scholarly journals Evaluation of CT-Guided Ultra-Low-Dose Protocol for Injection Guidance in Preparation of MR-Arthrography of the Shoulder and Hip Joints in Comparison to Conventional and Low-Dose Protocols

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1835
Author(s):  
Anja Goeller ◽  
Tobias Pogarell ◽  
Matthias May ◽  
Michael Uder ◽  
Peter Dankerl
Keyword(s):  
Radiation Exposure ◽  
Success Rate ◽  
Low Dose ◽  
Mr Arthrography ◽  
Joint Injection ◽  
Hip Joints ◽  
Ct Guided ◽  
Injection Protocol ◽  
Tin Filtration ◽  
Joint Injections

To evaluate patients’ radiation exposure undergoing CT-guided joint injection in preparation of MR-arthrography. We developed a novel ultra-low-dose protocol utilizing tin-filtration, performed it in 60 patients and compared the radiation exposure (DLP) and success rate to conventional protocol (26 cases) and low-dose protocol (37 cases). We evaluated 123 patients’ radiation exposure undergoing CT-guided joint injection from 16 January–21 March. A total of 55 patients received CT-guided joint injections with various other examination protocols and were excluded from further investigation. In total, 56 patients received shoulder injection and 67 received hip injection with consecutive MR arthrography. The ultra-low-dose protocol was performed in 60 patients, the low-dose protocol in 37 patients and the conventional protocol in 26 patients. We compared the dose of the interventional scans for each protocol (DLP) and then evaluated success rate with MR-arthrography images as gold standard of intraarticular or extracapsular contrast injection. There were significant differences when comparing the DLP of the ultra-low-dose protocol (DLP 1.1 ± 0.39; p < 0.01) to the low dose protocol (DLP 5.3 ± 3.24; p < 0.01) as well as against the conventional protocol (DLP 22.9 ± 8.66; p < 0.01). The ultra-low-dose protocol exposed the patients to an average effective dose of 0.016 millisievert and resulted in a successful joint injection in all 60 patients. The low dose protocol as well as the conventional protocol were also successful in all patients. The presented ultra-low-dose CT-guided joint injection protocol for the preparation of MR-arthrography demonstrated to reduce patients’ radiation dose in a way that it was less than the equivalent of the natural radiation exposure in Germany over 3 days—and thereby, negligible to the patient.

First experiences of a low-dose protocol for CT-guided musculoskeletal biopsies combining different radiation dose reduction techniques

2019 ◽  
Vol 61 (1) ◽  
pp. 28-36
Author(s):  
Zlatan Alagic ◽  
Haris Alagic ◽  
Robert Bujila ◽  
Subhash Srivastava ◽  
Saif Jasim ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Success Rate ◽  
Low Dose ◽  
Quality Parameters ◽  
Ct Guided ◽  
Protocol Group ◽  
Group A ◽  
The Mean ◽  
Group B

Background The use of computed tomography (CT) for image guidance during biopsies is a powerful approach. The method is, however, often associated with a significant level of radiation exposure to the patient and operator. Purpose To investigate if a low-dose protocol for CT-guided musculoskeletal (MSK) biopsies, including a combination of different radiation dose (RD) techniques, is feasible in a clinical setting. Material and Methods Fifty-seven patients underwent CT-guided fine-needle aspiration cytology (FNAC) utilizing the low-dose protocol (group A). A similar number of patients underwent CT-guided FNAC using the reference protocol (group B). Between-group comparisons comprised radiation dose, success rate, image quality parameters, and workflow. Results In group A, the mean total dose-length product (DLP) was 41.2 ± 2.9 mGy*cm, which was statistically significantly lower than of group B (257.4 ± 22.0 mGy*cm), corresponding to a mean dose reduction of 84% ( P<0.001). The mean CTDIvol for the control scans were 1.88 ± 0.09 mGy and 13.16 ± 0.40 mGy for groups A and B, respectively ( P < 0.001). The success rate in group A was 91.2% and 87.9% in group B ( P = 0.56). No negative effect on image-quality parameters, time of FNAC, and number of control scans were found. Conclusion We successfully developed a low-dose protocol for CT-guided MSK biopsies that maintains diagnostic accuracy and image quality at a fraction of the RD compared to the reference biopsy protocol at our clinic.

