scholarly journals Ultrasound-assisted catheter placement in CT-guided HDR brachytherapy for the local ablation of abdominal malignancies: Initial experience

2018 ◽  
Vol 191 (01) ◽  
pp. 48-53 ◽  
Author(s):  
Robert Damm ◽  
Shahen El-Sanosy ◽  
Jazan Omari ◽  
Romy Damm ◽  
Peter Hass ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Medical Staff ◽  
Cell Cancer ◽  
Catheter Placement ◽  
Fluoroscopy Time ◽  
High Dose ◽  
Ct Fluoroscopy ◽  
Ct Guided ◽  
Abdominal Tumors ◽  
Ultrasound Assisted

Purpose To evaluate the safety and feasibility of sonographically-assisted catheter placement in interstitial high-dose-rate brachytherapy of abdominal malignancies. Materials and Methods In an initial cohort of 12 patients and 16 abdominal tumors (colorectal liver metastases n = 9; renal cell cancer n = 3; hepatocellular carcinoma n = 2; cholangiocellular carcinoma n = 2), initial puncture and catheter placement for CT-guided brachytherapy were performed under sonographic assistance when possible. The interventional procedure was prospectively recorded and in-patient data were collected. All data underwent descriptive statistics and comparative analysis by the Mann-Whitney test. Results In 12 out of 16 lesions (diameter 1.5 – 12.9 cm), initial puncture was successfully achieved under ultrasound guidance without utilization of CT fluoroscopy, yielding a significantly shorter mean total fluoroscopy time (14.5 vs. 105.5 s; p = 0.006). In 8 lesions visibility was rated better in ultrasound than in CT fluoroscopy (p = 0.2). No major or minor complications occurred within 30 days after treatment. Conclusion Ultrasound-assisted catheter placement during interstitial CT-guided brachytherapy of abdominal tumors could improve catheter positioning and reduce radiation exposure for medical staff. Key points Ultrasound-assisted catheter placement in CT-guided brachytherapy is safe and feasible. Ultrasound puncture may improve catheter positioning. Reduced CT fluoroscopy time can significantly help to minimize radiation exposure for medical staff. Citation Format

Evaluation of Radiation Exposure of Medical Staff During CT-Guided Interventions

2015 ◽  
Vol 12 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Nils Rathmann ◽  
Uwe Haeusler ◽  
Patricius Diezler ◽  
Christel Weiss ◽  
Michael Kostrzewa ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Medical Staff ◽  
Ct Guided

scholarly journals Occupational Radiation Dose to Eye Lenses in CT-Guided Interventions Using MDCT-Fluoroscopy

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 646
Author(s):  
Yohei Inaba ◽  
Shin Hitachi ◽  
Munenori Watanuki ◽  
Koichi Chida
Keyword(s):  
Radiation Dose ◽  
Radiation Protection ◽  
Medical Staff ◽  
Ct Fluoroscopy ◽  
Related Factors ◽  
Dose Length Product ◽  
Ct Guided ◽  
Reduction Methods ◽  
Ct System ◽  
Occupational Radiation

In computed tomography (CT)-guided interventions (CTIs), physicians are close to a source of scattered radiation. The physician and staff are at high risk of radiation-induced injury (cataracts). Thus, dose-reducing measures for physicians are important. However, few previous reports have examined radiation doses to physicians in CTIs. This study evaluated the radiation dose to the physician and medical staff using multi detector (MD)CT-fluoroscopy, and attempted to understand radiation-protection and -reduction methods. The procedures were performed using an interventional radiology (IVR)-CT system. We measured the occupational radiation dose (physician and nurse) using a personal dosimeter in real-time, gathered CT-related parameters (fluoroscopy time, mAs, CT dose index (CTDI), and dose length product (DLP)), and performed consecutive 232 procedures in CT-guided biopsy. Physician doses (eye lens, neck, and hand; μSv, average ± SD) in our CTIs were 39.1 ± 36.3, 23.1 ± 23.7, and 28.6 ± 31.0, respectively. Nurse doses (neck and chest) were lower (2.3 ± 5.0 and 2.4 ± 4.4, respectively) than the physician doses. There were significant correlations between the physician doses (eye and neck) and related factors, such as CT-fluoroscopy mAs (eye dose: r = 0.90 and neck dose: r = 0.83). We need to understand the importance of reducing/optimizing the dose to the physician and medical staff in CTIs. Our study suggests that physician and staff doses were not significant when the procedures were performed with the appropriate radiation protection and low-dose techniques.

