CT Fluoroscopy for Image-Guided Procedures: Physician Radiation Dose During Full-Rotation and Partial-Angle CT Scanning

Knott, Emily A.; Rose, Sean; Wagner, Martin; Lee, Fred T.; Radtke, Jeff; Anderson, Daniel R.; Zlevor, Annie M.; Lubner, Meghan G.; Hinshaw, J. Louis; Szczykutowicz, Timothy P.

doi:10.1016/j.jvir.2020.10.033

Cited by 8 publications

(26 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A PPS scan is commonly obtained prior to CT-guided procedures for localization purposes [ 5 , 6 , 7 ]. It may provide valuable information for the radiologist, but can also contribute substantially to a patient’s radiation dose during CT-guided procedures, particularly when the remainder of the procedure is performed with intermittent CT fluoroscopy [ 3 , 6 , 7 ]. Multiple techniques have been previously described to lower the dose of PPS, including shortening the scan length and reducing the beam energy [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…While we did not directly measure radiation exposure of the radiologist, the increased number of intermittent CT fluoroscopy acquisitions could potentially increase scatter dose to the radiologist. Indeed, operator dose is an important recognized limitation of intermittent CT fluoroscopy since the operator is usually required to be in the procedure suite at the time of image acquisitions [ 6 , 7 ]. Our results suggest that CT-guided bone marrow biopsies that rely entirely on intermittent CT fluoroscopy by omitting the PPS may increase operator radiation dose by increasing the utilization of intermittent CT fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Omission of Planning CT Reduces Patient Radiation Exposure during CT-Guided Bone Marrow Biopsy and Aspiration

et al. 2021

View full text Add to dashboard Cite

The purpose of this study is to evaluate the impact of eliminating a preprocedural planning computed tomography during CT-guided bone marrow biopsy on the technical aspects of the procedure, including patient dose, sample quality, procedure time, and CT fluoroscopy usage. Retrospective analysis of 109 patients between 1 June 2018 and 1 January 2021 was performed. Patients were grouped based on whether they received a planning CT scan. Relative radiation exposure was measured using dose-length product (DLP). Secondary metrics included number of CT fluoroscopic acquisitions until target localization, total number of CT fluoroscopic acquisitions, biopsy diagnostic yield, and procedure time. A total of 43 bone marrow biopsies with planning CT scans (Group 1) and 66 bone marrow biopsies without planning CT scans (Group 2) were performed. The average total DLP for Group 1 and Group 2 was 268.73 mGy*cm and 50.92 mGy*cm, respectively. The mean radiation dose reduction between the groups was 81% (p < 0.0001). Significantly more CT fluoroscopy acquisitions were needed for needle localization in Group 2 than Group 1 (p < 0.0001). Total number of CT fluoroscopy acquisitions was four for Group 1 and eight for Group 2 (p = 0.0002). There was no significant difference between the groups in procedure time or diagnostic yield. Patients without a planning CT scan received more fluoroscopic CT acquisitions but overall were exposed to significantly less radiation without an increase in procedure time.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Omission of Planning CT Reduces Patient Radiation Exposure during CT-Guided Bone Marrow Biopsy and Aspiration

et al. 2021

View full text Add to dashboard Cite

show abstract

“…We used a Society of Interventional Radiology literature review to obtain typical physician scatter doses. 11 Briefly, Knott et al (2022) analyzed 15 studies acquired from the following search words: aortic repair, urethrogram, ERCP, antegrade, HSG, barium swallow, cystogram, transhepatic biliary drainage and stents, and percutaneous vertebroplasty procedures. 11 This literature review pulled personal dose equivalents or entrance air kerma values for C-Arm and CTF procedures,which provided the basis of comparison to our study for relative scatter production.…”

Section: Literature Review On Physician Doses In C-arm and Ctf Proced...mentioning

confidence: 99%

Technical note: A comparison of physician doses in C‐Arm and CT fluoroscopy procedures

