Monoplane 3D Overlay Roadmap versus Conventional Biplane 2D Roadmap Technique for Neurointervenional Procedures / 신경중재치료의학

PURPOSE: We investigated whether a 3D overlay roadmap using monoplane fluoroscopy offers advantages over a conventional 2D roadmap using biplane fluoroscopy during endovascular aneurysm treatment. MATERIALS AND METHODS: A retrospective chart review was conducted for 131 consecutive cerebral aneurysm embolizations by three neurointerventionalists at a single institution. Allowing for a transition period, the periods from January 2012 to August 2012 (Time Period 1) and February 2013 to July 2013 (Time Period 2) were analyzed for radiation exposure, contrast administration, fluoroscopy time, procedure time, angiographic results, and perioperative complications. Two neurointerventionalists (Group 1) used a conventional 2D roadmap for both Time Periods, and one neurointerventionalist (Group 2) transitioned from a 2D roadmap during Time Period 1 to a 3D overlay roadmap during Time Period 2. RESULTS: During Time Period 2, Group 2 demonstrated reduced fluoroscopy time (p<0.001), procedure time (P=0.023), total radiation dose (p=0.001), and fluoroscopy dose (P=0.017) relative to Group 1. During Time Period 2, there was no difference of immediate angiographic results and procedure complications between the two groups. Through the transition from Time Period 1 to Time Period 2, Group 2 demonstrated decreased fluoroscopy time (p<0.001), procedure time (p=0.022), and procedure complication rate (p=0.041) in Time Period 2 relative to Time Period 1. CONCLUSION: The monoplane 3D overlay roadmap technique reduced fluoroscopy dose and fluoroscopy time during neurointervention of cerebral aneurysms with similar angiographic occlusions and complications rate relative to biplane 2D roadmap, which implies possible compensation of limitations of monoplane fluoroscopy by 3D overlay technique.

Low-dose technology in the diagnosis and treatment of children interventional applications / 中国医学装备

Objective:Cardiovascular interventional therapy for children Statistics and Analysis of X-ray radiation dose to explore low-dose technology in the protection of children. Methods:The hospital nearly two years the use of low-dose technology in the interventional diagnosis and treatment of children, a retrospective analysis of 18 patients under the age of three kinds of treated me institutes common childhood intervention operations radiation levels were nearly two years and two years ago the same operation of the radiation levels in patients with technical analysis, a total of 300 cases. Among them, 60 cases of atrial septal defect occlusion in patients with ventricular septal defect occlusion in patients with 90 cases, patent ductus arteriosus occlusion in patients with 150 cases. Using digital subtraction angiography machine automatically adjusts the exposure conditions. Including entrance dose ED(mGy), dose area product DAP and fluoroscopy time F were measured. Results:The two groups results in the perspective of time, entrance dose, there was a significant difference, nearly 2 years statistics show a significant reduction in radiation dose in children suffered, both between entrance dose and fluoroscopy time was significantly a linear relationship. Area of operation of different doses of the product of cardiovascular intervention there was a significant difference, ventricular septal defect occlusion area dose product is still large. Conclusion:Low-dose technology effectively reduces the radiation dose for children, worthy of promotion.

Study on the relationship between body mass index and dose area product as well as fluoroscopy time in Han nationality during coronary angiography / 介入放射学杂志

