WorldWideScience

Sample records for special fluoroscopy procedures

  1. Dose evaluation in special fluoroscopy procedures: Hysterosalpingography and Dacryocystography

    International Nuclear Information System (INIS)

    Lopes, Cintya Carolina Barbosa

    2006-04-01

    The hysterosalpingography (HSG) and dacryocystography (DCG) are among the special fluoroscopy procedures. The HSG is a radiodiagnostic technique used to detect uterine and tubal pathologies and it is fundamental for the investigation of infertility. The DCG is a form of lacrimal system imaging, being important to show the level of obstruction, the presence of dilatation of the lacrimal sac, as well as alterations in nearby structures. At this research, the study of skin entrance dose was evaluated for these two special fluoroscopy procedures, besides the analyses of staff doses whose performs the exams. The exams of 22 HSG patients and 8 DCG patients were evaluated using TL-100 dosimeters attached on patient' skin at anatomical landmarks evolved on each exam. In the case of HSG, the results showed that skin entrance doses varied from 0.5 mGy to 73.4 mGy, with an average value of 22.1 mGy. The estimated uterus dose was 5.5 mGy, and 6.6 mGy was the average dose estimated to the ovaries. The patient' skin entrance dose undergoing to DCG examinations varied from 2.1 mGy to 10.6 mGy, and the average eye's dose was 6.1 mGy. The results of staff dose showed that, on HSG, the average dose on doctor's right hand was 4.3 mGy per examination. This value had to the fact that the physician introduces the contrast manually while all contrast exposures. In relation of DCG, the staff's dose values were nearby background radiation, evidencing that, inside of permitted limits, there is no risk for the physicians at this procedure. (author)

  2. Dosimetric study in fluoroscopy procedures realized on Recife, PE, Brazil

    International Nuclear Information System (INIS)

    Maia, Ana Figueiredo

    2001-08-01

    Fluoroscopy is a special radiological examination that uses radiation to visualize the image directly in a TV monitor. Due to of the large exposure times, these procedures often give high doses to the patient, usually higher than those from conventional radiology. Since there are not international diagnostic references levels for fluoroscopy procedures, this research had the objective of making the first study of the fluoroscopy procedures in the Northeast Region of Brazil, providing, therefore, data for the implementation of diagnostic reference levels. Three institutions were evaluated in Recife, two of them teaching hospitals. The quantities measured were the air kerma-area-product, the screening time and the number of radiographs taken in each exam. The results show that the value of the air kerma-area-product varied among the institutions and the results in the institution which uses the last generation equipment were better than those obtained in the other institutions. A relevant fact, and also alarming, is that the population in the institutions that showed the worse results are children. The results obtained in these institutions are higher than those observed in other countries. The results of this research show that there is a need for optimization in those procedures, specially the ones that involve older equipment. It is also points to the continuity of this study to gather more information to define the fluoroscopy reference levels in the country. (author)

  3. Dose evaluation in special fluoroscopy procedures: Hysterosalpingography and Dacryocystography; Avaliacao de dose em procedimentos especiais de fluoroscopia: histerossalpingografia e dacriocistografia

    Energy Technology Data Exchange (ETDEWEB)

    Lopes, Cintya Carolina Barbosa

    2006-04-15

    The hysterosalpingography (HSG) and dacryocystography (DCG) are among the special fluoroscopy procedures. The HSG is a radiodiagnostic technique used to detect uterine and tubal pathologies and it is fundamental for the investigation of infertility. The DCG is a form of lacrimal system imaging, being important to show the level of obstruction, the presence of dilatation of the lacrimal sac, as well as alterations in nearby structures. At this research, the study of skin entrance dose was evaluated for these two special fluoroscopy procedures, besides the analyses of staff doses whose performs the exams. The exams of 22 HSG patients and 8 DCG patients were evaluated using TL-100 dosimeters attached on patient' skin at anatomical landmarks evolved on each exam. In the case of HSG, the results showed that skin entrance doses varied from 0.5 mGy to 73.4 mGy, with an average value of 22.1 mGy. The estimated uterus dose was 5.5 mGy, and 6.6 mGy was the average dose estimated to the ovaries. The patient' skin entrance dose undergoing to DCG examinations varied from 2.1 mGy to 10.6 mGy, and the average eye's dose was 6.1 mGy. The results of staff dose showed that, on HSG, the average dose on doctor's right hand was 4.3 mGy per examination. This value had to the fact that the physician introduces the contrast manually while all contrast exposures. In relation of DCG, the staff's dose values were nearby background radiation, evidencing that, inside of permitted limits, there is no risk for the physicians at this procedure. (author)

