scholarly journals Radiation Dose and Fluoroscopy Time of Diagnostic Angiography in Patients with Spinal Dural Arteriovenous Fistula

2022 ◽  
Author(s):  
Yigit Ozpeynirci ◽  
Christoph Trumm ◽  
Robert Stahl ◽  
David Fischer ◽  
Thomas Liebig ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Low Dose ◽  
Fluoroscopy Time ◽  
Reference Level ◽  
Spinal Angiography ◽  
Spinal Dural Arteriovenous Fistula ◽  
Dose Area Product ◽  
Arteriovenous Fistulas ◽  
Diagnostic Angiography ◽  
Area Product

Abstract Purpose Spinal dural arteriovenous fistulas (SDAVFs) represent the most common indication for a spinal angiography. The diagnostic reference level (DRL) for this specific endovascular procedure is still to be determined. This single-center study provides detailed dosimetrics of diagnostic spinal angiography performed in patients with SDAVFs. Methods Retrospective analysis of all diagnostic spinal angiographies between December 2011 and January 2021. Only patients with an SDAVF who had baseline magnetic resonance angiography (MRA), diagnostic digital subtraction angiography (DSA), treatment and follow-up at this institution were included. Dose area product (DAP, Gy cm2) and fluoroscopy time were compared between preoperative and postoperative angiographies, according to SDAVF locations (common versus uncommon), MRA results at baseline (positive versus negative) and DSA protocols (low-dose, mixed-dose, normal-dose). The 75th percentile of the DAP distribution was used to define the local DRL. Results A total of 62 spinal angiographies were performed in 25 patients with SDAVF. Preoperative angiographies (30/62, 48%) yielded a significantly higher DAP and longer fluoroscopy time when compared to postoperative angiographies (32/62, 53%) (p < 0.01). The local DRL was 329.41 Gy cm2 for a nonspecific (n = 62), 395.59 Gy cm2 for a preoperative and 138.6 Gy cm2 for a postoperative spinal angiography. Preoperative angiography of uncommonly located SDAVFs yielded a significantly longer fluoroscopy time (p = 0.02). The MRA-based fistula detection had no significant impact on dosimetrics (p > 0.05). A low-dose protocol yielded a 61% reduction of DAP. Conclusion The results of the present study suggest novel DRLs for spinal angiography in patients with SDAVF. Dedicated low-dose protocols enable radiation dose optimization in these procedures.

scholarly journals Feasibility of low-dose digital pulsed video-fluoroscopic swallow exams (VFSE): effects on radiation dose and image quality

2017 ◽  
Vol 58 (9) ◽  
pp. 1037-1044 ◽  
Author(s):  
Jakob Weiss ◽  
Mike Notohamiprodjo ◽  
Klement Neumaier ◽  
Minglun Li ◽  
Wilhelm Flatz ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Dose Reduction ◽  
Low Dose ◽  
Research Evaluation ◽  
Diagnostic Image Quality ◽  
Organ Doses ◽  
Dose Area Product ◽  
Thermoluminescent Dosimeters ◽  
Area Product

Background Fluoroscopy is a frequently used examination in clinical routine without appropriate research evaluation latest hardware and software equipment. Purpose To evaluate the feasibility of low-dose pulsed video-fluoroscopic swallowing exams (pVFSE) to reduce dose exposure in patients with swallowing disorders compared to high-resolution radiograph examinations (hrVFSE) serving as standard of reference. Material and Methods A phantom study (Alderson-Rando Phantom, 60 thermoluminescent dosimeters [TLD]) was performed for dose measurements. Acquisition parameters were as follows: (i) pVFSE: 76.7 kV, 57 mA, 0.9 Cu mm, pulse rate/s 30; (ii) hrVFSE: 68.0 kV, 362 mA, 0.2 Cu mm, pictures 30/s. The dose area product (DAP) indicated by the detector system and the radiation dose derived from the TLD measurements were analyzed. In a patient study, image quality was assessed qualitatively (5-point Likert scale, 5 = hrVFSE; two independent readers) and quantitatively (SNR) in 35 patients who subsequently underwent contrast-enhanced pVFSE and hrVFSE. Results Phantom measurements showed a dose reduction per picture of factor 25 for pVFSE versus hrVFSE images (0.0025 mGy versus 0.062 mGy). The DAP (µGym2) was 28.0 versus 810.5 (pVFSE versus hrVFSE) for an average examination time of 30 s. Direct and scattered organ doses were significantly lower for pVFSE as compared to hrVFSE ( P < 0.05). Image quality was rated 3.9 ± 0.5 for pVFSE versus the hrVFSE standard; depiction of the contrast agent 4.8 ± 0.3; noise 3.6 ± 0.5 ( P < 0.05); SNR calculations revealed a relative decreased of 43.9% for pVFSE as compared to hrVFSE. Conclusion Pulsed VFSE is feasible, providing diagnostic image quality at a significant dose reduction as compared to hrVFSE.

