目的以心血管介入术后采集空气比释动能(reference air kerma,AK)值和剂量面积乘积(dose-area product,DAP)值数据为依据,分析术中透视时间报警设置作为心血管介入手术辐射剂量的监测和警示工具的可行性。方法回顾性分析2016年11月至201...目的以心血管介入术后采集空气比释动能(reference air kerma,AK)值和剂量面积乘积(dose-area product,DAP)值数据为依据,分析术中透视时间报警设置作为心血管介入手术辐射剂量的监测和警示工具的可行性。方法回顾性分析2016年11月至2018年1月上海长海医院736例冠状动脉造影术(CAG)和经皮冠状动脉治疗术(PCI)病例,收集术中透视时间、AK和DAP数据资料。德国西门子成像设备分组(Ceiling系统和Biplane系统)和手术类型分组(CAG和PCI),对辐射剂量数据进行比较,以及对心血管介入手术AK和DAP值与透视时间数据采用Spearman检验解析相关性。结果Ceiling和Biplane成像系统中手术透视时间为(8.9±7.8)和(8.6±7.3)min,透视AK均值和DAP均值分别为(472±474)、(510±509)mGy、(4548±4085)和(4255±3781)μGy·m^2,术中总(透视+造影)AK和DAP均值为(703±595)、(733±614)mGy、(6253±4938)和(5681±4432)μGy·m^2。CAG与PCI术中透视时间均值分别为(2.4±0.9)和(15.7±4.9)min。PCI透视辐射剂量(AK和DAP)与术中总辐射剂量比值分别为74%和78%。心血管介入手术中透视时间与AK值(r=0.822)和DAP值(r=0.844)都呈高度相关性(P<0.001)。结论透视采集辐射剂量是心血管介入手术中辐射剂量的主要来源,辐射剂量随透视时间延长而增加,透视时间监测和报警设置在心血管介入临床应用中作为术中辐射防护工具有一定的参考和警示价值。展开更多
BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associat...BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries(PAs)and with the systematic attempts to catheterize the PAs of both pelvic sides.Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE.The authors hypothesized that,in selected patients,these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.AIM To describe the authors’approach for intentionally unilateral PAE(IU-PAE)and its potential benefits.METHODS This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years.IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA(subgroup A),or with markedly asymmetric prostatic enlargement,with the dominant prostatic lobe occupying at least two thirds of the entire gland(subgroup B).All patients treated with IU-PAE also fulfilled at least one of the following criteria:Severe tortuosity or severe atheromatosis of the pelvic arteries,non-visualization,or visualization of a tiny(<1 mm)contralateral PA on preprocedural computed tomographic angiography.Intraprocedural contrast-enhanced ultrasonography(iCEUS)was applied to monitor prostatic infarction.IU-PAE patients were compared to a control group treated with bilateral PAE.RESULTS IU-PAE was performed in a total 13 patients(subgroup A,n=7;subgroup B,n=6).Dose-area product,fluoroscopy time and operation time in the IU-PAE group(9767.8μGy∙m^(2),30.3 minutes,64.0 minutes,respectively)were significantly shorter(45.4%,35.9%,45.8%respectively,P<0.01)compared to the control group.Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group.In the 2 clinical failures of IU-PAE(展开更多
目的通过现场调查ERCP手术的相关参数,模拟ERCP手术的全过程,借助水模体,测量面积剂量乘积(Dose Area Product,DAP),为估算患者受照剂量提供基础数据。方法现场调查记录ERCP过程中设备的相关参数(主要是透视时间及摄片帧数),并以记录的...目的通过现场调查ERCP手术的相关参数,模拟ERCP手术的全过程,借助水模体,测量面积剂量乘积(Dose Area Product,DAP),为估算患者受照剂量提供基础数据。方法现场调查记录ERCP过程中设备的相关参数(主要是透视时间及摄片帧数),并以记录的设备相关参数为投照条件,用水模替代人体,测量DAP。结果共调查56例ERCP手术,其中胆总管结石取石49例(87.5%)、支架置入7例(12.5%)。透视时间为1.3~27.3min,平均为(6.9±6.0)min;摄片帧数为0~14帧,平均为(4±3)帧;DAP为3.2~58.5 Gy·cm^2,平均为(15.0±12.9)Gy·cm^2。结论透视时间与DAP有较好的相关性,r=0.999,P<0.01;透视导致的DAP在ERCP中占96%;胆管支架置入术的透视时间比胆总管取石术略长,相应地,胆管支架置入术的DAP略高于胆总管结石取石术。由于手术操作的复杂性和操作者的熟练程度的不同,导致患者的DAP差别较大。展开更多