  4. Critical analysis of dose reduction trends with special reference to procedures involved in fluoroscopy

    International Nuclear Information System (INIS)

    Anderson, K.; Mattsson, O.

    1985-01-01

    Experiences of a half-year's use of dose-checking instrumentation in fluoroscopy are presented. Radiologists under training succeeded in lowering the patient dose surprisingly well - the diagnostic results remaining unchanged or even improving, because of higher image quality as a result of better diaphragming. Other factors involved in fluoroscopy are discussed. Present systems with heavy bulky intensifiers create problems for close patient contact and for the necessary manipulation, patient adjustment and application of compression. The examination will be simplified and facilitated by the use of a flat image system: proper adjustments need fewer fluoroscopic observations, and patient dose as well as examination time can be saved. Flat display principles will take over the function of the present old-fashioned intensifiers and monitors, either as single units or equipped with TV, video or digital processing accessories. A flat image system, the 'PET-scope', was tested and found to be very convenient for fluoroscopic procedures. The physical properties were studied thoroughly - the high intensification particularly gives these systems an advantage in dose reduction. New applications are possible with these light-weight low-dose units. Fluoroscopy represents a field where considerable contributions to the 'Quality Assurance' trend can be obtained. (author)

  5. Dose evaluation in special fluoroscopy procedures: Hysterosalpingography and Dacryocystography; Avaliacao de dose em procedimentos especiais de fluoroscopia: histerossalpingografia e dacriocistografia

    Energy Technology Data Exchange (ETDEWEB)

    Lopes, Cintya Carolina Barbosa

    2006-04-15

    The hysterosalpingography (HSG) and dacryocystography (DCG) are among the special fluoroscopy procedures. The HSG is a radiodiagnostic technique used to detect uterine and tubal pathologies and it is fundamental for the investigation of infertility. The DCG is a form of lacrimal system imaging, being important to show the level of obstruction, the presence of dilatation of the lacrimal sac, as well as alterations in nearby structures. At this research, the study of skin entrance dose was evaluated for these two special fluoroscopy procedures, besides the analyses of staff doses whose performs the exams. The exams of 22 HSG patients and 8 DCG patients were evaluated using TL-100 dosimeters attached on patient' skin at anatomical landmarks evolved on each exam. In the case of HSG, the results showed that skin entrance doses varied from 0.5 mGy to 73.4 mGy, with an average value of 22.1 mGy. The estimated uterus dose was 5.5 mGy, and 6.6 mGy was the average dose estimated to the ovaries. The patient' skin entrance dose undergoing to DCG examinations varied from 2.1 mGy to 10.6 mGy, and the average eye's dose was 6.1 mGy. The results of staff dose showed that, on HSG, the average dose on doctor's right hand was 4.3 mGy per examination. This value had to the fact that the physician introduces the contrast manually while all contrast exposures. In relation of DCG, the staff's dose values were nearby background radiation, evidencing that, inside of permitted limits, there is no risk for the physicians at this procedure. (author)

  6. Dosimetric study in fluoroscopy procedures realized on Recife, PE, Brazil; Estudo dosimetrico em procedimentos de fluoroscopia realizados no Recife

    Energy Technology Data Exchange (ETDEWEB)