scholarly journals Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

2020 ◽  
Author(s):  
Robert Forbrig ◽  
Robert Stahl ◽  
Lucas L. Geyer ◽  
Yigit Ozpeynirci ◽  
Thomas Liebig ◽  
...  
Keyword(s):  
Low Dose ◽  
Endovascular Embolization ◽  
Fluoroscopy Time ◽  
Low Grade ◽  
Endovascular Technique ◽  
Dose Area Product ◽  
Single Center Study ◽  
Life Threatening ◽  
Area Product ◽  
Dosimetry Data

Abstract Purpose Intracranial lateral dural arteriovenous fistula (LDAVF) represents a specific subtype of cerebrovascular fistulae, harboring a potentially life-threatening risk of brain hemorrhage. Fluoroscopically guided endovascular embolization is the therapeutic gold standard. We provide detailed dosimetry data to suggest novel diagnostic reference levels (DRL). Methods Retrospective single-center study of LDAVFs treated between January 2014 and December 2019. Regarding dosimetry, the dose area product (DAP) and fluoroscopy time were analyzed for the following variables: Cognard scale grade, endovascular technique, angiographic outcome, and digital subtraction angiography (DSA) protocol. Results A total of 70 patients (19 female, median age 65 years) were included. Total median values for DAP and fluoroscopy time were 325 Gy cm2 (25%/75% percentile: 245/414 Gy cm2) and 110 min (68/142min), respectively. Neither median DAP nor fluoroscopy time were significantly different when comparing low-grade with high-grade LDAVF (Cognard I + IIa versus IIb–V; p > 0.05, each). Transvenous coil embolization yielded the lowest dosimetry values, with significantly lower median values when compared to a combined transarterial/transvenous technique (DAP 290 Gy cm2 versus 388 Gy cm2, p = 0.031; fluoroscopy time 85 min versus 170 min, p = 0.016). A significant positive correlation was found between number of arterial feeders treated by liquid embolization and both DAP (rs = 0.367; p = 0.010) and fluoroscopy time (rs = 0.295; p = 0.040). Complete LDAVF occlusion was associated with transvenous coiling (p = 0.001). A low-dose DSA protocol yielded a 20% reduction of DAP (p = 0.021). Conclusion This LDAVF study suggests several local DRLs which varied substantially dependent on the endovascular technique and DSA protocol.

Using 7.5 frames per second reduces radiation exposure in lower extremity peripheral vascular interventions

Vascular ◽  
2014 ◽  
Vol 23 (3) ◽  
pp. 240-244 ◽  
Author(s):  
Nuri I Akkus ◽  
George S Mina ◽  
Abdulrahman Abdulbaki ◽  
Fereidoon Shafiei ◽  
Neeraj Tandon
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Success Rate ◽  
Frame Rate ◽  
Fluoroscopy Time ◽  
Peripheral Vascular ◽  
Dose Area Product ◽  
Group A ◽  
Group B ◽  
Area Product