Objective To investigate the relationship between body mass index (BMI) and dose area product (DAP) as well as fluoroscopy time during coronary angiography (CAG) in Han nationality subjects in order to improve early judging and reducing high radiation risk. Methods CAG materials of 451 Han nationality subjects were retrospectively analyzed. The patients included 276 males (age 32-87 years) and 175 females (age 42-84 years), and the BMI values ranged from 17.30 to 35.42 kg/m2. According to BMI values, the patients were divided into group A(BMI30 kg/m2,n=30). The mean DAP and fluoroscopy time of each group were calculated; the DAP values were compared between each other among the four groups by using nonparametric Kruskal-Wallis test, while the fluoroscopy time was compared between each other among the four groups by using single factor analysis of variance or LSD-t test. Results The mean DAP of group A, B, C and D was(1 070.07±541.33) μGym2,(1 326.82±606.91) μGym2,(1 937.99±1 030.31) μGym2 and (2 654.53±1 296.69) μGym2 respectively. The mean fluoroscopy time of group A, B, C and D was (3.53± 2.08) min, (2.70 ±1.80) min, (2.75 ±1.88) min and (2.71 ±1.69) min respectively. Statistically significant difference in DAP values existed between each other among the four groups (P0.05). Conclusion The DAP values of adult Han subjects receiving CAG are increased with the increase of BMI values; the fluoroscopy time is significantly prolonged in patients with BMI<20 kg/m2. In performing interventional procedure, the operator should not only understand that the increase of BMI can cause the increase of DAP, but also need to pay special attention to the increase of DAP value caused by operation difficulty when the patient’s BMI is <20 kg/m2.

Comparison of Radiation Exposure during Fluoroscopy-Guided Transforaminal Epidural Steroid Injections at Different Vertebral Levels

OBJECTIVE: To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels. MATERIALS AND METHODS: Fluoroscopy-guided TFESI was performed in 181 patients. The patients were categorized into three groups according to the injected lumbosacral nerve level of L2-4, L5, or S1. Fluoroscopy time (FT) and dose area product (DAP) were recorded for all patients; correlations between FT and DAP were determined at each level, and both FT and DAP were compared between the different vertebral levels. RESULTS: The numbers of patients who received ESI at L2-4, L5, and S1 were 29, 123, and 29. Mean FT was 44 seconds at L2-4, 33.5 seconds at L5, and 37.7 seconds at S1. Mean DAP was 138.6 microGy.m2 at L2-4, 100.6 microGy.m2 at L5, and 72.1 microGy.m2 at S1. FT and DAP were positively correlated in each group (p values < 0.001). FT was significantly shorter at L5 than that at L2-4 (p = 0.004) but was not significantly different between S1 and L2-4 or L5 (p values = 0.286 and 0.532, respectively). DAP was significantly smaller at L5 and S1 than that at L2-4, but L5 and S1 were not significantly different. After correcting for FT, DAP was significantly smaller at S1 than that at either L2-4 or L5 (p values = 0.001 and 0.010). CONCLUSION: The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.

Analysis of X-ray radiation doses from different types of intervention for cardiovascular patients / 中华放射医学与防护杂志

Objective To explore the X-ray radiation dose to patients from different cardiovascular interventional procedures and analyze the dose-affecting factors.Methods In accordance with the A,B,C operators,442 patients undergoing cardiovascular interventional procedures were collected,including single coronary angiography (CAG),percutaneous coronary intervention ( PCI ),radiofrequency catheter ablation (RFCA),congenital heart disease intervention (CHD) and permanent cardiac pacemaker implantation (PCPI),to observe dose area product (DAP),cumulative radiation dose (CD),fluoroscopy time.Results CD values of patients in groups of CAG,PCI,RFCA,CHD,PCPI were (0.34 ±0.23),(1.33 ±0.76),(0.71 ±0.43),(0.27 ±0.22) and (0.92±0.42) Gy and DAP values were (34.18 ±23.33),(135.92 ±81.14),(79.79 ±50.66),(27.93 ±23.66),and (94.60 ±48.11 ) Gy·cm2,respectively.Fluoroscopy time were (4.82 ±3.73),( 16.64 ±9.01 ),( 17.04 ± 15.29),(9.60 ±5.97)and (7.31 ±6.45) min.DAP values and fluoroscopy time were highly correlated (r =0.84,P ＜ 0.05 ).Conclusions There is significant difference in radiation dose for cardiovascular interventional procedures.Radiation dose and fluoroscopy time are directly related to surgeons' proficiency in operations.Improvement of operation proficiency should be carried out to reduce the patients' radiation dose.