    Maia, Ana Figueiredo

    2001-08-01

    Fluoroscopy is a special radiological examination that uses radiation to visualize the image directly in a TV monitor. Due to of the large exposure times, these procedures often give high doses to the patient, usually higher than those from conventional radiology. Since there are not international diagnostic references levels for fluoroscopy procedures, this research had the objective of making the first study of the fluoroscopy procedures in the Northeast Region of Brazil, providing, therefore, data for the implementation of diagnostic reference levels. Three institutions were evaluated in Recife, two of them teaching hospitals. The quantities measured were the air kerma-area-product, the screening time and the number of radiographs taken in each exam. The results show that the value of the air kerma-area-product varied among the institutions and the results in the institution which uses the last generation equipment were better than those obtained in the other institutions. A relevant fact, and also alarming, is that the population in the institutions that showed the worse results are children. The results obtained in these institutions are higher than those observed in other countries. The results of this research show that there is a need for optimization in those procedures, specially the ones that involve older equipment. It is also points to the continuity of this study to gather more information to define the fluoroscopy reference levels in the country. (author)

  7. Rapid fusion of 2D X-ray fluoroscopy with 3D multislice CT for image-guided electrophysiology procedures

    Science.gov (United States)

    Zagorchev, Lyubomir; Manzke, Robert; Cury, Ricardo; Reddy, Vivek Y.; Chan, Raymond C.

    2007-03-01

    Interventional cardiac electrophysiology (EP) procedures are typically performed under X-ray fluoroscopy for visualizing catheters and EP devices relative to other highly-attenuating structures such as the thoracic spine and ribs. These projections do not however contain information about soft-tissue anatomy and there is a recognized need for fusion of conventional fluoroscopy with pre-operatively acquired cardiac multislice computed tomography (MSCT) volumes. Rapid 2D-3D integration in this application would allow for real-time visualization of all catheters present within the thorax in relation to the cardiovascular anatomy visible in MSCT. We present a method for rapid fusion of 2D X-ray fluoroscopy with 3DMSCT that can facilitate EP mapping and interventional procedures by reducing the need for intra-operative contrast injections to visualize heart chambers and specialized systems to track catheters within the cardiovascular anatomy. We use hardware-accelerated ray-casting to compute digitally reconstructed radiographs (DRRs) from the MSCT volume and iteratively optimize the rigid-body pose of the volumetric data to maximize the similarity between the MSCT-derived DRR and the intra-operative X-ray projection data.

  8. Navigation for fluoroscopy-guided cryo-balloon ablation procedures of atrial fibrillation

    Science.gov (United States)

    Bourier, Felix; Brost, Alexander; Kleinoeder, Andreas; Kurzendorfer, Tanja; Koch, Martin; Kiraly, Attila; Schneider, Hans-Juergen; Hornegger, Joachim; Strobel, Norbert; Kurzidim, Klaus

    2012-02-01

    Atrial fibrillation (AFib), the most common arrhythmia, has been identified as a major cause of stroke. The current standard in interventional treatment of AFib is the pulmonary vein isolation (PVI). PVI is guided by fluoroscopy or non-fluoroscopic electro-anatomic mapping systems (EAMS). Either classic point-to-point radio-frequency (RF)- catheter ablation or so-called single-shot-devices like cryo-balloons are used to achieve electrically isolation of the pulmonary veins and the left atrium (LA). Fluoroscopy-based systems render overlay images from pre-operative 3-D data sets which are then merged with fluoroscopic imaging, thereby adding detailed 3-D information to conventional fluoroscopy. EAMS provide tracking and visualization of RF catheters by means of electro-magnetic tracking. Unfortunately, current navigation systems, fluoroscopy-based or EAMS, do not provide tools to localize and visualize single shot devices like cryo-balloon catheters in 3-D. We present a prototype software for fluoroscopy-guided ablation procedures that is capable of superimposing 3-D datasets as well as reconstructing cyro-balloon catheters in 3-D. The 3-D cyro-balloon reconstruction was evaluated on 9 clinical data sets, yielded a reprojected 2-D error of 1.72 mm +/- 1.02 mm.