Information about the peak skin dose and Dose Area product (DAP) from percutaneous transluminal coronary angioplasty (PTCA) and coronary angiography (CA) was collected from three catheter application rooms. The range ...Information about the peak skin dose and Dose Area product (DAP) from percutaneous transluminal coronary angioplasty (PTCA) and coronary angiography (CA) was collected from three catheter application rooms. The range of maximum photon energy was 50 - 125 kVp and the fluoroscopy time was 0.6 - 52 seconds. Values of up to 143 Gy·cm2 for DAP and 0.752 mGy for cumulative dose (CD) were found in CA procedures. Otherwise the DAP and CD for PTCA were found to be 143 Gy·cm2 and 2.287 mGy respectively in 3rd Quartile. The relation between the fluoroscopy time and the DAP is also considered. Objectives: The objective of this study is to obtain information about patient peak skin doses (PSD), dose area product (DAP), Fluoroscopy Time (FT) and Cumulative Dose (CD) from PTCA and CA which is the most predominant with respect to high skin doses in addition to other procedures. The aim of this study is also to assess the radiation dose received by patients undergoing interventional radiology procedures, by identifying the procedures that deliver the highest doses. This study is also helpful to establish the reference dose level for adult patients undergoing interventional procedure, and to provide recommendations on how to reduce dose on selected procedures that have been identified to deliver patient dose values near the ICRP (International Commission on Radiological Protection) threshold values.展开更多
Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to ...Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable(ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 m Sv and in some cases > 50 m Sv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, nonfluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zerofluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for the operators in the non-fluoroscopic manipulatio展开更多
Purpose: Increasing physician awareness of patient exposure to radiation is an important step towards the reduction of potentially harmful effects of radiation. Published studies demonstrated that providing physicians...Purpose: Increasing physician awareness of patient exposure to radiation is an important step towards the reduction of potentially harmful effects of radiation. Published studies demonstrated that providing physicians with feedback regarding their fluoroscopy time leads to a reduction in average fluoroscopy times. The aim of this work was to analyze and publish our medical center data observed during the past year;fluoroscopy time (FT), Dose Area Product (DAP) and cumulative dose (CD) were monitored for radiation protection purposes. Methods: Fluoroscopy time is one of multiple radiation dose indices used in radiation safety auditing. Such auditing is nowadays turning into requirement of patient care safety and quality improvement;as indicated by accreditation bodies both nationally and internationally. All non-cardiac procedures performed outside radiology department by surgeons and interventionists are viewed. FT, DAP and CD are extracted for analysis. Results: a total of 846 cases were studied (643 orthopedic, 99 others, 73 urology, 17 chest, 7 vascular and 4 ERCP cases). Mean FT was 1.3 minutes, mean CD to the patient was 12.98 mGy and the mean DAP was 4.53 Gy/cm2. The longest FT noted was 55 min. The maximum CD was 904 mGy and the maximum DAP was 