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SCATTER RADIATION IN THE FLUOROSCOPY-GUIDED INTERVENTIONAL ROOM

Bohari A, Hashim S, Mohd Mustafa SN

Radiat Prot Dosimetry, 2020 Jun 24;188(3):397-402.
PMID: 31950168 DOI: 10.1093/rpd/ncz299

Radiation scattered throughout the room during fluoroscopy-guided interventional (FGI) procedures was quantified at different locations using nanoDot optically stimulated luminescence dosemeters. All the tube angulation imaging shows that the radiation spectrum resembled a single peak distribution. The left anterior oblique 90° shows the highest single peak distribution (28.65 mSv/h). The single peak distribution for standard anteroposterior, left anterior oblique 45° and right anterior oblique 45° imaging was 13.32, 22.99 and 17.40 mSv/h, respectively. All tube angulation shows that the position of the interventional radiologist experienced a higher radiation level compared to other staffs. The doses of radiation varied widely around the perimeter of the patient's table and changed in accordance to imaging angles during procedures. Knowledge pertaining to radiation exposure levels is integral in order to avoid adverse risks, particularly among staff.

Matched MeSH terms: Radiography, Interventional
Patient skin dose measurements during coronary interventional procedures using Gafchromic film

Ying CK, Kandaiya S

J Radiol Prot, 2010 Sep;30(3):585-96.
PMID: 20826892 DOI: 10.1088/0952-4746/30/3/012

Interventional cardiology (IC) procedures are known to give high radiation doses to patients and cardiologists as they involve long fluoroscopy times and several cine runs. Patients' dose measurements were carried out at the cardiology department in a local hospital in Penang, Malaysia, using Gafchromic XR-RV2 films. The dosimetric properties of the Gafchromic film were first characterised. The film was energy and dose rate independent but dose dependent for the clinically used values. The film had reproducibility within ± 3% when irradiated on three different days and hence the same XR-RV2 dose-response calibration curve can be used to obtain patient entrance skin dose on different days. The increase in the response of the film post-irradiation was less than 4% over a period of 35 days. For patient dose measurements, the films were placed on the table underneath the patient for an under-couch tube position. This study included a total of 44 patients. Values of 35-2442 mGy for peak skin dose (PSD) and 10.9-344.4 Gy cm(2) for dose-area product (DAP) were obtained. DAP was found to be a poor indicator of PSD for PTCA procedures but there was a better correlation (R(2) = 0.7344) for CA + PTCA procedures. The highest PSD value in this study exceeded the threshold dose value of 2 Gy for early transient skin injury recommended by the Food and Drug Administration.

Matched MeSH terms: Radiography, Interventional*
Computed tomography scan for cardiac interventions

Sim KH, Ong TK, Chin SP, Wong M

Indian Heart J, 2007 Mar-Apr;59(2 Suppl B):B25-32.
PMID: 19153433
Matched MeSH terms: Radiography, Interventional*
Real-time eye lens dose monitoring during cerebral angiography procedures

Safari MJ, Wong JH, Kadir KA, Thorpe NK, Cutajar DL, Petasecca M, et al.

