BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associat...BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries(PAs)and with the systematic attempts to catheterize the PAs of both pelvic sides.Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE.The authors hypothesized that,in selected patients,these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.AIM To describe the authors’approach for intentionally unilateral PAE(IU-PAE)and its potential benefits.METHODS This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years.IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA(subgroup A),or with markedly asymmetric prostatic enlargement,with the dominant prostatic lobe occupying at least two thirds of the entire gland(subgroup B).All patients treated with IU-PAE also fulfilled at least one of the following criteria:Severe tortuosity or severe atheromatosis of the pelvic arteries,non-visualization,or visualization of a tiny(<1 mm)contralateral PA on preprocedural computed tomographic angiography.Intraprocedural contrast-enhanced ultrasonography(iCEUS)was applied to monitor prostatic infarction.IU-PAE patients were compared to a control group treated with bilateral PAE.RESULTS IU-PAE was performed in a total 13 patients(subgroup A,n=7;subgroup B,n=6).Dose-area product,fluoroscopy time and operation time in the IU-PAE group(9767.8μGy∙m^(2),30.3 minutes,64.0 minutes,respectively)were significantly shorter(45.4%,35.9%,45.8%respectively,P<0.01)compared to the control group.Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group.In the 2 clinical failures of IU-PAE(both in subgroup A),the extent of prostatic infarction(demonstrated by iCEUS)was significantly smaller compared to the rest of the IU-PAE group.CONCLUSION In selected patients,IU-PAE is associated with comparable outcomes,but with lower radiation exposure and a shorter procedure compared to bilateral PAE.iCEUS could facilitate patient selection for IU-PAE.展开更多
目的探讨颈椎低剂量数字化X线摄影的应用价值。方法在对60例颈椎外伤患者初诊与复查时,分别以常规剂量和低剂量进行颈椎正、侧位数字化X线摄影,获得常规组和低剂量组各120幅图像,并对其曝光量和剂量面积值(dose area product,DAP)进行...目的探讨颈椎低剂量数字化X线摄影的应用价值。方法在对60例颈椎外伤患者初诊与复查时,分别以常规剂量和低剂量进行颈椎正、侧位数字化X线摄影,获得常规组和低剂量组各120幅图像,并对其曝光量和剂量面积值(dose area product,DAP)进行对比。结果①低剂量组颈椎正、侧位摄影的曝光量值和DAP明显均低于常规组(P<0.01)。②两组图像质量差异无统计学意义(Manne-Whitney U=1180.00,P=0.35)。结论颈椎低剂量数字化X线摄影可明显降低曝光量和吸收剂量,而不影响图像质量。展开更多
Diagnostic Reference Levels (DRLs) are indicators that allow assessing the quality of equipment and procedures from the point of view of the doses delivered to patients and subsequently initiate corrective actions if ...Diagnostic Reference Levels (DRLs) are indicators that allow assessing the quality of equipment and procedures from the point of view of the doses delivered to patients and subsequently initiate corrective actions if necessary. The purpose of this study is to encourage health professionals to investigate patient radiation doses and to determine whether those doses comply with the principles of radiation protection in medical fields so as to improve practices by reducing patient exposure without reducing clinical effectiveness. To perform this work, we have investigated patient doses for different radiological examinations from six (6) medical centers in Dakar, including the following nine routine types: chest (PA), abdomen (AP), pelvis (AP), cervical spine (AP), lumbar spine (AP, Lat), hip (AP), thoracic spine (AP, Lat). Three types of data were collected, <em>i.e.</em>, X-ray tube machine data, patient data and output measurements. The data were analyzed statistically and the median, minimum, maximum, and third quartile values were calculated and displayed throughout boxplots graphs for all exams and medical centers. The two sigma range (95% confidence interval) was also checked. Comparison of third quartiles of Entrance Surface Dose (ESD) and Dose Area Product (DAP) by type of examination with recommended international DRLs was performed. The third quartile of ESD for pelvis (AP) and thoracic spine (AP) was up to 16% and 38% higher, respectively than their corresponding DRLs in the European Commission Report RP 180 Part 2. For all exams, except thoracic spine (lat), the third quartiles of the dose area product were higher than the corresponding DRLs in the above report. The source of dose variability between medical centers was related to many parameters such as poor radiographic techniques, lack of modern X-ray machines and adequately documented radiation protection practices. The results show the need to develop protocols for dose measurement as well as to carry out quality assurance programs and dose optimization in Senegal.展开更多
