise radiation exposure in order to reduce risk of induced cancers.MethodsWe retrospectively reviewed all consecutive children who underwent transcatheter closure of patent ductus arteriosus from January 2012 to January 2016. Clinical data, anatomical characteristics, and catheterisation procedure parameters were reported. Radiation doses were analysed for the following variables: total air kerma, mGy; dose area product, Gy.cm2; dose area product per body weight, Gy.cm2/kg; and total fluoroscopic time.ResultsA total of 324 patients were included (median age=1.51 [Q1–Q3: 0.62–4.23] years; weight=10.3 [6.7–17.0] kg). In all, 322/324 (99.4%) procedures were successful. The median radiation doses were as follows: total air kerma: 26 (14.5–49.3) mGy; dose area product: 1.01 (0.56–2.24) Gy.cm2; dose area product/kg: 0.106 (0.061–0.185) Gy.cm2/kg; and fluoroscopic time: 2.8 (2–4) min. In multivariate analysis, a weight >10 kg, a ductus arteriosus width <2 mm, complications during the procedure, and a high frame rate (15 frames/second) were risk factors for an increased exposure.ConclusionLower doses of radiation can be achieved with subsequent recommendations: technical improvement, frame rate reduction, avoidance of biplane cineangiograms, use of stored fluoroscopy as much as possible, and limitation of fluoroscopic time. A greater use of echocardiography might even lessen the exposure.

Reduction of radiation exposure using low pulse rate fluoroscopy during neuroendovascular surgery

2020 ◽  
pp. 159101992094931
Author(s):  
Takeshi Shimizu ◽  
Shingo Toyota ◽  
Kanji Nakagawa ◽  
Tomoaki Murakami ◽  
Tetsuya Kumagai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Minimally Invasive ◽  
Radiation Exposure ◽  
Pulse Rate ◽  
Carotid Artery Stenting ◽  
Dose Area Product ◽  
Radiation Data ◽  
Air Kerma ◽  
Fluoroscopic Time ◽  
Area Product

Introduction Endovascular surgery is minimally invasive, but the radiation exposure can be problematic. There is no report assessing whether radiation exposure can be reduced by using a low pulse rate during carotid artery stenting (CAS). The aim of this study was to evaluate whether reducing the pulse rate from 7.5 to 4 frames per second (f/s) can reduce the radiation exposure while maintaining safety during CAS procedure. Methods We retrospectively reviewed the radiation data and clinical features of all 100 patients who underwent CAS between 2014 and 2019. We changed the pulse rate from 7.5 to 4 f/s in 2017. The fluoroscopic time (FT), dose area product (DAP), and total air kerma (AK) were collected. Statistical analyses were performed between the pulse rate and clinical outcomes, including radiation exposure.

scholarly journals Pediatric Diagnostic Reference Levels for Diagnostic and Therapeutic Cardiac Catheterization in Japan

2021 ◽  
Author(s):  
Toru Ishibashi ◽  
Yasutaka Takei ◽  
Mamoru Kato ◽  
Yukari Yamashita ◽  
Atsuko Tsukamoto ◽  
...  
Keyword(s):  
Cardiac Catheterization ◽  
Pediatric Patients ◽  
Age Groups ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Air Kerma ◽  
Cardiac Angiography ◽  
Pediatric Cardiac Catheterization ◽  
One Year ◽  
Area Product