Eur Radiol, 2016 Jan;26(1):79-86.
PMID: 26002131 DOI: 10.1007/s00330-015-3818-9

OBJECTIVES: To develop a real-time dose-monitoring system to measure the patient's eye lens dose during neuro-interventional procedures.
METHODS: Radiation dose received at left outer canthus (LOC) and left eyelid (LE) were measured using Metal-Oxide-Semiconductor Field-Effect Transistor dosimeters on 35 patients who underwent diagnostic or cerebral embolization procedures.
RESULTS: The radiation dose received at the LOC region was significantly higher than the dose received by the LE. The maximum eye lens dose of 1492 mGy was measured at LOC region for an AVM case, followed by 907 mGy for an aneurysm case and 665 mGy for a diagnostic angiography procedure. Strong correlations (shown as R(2)) were observed between kerma-area-product and measured eye doses (LOC: 0.78, LE: 0.68). Lateral and frontal air-kerma showed strong correlations with measured dose at LOC (AKL: 0.93, AKF: 0.78) and a weak correlation with measured dose at LE. A moderate correlation was observed between fluoroscopic time and dose measured at LE and LOC regions.
CONCLUSIONS: The MOSkin dose-monitoring system represents a new tool enabling real-time monitoring of eye lens dose during neuro-interventional procedures. This system can provide interventionalists with information needed to adjust the clinical procedure to control the patient's dose.
KEY POINTS: Real-time patient dose monitoring helps interventionalists to monitor doses. Strong correlation was observed between kerma-area-product and measured eye doses. Radiation dose at left outer canthus was higher than at left eyelid.

Matched MeSH terms: Radiography, Interventional/methods
Fulltext Assessment of Anteroposterior Subpedicular Approach and Oblique Scotty Dog Subpedicular Approach for Selective Nerve Root Block

Kaliya-Perumal AK, Yeh YC, Luo CA, Joey-Tan KY

Clin Orthop Surg, 2017 Mar;9(1):71-76.
PMID: 28261430 DOI: 10.4055/cios.2017.9.1.71

BACKGROUND: The technique used to administer a selective nerve root block (SNRB) varies depending on individual expertise. Both the anteroposterior (AP) subpedicular approach and oblique Scotty dog subpedicular approach are widely practiced. However, the literature does not provide a clear consensus regarding which approach is more suitable. Hence, we decided to analyse the procedural parameters and clinical outcomes following SNRBs using these two approaches.
METHODS: Patients diagnosed with a single lumbar herniated intervertebral disc (HIVD) refractory to conservative management but not willing for immediate surgery were selected for a prospective nonrandomized comparative study. An SNRB was administered as a therapeutic alternative using the AP subpedicular approach in one group (n = 25; mean age, 45 ± 5.4 years) and the oblique Scotty dog subpedicular approach in the other group (n = 22; mean age, 43.8 ± 4.7 years). Results were compared in terms of the duration of the procedure, the number of C-arm exposures, accuracy, pain relief, functional outcome and the duration of relief.
RESULTS: Our results suggest that the oblique Scotty dog subpedicular approach took a significantly longer duration (p = 0.02) and a greater number of C-arm exposures (p = 0.001). But, its accuracy of needle placement was 95.5% compared to only 72% using the AP subpedicular approach (p = 0.03). There was no significant difference in terms of clinical outcomes between these approaches.
CONCLUSIONS: The AP subpedicular approach was simple and facile, but the oblique Scotty dog subpedicular approach was more accurate. However, a brief window period of pain relief was achieved irrespective of the approaching technique used.

Matched MeSH terms: Radiography, Interventional/methods*
Comparison between percutaneous fluoroscopic-guided and conventional open pedicle screw placement techniques for the thoracic spine: a safety evaluation in human cadavers

Kwan MK, Chiu CK, Lee CK, Chan CY

Bone Joint J, 2015 Nov;97-B(11):1555-61.
PMID: 26530660 DOI: 10.1302/0301-620X.97B11.35789

Percutaneous placement of pedicle screws is a well-established technique, however, no studies have compared percutaneous and open placement of screws in the thoracic spine. The aim of this cadaveric study was to compare the accuracy and safety of these techniques at the thoracic spinal level. A total of 288 screws were inserted in 16 (eight cadavers, 144 screws in percutaneous and eight cadavers, 144 screws in open). Pedicle perforations and fractures were documented subsequent to wide laminectomy followed by skeletalisation of the vertebrae. The perforations were classified as grade 0: no perforation, grade 1: < 2 mm perforation, grade 2: 2 mm to 4 mm perforation and grade 3: > 4 mm perforation. In the percutaneous group, the perforation rate was 11.1% with 15 (10.4%) grade 1 and one (0.7%) grade 2 perforations. In the open group, the perforation rate was 8.3% (12 screws) and all were grade 1. This difference was not significant (p = 0.45). There were 19 (13.2%) pedicle fractures in the percutaneous group and 21 (14.6%) in the open group (p = 0.73). In summary, the safety of percutaneous fluoroscopy-guided pedicle screw placement in the thoracic spine between T4 and T12 is similar to that of the conventional open technique.