scholarly journals Radiation Reduction in Low Dose Pulsed Fluoroscopy versus Standard Dose Continuous Fluoroscopy during Fluoroscopically-Guided Lumbar Punctures: A Prospective Controlled Study

2018 ◽  
Vol 8 ◽  
pp. 9
Author(s):  
Shyam Sabat ◽  
Einat Slonimsky
Keyword(s):  
Radiation Exposure ◽  
Success Rate ◽  
Low Dose ◽  
Standard Dose ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Surface Dose ◽  
Technical Success ◽  
Entrance Surface Dose

Purpose: The purpose of this study was to evaluate radiation dose reduction in fluoroscopically guided lumbar punctures (FGLP) using “pulsed fluoroscopy in a low dose mode” compared with the commonly used “continuous fluoroscopy in a standard dose mode” while maintaining the technical success. Materials and Methods: Thirty-five consecutive patients who underwent FGLP divided randomly to seventeen patients in the control group with standard dose continuous FGLP and eighteen patients in the study group with low-dose low-frame-rate of 3 frames per second (fps) FGLP. Entrance surface dose measurements from a dosimeter device were recorded as well as the dose area product (DAP). Results: A total of 35 patients with average age of 52 years (range: 15–87 [±17 standard deviation [SD]]) were evaluated. Average entrance surface dose of the study group was significantly lower (3.81 mGy [range: 0.21–11.14, [±2.8 SD]]) compared with the control group (22.45 mGy [range: 1.23–73.44, [±19.41 [SD]]). The average DAP of the study group (10 mGy·cm2 [range: 1–41, [±9.8 SD]]) was also significantly lower than the control group (65 mGy·cm2 [range: 5–199, [±53 SD]]). Success rate was similar between the study and control groups. Conclusion: Low dose pulsed fluoroscopy of 3 fps significantly reduces radiation exposure by about 600% compared with standard dose continuous fluoroscopy in FGLP. Utilizing this radiation saving strategy will allow to dramatically reduce radiation exposure, without impacting the technical success rate.

scholarly journals A systematic review on the effect of low-dose radiation on hearing

2021 ◽  
Author(s):  
Srikanth Nayak ◽  
Arivudai Nambi ◽  
Sathish Kumar ◽  
P Hariprakash ◽  
Pradeep Yuvaraj ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ionizing Radiation ◽  
Radiation Exposure ◽  
Low Dose ◽  
Behavioral Symptoms ◽  
National Council ◽  
Low Dose Radiation ◽  
Cochlear Function ◽  
High Frequencies ◽  
Dose Radiation

AbstractNumerous studies have documented the adverse effects of high-dose radiation on hearing in patients. On the other hand, radiographers are exposed to a low dose of ionizing radiation, and the effect of a low dose of radiation on hearing is quite abstruse. Therefore, the present systematic review aimed to elucidate the effect of low-dose ionizing radiation on hearing. Two authors independently carried out a comprehensive data search in three electronic databases, including PUBMED/MEDLINE, CINAHL, and SCOPUS. Eligible articles were independently assessed for quality by two authors. Cochrane Risk of Bias tool was used assess quality of the included studies. Two articles met the low-dose radiation exposure criteria given by Atomic Energy Regulatory Board (AERB) and National Council on Radiation Protection (NCRP) guidelines. Both studies observed the behavioral symptoms, pure-tone hearing sensitivity at the standard, extended high frequencies, and the middle ear functioning in low-dose radiation-exposed individuals and compared with age and gender-matched controls. One study assessed the cochlear function using transient-evoked otoacoustic emissions (TEOAE). Both studies reported that behavioral symptoms of auditory dysfunction and hearing thresholds at extended high frequencies were higher in radiation-exposed individuals than in the controls. The current systematic review concludes that the low-dose ionizing radiation may affect the hearing adversely. Nevertheless, further studies with robust research design are required to explicate the cause and effect relationship between the occupational low-dose ionizing radiation exposure and hearing.

scholarly journals Radiation Dose Reduction in CT Torsion Measurement of the Lower Limb: Introduction of a New Ultra-Low Dose Protocol

