Significant Radiation Dose Reduction in the Hybrid Operating Room Using a Novel X-ray Imaging Technology

Haak, R.F.F. van den; Hamans, BC; Zuurmond, Kirsten; Verhoeven, Bart A.N.; Koning, Olivier H.J.

doi:10.1016/j.ejvs.2015.06.025

Cited by 32 publications

(23 citation statements)

References 27 publications

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“…A hybrid operating room (OR) is a surgical suite containing an integrated C‐arm system within the room construction. Hybrid ORs are used in vascular surgery and have shown radiation dose reduction to the patient The benefit of using imaging equipment within a hybrid OR for pedicle screw placement and assessment with intraoperative 3D imaging has been documented . Such benefits include the seamless integration of the C‐arm and the surgical table within the OR suite, the robotic movement of the C‐arm, and the ability to intraoperatively replace/adjust misplaced screws that could potentially require revision surgery after discovery during follow‐up CT imaging after closure.…”

Section: Introductionmentioning

confidence: 99%

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Nachabé

Strauss

Schueler

et al. 2019

J Applied Clin Med Phys

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Careful protocol selection is required during intraoperative three‐dimensional (3D) imaging for spine surgery to manage patient radiation dose and achieve clinical image quality. Radiation dose and image quality of a Medtronic O‐arm commonly used during spine surgery, and a Philips hybrid operating room equipped with XperCT C‐arm 3D cone‐beam CT (hCBCT) are compared. The mobile O‐arm (mCBCT) offers three different radiation dose settings (low, standard, and high), for four different patient sizes (small, medium, large, and extra large). The patient's radiation dose rate is constant during the entire 3D scan. In contrast, C‐CBCT spine imaging uses three different field of views (27, 37, and 48 cm) using automatic exposure control (AEC) that modulates the patient's radiation dose rate during the 3D scan based on changing patient thickness. hCBCT uses additional x‐ray beam filtration. Small, medium, and large trunk phantoms designed to mimic spine and soft tissue were imaged to assess radiation dose and image quality of the two systems. The estimated measured “patient” dose for the small, medium, and large phantoms imaged by the mCBCT considering all the dose settings ranged from 9.4–27.6 mGy, 8.9–33.3 mGy, and 13.8–40.6 mGy, respectively. The “patient” dose values for the same phantoms imaged with hCBCT were 2.8–4.6 mGy, 5.7–10.0 mGy, and 11.0–15.2 mGy. The CNR for the small, medium, and large phantoms was 2.9 to 3.7, 2.0 to 3.0, and 2.5 to 2.6 times higher with the hCBCT system, respectively. Hounsfield unit accuracy, noise, and uniformity of hCBCT exceeded the performance of the mCBCT; spatial resolution was comparable. Added x‐ray beam filtration and AEC capability achieved clinical image quality for intraoperative spine surgery at reduced radiation dose to the patient in comparison to a reference O‐arm system without these capabilities.

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Section: Introductionmentioning

confidence: 99%

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Nachabé

Strauss

Schueler

et al. 2019

J Applied Clin Med Phys

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“…An update with Clarity was shown to be an effective method of reducing the DSA exposure doses 14 even in EVAR. 15 However, the exposure with DSA is still 19-fold larger compared with fluoroscopy, and in extreme cases, up to a factor of 60 when low-dose fluoroscopy is compared with 3-fps high-dose DSA. Overall, the DSA doses using fixed C-arms (independent of this update) are much higher when fixed X-ray equipment is used compared with mobile equipment.…”

Section: Discussionmentioning

confidence: 99%

Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice

et al. 2017

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Purpose: To determine which patient and C-arm characteristics are the strongest predictors of intraoperative patient radiation dose rates (DRs) during endovascular aneurysm repair (EVAR) procedures and create a patient risk chart. Methods: A retrospective analysis was performed of 74 EVAR procedures, including 16,889 X-ray runs using fixed C-arm imaging equipment. Four multivariate log-linear mixed models (with patient as a random effect) were constructed. Mean air kerma DR (DRAK, mGy/s) and the mean dose area product DR (DRDAP, mGycm2/s) were the outcome variables utilized for fluoroscopy as differentiated from digital subtraction angiography (DSA). These models were used to predict the maximum radiation duration allowed before a 2-Gy skin threshold (for DRAK) or a 500-Gycm2 threshold (for DRDAP) was reached. Results: The strongest predictor of DRAK and DRDAP for fluoroscopy imaging was the radiation protocol, with an increase of 200% when changing from “low” to “medium” and 410% from “low” to “normal.” The strongest predictors of DRAK and DRDAP for DSA were C-arm angulation, with an increase of 47% per 30° of angulation, and body mass index (BMI), with an increase of 58% for every 5-point increase in BMI. Based on these models, a patient with a BMI of 30 kg/m2, combined with 45° of rotation and a field size of 800 cm2 in the medium fluoroscopy protocol has a predicted DRAK of 0.39 mGy/s (or 85.5 minutes until the 2-Gy skin threshold is reached). While using comparable settings but switching the acquisition to a DSA with a “2 frames per second” protocol, the predicted DRAK will be 6.6 mGy/s (or 5.0 minutes until the 2-Gy threshold is reached). Conclusion: X-ray radiation DRs are constantly fluctuating during and between patients based on BMI, the protocols, C-arm position, and the image acquisitions that are used. An instant patient risk chart visualizes these radiation dose fluctuations and provides an overview of the expected duration of X-ray radiation, which can be used to predict when follow-up dose thresholds are reached during abdominal endovascular procedures.

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“…19 The concept of the hybrid operating room involves radiation exposure to the surgical team and interventional cardiologists. 20 The exposure can be minimized by various methods, as described later in this article.…”

Section: Magnitude Of Radiation Exposurementioning

confidence: 99%

Strategies to Reduce Radiation Exposure in Electrophysiology and Interventional Cardiology

Shankar

Padmanabhan

Chandrashekharaiah

et al. 2020

US Cardiology Review

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Clinical diagnosis sometimes involves the use of medical instruments that employ ionizing radiation. However, ionizing radiation exposure is a workplace hazard that goes undetected and is detrimental to patients and staff in the catheterization laboratory. Every possible effort should be made to reduce the amount of radiation, including scattered radiation. Implementing radiation dose feedback may have a role in reducing exposure. In medicine, it is important to estimate the potential biologic effects on, and the risk to, an individual. In general, implantation of cardiac resynchronization devices is associated with one of the highest operator exposure doses due to the proximity of the operator to the radiation source. All physicians should work on the principle of as low as reasonably achievable. Methods for reducing radiation exposure must be implemented in the catheterization laboratory. In this article, we review the available tools to lower the radiation exposure dose to the operator during diagnostic, interventional, and electrophysiological cardiac procedures.

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Significant Radiation Dose Reduction in the Hybrid Operating Room Using a Novel X-ray Imaging Technology

Abstract: A novel X-ray imaging technology in the hybrid OR suite resulted in a significant reduction of patient and staff radiation dose without affecting procedure length, fluoroscopy time, or use of contrast.

Cited by 32 publications

References 27 publications

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice

Strategies to Reduce Radiation Exposure in Electrophysiology and Interventional Cardiology

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