689 Gy/cm2. Using spearman’s correlation test we found out that there is a significant correlation between FT and DAP (correlation coefficient = 0.615, p. value 0.001). There is a significant correlation between FT and CD (correlation coefficient = 0.628, p. value 0.001). Conclusion: Information about FT that used in each procedure can be used as a tool for patient dose optimization. As we found a significant correlation between DAP as well as CD. Reducing fluoroscopic time (FT) is a radiation protection goal, since it serves the purpose of protection for both the patient and the workers.展开更多
Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcom...Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcomes.Methods:Data of CIED implantation procedures from September 2015 to December 2019 of all the CIED implantation procedures performed at our institute were retrospectively analyzed.The procedural data were divided into two groups:a)pre-group:procedures that were performed under fluoroscopy frame rate of 7.5 frames per second(fps);b)post-group:procedures that were performed under fluoroscopy frame rate of 3.75 fps.We compared procedure time,fluoroscopy time,Kerma air product,effective dose,and in-hospital outcomes between the two groups.Results:A total of 2,225 procedures were included in the analysis with mean age of(62±15)years.The procedures consisted of the implantation of single-chamber(n=1,436),double chamber(n=656),and biventricular devices(n=133).Procedure time and radiation indices showed a significant reduction over the study period(P<0.001).Reduction in the fluoroscopy frame rate was associated with a significant reduction in radiation exposure indices(P<0.001).In-hospital outcomes did not differ between the two groups.Conclusions:Reduction in the fluoroscopy frame rate from 7.5 to 3.75 fps significantly decreased the radiation exposure in CIED implantation procedures.A framerate lower than 3.75 fps should be the default setting during such procedures.展开更多
目的探讨EnSite NavX标测指导下房室结折返性心动过速(AVNRT)射频消融术的可行性和安全性。方法 124例阵发性室上性心动过速的患者接受射频消融术被随机分为采用EnSite NavX系统标测指导组和常规透视组(X线)。结果 65例为AVNRT,其中标...目的探讨EnSite NavX标测指导下房室结折返性心动过速(AVNRT)射频消融术的可行性和安全性。方法 124例阵发性室上性心动过速的患者接受射频消融术被随机分为采用EnSite NavX系统标测指导组和常规透视组(X线)。结果 65例为AVNRT,其中标测指导组32例,常规透视组33例。所有手术均获得即刻的成功,无手术并发症。与常规透视组比较,标测指导组手术时间长(64.6±12.7 min vs 37.5±13.6 min,P<0.01);而X线透视时间少(27.62±31.5 s vs 324.2±108.3 s,P<0.01),其中有21例(65.6%)未接受X线透视。平均随访6个月均无心动过速复发。结论 EnSite NavX标测指导下AVNRT射频消融安全有效,且显著减少了X线透视时间。展开更多
文摘目的以心血管介入术后采集空气比释动能(reference air kerma,AK)值和剂量面积乘积(dose-area product,DAP)值数据为依据,分析术中透视时间报警设置作为心血管介入手术辐射剂量的监测和警示工具的可行性。方法回顾性分析2016年11月至2018年1月上海长海医院736例冠状动脉造影术(CAG)和经皮冠状动脉治疗术(PCI)病例,收集术中透视时间、AK和DAP数据资料。德国西门子成像设备分组(Ceiling系统和Biplane系统)和手术类型分组(CAG和PCI),对辐射剂量数据进行比较,以及对心血管介入手术AK和DAP值与透视时间数据采用Spearman检验解析相关性。结果Ceiling和Biplane成像系统中手术透视时间为(8.9±7.8)和(8.6±7.3)min,透视AK均值和DAP均值分别为(472±474)、(510±509)mGy、(4548±4085)和(4255±3781)μGy·m^2,术中总(透视+造影)AK和DAP均值为(703±595)、(733±614)mGy、(6253±4938)和(5681±4432)μGy·m^2。CAG与PCI术中透视时间均值分别为(2.4±0.9)和(15.7±4.9)min。PCI透视辐射剂量(AK和DAP)与术中总辐射剂量比值分别为74%和78%。心血管介入手术中透视时间与AK值(r=0.822)和DAP值(r=0.844)都呈高度相关性(P<0.001)。结论透视采集辐射剂量是心血管介入手术中辐射剂量的主要来源,辐射剂量随透视时间延长而增加,透视时间监测和报警设置在心血管介入临床应用中作为术中辐射防护工具有一定的参考和警示价值。
基金the General Hospital“Tzanio”Institutional Review Board(Approval No.15/9-3-2024).