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1209
Author(s):  
Gabriel Keller ◽  
Simon Götz ◽  
Mareen Sarah Kraus ◽  
Leonard Grünwald ◽  
Fabian Springer ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Lower Limb ◽  
Low Dose ◽  
Body Volume ◽  
Reconstruction Algorithms ◽  
Pelvic Radiograph ◽  
Lower Radiation Dose ◽  
Median Total Dose ◽  
Image Reconstruction Algorithms

This study analyzed the radiation exposure of a new ultra-low dose (ULD) protocol compared to a high-quality (HQ) protocol for CT-torsion measurement of the lower limb. The analyzed patients (n = 60) were examined in the period March to October 2019. In total, 30 consecutive patients were examined with the HQ and 30 consecutive patients with the new ULD protocol comprising automatic tube voltage selection, automatic exposure control, and iterative image reconstruction algorithms. Radiation dose parameters as well as the contrast-to-noise ratio (CNR) and diagnostic confidence (DC; rated by two radiologists) were analyzed and potential predictor variables, such as body mass index and body volume, were assessed. The new ULD protocol resulted in significantly lower radiation dose parameters, with a reduction of the median total dose equivalent to 0.17 mSv in the ULD protocol compared to 4.37 mSv in the HQ protocol (p < 0.001). Both groups showed no significant differences in regard to other parameters (p = 0.344–0.923). CNR was 12.2% lower using the new ULD protocol (p = 0.033). DC was rated best by both readers in every HQ CT and in every ULD CT. The new ULD protocol for CT-torsion measurement of the lower limb resulted in a 96% decrease of radiation exposure down to the level of a single pelvic radiograph while maintaining good image quality.

scholarly journals Differences in Radiation Exposure of CT-Guided Percutaneous Manual and Powered Drill Bone Biopsy

2021 ◽  
Author(s):  
Sebastian Zensen ◽  
Sumitha Selvaretnam ◽  
Marcel Opitz ◽  
Denise Bos ◽  
Johannes Haubold ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Diagnostic Yield ◽  
Bone Biopsy ◽  
Lumbar Vertebrae ◽  
Bone Lesions ◽  
Anatomical Location ◽  
Thoracic Vertebrae ◽  
Level Of Evidence ◽  
Ct Guided ◽  
Bone Biopsies

Abstract Purpose Apart from the commonly applied manual needle biopsy, CT-guided percutaneous biopsies of bone lesions can be performed with battery-powered drill biopsy systems. Due to assumably different radiation doses and procedural durations, the aim of this study is to examine radiation exposure and establish local diagnostic reference levels (DRLs) of CT-guided bone biopsies of different anatomical regions. Methods In this retrospective study, dose data of 187 patients who underwent CT-guided bone biopsy with a manual or powered drill biopsy system performed at one of three different multi-slice CT were analyzed. Between January 2012 and November 2019, a total of 27 femur (A), 74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae (E) biopsies were included. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose–length product (DLP). Results CTDIvol and DLP of manual versus powered drill biopsy were (median, IQR): A: 56.9(41.4–128.5)/66.7(37.6–76.2)mGy, 410(203–683)/303(128–403)mGy·cm, B: 83.5(62.1–128.5)/59.4(46.2–79.8)mGy, 489(322–472)/400(329–695)mGy·cm, C: 97.5(71.6–149.2)/63.1(49.1–83.7)mGy, 627(496–740)/404(316–515)mGy·cm, D: 67.0(40.3–86.6)/39.7(29.9–89.0)mGy, 392(267–596)/207(166–402)mGy·cm and E: 100.1(66.5–162.6)/62.5(48.0–90.0)mGy, 521(385–619)/315(240–452)mGy·cm. Radiation exposure with powered drill was significantly lower for ilium and sacrum, while procedural duration was not increased for any anatomical location. Local DRLs could be depicted as follows (CTDIvol/DLP): A: 91 mGy/522 mGy·cm, B: 90 mGy/530 mGy·cm, C: 116 mGy/740 mGy·cm, D: 87 mGy/578 mGy·cm and E: 115 mGy/546 mGy·cm. The diagnostic yield was 82.4% for manual and 89.4% for powered drill biopsies. Conclusion Use of powered drill bone biopsy systems for CT-guided percutaneous bone biopsies can significantly reduce the radiation burden compared to manual biopsy for specific anatomical locations such as ilium and sacrum and does not increase radiation dose or procedural duration for any of the investigated locations. Level of Evidence Level 3.