Troville,

Knott,

Reynoso‐Mejia

et al. 2024

J Applied Clin Med Phys

Self Cite

View full text Add to dashboard Cite

PurposeWe address the misconception that the typical physician dose is higher for CT fluoroscopy (CTF) procedures compared to C‐Arm procedures.MethodsWe compare physician scatter doses using two methods: a literature review of reported doses and a model based on a modified form of the dose area product (DAP). We define this modified form of DAP, “cumulative absorbed DAP,” as the product of the area of the x‐ray beam striking the patient, the dose rate per unit area, and the exposure time.ResultsThe patient entrance dose rate for C‐Arm fluoroscopy (0.2 mGy/s) was found to be 15 times lower than for CT fluoroscopy (3 mGy/s). A typical beam entrance area for C‐Arm fluoroscopy reported in the literature was found to be 10.6 × 10.6 cm (112 cm2), whereas for CTF was 0.75 × 32 cm (24 cm2). The absorbed DAP rate for C‐Arm fluoroscopy (22 mGy*cm2/s) was found to be 3.3 times lower than for CTF (72 mGy*cm2/s). The mean fluoroscopy time for C‐Arm procedures (710 s) was found to be 21 times higher than for CT fluoroscopy procedures (23 s). The cumulative absorbed DAP for C‐Arm procedures was found to be 9.4 times higher when compared to CT procedures (1.59 mGy*m2 vs. 0.17 mGy*m2).ConclusionsThe higher fluoroscopy time in C‐Arm procedures leads to a much lower cumulative DAP (i.e., physician scatter dose) in CTF procedures. This result can inform interventional physicians deciding on whether to perform inter‐procedural imaging inside the room as opposed to retreating from the room.

show abstract

“…Some CT scanners are equipped with a function to reconstruct CT images by only scanning 240°and stopping irradiation in the remaining direction [12,22,23]. When irradiation from above was stopped using partial exposure mode (Canon Medical Systems, Tochigi, Japan), the radiation dose, which included exposure to direct radiation within the CT scan plane above the CT table, was reduced by 84% from 2.33 mGy to 0.35 mGy [22].…”

Section: ) Radiation Exposure-reducing Functions Of Ct Scannersmentioning

confidence: 99%

“…Furthermore, the radiation dose from exposure to scattered radiation at a position 10 cm from the CT scan plane above the CT table was reduced by 27% from 0.11 mSv/sec to 0.08 mSv/sec. When irradiation was stopped at the side of the upper half of the operator's body using a partial angle scan (GE Healthcare, Wisconsin, USA), the radiation dose to the operator's chest was 35.2% lower than when a 360°scan was performed [23]. When irradiation was stopped at the opposite side, the radiation dose was increased by 33.9%.…”

Section: ) Radiation Exposure-reducing Functions Of Ct Scannersmentioning

confidence: 99%

Radiation Exposure and Protection in Computed Tomography Fluoroscopy

Nakatani

Kariya

Ono

et al. 2022

Interventional Radiology

View full text Add to dashboard Cite

Computed tomography (CT) fluoroscopy-guided procedures, such as those used for percutaneous biopsy, drainage, and radiofrequency ablation, are highly safe and quite often very successful due to the precision offered by the real-time, high-resolution tomographic images. Even so, international guidelines raised concerns regarding operator exposure to high doses of radiation during these procedures. In light of these concerns, operators conducting CT fluoroscopy-guided procedures not only need to be cognizant of the exposure risk but also exhibit sufficient knowledge of radiation protection. This paper reviews the current literature on experimental and clinical studies of radiation exposure doses to operators during CT fluoroscopy-guided procedures. In addition to the literature review, this paper also introduces different approaches that can be implemented to ensure appropriate radiation protection.

show abstract

CT Fluoroscopy for Image-Guided Procedures: Physician Radiation Dose During Full-Rotation and Partial-Angle CT Scanning

Cited by 8 publications

References 26 publications

Omission of Planning CT Reduces Patient Radiation Exposure during CT-Guided Bone Marrow Biopsy and Aspiration

Omission of Planning CT Reduces Patient Radiation Exposure during CT-Guided Bone Marrow Biopsy and Aspiration

Technical note: A comparison of physician doses in C‐Arm and CT fluoroscopy procedures

Radiation Exposure and Protection in Computed Tomography Fluoroscopy

Contact Info

Product

Resources

About