Image Fusion Guidance with Pre-procedural CT with Real-Time Fluoroscopy for Adrenal Venous Sampling

Morita, Satoru; Yamazaki, Hiroshi; Endo, Kenji; Suzaki, Shingo; Mitsuhashi, Akira; Shiohara, Takafumi; Yatabe, Midori; Ichihara, Atsuhiro; Sakai, Shuji

doi:10.1007/s00270-018-1930-3

Cited by 9 publications

(10 citation statements)

References 18 publications

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“…[20,21] The first of these is associated with an increased radiation dose, and both are costlier than the conventional catheterization technique described here. The median DAP during AVS in the study was 11.3 Gy.cm 2 , which is lower than previously published reports ranging between 32.5 Gy.cm 2 and 72.2 Gy.cm 2 [8][9][10][11] including on some new generation angiography machines. Some of the differences may be, as some groups use CBCT to improve the success rate at the expense of an increased dose.…”

Section: Discussioncontrasting

confidence: 73%

“…Intraprocedural image fusion of prior CT data with live fluoroscopic images has been shown to aid right adrenal vein catheterization and to reduce both fluoroscopy time and radiation exposure. [10] The authors of this article have shown a relative reduction in their radiation use, but the technique is still associated with a significant radiation dose and a prolonged procedure time. It may be a useful technique to help inexperienced operators improve right adrenal vein catheterization during initial procedures.…”

Section: Discussionmentioning

confidence: 99%

“…[6] AVS is a technically challenging procedure with a significant learning curve and may result in significant radiation exposure to both patient and operator. [7] The published median dose area product (DAP) for AVS ranges between 32.5 Gy.cm 2 and 72.2 Gy.cm 2 , [8][9][10][11] although doses as low as 15.7 Gy.cm 2 have been reported using the intraprocedural measurement of cortisol. [11]…”

Section: Introductionmentioning

confidence: 99%

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Adrenal Vein Sampling: Radiation Dose Reduction on New Angiography Platform

Alsafi

Wernig

Todd

et al. 2020

The Arab Journal of Interventional Radiology

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Objectives: Primary aldosteronism is one of the most common causes of secondary hypertension. Distinguishing unilateral from bilateral disease is essential as those with unilateral adrenal disease will benefit from adrenalectomy. This is best achieved by adrenal vein sampling (AVS) which may be a difficult procedure with significant radiation to both patient and operator. This study aims to measure the radiation dose during AVS before and after the installation of a new angiography platform. Materials and Methods: The dose area product (DAP), air kerma, and fluoroscopy time were collected retrospectively together with demographic data for the first ten patients who underwent AVS between April and September 2018 following the installation of the Philips Azurion 7 M20 interventional platform. These results were compared with those from ten patients who underwent AVS before the installation of the new machine using the Philips Allura Xper FD20 platform. Mann-Whitney test was used to compare DAP, air kerma, and fluoroscopy time. P < 0.05 was considered statistically significant. Results: Successful bilateral adrenal vein catheterization was achieved in all cases in both groups. There was no significant difference in fluoroscopy time: 5.5 (3.3-10.8) min (new) versus 5.3 (4.5-8.4) min (old) (P = 0.9502). The DAP and air kerma were both significantly lower on the new machine: 11.3 (5.2-26.7) Gy.cm 2 versus 45.5 (17.2-56.5) Gy.cm 2 (P = 0.0089) and 201.5 (88.1-464.0) mGy versus 682.5 (300.5-998.5) mGy (P = 0.0115), respectively. Conclusion: The installation of the Philips Azurion 7 M20 interventional platform has allowed a significant reduction in radiation dose during AVS.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adrenal Vein Sampling: Radiation Dose Reduction on New Angiography Platform

Alsafi

Wernig

Todd

et al. 2020

The Arab Journal of Interventional Radiology

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“…This protocol was repeated until venous access was achieved. Subsequently, AVS was performed according to the method described in previous reports [21,23,24]. The access site was checked after 2 h of bed rest and the next day to evaluate hematoma.…”

Section: Venous Access Methodsmentioning

confidence: 99%

High Deep Femoral Artery Bifurcation Can Disturb Safe Femoral Venous Access: CT Assessment in Patients Who Underwent Femoral Venous Access Under Doppler Ultrasound Guidance

