Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers

Abstract

High-definition fluoroscopic imaging is required to perform endovascular procedures safely and precisely, especially in complex cases, resulting in longer procedures and increased radiation exposure. This is of importance for training institutions as trainees, even with sound instruction in as low as reasonably achievable (ALARA) principles, tend to have high radiation exposures. Recently, there was an upgrade in the imaging system allowing for comparison of radiation exposure to patients and providers. We performed an analysis of consecutive endovascular aneurysm repair (EVAR) and superficial femoral artery (SFA) interventions in the years 2013 to 2014. We recorded body mass index (BMI) and fluoroscopy time (FT) and subsequently matched 1:1 based on BMI, FT, or both. We determined radiation dose using air kerma (AK) and also recorded individual surgeons' badge readings. Allura Xper FD20 was upgraded to AlluraClarity with ClarityIQ. We identified a total of 77 EVARs (52 pre and 25 post) and 134 SFA interventions (99 pre and 35 post). Unmatched results for EVAR were BMI pre 26.2 versus post 25.8 (kg/m, P = .325), FT 28.1 versus 21.2 (minutes, P = .051), and AK 1178.5 versus 581 (mGy, P < .001), respectively. After matching, there was a 53.2% reduction in AK (846.1 vs 395.9 mGy; P = .004) for EVAR. Unmatched results for SFA interventions were BMI pre 28.1 versus post 26.6 ( P = .327), FT 18.7 versus 16.2 ( P = .282), and AK 285.6 versus 106.0 ( P < .001), respectively. After matching, there was a 57.0% reduction in AK (305.0 vs 131.3, P < .001). The total deep dose equivalent from surgeons' badge readings decreased from 39.5 to 17 mrem ( P = .029). Aortic and peripheral endovascular interventions can be performed with reduced radiation exposure to patients and providers, employing modern fixed imaging systems with advanced dose reduction technology. This is of particular importance in the light of the increasing volume and complexity of endovascular and hybrid procedures as well as the prospect of decades of radiation exposure during training and practice.

Effect of urinary excretion on radiation dose in patients having PET/CT scans

“…The European Research Journal 2019;5(5):722-728 uclear medicine imaging procedures has been increasingly used over the past 20 years, and theyprovided considerable reductions in morbidity and increases in longevity [1]. 18 Fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) is a molecular imaging technique used to differentiate tumor cells from normal cells. It is especially useful for pre-and post-treatment evaluation of oncology patients [2,3].…”

“…PET/CT has proven useful in management of several tumors. Since urinary excretion of 18 F-FDG radiotracer masks the presence of lesions, diagnostic power of PET/CT scanning is lower in urologic tract tumors and prostate cancer [6]. It was reported that PET/CT scanning has a high frequency of false-negatives in urologic tumors [7].…”

“…Absorption of 18 F-FDG in both benign and malignant lesions may often result in misinterpretation. A glucose analogue, 18 F-FDG accumulates in malignant lesions because of their elevated glucose metabolism. Nevertheless, 18 F-FDG can also accumulate in normal tissues, benign tumors of the pelvic area and other non-neoplastic occurrences of pelvis.…”

“…A glucose analogue, 18 F-FDG accumulates in malignant lesions because of their elevated glucose metabolism. Nevertheless, 18 F-FDG can also accumulate in normal tissues, benign tumors of the pelvic area and other non-neoplastic occurrences of pelvis. 18 F-FDG is commonly excreted into urinary system and diagnostic evaluation may difficult in the bladder, prostate, uterus and ovarian cancer.…”

“…Nevertheless, 18 F-FDG can also accumulate in normal tissues, benign tumors of the pelvic area and other non-neoplastic occurrences of pelvis. 18 F-FDG is commonly excreted into urinary system and diagnostic evaluation may difficult in the bladder, prostate, uterus and ovarian cancer. 18 F-FDG accumulation in the urinary tract can be lowered by administration of diuretics, and patients are requested to empty their bladder completely before PET/CT imaging [8].…”