Radiation Exposure of Patients by Cone Beam CT during Endobronchial Navigation - A Phantom Study

Abstract

Rationale: Cone Beam Computed Tomography imaging has become increasingly important in many fields of interventional therapies. Objective: Lung navigation study which is an uncommon soft tissue approach. Methods: As no effective organ radiation dose levels were available for this kind of Cone Beam Computed Tomography application we simulated in our DynaCT (Siemens AG, Forchheim, Germany) suite 2 measurements including 3D acquisition and again for 3D acquisition and 4 endobronchial navigation maneuvers under fluoroscopy towards a nodule after the 8th segmentation in the right upper lobe over a total period of 20 minutes (min). These figures reflect the average complexity and time in our experience. We hereby describe the first time the exact protocol of lung navigation by a Cone Beam Computed Tomography approach. Measurement: The hereby first time measured body radiation doses in that approach showed very promising numbers between 0,98-1,15mSv giving specific lung radiation doses of 0,42-0,38 mSv. Main results: These figures are comparable or even better to other lung navigation systems. Cone Beam Computed Tomography offers some unique features for lung interventionists as a realtime 1-step navigation system in an open structure feasible for endobronchial and transcutaneous approach. Conclusions: Due to this low level of radiation exposure Cone Beam Computed Tomography is expected to attract interventionists interested in using and guiding endobronchial or transcutaneous ablative procedures to peripheral endobronchial and other lung lesions.

Cone Beam Computertomography (CBCT) in Interventional Chest Medicine - High Feasibility for Endobronchial Realtime Navigation

“…Of notice is the fact that for electromagnetic navigation sytems a complete additional multi-slice TCT with an average value of around 7 mSv is necessary15, in some systems (like Veran Systems) even 2 (in inspiration and exspiration) TCTs are required before application of such a navigation system. Therefore as shown in another publication the added radiation exposure by DynaCT navigation to a patient is in comparison to many other CT and navigation applications considerably very low 15. C) As prolonged and controlled apnea in hyperinflation is crucious for the whole method one has to be accustomed to jet-catheter-ventilation and this herein applied protocol 15.…”

“…Moreover the patient should be kept in the same position for data acquisition and examination. Complete and constant apnea by distinct sedation protocol during acquisition have been applied up to 90 minutes without any adverse effects 15. Complete apnea and constant inspiratory positioning of the diaphragm should be acquired between acquisition and navigation to realize best biopsy results 17.…”

“…(Figure 5.). Furthermore a distinct jet-ventilation protocol should be applied with nasal-jet-catheter to keep optimal ventilation setting and periods of complete apnea altering with sufficient ventilation for biopsy under expiration (in order to reduce the risk of pneumothorax) 15. (Figure 6,7,8.…”

Lowered dose full-spine radiography in pediatric patients with idiopathic scoliosis

“…Full-spine radiographs of a humanoid Alderson Rando phantom (The Phantom RANDO ® , Alderson Research Laboratories Inc., Stamford, CT, USA) ( Fig. 1) [8] were acquired with an Axiom Luminos dRF system (Siemens, Medical Solutions, Forchheim, Germany). The system is equipped with an automatic exposure control device (regulated by the relative exposure setting); the acquisition settings (kV, dose/pulse, filtration) were adapted in service mode.…”

Does virtual bronchoscopic navigation improve the diagnostic yield of transbronchial biopsy?

“…Cone beam CT has recently been used also for bronchoscopy, and cone beam CT‐TBB use may increase because of low radiation exposure and convenience of X‐ray fluoroscopy. As stated by Kato et al ., TBB is safe and effective when used in combination with VBN for CT‐BS‐positive lesions (even small lesions), but further investigations are necessary.…”