  9. Sensitivity of the diagnostic radiological index of protection to procedural factors in fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Jones, A. Kyle, E-mail: kyle.jones@mdanderson.org [Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States); Pasciak, Alexander S. [Department of Radiology, The University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee 37922 (United States); Wagner, Louis K. [Department of Diagnostic and Interventional Imaging, The John P. and Katharine G. McGovern Medical School, Houston, Texas 77030 (United States)

    2016-07-15

    Purpose: To evaluate the sensitivity of the diagnostic radiological index of protection (DRIP), used to quantify the protective value of radioprotective garments, to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams to be used in measuring the DRIP. Methods: Monte Carlo simulations were performed to determine the shape of the scattered x-ray spectra incident on the operator in different clinical fluoroscopy scenarios, including interventional radiology and interventional cardiology (IC). Two clinical simulations studied the sensitivity of the scattered spectrum to gantry angle and patient size, while technical factors were varied according to measured automatic dose rate control (ADRC) data. Factorial simulations studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size, and beam quality for constant technical factors. Average energy (E{sub avg}) was the figure of merit used to condense fluence in each energy bin to a single numerical index. Results: Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affect the scattered spectrum indirectly through their effect on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in IC, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effect of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. Conclusions: The scattered spectrum striking the operator in fluoroscopy is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle.

  10. Survey of effective doses to patients undergoing contrast-based X-ray fluoroscopy procedures in Tanzania

    International Nuclear Information System (INIS)

    Ngaile, J.E.; Msaki, P.K.; Kazema, R.R.

    2017-01-01

    The aim of this study was to assess the radiation burden imparted to patients from contrast-based X-ray fluoroscopy procedures in Tanzania. The effective doses (EDs) to patients from five contrast-based fluoroscopy procedures were obtained from four hospitals. The ED was estimated using the knowledge of the patient characteristics, patient-related exposure parameters, measurements of air kerma area product and PCXCM software. The median EDs for the barium swallow (BS), barium meal (BM), barium enema (BE), hysterosalpingography (HSG) and retrograde urethrography (RUG) were 0.50, 1.43, 2.83, 0.65 and 0.59 mSv, respectively. The median ED per hospital for the BS and BM procedures varied by factors of up to 9.9 and 4.2, respectively, while for the BE, HSG and RUG varied by factors of up to 2.3, 2.4 and 4.3, respectively. The overall differences between individual EDs across the four hospitals varied by factors of up to 53, 58.9 and 11.4 for the BS, BM and BE, respectively, while for the HSG and RUG differed by factors of up to 22 and 46.7, respectively. The mean EDs in this study were mostly lower than reported values from Spain, the UK, Ghana and Greece, while slightly higher than those reported from India. The observed wide variations of procedural protocols and patient doses within and across the hospitals; and the observed high patient doses in this study relative to those from the literature call for the need to standardize procedural protocols and optimize contrast-based fluoroscopy procedures. (authors)

  11. Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times.

    Science.gov (United States)

    Stenhammar, L; Wärngård, O; Lewander, P; Nordvall, M

    1993-01-01

    Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.

  12. Evaluation of Kerma rate in the skin entrance in interventional procedures guided by fluoroscopy

    International Nuclear Information System (INIS)

    Medeiros, Regina Bitelli; Alves, Fatima Faloppa Rodrigues; Ruberti Filha, Eny M.

    2005-01-01

    Interventional therapeutic procedures guided by fluoroscopy are responsible for delayed exposure to radiation of professionals and patients. The technology employed on generation of the pulsed fluoroscopy can be an important tool of protection used for reducing the exposure time. It generates constant width and varied frequency pulse or width pulse or varied frequency for a constant frequency. The typical doses into the skin and its relationship with the quality of the images in the various technical and operational conditions should be known by the professionals so that they can optimize them. Generated radiation doses were evaluated using the Toshiba Infinitix equipment used in invasive cardiology procedures and electrophysiological studies through the Kerma rate at the entrance of the patient's skin measured throughout the year of 2004. With these information shall be set out the criteria for the decision of the technical-operational conditions that allow minimizing of dose

  13. SU-F-I-77: Radiation Dose in Cardiac Catheterization Procedures: Impact of a Systematic Reduction in Pulsed Fluoroscopy Frame Rate

    Energy Technology Data Exchange (ETDEWEB)

    Schultz, C; Dixon, S [Beaumont Hospital, Royal Oak, MI (United States)