Reactive oxygen species in cell responses to toxic agents

2002 ◽  
Vol 21 (2) ◽  
pp. 85-90 ◽  
Author(s):  
L E Feinendegen
Keyword(s):  
Radiation Exposure ◽  
Mammalian Cells ◽  
Low Dose ◽  
X Rays ◽  
Low Dose Radiation ◽  
Cell Responses ◽  
Toxic Agents ◽  
Particle Tracks ◽  
Dose Radiation

This review first summarizes experimental data on biological effects of different concentrations of ROS in mammalian cells and on their potential role in modifying cell responses to toxic agents. It then attempts to link the role of steadily produced metabolic ROS at various concentrations in mammalian cells to that of environmentally derived ROS bursts from exposure to ionizing radiation. The ROS from both sources are known to both cause biological damage and change cellular signaling, depending on their concentration at a given time. At low concentrations signaling effects of ROS appear to protect cellular survival and dominate over damage, and the reverse occurs at high ROS concentrations. Background radiation generates suprabasal ROS bursts along charged particle tracks several times a year in each nanogram of tissue, i.e., average mass of a mammalian cell. For instance, a burst of about 200 ROS occurs within less than a microsecond from low-LET irradiation such as X-rays along the track of a Compton electron (about 6 keV, ranging about 1 μm). One such track per nanogram tissue gives about 1 mGy to this mass. The number of instantaneous ROS per burst along the track of a 4-meV ¬-particle in 1 ng tissue reaches some 70000. The sizes, types and sites of these bursts, and the time intervals between them directly in and around cells appear essential for understanding low-dose and low dose-rate effects on top of effects from endogenous ROS. At background and low-dose radiation exposure, a major role of ROS bursts along particle tracks focuses on ROS-induced apoptosis of damage-carrying cells, and also on prevention and removal of DNA damage from endogenous sources by way of temporarily protective, i.e., adaptive, cellular responses. A conclusion is to consider low-dose radiation exposure as a provider of physiological mechanisms for tissue homoeostasis.

scholarly journals Low dose Mifepristone (100 mg) for medical termination of pregnancy

2011 ◽  
Vol 3 (1) ◽  
Author(s):  
Shikha Seth ◽  
Arun Nagrath ◽  
Neeru Goel
Keyword(s):  
Side Effects ◽  
Success Rate ◽  
Low Dose ◽  
Medical Abortion ◽  
First Trimester ◽  
Effective Regimen ◽  
Minimal Dose ◽  
Medical Termination ◽  
Gestation Age ◽  
Post Abortion

Background: Abortion is the most common entity in the practice of obstetrics and gynaecology. Different methods and modes have been opted for until now to find an effective regimen with the least complications. We have tried the minimal dose (100 mg) of Mifepristone (PO) instead of the presently recommended 200 mg for medical abortion in early first trimester cases. Objectives: The objective of the study was to determine the efficacy of low dose (100 mg) Mifepristone for medical termination of early pregnancy with oral Misoprostol 800 μg, 24 hours later.Design: A prospective analytical study was conducted on a population of 82 early-pregnant patients who have requested medical abortions.Method: Pregnant women of less than 56 days gestation age from their last menstrual period, requesting medical abortion were selected over a period of 14 months from January 2007 to March 2008. They were given 100 mg Mifepristone orally on Day-1, followed by 800 μg Misoprostol orally 24 hours later on Day-2, keeping the patient in the ward for at least 6 hours. Abortion interval, success rate, post-abortion bleeding and side-effects were noted. Success was defined as complete uterine evacuation without the need for surgical intervention.Results: The total success rate of this minimal dose Mifepristone regimen was 96.25%. Pain and nausea were the predominant side-effects noted. In total 72 (90%) women had completely aborted within 5 hours of taking Misoprostol. Three (3.75%) women only required suction aspiration, hence termed as failed medical abortion. The abortion interval increased with the gestation age. All three failures were of the more-than-42-day gestational age group. The overall mean abortion interval was 4.68 ± 5.32 hours.Conclusion: Mifepristone 100 mg, followed 24 hours later by Misoprostol 800 μg orally, is a safe and effective regimen for medical abortion.

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