文摘BACKGROUND Prostatic artery embolization(PAE)is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia.Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries(PAs)and with the systematic attempts to catheterize the PAs of both pelvic sides.Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE.The authors hypothesized that,in selected patients,these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.AIM To describe the authors’approach for intentionally unilateral PAE(IU-PAE)and its potential benefits.METHODS This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years.IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA(subgroup A),or with markedly asymmetric prostatic enlargement,with the dominant prostatic lobe occupying at least two thirds of the entire gland(subgroup B).All patients treated with IU-PAE also fulfilled at least one of the following criteria:Severe tortuosity or severe atheromatosis of the pelvic arteries,non-visualization,or visualization of a tiny(<1 mm)contralateral PA on preprocedural computed tomographic angiography.Intraprocedural contrast-enhanced ultrasonography(iCEUS)was applied to monitor prostatic infarction.IU-PAE patients were compared to a control group treated with bilateral PAE.RESULTS IU-PAE was performed in a total 13 patients(subgroup A,n=7;subgroup B,n=6).Dose-area product,fluoroscopy time and operation time in the IU-PAE group(9767.8μGy∙m^(2),30.3 minutes,64.0 minutes,respectively)were significantly shorter(45.4%,35.9%,45.8%respectively,P<0.01)compared to the control group.Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group.In the 2 clinical failures of IU-PAE(
文摘目的通过现场调查ERCP手术的相关参数,模拟ERCP手术的全过程,借助水模体,测量面积剂量乘积(Dose Area Product,DAP),为估算患者受照剂量提供基础数据。方法现场调查记录ERCP过程中设备的相关参数(主要是透视时间及摄片帧数),并以记录的设备相关参数为投照条件,用水模替代人体,测量DAP。结果共调查56例ERCP手术,其中胆总管结石取石49例(87.5%)、支架置入7例(12.5%)。透视时间为1.3~27.3min,平均为(6.9±6.0)min;摄片帧数为0~14帧,平均为(4±3)帧;DAP为3.2~58.5 Gy·cm^2,平均为(15.0±12.9)Gy·cm^2。结论透视时间与DAP有较好的相关性,r=0.999,P<0.01;透视导致的DAP在ERCP中占96%;胆管支架置入术的透视时间比胆总管取石术略长,相应地,胆管支架置入术的DAP略高于胆总管结石取石术。由于手术操作的复杂性和操作者的熟练程度的不同,导致患者的DAP差别较大。
文摘Information about the peak skin dose and Dose Area product (DAP) from percutaneous transluminal coronary angioplasty (PTCA) and coronary angiography (CA) was collected from three catheter application rooms. The range of maximum photon energy was 50 - 125 kVp and the fluoroscopy time was 0.6 - 52 seconds. Values of up to 143 Gy·cm2 for DAP and 0.752 mGy for cumulative dose (CD) were found in CA procedures. Otherwise the DAP and CD for PTCA were found to be 143 Gy·cm2 and 2.287 mGy respectively in 3rd Quartile. The relation between the fluoroscopy time and the DAP is also considered. Objectives: The objective of this study is to obtain information about patient peak skin doses (PSD), dose area product (DAP), Fluoroscopy Time (FT) and Cumulative Dose (CD) from PTCA and CA which is the most predominant with respect to high skin doses in addition to other procedures. The aim of this study is also to assess the radiation dose received by patients undergoing interventional radiology procedures, by identifying the procedures that deliver the highest doses. This study is also helpful to establish the reference dose level for adult patients undergoing interventional procedure, and to provide recommendations on how to reduce dose on selected procedures that have been identified to deliver patient dose values near the ICRP (International Commission on Radiological Protection) threshold values.