    2016-06-15

    Purpose: To evaluate whether one small systematic reduction in fluoroscopy frame rate has a significant effect on the total air kerma and/or dose area product for diagnostic and interventional cardiac catheterization procedures. Methods: The default fluoroscopy frame rate (FFR) was lowered from 15 to 10 fps in 5 Siemens™ Axiom Artis cardiac catheterization labs (CCL) on July 1, 2013. A total of 7212 consecutive diagnostic and interventional CCL procedures were divided into two study groups: 3602 procedures from 10/1/12 –6/30/13 with FFR of 15 fps; and 3610 procedures 7/1/13 – 3/31/14 at 10 fps. For each procedure, total air kerma (TAK), fluoroscopy skin dose (FSD), total/fluoroscopy dose area products (TAD, FAD), and total fluoroscopy time (FT) were recorded. Patient specific data collected for each procedure included: BSA, sex, height, weight, interventional versus diagnostic; and elective versus emergent. Results: For pre to post change in FFR, each categorical variable was compared using Pearson’s Chi-square test, Odds ratios and 95% confidence intervals. No statistically significant difference in BSA, height, weight, number of interventional versus diagnostic, elective versus emergent procedures was found between the two study groups. Decreasing the default FFR from 15 fps to 10 fps in the two study groups significantly reduced TAK from 1305 to 1061 mGy (p<0.0001), FSD from 627 to 454 mGy (p<0.0001), TAD from 8681 to 6991 uGy × m{sup 2}(p<0.0001), and FAD from 4493 to 3297 uGy × m{sup 2}(p<0.0001). No statistically significant difference in FT was noted. Clinical image quality was not analyzed, and reports of noticeable effects were minimal. From July 1, 2013 to date, the default FFR has remained 10 fps. Conclusion: Reducing the FFR from 15 to 10 fps significantly reduced total air kerma and dose area product which may decrease risk for potential radiation-induced skin injuries and improve patient outcomes.

  14. SU-D-209-05: Sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to Procedural Factors in Fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Jones, A [UT MD Anderson Cancer Center, Houston, TX (United States); Pasciak, A [University of Tennessee Medical Center, Knoxville, TN (United States); Wagner, L [UT Medical School, Houston, TX (United States)

    2016-06-15

    Purpose: To evaluate the sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams (SMPB) to be used in measuring the DRIP. Methods: A series of clinical and factorial Monte Carlo simulations were conducted to determine the shape of the scattered X-ray spectra incident on the operator in different clinical fluoroscopy scenarios. Two clinical evaluations studied the sensitivity of the scattered spectrum to gantry angle and patient size while technical factors were varied according to measured automatic dose rate control (ADRC) data. Factorial evaluations studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size and beam quality for constant technical factors. Average energy was the figure of merit used to condense fluence in each energy bin to a single numerical index. Results: Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affected the scattered spectrum indirectly through their effects on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in interventional cardiology, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effect of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. Conclusion: The scattered spectrum striking the operator in fluoroscopy, and therefore the DRIP, is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle. These results will help determine an appropriate set of SMPB to be used for measuring the DRIP.

  15. Percutaneous vertebroplasty with the rotational fluoroscopy imaging technique

    Energy Technology Data Exchange (ETDEWEB)

    Cannavale, Alessandro; Salvatori, Filippo Maria; Wlderk, Andrea; Cirelli, Carlo; D' Adamo, Alessandro; Fanelli, Fabrizio [University of Rome, Vascular and Interventional Unit, Department of Radiological Sciences, Rome (Italy)