Matched MeSH terms: Radiography, Interventional/adverse effects; Radiography, Interventional/methods
Patient Exposure during Fluoroscopy-guided Pacemaker Implantation Procedures

Alkhorayef M, Sulieman A, Babikir E, Daar E, Alnaaimi M, Alduaij M, et al.

Appl Radiat Isot, 2018 Aug;138:14-17.
PMID: 28830729 DOI: 10.1016/j.apradiso.2017.08.010

A pacemaker, which is used for heart resynchronization with electrical impulses, is used to manage many clinical conditions. Recently, the frequency of pacemaker implantation procedures has increased to more than 50% worldwide. During this procedure, patients can be exposed to excessive radiation exposure. Wide range of doses has been reported in previous studies, suggesting that optimization of this procedure has not been fulfilled yet. The current study evaluated patient radiation exposure during cardiac pacemaker procedures and quantified the patient effective dose. A total of 145 procedures were performed for five pacemaker procedures (VVI, VVIR, VVD, VVDR, and DDDR) at two hospitals. Patient doses were measured using the kerma-area product meter. Effective doses were estimated using software based on Monte Carlo simulation from the National Radiological Protection Board (NRPB, now The Health Protection Agency). The effective dose values were used to estimate cancer risk from the pacemaker procedure. Patient demographic data and exposure parameters for fluoroscopy and radiography were quantified. The mean patient doses ± SD per procedure (Gycm2) for VVI, VVIR, VVD, VVDR, and DDDR were 1.52 ± 0.13 (1.43-1.61), 3.28 ± 2.34 (0.29-8.73), 3.04 ± 1.67 (1.57-4.86), 6.04 ± 2.326 3.29-8.58), and 8.8 ± 3.6 (4.5-26.20), respectively. The overall patient effective dose was 1.1mSv per procedure. It is obvious that the DDDR procedure exposed patients to the highest radiation dose. Patient dose variation can be attributed to procedure type, exposure parameter settings, and fluoroscopy time. The results of this study showed that patient doses during different pacemaker procedures are lower compared to previous reported values. Patient risk from pacemaker procedure is low, compared to other cardiac interventional procedures. Patients' exposures were mainly influenced by the type of procedures and the clinical indication.

Matched MeSH terms: Radiography, Interventional/adverse effects; Radiography, Interventional/methods*
EDR2 film for skin dose measurement in coronary angiography

Ying C, Kandaiya S

Sains Malaysiana, 2012;41:133-140.

Patient skin dose measurements were performed at the cardiology department in a hospital in Penang, Malaysia using EDR films during coronary angiography (CA) procedures. The EDR2 film was first characterized in terms of dose and energy dependence as well reproducibility. For patient dose measurements, the films were placed on the table underneath the patient for an under couch tube position. A total of 27 CA procedures were studied. Results for peak skin doses (PSD) ranged from 35 to 684 mGy while the dose area product (DAP) values were from 5.5 to 93.1 Gy cm2. DAP correlated reasonably with PSD for CA procedure (R2= 0.8212). The highest PSD value in this study is below the threshold dose value of 2 Gy for early transient skin injury recommended by the Food and Drug Administration (FDA 1994).