Our study aims to determine diagnostic reference levels (DRL) for chest front examination in postero anterior (PA) for optimizing patient entrance surface dose (ESD) and dose-area product (DAP) of patients in west of ...Our study aims to determine diagnostic reference levels (DRL) for chest front examination in postero anterior (PA) for optimizing patient entrance surface dose (ESD) and dose-area product (DAP) of patients in west of Côte d’Ivoire. 90 patients from three hospitals undergoing conventional radiology were considered. The ESD and DAP for each patient were obtained during chest radiography (PA) examination. The measurements were performed with the device call Dose-Area Product-meter (DAP-meter) with brand Diamentor M4-KDK, type 11017. The DRL were obtained in applying the 75th percentile statistical method to the obtained ESD and DAP. The obtained DRL in ESD for chest radiography for all rooms is 0.40 mGy and in DAP is 54.85 cGy·cm2. Our DRL for ESD is higher than those obtained in Abidjan District and in other countries like UK and Cameroon. Our DRL for DAP is higher than those from Abidjan and all other countries for which a similar study was made. The comparison of these values to those from Abidjan and other countries, shows us that radiology technicians can make efforts to choose radiological parameters to reduce ESD. They must use convenable the X-rays tube to reduce DAP by reducing the patient exposure surface.展开更多
目的:比较冠状动脉造影不同体位的辐射剂量。方法:采用PHILIP Allura Xper FD 20进行冠状动脉造影患者77例。分别选择头位30o、足位30o、右肩位、左肩位、肝位、蜘蛛位进行左冠状动脉造影;选择左前斜45o和头倾30o进行右冠状动脉造影。...目的:比较冠状动脉造影不同体位的辐射剂量。方法:采用PHILIP Allura Xper FD 20进行冠状动脉造影患者77例。分别选择头位30o、足位30o、右肩位、左肩位、肝位、蜘蛛位进行左冠状动脉造影;选择左前斜45o和头倾30o进行右冠状动脉造影。记录每位患者总的透视时间(FT)、累积剂量(CD)和剂量面积乘积(DAP)以及每个体位的投照角度、采集图像总数、管电压、管电流和DAP值,计算不同体位单帧图像的DAP值并进行比较。结果:77例患者平均FT、CD和DAP值分别为216.56±115.52s、281.28.±126.28mGy和34114.74±16587.81 mGy.cm^2。左冠状动脉造影6个体位中,左前斜位的DAP值显著高于头足位和右前斜位,差异具有统计学意义(P值均<0.05);头足方向即左肩位和蜘蛛位、头位和足位、右肩位和肝位之间的DAP值差异均没有统计学意义(P值均>0.05)。结论:冠状动脉造影不同投照体位对辐射剂量有影响;球管左右方向倾斜对辐射剂量影响较大,球管头足方向倾斜对辐射剂量影响不明显;利用单帧图像的DAP值进行辐射剂量对比研究,方法简单,易于推广。展开更多
Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to ...Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable(ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 m Sv and in some cases > 50 m Sv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, nonfluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zerofluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for the operators in the non-fluoroscopic manipulation of catheters; however, the learning curve is shorter for more experienced operators compared to less experienced operators.展开更多
Purpose: Increasing physician awareness of patient exposure to radiation is an important step towards the reduction of potentially harmful effects of radiation. Published studies demonstrated that providing physicians...Purpose: Increasing physician awareness of patient exposure to radiation is an important step towards the reduction of potentially harmful effects of radiation. Published studies demonstrated that providing physicians with feedback regarding their fluoroscopy time leads to a reduction in average fluoroscopy times. The aim of this work was to analyze and publish our medical center data observed during the past year;fluoroscopy time (FT), Dose Area Product (DAP) and cumulative dose (CD) were monitored for radiation protection purposes. Methods: Fluoroscopy time is one of multiple radiation dose indices used in radiation safety auditing. Such auditing is nowadays turning into requirement of patient care safety and quality improvement;as indicated by accreditation bodies both nationally and internationally. All non-cardiac procedures performed outside radiology department by surgeons and interventionists are viewed. FT, DAP and CD are extracted for analysis. Results: a total of 846 cases were studied (643 orthopedic, 99 others, 73 urology, 17 chest, 7 vascular and 4 ERCP cases). Mean FT was 1.3 minutes, mean CD to the patient was 12.98 mGy and the mean DAP was 4.53 Gy/cm2. The longest FT noted was 55 min. The maximum CD was 904 mGy and the maximum DAP was 689 Gy/cm2. Using spearman’s correlation test we found out that there is a significant correlation between FT and DAP (correlation coefficient = 0.615, p. value 0.001). There is a significant correlation between FT and CD (correlation coefficient = 0.628, p. value 0.001). Conclusion: Information about FT that used in each procedure can be used as a tool for patient dose optimization. As we found a significant correlation between DAP as well as CD. Reducing fluoroscopic time (FT) is a radiation protection goal, since it serves the purpose of protection for both the patient and the workers.展开更多