Background Peripheral vascular interventions can be associated with significant radiation exposure to the patient and the operator. Objective In this study, we sought to compare the radiation dose between peripheral vascular interventions using fluoroscopy frame rate of 7.5 frames per second (fps) and those performed at the standard 15 fps and procedural outcomes. Methods We retrospectively collected data from consecutive 87 peripheral vascular interventions performed during 2011 and 2012 from two medical centers. The patients were divided into two groups based on fluoroscopy frame rate; 7.5 fps (group A, n = 44) and 15 fps (group B, n = 43). We compared the demographic, clinical, procedural characteristics/outcomes, and radiation dose between the two groups. Radiation dose was measured as dose area product in micro Gray per meter square. Results Median dose area product was significantly lower in group A (3358, interquartile range (IQR) 2052–7394) when compared to group B (8812, IQR 4944–17,370), p < 0.001 with no change in median fluoroscopy time in minutes (18.7, IQR 11.1–31.5 vs. 15.7, IQR 10.1–24.1), p = 0.156 or success rate (93.2% vs. 95.3%), p > 0.999. Conclusion Using fluoroscopy at the rate of 7.5 fps during peripheral vascular interventions is associated with lower radiation dose compared to the standard 15 fps with comparable success rate without associated increase in the fluoroscopy time or the amount of the contrast used. Therefore, using fluoroscopy at the rate of 7.5 fps should be considered in peripheral vascular interventions.

Radiation dose monitoring in pediatric fluoroscopy: comparison of fluoroscopy time and dose–area product thresholds for identifying high-exposure cases

2019 ◽  
Vol 49 (5) ◽  
pp. 600-608
Author(s):  
Matthew S. Lazarus ◽  
Benjamin H. Taragin ◽  
William Malouf ◽  
Terry L. Levin ◽  
Eduardo Nororis ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Fluoroscopy Time ◽  
High Exposure ◽  
Dose Area Product ◽  
Dose Monitoring ◽  
Radiation Dose Monitoring ◽  
Area Product

scholarly journals What factors affect fluoroscopy use during Bernese periacetabular osteotomy for acetabular dysplasia?

2019 ◽  
Vol 6 (3) ◽  
pp. 259-264
Author(s):  
James D Wylie ◽  
Michael P McClincy ◽  
Evan K Stieler ◽  
Michael B Millis ◽  
Young-Jo Kim ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Male Gender ◽  
Fluoroscopy Time ◽  
Linear Modeling ◽  
Factors Affecting ◽  
Dose Area Product ◽  
Area Product ◽  
Open Arthrotomy

Abstract Periacetabular osteotomy (PAO) is the treatment of choice for acetabular dysplasia in the skeletally mature. Little is known about factors affecting fluoroscopy use in PAO. Therefore, we strived to determine patient and surgery factors are associated with the amount of fluoroscopy time and radiation dose during PAO. We performed a retrospective review of 378 patients who underwent PAO between January 2012 and August 2017. The mean age was 21.7 years and 326 (86%) were females. A total of 85 patients underwent concomitant arthroscopy and 60 underwent open arthrotomy. We recorded fluoroscopy time in minutes and radiation dose area product (DAP) in mGy·m2. Multivariate general linear modeling identified independent predictors of fluoroscopy time and radiation dose. Mean fluoroscopy time was 1.21 minutes and mean fluoroscopy DAP was 0.71 mGy·m2. Multivariate predictors of increased fluoroscopy time were male gender (P = 0.001), surgeon (P < 0.001) and whether an arthroscopy was performed (P < 0.001). Multivariate predictors of increased fluoroscopy DAP were increased body mass index (BMI) (P = 0.001), surgeon (P < 0.001) and whether an arthroscopy was performed (P < 0.001). Patients undergoing hip arthroscopy concomitant to PAO are at higher risk of longer fluoroscopy time and higher radiation dose. Other factors affecting fluoroscopy time included male gender and surgeon, while radiation dose was further affected by surgeon and BMI. Our findings can facilitate discussion about the risk of radiation exposure during PAO.