Matched MeSH terms: Radiography, Interventional
The accuracy and safety of fluoroscopically guided percutaneous pedicle screws in the lumbosacral junction and the lumbar spine: a review of 880 screws

Chiu CK, Kwan MK, Chan CY, Schaefer C, Hansen-Algenstaedt N

Bone Joint J, 2015 Aug;97-B(8):1111-7.
PMID: 26224830 DOI: 10.1302/0301-620X.97B8.35330

We undertook a retrospective study investigating the accuracy and safety of percutaneous pedicle screws placed under fluoroscopic guidance in the lumbosacral junction and lumbar spine. The CT scans of patients were chosen from two centres: European patients from University Medical Center Hamburg-Eppendorf, Germany, and Asian patients from the University of Malaya, Malaysia. Screw perforations were classified into grades 0, 1, 2 and 3. A total of 880 percutaneous pedicle screws from 203 patients were analysed: 614 screws from 144 European patients and 266 screws from 59 Asian patients. The mean age of the patients was 58.8 years (16 to 91) and there were 103 men and 100 women. The total rate of perforation was 9.9% (87 screws) with 7.4% grade 1, 2.0% grade 2 and 0.5% grade 3 perforations. The rate of perforation in Europeans was 10.4% and in Asians was 8.6%, with no significant difference between the two (p = 0.42). The rate of perforation was the highest in S1 (19.4%) followed by L5 (14.9%). The accuracy and safety of percutaneous pedicle screw placement are comparable to those cited in the literature for the open method of pedicle screw placement. Greater caution must be taken during the insertion of L5 and S1 percutaneous pedicle screws owing to their more angulated pedicles, the anatomical variations in their vertebral bodies and the morphology of the spinal canal at this location.

Matched MeSH terms: Radiography, Interventional/methods*
Fulltext Tumour seeding following percutaneous needle biopsy of hepatocellular carcinoma

Qua CS, Wong CH, Goh KL

Singapore Med J, 2008 Jan;49(1):e8-11.
PMID: 18204759

We report a hepatocellular carcinoma seeding following needle biopsy in a 57-year-old man who first presented with a focal hepatic lesion at another hospital. The patient had been a hepatitis B carrier for 20 years. Initial surveillance ultrasonography showed a lesion in segment IV, in the background of non-cirrhotic liver and normal serum alpha-foetoprotein level (8 ng/ml). A percutaneous needle biopsy was done and histopathology confirmed well-differentiated hepatocellular carcinoma. The patient had refused surgery and preferred to try traditional medicine. He presented to us four months after the initial biopsy with epigastric swelling. This was found to be due to a tumour seeding along the previous biopsy tract. He was given radiofrequency ablation (RFA) of tumour along the needle tract, in addition to the primary tumour. We conclude that the need for percutaneous needle biopsy should be critically evaluated in patients presenting with focal hepatic lesions and the role of RFA in treating tumour seeding needs further evaluation.

Matched MeSH terms: Radiography, Interventional
Fulltext In-centre intermittent peritoneal dialysis: a viable interim option to an eventual definitive renal replacement therapy?

Ng EK, Goh BL, Hamdiah P

Med J Malaysia, 2012 Apr;67(2):151-4.
PMID: 22822633 MyJurnal

In-centre intermittent peritoneal dialysis (IPD), a decade-old modality commonly associated with acute (stab) PD, continues to play an undeniably important role of providing "temporary" renal replacement therapy (RRT) in Malaysia. In our center, IPD is commenced after insertion of Tenckhoff catheter by interventional nephrologists as an interim option until a definitive RRT is established. This study aims to describe our experience and evaluate the viability of this modality as a bridging therapy. We retrospectively analyzed 39 IPD patients from January 2007 to December 2009; looking at demographics, cause of end-stage renal disease, duration on the program, length of hospitalization, PD-related infection profile, biochemical parameters and clinical outcomes. We accumulated a total experience of 169 patient-months, the average age of patients was 54.6 +/- 11.6 years, 84.6% of them diabetics. The median duration of a patient in the program was 88 days with accumulated in-hospital stay of 45 days. Eventually 48.7% of the patients secured placement for long-term haemodialysis while 20.5% were converted to CAPD. The mortality rate was 7.7% while the peritonitis rate was at 1 per 18.8 patient months. Our study shows that IPD is a viable interim option with a low infection rate and good clinical outcome.