文摘Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable(ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 m Sv and in some cases > 50 m Sv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, nonfluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zerofluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for the operators in the non-fluoroscopic manipulatio
文摘Purpose: Increasing physician awareness of patient exposure to radiation is an important step towards the reduction of potentially harmful effects of radiation. Published studies demonstrated that providing physicians with feedback regarding their fluoroscopy time leads to a reduction in average fluoroscopy times. The aim of this work was to analyze and publish our medical center data observed during the past year;fluoroscopy time (FT), Dose Area Product (DAP) and cumulative dose (CD) were monitored for radiation protection purposes. Methods: Fluoroscopy time is one of multiple radiation dose indices used in radiation safety auditing. Such auditing is nowadays turning into requirement of patient care safety and quality improvement;as indicated by accreditation bodies both nationally and internationally. All non-cardiac procedures performed outside radiology department by surgeons and interventionists are viewed. FT, DAP and CD are extracted for analysis. Results: a total of 846 cases were studied (643 orthopedic, 99 others, 73 urology, 17 chest, 7 vascular and 4 ERCP cases). Mean FT was 1.3 minutes, mean CD to the patient was 12.98 mGy and the mean DAP was 4.53 Gy/cm2. The longest FT noted was 55 min. The maximum CD was 904 mGy and the maximum DAP was 689 Gy/cm2. Using spearman’s correlation test we found out that there is a significant correlation between FT and DAP (correlation coefficient = 0.615, p. value 0.001). There is a significant correlation between FT and CD (correlation coefficient = 0.628, p. value 0.001). Conclusion: Information about FT that used in each procedure can be used as a tool for patient dose optimization. As we found a significant correlation between DAP as well as CD. Reducing fluoroscopic time (FT) is a radiation protection goal, since it serves the purpose of protection for both the patient and the workers.
文摘Objective:To assess the radiation exposure in cardiovascular implantable electronic device(CIED)implantation procedures,the effect of fluoroscopy frame rate on various radiation exposure indices,and in-hospital outcomes.Methods:Data of CIED implantation procedures from September 2015 to December 2019 of all the CIED implantation procedures performed at our institute were retrospectively analyzed.The procedural data were divided into two groups:a)pre-group:procedures that were performed under fluoroscopy frame rate of 7.5 frames per second(fps);b)post-group:procedures that were performed under fluoroscopy frame rate of 3.75 fps.We compared procedure time,fluoroscopy time,Kerma air product,effective dose,and in-hospital outcomes between the two groups.Results:A total of 2,225 procedures were included in the analysis with mean age of(62±15)years.The procedures consisted of the implantation of single-chamber(n=1,436),double chamber(n=656),and biventricular devices(n=133).Procedure time and radiation indices showed a significant reduction over the study period(P<0.001).Reduction in the fluoroscopy frame rate was associated with a significant reduction in radiation exposure indices(P<0.001).In-hospital outcomes did not differ between the two groups.Conclusions:Reduction in the fluoroscopy frame rate from 7.5 to 3.75 fps significantly decreased the radiation exposure in CIED implantation procedures.A framerate lower than 3.75 fps should be the default setting during such procedures.
文摘目的探讨EnSite NavX标测指导下房室结折返性心动过速(AVNRT)射频消融术的可行性和安全性。方法 124例阵发性室上性心动过速的患者接受射频消融术被随机分为采用EnSite NavX系统标测指导组和常规透视组(X线)。结果 65例为AVNRT,其中标测指导组32例,常规透视组33例。所有手术均获得即刻的成功,无手术并发症。与常规透视组比较,标测指导组手术时间长(64.6±12.7 min vs 37.5±13.6 min,P<0.01);而X线透视时间少(27.62±31.5 s vs 324.2±108.3 s,P<0.01),其中有21例(65.6%)未接受X线透视。平均随访6个月均无心动过速复发。结论 EnSite NavX标测指导下AVNRT射频消融安全有效,且显著减少了X线透视时间。