Radiation dose reduction during neurointerventional procedures by modification of default settings on biplane angiography equipment

2015 ◽  
Vol 8 (8) ◽  
pp. 819-823 ◽  
Author(s):  
Elyne N Kahn ◽  
Joseph J Gemmete ◽  
Neeraj Chaudhary ◽  
Byron Gregory Thompson ◽  
Kevin Chen ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Frame Rate ◽  
Fluoroscopy Time ◽  
P Value ◽  
Dose Cohort ◽  
Dose Area Product ◽  
Reduced Dose ◽  
Cine Frame ◽  
Area Product ◽  
Neurointerventional Procedures

BackgroundNeurointerventional procedures represent a significant source of ionizing radiation. We sought to assess the effect during neurointerventional procedures of varying default rates of radiation dose in fluoroscopy (F) and image acquisition (IA) modes, and frame rates during cine acquisition (CINE) on total X-ray dose, acquisition exposures, fluoroscopy time, and complications.MethodsWe retrospectively reviewed procedures performed with two radiation dose and CINE settings: a factory setting dose cohort (30 patients, F 45 nGy/pulse, IA 3.6 μGy/pulse, factory CINE frame rate) and a reduced dose cohort (30 patients, F 32 nGy/pulse, IA 1.2 μGy/pulse, with a decreased CINE frame rate). Total radiation dose, dose area product, number of acquisition exposures, fluoroscopy time, and complications were compared between the groups. Means comparisons (t tests) were employed to evaluate differences in the outcome variables between the two groups. p Value <0.05 was considered significant.ResultsThe reduced dose cohort had a significant reduction in mean radiation dose (factory, 3650 mGy; reduced, 1650 mGy; p=0.005) and dose area product (factory, 34 700 μGy×m2; reduced, 15 000 μGy×m2; p=0.02). There were no significant differences between cohorts in acquisition exposure (p=0.73), fluoroscopy time (p=0.45), or complications.ConclusionsSignificant reductions in radiation dose delivered by neurointerventional procedures can be achieved through simple modifications of default radiation dose in F and IA and frame rate during CINE without an increase in procedural complexity (fluoroscopy time) or rate of complications.

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.

PF7 Monitoring the radiation dose delivered by the fluoroscopic units with DAP (dose area product) values in locking intra-medullary nailing operations

Injury ◽  
2013 ◽  
Vol 44 ◽  
pp. S39
Author(s):  
T. Ege ◽  
K. Koca ◽  
Y. Yurttas ◽  
M. Kürklü ◽  
H. Özkan ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Dose Area Product ◽  
Medullary Nailing ◽  
Area Product

AN ASSESSMENT OF RADIATION EXPOSURE DOSES IN PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION BASED ON ANGIOGRAPHIC RECORDS

2018 ◽  
Vol 183 (4) ◽  
pp. 475-482 ◽  
Author(s):  
M Maghbool ◽  
M A Hosseini
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Primary Percutaneous Coronary Intervention ◽  
Standard Dose ◽  
Coronary Intervention ◽  
Skin Dose ◽  
Dose Area Product ◽  
Percutaneous Coronary ◽  
Using Data ◽  
Area Product

Abstract The stochastic and non-stochastic (deterministic) effects of radiation dose in patients undergoing primary percutaneous coronary intervention (PPCI) have been investigated using data recorded by an angiographic monitoring system. A total of 132 patients with acute myocardial infarction referred to the angiography department of Vali-Asr hospital, Fasa, Iran, during the second half of 2016 were recruited. Quantities like dose–area product (DAP), total air kerma (Ka,r) and fluoroscopy time (FT) were calculated and converted into effective dose (ED) and peak skin dose (PSD). The values for Ka,r, DAP and FT equaled 80 399.20 ± 63 312 mGy cm2, 1392.80 ± 1155.373 mGy and 524.11 ± 423.057 s, respectively, which were within the ranges reported in previous studies. After considering standard dose thresholds for Ka,r and PSD, it was revealed that only a small portion of patients had reached these thresholds and exceeded them (<3%). Moreover, ED < 20 mSv for the majority of patients was fairly consistent with results from a recent research in eight Belgian hospitals. It was shown that angiographic records are reliable for assessing radiation dose in patients.

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