Matched MeSH terms: Radiography, Interventional
Fulltext Hemorrhagic cardiac tamponade: rare complication of radiofrequency ablation of hepatocellular carcinoma

Loh KB, Bux SI, Abdullah BJ, Raja Mokhtar RA, Mohamed R

Korean J Radiol, 2012 Sep-Oct;13(5):643-7.
PMID: 22977334 DOI: 10.3348/kjr.2012.13.5.643

Local treatment for hepatocellular carcinoma (HCC) has been widely used in clinical practice due to its minimal invasiveness and high rate of cure. Percutaneous radiofrequency ablation (RFA) is widely used because its treatment effectiveness. However, some serious complications can arise from percutaneous RFA. We present here a rare case of hemorrhagic cardiac tamponade secondary to an anterior cardiac vein (right marginal vein) injury during RFA for treatment of HCC.

Matched MeSH terms: Radiography, Interventional
Biloma and biliary fistula associated with hepatorrhaphy for liver injury

Shahrudin MD, Noori SM

Hepatogastroenterology, 1997 Mar-Apr;44(14):519-21.
PMID: 9164529

To review our experience in managing post-hepatorrhaphy complications in liver trauma.

Matched MeSH terms: Radiography, Interventional
Fulltext Concomitant stenting of the patent ductus arteriosus and radiofrequency valvotomy in pulmonary atresia with intact ventricular septum and intermediate right ventricle: early in-hospital and medium-term outcomes

Alwi M, Choo KK, Radzi NA, Samion H, Pau KK, Hew CC

J. Thorac. Cardiovasc. Surg., 2011 Jun;141(6):1355-61.
PMID: 21227471 DOI: 10.1016/j.jtcvs.2010.08.085

Objectives: Our objective was to determine the feasibility and early to medium-term outcome of stenting the patent ductus arteriosus at the time of radiofrequency valvotomy in the subgroup of patients with pulmonary atresia with intact ventricular septum and intermediate right ventricle.
Background: Stenting of the patent ductus arteriosus and radiofrequency valvotomy have been proposed as the initial intervention for patients with intermediate right ventricle inasmuch as the sustainability for biventricular circulation or 1½-ventricle repair is unclear in the early period.
Methods: Between January 2001 and April 2009, of 143 patients with pulmonary atresia and intact ventricular septum, 37 who had bipartite right ventricle underwent radiofrequency valvotomy and stenting of the patent ductus arteriosus as the initial procedure. The mean tricuspid valve z-score was -3.8 ± 2.2 and the mean tricuspid valve/mitral valve ratio was 0.62 ± 0.16.
Results: Median age was 10 days (3-65 days) and median weight 3.1 kg (2.4-4.9 kg). There was no procedural mortality. Acute stent thrombosis developed in 1 patient and necessitated emergency systemic-pulmonary shunt. There were 2 early in-hospital deaths owing to low cardiac output syndrome. One late death occurred owing to right ventricular failure after the operation. Survival after the initial procedure was 94% at 6 months and 91% at 5 years. At a median follow-up of 4 years (6 months to 8 years), 17 (48%) attained biventricular circulation with or without other interventions and 9 (26%) achieved 1½-ventricle repair. The freedom from reintervention was 80%, 68%, 58%, and 40% at 1, 2, 3, and 4 years, respectively.
Conclusions: Concomitant stenting of the patent ductus arteriosus at the time of radiofrequency valvotomy in patients with pulmonary atresia with intact ventricular septum and intermediate right ventricle is feasible and safe with encouraging medium-term outcome.

Matched MeSH terms: Radiography, Interventional

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