Morita

Yamamoto

Kamoshida

et al. 2021

Interventional Radiology

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To retrospectively evaluate the variations of deep femoral artery (DFA) bifurcation on computed tomography (CT) and technical success in femoral venous access.Materials and Methods: CT images of 353 patients who underwent adrenal venous sampling were evaluated. Height with relation to the inferior border of the femoral head and direction of DFA bifurcations were classified as follows: type L, low bifurcation; type H1, high lateral bifurcation; type H2, high posterior to posterolateral bifurcation; type H3, high posteromedial bifurcation; and type H4, high medial bifurcation crossing in front of the femoral vein. Technical success and complications during femoral venous access were also evaluated.Results: The frequencies of types L, H1, H2, H3, and H4 were 82.7%, 9.1%, 6.9%, 0.4%, and 0.9%, respectively. In 92.2% of type H1 and 69.4% of type H2, the superior femoral artery displaced medially by the high DFA partially overlapped the femoral vein. Upon the inclusions of H3 and H4, in 14.4% of cases, the high DFAs could obstruct the access route to the femoral vein. Using Doppler ultrasound guidance, no significant differences were observed in the rates of success for puncture in the first attempt (84.5% vs. 75.4%, p = 0.122) and accidental arterial puncture (1.0% vs. 0%, p = 1.00) between low and high DFA bifurcations, respectively.Conclusions: High DFA bifurcation is observed in 17.3% of patients and could obstruct the access route to the femoral vein. This can be evaluated using Doppler ultrasound guidance to avoid accidental arterial puncture during femoral venous access.

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“…Only few approaches for improvement of adrenal vein sampling combine preand peri-interventional methods such as the simple to use planning ruler approach successfully evaluated in our study. Technically more demanding approaches have been described by Morita et al or Busser et al who propose co-registration of pre-interventionally acquired CTs and real-time fluoroscopy during adrenal vein sampling [21,35]. In the study by Morita et al, the proposed co-registration technique significantly reduced fluoroscopy time (95.6 vs. 108.4 min), DAP (43.1 vs 72.2 Gy � cm 2 ) and contrast volume (54.6 vs 65.7 ml) [35].…”

Section: Plos Onementioning

confidence: 99%

Pre-interventional assessment of right renal to right adrenal vein distance: Impact on procedure time and radiation dose in adrenal vein sampling

et al. 2022

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Purpose Adrenal vein sampling (AVS) is the reference standard for evaluation of lateralized hormone production in primary aldosteronism. We aimed to investigate the impact of pre-interventional right renal vein (RRV) to right adrenal vein (RAV) distance measurement on fluoroscopy time, contrast agent exposure and radiation dose during AVS. Materials and methods Forty-five patients with primary aldosteronism undergoing AVS were enrolled in our retrospective study and divided into three groups. In the group “ruler” (n = 14), RRV-RAV-distances were determined pre-interventionally by cross-sectional imaging (CT/MRI) and AVS was performed by one interventional radiologist with limited experience in AVS. CT/MRI-derived and fluoroscopy-derived RRV-RAV-distances were correlated for aimed cannulation of the RAV. Patients in group “no ruler” (n = 24, three interventional radiologists with limited experience in AVS) and in group “expert”, (n = 7, one expert interventional radiologist) underwent AVS without pre-interventional estimation of RRV-RAV-distances. Procedure parameters (fluoroscopy time, contrast agent volume, radiation dose) of group “ruler” were compared to both other groups by Kruskal-Wallis rank-sum test. Results Correlation of CT/MRI-derived and fluoroscopy-derived RRV-RAV-distances was good (r = 0.74;p = 0.003). The median RRV-RAV-distance was 4.5cm at CT/MRI (95%-CI:4.2–5.0cm) and 4.0cm at fluoroscopy (95%-CI:3.8–4.5cm). Fluoroscopy time (p<0.0001), contrast agent exposure (p = 0.0003) and radiation dose (air kerma and dose area product both p = 0.038) were significantly lower in group “ruler” compared to group “no ruler” (all p<0.05), and similar to group “expert” (all p>0.05). Conclusions CT/MRI-derived pre-interventional renal-adrenal vein distance measurements correlate well with angiographic distance measurements. Pre-interventional estimation of the RRV-RAV-distance allows for aimed cannulation of the RAV with potential reduction of fluoroscopy time, contrast agent exposure and radiation-dose during AVS.

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Image Fusion Guidance with Pre-procedural CT with Real-Time Fluoroscopy for Adrenal Venous Sampling

Abstract: Although the contribution to improving the technical success rates was small in our study, IF can effectively reduce procedure time, radiation exposure, and volume of contrast medium during AVS.

Cited by 9 publications

References 18 publications

Adrenal Vein Sampling: Radiation Dose Reduction on New Angiography Platform

Adrenal Vein Sampling: Radiation Dose Reduction on New Angiography Platform

High Deep Femoral Artery Bifurcation Can Disturb Safe Femoral Venous Access: CT Assessment in Patients Who Underwent Femoral Venous Access Under Doppler Ultrasound Guidance

Pre-interventional assessment of right renal to right adrenal vein distance: Impact on procedure time and radiation dose in adrenal vein sampling

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