Abstract To propose Japanese national DRLs for air-kerma at the reference point (Ka,r), air-kerma area product (PKA), fluoroscopy time (FT), and number of cine images (CI) for four age groups. We posted a nationwide questionnaire to 132 facilities. Questions focused on identifying the procedure, age, weight, height, Ka,r, PKA, FT, and CI during diagnostic and therapeutic pediatric cardiac catheterization. For diagnostic cardiac angiography, the 75th percentile values were as follows; Ka,r: 103, 127, 194, and 351 mGy; PKA: 7.0, 12.3, 14.3, and 47.2 Gy.cm2; FT: 36.8, 30.7, 33.4, and 35.7 min; and CI: 2018, 2313, 2408, and 2016 images for less than one year, 1–5 years, 6–10 years, and 11–15 years respectively. For therapeutic cardiac angiography, the 75th percentile values were as follows: Ka,r: 146, 209, 130, and 501 mGy; PKA: 7.54, 16.0, 8.35, and 46.0 Gy.cm2; FT: 56.5, 52.0, 49.4, and 52.0 min; and CI: 4075, 4514, 3576, and 5984 images for less than one year, 1–5 years, 6–10 years, and 11–15 years respectively. Our survey of diagnostic and therapeutic cardiac catheterization in Japanese pediatric patients showed that all age-based Japanese 75th percentiles for the Ka,r, PKA, FT, and CI were higher than in other surveys. Based on the result of our study, it is necessary to establish DRLs for pediatric cardiac catheterization examinations in Japan, in order to optimize the safety of pediatric protocols for diagnostic and therapeutic cardiac catheterization.

scholarly journals Establishing local diagnostic reference levels for common orthopaedic procedures using the mini C-arm fluoroscope

2021 ◽  
Vol 94 (1117) ◽  
pp. 20190878
Author(s):  
Anna Kropelnicki ◽  
Rosemary Eaton ◽  
Alexandra Adamczyk ◽  
Jacqueline Waterman ◽  
Pegah Mohaghegh
Keyword(s):  
Radiation Exposure ◽  
Best Practice ◽  
District General Hospital ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Data Set ◽  
Dose Area Product ◽  
The Third ◽  
Retrospective Audit ◽  
Area Product

Objective: Mini C-arm fluoroscopes are widely used by orthopaedic surgeons for intraoperative image guidance without the need for radiographers. This puts the responsibility for radiation exposure firmly with the operating surgeon. In order to maintain safe and best practice under U.K. Ionising Radiation (Medical Exposure) Regulations, one must limit radiation exposure and audit performance using national diagnostic reference levels (DRLs). In the case of the mini C-arm, there are no national DRLs. IR(ME)R, therefore, require the establishment of local DRLs by each hospital to act as an alternative guideline for safe radiation use. The aim of our audit was to establish local DRLs based on our experience operating with the use of the mini C-arm over the last 7 years. Methods: This retrospective audit evaluates the end dose–area product (DAP) recorded for common trauma and orthopaedic procedures using the mini C-arm in a busy district general hospital. We present the quartile data and have set the cut-off point as the third quartile for formulating the local DRLs, consistent with the methodology for the conventional fluoroscope. Results: For our data set (n = 1664), the third quartile DAP values were lowest for surgeries to the forearm (5.38 cGycm2), hand (7.62 cGycm2), and foot/ankle (8.56 cGycm2), and highest for wrist (10.64 cGycm2) and elbow (14.61 cGycm2) procedures. Advances in knowledge: To our knowledge, this is the largest data set used to establish local DRLs. Other centres may find our guidelines useful whilst they establish their own local DRLs.

NATIONAL DIAGNOSTIC REFERENCE LEVELS IN INTERVENTIONAL RADIOLOGY SUITES IN LEBANON: A MULTICENTER SURVEY

2019 ◽  
Vol 187 (1) ◽  
pp. 50-60 ◽  
Author(s):  
C Rizk ◽  
J Farah ◽  
F Vanhavere ◽  
G Fares
Keyword(s):  
Radiation Protection ◽  
Pacemaker Implantation ◽  
High Dose ◽  
National Council ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Air Kerma ◽  
Transcatheter Aortic Valve ◽  
Multicenter Survey ◽  
Area Product