基金the General Hospital“Tzanio”Institutional Review Board(Approval No.15/9-3-2024).
文摘BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries(PAs)and with the systematic attempts to catheterize the PAs of both pelvic sides.Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE.The authors hypothesized that,in selected patients,these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.AIM To describe the authors’approach for intentionally unilateral PAE(IU-PAE)and its potential benefits.METHODS This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years.IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA(subgroup A),or with markedly asymmetric prostatic enlargement,with the dominant prostatic lobe occupying at least two thirds of the entire gland(subgroup B).All patients treated with IU-PAE also fulfilled at least one of the following criteria:Severe tortuosity or severe atheromatosis of the pelvic arteries,non-visualization,or visualization of a tiny(<1 mm)contralateral PA on preprocedural computed tomographic angiography.Intraprocedural contrast-enhanced ultrasonography(iCEUS)was applied to monitor prostatic infarction.IU-PAE patients were compared to a control group treated with bilateral PAE.RESULTS IU-PAE was performed in a total 13 patients(subgroup A,n=7;subgroup B,n=6).Dose-area product,fluoroscopy time and operation time in the IU-PAE group(9767.8μGy∙m^(2),30.3 minutes,64.0 minutes,respectively)were significantly shorter(45.4%,35.9%,45.8%respectively,P<0.01)compared to the control group.Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group.In the 2 clinical failures of IU-PAE(both in subgroup A),the extent of prostatic infarction(demonstrated by iCEUS)was significantly smaller compared to the rest of the IU-PAE group.CONCLUSION In selected patients,IU-PAE is associated with comparable outcomes,but with lower radiation exposure and a shorter procedure compared to bilateral PAE.iCEUS could facilitate patient selection for IU-PAE.
文摘目的探讨颈椎低剂量数字化X线摄影的应用价值。方法在对60例颈椎外伤患者初诊与复查时,分别以常规剂量和低剂量进行颈椎正、侧位数字化X线摄影,获得常规组和低剂量组各120幅图像,并对其曝光量和剂量面积值(dose area product,DAP)进行对比。结果①低剂量组颈椎正、侧位摄影的曝光量值和DAP明显均低于常规组(P<0.01)。②两组图像质量差异无统计学意义(Manne-Whitney U=1180.00,P=0.35)。结论颈椎低剂量数字化X线摄影可明显降低曝光量和吸收剂量,而不影响图像质量。
文摘Diagnostic Reference Levels (DRLs) are indicators that allow assessing the quality of equipment and procedures from the point of view of the doses delivered to patients and subsequently initiate corrective actions if necessary. The purpose of this study is to encourage health professionals to investigate patient radiation doses and to determine whether those doses comply with the principles of radiation protection in medical fields so as to improve practices by reducing patient exposure without reducing clinical effectiveness. To perform this work, we have investigated patient doses for different radiological examinations from six (6) medical centers in Dakar, including the following nine routine types: chest (PA), abdomen (AP), pelvis (AP), cervical spine (AP), lumbar spine (AP, Lat), hip (AP), thoracic spine (AP, Lat). Three types of data were collected, <em>i.e.</em>, X-ray tube machine data, patient data and output measurements. The data were analyzed statistically and the median, minimum, maximum, and third quartile values were calculated and displayed throughout boxplots graphs for all exams and medical centers. The two sigma range (95% confidence interval) was also checked. Comparison of third quartiles of Entrance Surface Dose (ESD) and Dose Area Product (DAP) by type of examination with recommended international DRLs was performed. The third quartile of ESD for pelvis (AP) and thoracic spine (AP) was up to 16% and 38% higher, respectively than their corresponding DRLs in the European Commission Report RP 180 Part 2. For all exams, except thoracic spine (lat), the third quartiles of the dose area product were higher than the corresponding DRLs in the above report. The source of dose variability between medical centers was related to many parameters such as poor radiographic techniques, lack of modern X-ray machines and adequately documented radiation protection practices. The results show the need to develop protocols for dose measurement as well as to carry out quality assurance programs and dose optimization in Senegal.