scholarly journals 3D imaging and stealth navigation instead of CT guidance for radiofrequency ablation of osteoid osteomas: a series of 52 patients

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ran Ankory ◽  
Assaf Kadar ◽  
Doron Netzer ◽  
Haggai Schermann ◽  
Yair Gortzak ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Radiation Exposure ◽  
Medical Center ◽  
Young Patients ◽  
Bone Neoplasms ◽  
Ct Guidance ◽  
Major Influence ◽  
High Dose ◽  
Limit Function ◽  
Ct Guided

Abstract Background Osteoid osteomas are benign bone neoplasms that may cause severe pain and limit function. They are commonly treated by radiofrequency ablation (RFA) through a needle inserted into the nidus of the lesion under CT guidance, which is associated with exposure of young patients to relatively high dose of radiation. The objective of this study was to investigate the amount of radiation, effectiveness and safety of an alternative imaging approach, the 3D image-guided (O-arm) technology and the Stealth navigation. Methods We retrospectively reviewed 52 electronic medical files of patients (mean age 24.7 years, range 8–59 years) who were treated with thermal ablation of benign osteoid osteomas guided by the navigated O-arm-assisted technique in our institution between 2015 and 2017. Data were extracted on the associated complications, the reduction in pain at 3 months and one year postoperatively, and the amount of radiation administered during the procedure. Results The level of pain on a visual analogue scale decreased from the preoperative average of 7.73 to 0 at the 3-month follow-up. The mean dose-length product was 544.7 mGycm2 compared to the reported radiation exposure of 1971–7946 mGycm2 of CT-guided radio ablations. The one intra-operative complication was a superficial burn in the subcutaneous lesion in a tibia that was treated locally with no major influence on recovery. Conclusions RFA ablation guided by 3D O-arm stealth navigation is as effective as the traditional CT-guided technique with the advantage of lower radiation exposure. Trial registration Retrospective study number 0388–17-TLV at Tel Aviv Sourasky Medical Center IRB, approved at 25.10.17.

The Efficacy of Electromagnetic Navigation to Assist with Computed Tomography–Guided Percutaneous Thermal Ablation of Lung Tumors

2012 ◽  
Vol 7 (3) ◽  
pp. 187-190 ◽  
Author(s):  
Chaitan K. Narsule ◽  
Ricardo Sales dos Santos ◽  
Avneesh Gupta ◽  
Michael I. Ebright ◽  
Roberto Rivas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Thermal Ablation ◽  
Lung Tumors ◽  
Ct Scans ◽  
Fluoroscopy Time ◽  
Women Patients ◽  
Ct Fluoroscopy ◽  
Ct Guided ◽  
Electromagnetic Navigation ◽  
Percutaneous Thermal Ablation

Objective Electromagnetic (EM) navigation is increasingly used to assist with bronchoscopic interventions such as biopsy or fiducial placement. Electromagnetic navigation can also be a useful adjunct to computed tomography (CT)–guided thermal ablation and biopsy of lung tumors. This study compares procedures carried out using an EM navigation system (Veran Medical Technologies Inc, St Louis, MO) with procedures using CT fluoroscopy only. Methods Over a 23-month period, 17 patients scheduled for thermal ablation were prospectively enrolled in this study. The mean age was 72 years (range, 60–84 years). Seven patients were women. Patients were randomized to EM navigation (n = 7) or CT fluoroscopy alone (n = 10). In some cases, additional ablation or biopsies were performed with or without EM navigation depending on the randomization arm. All procedures were performed under general anesthesia either by a thoracic surgeon or a radiologist. Results A total of 23 procedures were performed in 17 patients: 20 were ablation procedures and 3 were biopsies. Fourteen were performed for non–small cell lung cancer, and 9 for pulmonary metastases from other organs. Despite randomization, patients receiving EM navigation had a trend for smaller tumors (mean diameter, 1.45 vs 2.90 cm; P = 0.06). For thermal ablation procedures, the time to complete intervention was significantly less when EM navigation was used (mean, 7.6 vs 19 minutes; P = 0.022). Although not statistically significant, there were fewer skin punctures (mean, 1 vs 1.25; P = 0.082), fewer adjustments (mean, 5.6 vs 11.8; P = 0.203), less CT fluoroscopy time (mean, 21.3 vs 34.3 seconds; P = 0.345), and fewer CT scans (mean, 7 vs 15; P = 0.204) whenever EM navigation was used. Conclusions Electromagnetic navigation reduces the time to successfully place an ablation probe in a target tumor. Further study is required to determine whether EM navigation may also reduce the number of adjustments, skin punctures, and CT scans as well as decrease CT fluoroscopy time.