ABSTRACT Air kerma-area product (PKA), cumulative air kerma at patient entrance reference point, fluoroscopy time and number of images were retrospectively collected from 15 hospitals in Lebanon for 11282 fluoroscopically-guided interventional (FGI) procedures between March 2016 and November 2018. National diagnostic reference levels (NDRLs) were established based on the third quartile of the distribution of median values of exposure parameters per department for 27 types of FGI procedures. NDRLs were in line with international DRLs except for coronary angiography (CA), percutaneous coronary interventions (PCI) and transcatheter aortic valve implantation (TAVI) which require optimisation. Additionally, following the National Council on Radiation Protection and Measurements report 168, PCI, TAVI, triple chamber pacemaker implantation, endovascular aortic repair, nephrostomy, kyphoplasty and percutaneous transhepatic biliary drainage were classified as potentially high-dose procedures with &gt;5% of the patients with PKA exceeding 300 Gycm2. The established NDRLs will promote dose optimisation and patient radiation protection.

scholarly journals Establishment of CTPA Local Diagnostic Reference Levels with Noise Magnitude as a Quality Indicator in a Tertiary Care Hospital

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 680
Author(s):  
Hanif Haspi Harun ◽  
Muhammad Khalis Abdul Karim ◽  
Mohd Amiruddin Abd Rahman ◽  
Hairil Rashmizal Abdul Razak ◽  
Iza Nurzawani Che Isa ◽  
...  
Keyword(s):  
Body Size ◽  
Quality Indicator ◽  
Tertiary Care ◽  
Pulmonary Arteries ◽  
The Body ◽  
Care Hospital ◽  
Diagnostic Reference Levels ◽  
Ct Scanner ◽  
Reference Levels ◽  
Dose Length Product

This study aimed to establish the local diagnostic reference levels (LDRLs) of computed tomography pulmonary angiography (CTPA) examinations based on body size with regard to noise magnitude as a quality indicator. The records of 127 patients (55 males and 72 females) who had undergone CTPAs using a 128-slice CT scanner were retrieved. The dose information, scanning acquisition parameters, and patient demographics were recorded in standardized forms. The body size of patients was categorized into three groups based on their anteroposterior body length: P1 (14–19 cm), P2 (19–24 cm), and P3 (24–31 cm), and the radiation dose exposure was statistically compared. The image noise was determined quantitatively by measuring the standard deviation of the region of interest (ROI) at five different arteries—the ascending and descending aorta, pulmonary trunk, and the left and right main pulmonary arteries. We observed that the LDRL values were significantly different between body sizes (p < 0.05), and the median values of the CT dose index volume (CTDIvol) for P1, P2, and P3 were 6.13, 8.3, and 21.40 mGy, respectively. It was noted that the noise reference values were 23.78, 24.26, and 23.97 HU for P1, P2, and P3, respectively, which were not significantly different from each other (p > 0.05). The CTDIvol of 9 mGy and dose length product (DLP) of 329 mGy∙cm in this study were lower than those reported by other studies conducted elsewhere. This study successfully established the LDRLs of a local healthcare institution with the inclusion of the noise magnitude, which is comparable with other established references.

scholarly journals A Comparison of Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography (ERCP) by Different Fluoroscope Techniques

2020 ◽  
Author(s):  
Saleh A. Alghsoon ◽  
Khaled S. Shaban ◽  
Altaf H. Khan ◽  
Fares M. Almeshal ◽  
Sulaimon O. Balogun ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Gastrointestinal Endoscopy ◽  
Tertiary Care ◽  
Care Hospital ◽  
Endoscopic Retrograde ◽  
Dose Area Product ◽  
The Mean ◽  
Level I ◽  
American Society