文摘Our study aims to determine diagnostic reference levels (DRL) for chest front examination in postero anterior (PA) for optimizing patient entrance surface dose (ESD) and dose-area product (DAP) of patients in west of Côte d’Ivoire. 90 patients from three hospitals undergoing conventional radiology were considered. The ESD and DAP for each patient were obtained during chest radiography (PA) examination. The measurements were performed with the device call Dose-Area Product-meter (DAP-meter) with brand Diamentor M4-KDK, type 11017. The DRL were obtained in applying the 75th percentile statistical method to the obtained ESD and DAP. The obtained DRL in ESD for chest radiography for all rooms is 0.40 mGy and in DAP is 54.85 cGy·cm2. Our DRL for ESD is higher than those obtained in Abidjan District and in other countries like UK and Cameroon. Our DRL for DAP is higher than those from Abidjan and all other countries for which a similar study was made. The comparison of these values to those from Abidjan and other countries, shows us that radiology technicians can make efforts to choose radiological parameters to reduce ESD. They must use convenable the X-rays tube to reduce DAP by reducing the patient exposure surface.
文摘Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable(ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 m Sv and in some cases > 50 m Sv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, nonfluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zerofluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for the operators in the non-fluoroscopic manipulation of catheters; however, the learning curve is shorter for more experienced operators compared to less experienced operators.
文摘Purpose: Increasing physician awareness of patient exposure to radiation is an important step towards the reduction of potentially harmful effects of radiation. Published studies demonstrated that providing physicians with feedback regarding their fluoroscopy time leads to a reduction in average fluoroscopy times. The aim of this work was to analyze and publish our medical center data observed during the past year;fluoroscopy time (FT), Dose Area Product (DAP) and cumulative dose (CD) were monitored for radiation protection purposes. Methods: Fluoroscopy time is one of multiple radiation dose indices used in radiation safety auditing. Such auditing is nowadays turning into requirement of patient care safety and quality improvement;as indicated by accreditation bodies both nationally and internationally. All non-cardiac procedures performed outside radiology department by surgeons and interventionists are viewed. FT, DAP and CD are extracted for analysis. Results: a total of 846 cases were studied (643 orthopedic, 99 others, 73 urology, 17 chest, 7 vascular and 4 ERCP cases). Mean FT was 1.3 minutes, mean CD to the patient was 12.98 mGy and the mean DAP was 4.53 Gy/cm2. The longest FT noted was 55 min. The maximum CD was 904 mGy and the maximum DAP was 689 Gy/cm2. Using spearman’s correlation test we found out that there is a significant correlation between FT and DAP (correlation coefficient = 0.615, p. value 0.001). There is a significant correlation between FT and CD (correlation coefficient = 0.628, p. value 0.001). Conclusion: Information about FT that used in each procedure can be used as a tool for patient dose optimization. As we found a significant correlation between DAP as well as CD. Reducing fluoroscopic time (FT) is a radiation protection goal, since it serves the purpose of protection for both the patient and the workers.