scholarly journals Radioablation of Upper Abdominal Malignancies by CT-Guided, Interstitial HDR Brachytherapy: A Multivariate Analysis of Catheter Placement Assisted by Ultrasound Imaging

2021 ◽  
Author(s):  
Robert Damm ◽  
Romy Damm ◽  
Constanze Heinze ◽  
Alexey Surov ◽  
Jazan Omari ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Effective Dose ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Catheter Placement ◽  
Interstitial Brachytherapy ◽  
Ct Fluoroscopy ◽  
Ct Guided ◽  
Dosimetric Data ◽  
Upper Abdominal

Purpose To evaluate the use of ultrasound (US) during catheter placement in interstitial brachytherapy (iBT) of abdominal malignancies as an alternative to computed tomography (CT) fluoroscopy. Materials and Methods Catheter placement for CT-guided iBT was, if US visibility was sufficient, assisted by sonography in 52 consecutive patients with 82 lesions (liver N = 62; kidney N = 16; peritoneum N = 4) of various malignancies. We collected data on lesion visibility, location, depth, size, and dosimetry. Comparison of CT fluoroscopy versus US-assisted catheter placement was performed by Fisher’s exact test for frequencies and U-test for lesion visibility and dosimetric data. Factors predicting the utility of sonography were determined in a lesion-based multivariate regression analysis. A p-value < 0.05 was regarded as statistically significant. Results 150 catheters (1 to 6 per lesion; mean diameter 3.6 ± 2.4 cm) were implanted. CT fluoroscopy was used for 44 catheters, and US was used for 106 catheters. Lesion visibility assessed by 5-point Likert scale was significantly better in US (median 2 vs. 3; p = 0.011) and effective dose was significantly reduced if US guidance was applicable (median 1.75 vs. 8.19 mSv; p = 0.014). In a multivariate regression analysis, we identified increased lesion size and caudal location within the target organ to independently predict the utility of ultrasound in catheter placement for iBT. Conclusion Sonography is a helpful technique to assist CT-guided interstitial brachytherapy of upper abdominal malignancies. Especially for larger lesions localized in the lower liver segments or lower half of the kidney, superior visibility can be expected. As the effective dose of the patient is also reduced, radiation exposure of the medical staff may be indirectly lowered. Key Points:  Citation Format

scholarly journals Navigated iliac screw placement may reduce radiation and OR time in lumbopelvic fixation of unstable complex sacral fractures

2021 ◽  
Author(s):  
M. F. Hoffmann ◽  
E. Yilmaz ◽  
D. C. Norvel ◽  
T. A. Schildhauer
Keyword(s):  
Radiation Exposure ◽  
Operative Time ◽  
Pelvic Ring ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Lumbopelvic Fixation ◽  
Navigation Group ◽  
Iliac Screws ◽  
Iliac Screw

Abstract Purpose Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views. The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates. Methods Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated. Results Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures. Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm2; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing. Conclusion For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

PO-0255 CT-guided high-dose interstitial brachytherapy vs. SBRT in hepatocellular carcinoma

2021 ◽  
Vol 158 ◽  
pp. S210
Author(s):  
F. Walter ◽  
A.S. Duque ◽  
H. Weingandt ◽  
J. Well ◽  
R. Shpani ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Interstitial Brachytherapy ◽  
High Dose ◽  
Ct Guided

scholarly journals A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

2021 ◽  
Author(s):  
Andrew G. Yun ◽  
Marilena Qutami ◽  
Kory B. Dylan Pasko
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Radiation Exposure ◽  
Hip Arthroplasty ◽  
Fluoroscopy Time ◽  
Lesser Trochanter ◽  
Total Hip ◽  
Preoperative Templating ◽  
The Mean ◽  
Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

Sign in / Sign up

Export Citation Format

Share Document