ABSTRACT Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is a relatively new endoscopic procedure combined with fluoroscopy that is performed for multiple diagnostic and therapeutic indications. It carries a known risk of radiation exposure to patients and staff. We aimed to examine radiation administration techniques and to measure the radiation dose delivered by these techniques. Methods This was a retrospective analysis of 437 ERCP procedures performed at a tertiary care hospital between April 2015 and April 2017. Results A total of 437 ERCP procedural charts were reviewed: fluoroscopy administration was endoscopist controlled (EC, n = 187, 42.79%) or technician controlled (TC, n = 250, 57.21%). The mean (and SD) fluoroscopy time (FT) was 2.107 ± 2.0 minutes. The mean (and SD) dose–area product (DAP) was 15,227.371 ± 16,784.738 Gy·cm2. The degree of ERCP difficulty was evaluated as recommended by the American Society for Gastrointestinal Endoscopy, and graded 1–4. Level I TC procedures had a mean FT and DAP of 1.600 minutes and 12,644.72 Gy·cm2, respectively. The FT and DAP values for level I EC procedures were 1.514 minutes and 12,966.71 Gy·cm2, respectively, as compared with level IV TC procedures (mean FT, 2.539 minutes; mean DAP, 19,469.94 Gy·cm2) and level IV EC procedures (mean FT, 4.890 minutes; mean DAP, 37,921.00 Gy·cm2). Conclusion DAP and FT are increased significantly in EC ERCP in American Society for Gastrointestinal Endoscopy 4 procedures. Comparison of the different degrees of difficulty indicated that there is a linear correlation between the degree of difficulty and both FT and DAP.

scholarly journals Standardized approach to result analysis and interpretation of initial experience of coronary computed tomography angiography in a tertiary care hospital

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Tahira Nishtar ◽  
Nadeem Ullah ◽  
Tabish Ahmad ◽  
Fatima Ahmad
Keyword(s):  
Computed Tomography ◽  
Coronary Computed Tomography Angiography ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Radiology Department ◽  
Care Hospital ◽  
Stent Patency ◽  
Coronary Ct ◽  
Triple Vessel Disease ◽  
Result Analysis

Objective: To have a systematic standardized approach to performing and interpretation of coronary CT Angiography (CTA) in order to maintain and enhance the diagnostic accuracy of the imaging modality. Methods: This retrospective observational study was performed in Radiology Department, Lady Reading Hospital, Medical Teaching Institute, Peshawar, Pakistan from August 2018 to September 2019. Patients referred for coronary CT angiography were screened and prepared in radiology department. The examination was performed on Toshiba-160 slice CT Scanner (Prime Aquilion) utilizing standardized protocols tailored towards optimum image acquisition. Interpretation of the images were based on the guidelines provided by the Society of Cardiovascular Computed Tomography (SCCT). Results: Total 95 CTCA procedures were performed in the department, out of which 85 were included in study showing 49 (57%) as normal and 36 (42%) were positive for coronary disease. Of the abnormal cases 16(18.8%) had mild disease, nine (10.6%) patients had moderate disease, while severe disease was noted in 11 (12.9%) cases. Coronary quantitative stenosis revealed five cases (5.9%) with LAD involvement only and five (5.9%) with severe triple vessel disease. The remaining varied in degree of stenosis and number of segments involved. Post CABG were 14 cases (16%) and native arteries showed triple vessel disease. CTA for percutaneous stent patency were three (3.5%) cases with 100% stent patency. Conclusion: Patient selection with tailored protocols are the mainstay for achieving optimal images. This form the basis for accurate interpretation, based on a standardized and systematic approach, utilizing various post processing tools, in order to maintain the high diagnostic accuracy of this semi-invasive, safe imaging modality in a variety of patients suspected of coronary artery disease, coronary artery bypass grafts and stent patency. doi: https://doi.org/10.12669/pjms.36.4.2174 How to cite this:Nishtar T, Nadeem Ullah, Ahmad T, Ahmed F. Standardized approach to result analysis and interpretation of initial experience of coronary computed tomography angiography in a tertiary care hospital. Pak J Med Sci. 2020;36(4):---------.  doi: https://doi.org/10.12669/pjms.36.4.2174 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Low dose computed tomography KUB region for management of urolithiasis in Indian scenario

2018 ◽  
Vol 5 (2) ◽  
pp. 638
Author(s):  
Satyadeo Sharma ◽  
Rajeev Chaudhari ◽  
Krutik Rawal ◽  
Shahil Khant
Keyword(s):  
Radiation Exposure ◽  
Low Dose ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Helical Ct ◽  
Care Hospital ◽  
Ct Scanner ◽  
Medical Systems ◽  
Low Dose Ct ◽  
The North

Background: The incidence, prevalence and recurrence of urolithiasis are very high; especially in the north-western part of India. Ultrasonography has decreased sensitivity and specificity as compared with NCCT for detection of both renal and ureteral calculi. Drawbacks of NCCT in terms of radiation exposure, cost and repeatability can be overcome by Low dose NCCT protocols. Low dose NCCT can be an investigation with high diagnostic accuracy, less radiation hazards and financial acceptability. Aim of this study was to evaluate use of Low dose CT-KUB over ultrasound (US) for diagnosis of urolithiasis, in Indian scenario.Methods: This is a prospective study, at Tertiary Care Hospital. Patients with acute flank pain, who underwent both US and Low dose NCCT within an interval of 24 hours, at Tertiary Care Hospital. Helical CT scanner (Phillips 128 slice medical systems) with exposure factors setting of KVp 120 and mAs 70 was used.Results: A total of 136 Patients with mean age of 33.01 years (range 19-62 years, SD 10.93), were examined with 82(60.29%) males and 54(39.7%) females, average BMI was 25.07(range 17.2 to 35.02). Low Dose NCCT has a sensitivity of 95% (CI of 89.43-98.14%) and specificity of 87.50% (95% CI of 61.65-98.45%) in the diagnosis of urolithiasis. Mean effective dose of radiation administered in low dose CT-KUB was 1.8-2.2 mSv.Conclusions: In view of information, reliability, repeatability, radiation exposure and cost acceptability; unenhanced Low dose CT-KUB region should be the preferred investigation for the management of urolithiasis, in the scenario of a developing country.

scholarly journals Annual Radiation Exposure to Workers in a Tertiary Care Hospital in Kashmir : A 10-Year Analysis and Comparison with National Levels of exposure

JMS SKIMS ◽  
2009 ◽  
Vol 12 (2) ◽  
pp. 41-45
Author(s):  
Tanveer A Rather ◽  
Showkat H Khan ◽  
Mohib Ul Haq ◽  
Riyaz A Rangrez ◽  
Ajaz Mustafa
Keyword(s):  
Radiation Exposure ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Whole Body ◽  
Care Hospital ◽  
Medical Sciences ◽  
Annual Dose ◽  
Medicine Department ◽  
Nuclear Medicine Department ◽  
Radiation Workers

Objective: To assess the radiation exposure amongst radiation workers in Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, a tertiary care 620 bedded superspeciality hospital was carried out. Material and Methods: A 10-year retrospective analysis of the whole body radiation exposure to the radiation workers of SKIMS Srinagar, Two blocks of five years each from 1995 to 1999 & 2002 to 2007 were studied and compared with the national pool of radiation workers for the same period. The average annual dose of radiation workers working in different radiation departments of SKIMS was compared with the workers of the similar department of the national pool. Results & Conclusion: It was observed that in the block of 5 years from 1995 to 1999 the average whole body dose to the radiation works at SKIMS during the latter half showed a rising trend for three years as compared to the national pool. However in the block 2002 to 2005 the average annual dose was mostly similar except for a higher dose to SKIMS workers in 2005. It was observed that the average annual dose received by the workers of Nuclear Medicine department of SKIMS was usually high more so in the five year block of 2000 to 2005.The workers of Radiodiagnosis at SKIMS also received a higher annual dose in 7 of the 10 years of study. J Med Sci 2009;12(2):41-45

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