    2014-11-15

    To evaluate the feasibility of the rotational angiography unit (RAU) as a single technique to guide percutaneous vertebroplasty (PVP). Twenty-five consecutive patients (35 vertebral bodies, 20 lumbar and 15 thoracic) were treated using RA fluoroscopy. Using a state-of-the-art flat-panel angiographer (Artis zee, Siemens, Erlangen, Germany), rotational acquisitions were obtained in all patients for immediate post-procedure 2D/3D reconstructions. Pre- and postoperative back pain was assessed with the visual analog scale (VAS). Fluoroscopy time, patient radiation dose exposure, technical success, mean procedure time, mean number of rotational acquisitions and procedural complications were recorded. All features were compared with a historical cohort of patients (N = 25) who underwent PVP under CT and mobile C-arm fluoroscopy guidance. In all cases, safe and accurate control of the needle insertion and bone-cement injection was successfully obtained with high-quality fluoroscopy images. One cement leakage was detected in the RAU group, and two leakages were detected in the CT and C-arm fluoroscopy group. Technical features were significantly different between the two groups (RAU vs. CT): mean procedure time: 38.2 min vs. 60.2 min (p = 0.02); median fluoroscopy time: 14.58 and 4.58 min (p = 0.02); median number of rotational acquisitions: 5 vs. 10 (p = 0.02); mean patient dose: 6 ± 1.3 mSv vs. 23 ± 1.3 mSv (p = 0.02). There were minor complications (pain, small hematoma) in two patients (8%) in the study group and three cases (12%) in the control group. RAU guidance is an effective and safe technique for performing PVP because it reduces the procedural time and radiation exposure. (orig.)

  16. Monte Carlo based estimation of organ and effective doses to patients undergoing hysterosalpingography and retrograde urethrography fluoroscopy procedures

    Science.gov (United States)

    Ngaile, J. E.; Msaki, P. K.; Kazema, R. R.

    2018-04-01

    Contrast investigations of hysterosalpingography (HSG) and retrograde urethrography (RUG) fluoroscopy procedures remain the dominant diagnostic tools for the investigation of infertility in females and urethral strictures in males, respectively, owing to the scarcity and high cost of services of alternative diagnostic technologies. In light of the radiological risks associated with contrast based investigations of the genitourinary tract systems, there is a need to assess the magnitude of radiation burden imparted to patients undergoing HSG and RUG fluoroscopy procedures in Tanzania. The air kerma area product (KAP), fluoroscopy time, number of images, organ dose and effective dose to patients undergoing HSG and RUG procedures were obtained from four hospitals. The KAP was measured using a flat transmission ionization chamber, while the organ and effective doses were estimated using the knowledge of the patient characteristics, patient related exposure parameters, geometry of examination, KAP and Monte Carlo calculations (PCXMC). The median values of KAP for the HSG and RUG were 2.2 Gy cm2 and 3.3 Gy cm2, respectively. The median organ doses in the present study for the ovaries, urinary bladder and uterus for the HSG procedures, were 1.0 mGy, 4.0 mGy and 1.6 mGy, respectively, while for urinary bladder and testes of the RUG were 3.4 mGy and 5.9 mGy, respectively. The median values of effective doses for the HSG and RUG procedures were 0.65 mSv and 0.59 mSv, respectively. The median values of effective dose per hospital for the HSG and RUG procedures had a range of 1.6-2.8 mSv and 1.9-5.6 mSv, respectively, while the overall differences between individual effective doses across the four hospitals varied by factors of up to 22.0 and 46.7, respectively for the HSG and RUG procedures. The proposed diagnostic reference levels (DRLs) for the HSG and RUG were for KAP 2.8 Gy cm2 and 3.9 Gy cm2, for fluoroscopy time 0.8 min and 0.9 min, and for number of images 5 and 4

  17. Ablation of an atriofascicular accessory pathway with a zero-fluoroscopy procedure

    Directory of Open Access Journals (Sweden)

    Riccardo Proietti, MD, PhD

    2015-10-01

    Full Text Available A 16-year-old patient with recurrent palpitations and documented left bundle branch block superior axis wide complex tachycardia underwent an electrophysiological study and ablation with a zero-fluoroscopy procedure. The electrophysiological study showed a decremental antegrade conducting atriofascicular pathway. Three-dimensional CARTO-guided mapping of the tricuspid annulus in sinus rhythm was performed, and a distinct signal corresponding to the accessory pathway potential of the atriofascicular pathway was found in the posterolateral region. By using an SR0 sheath and a 4-mm-tip catheter, radiofrequency application was delivered at this point on the annulus and successfully eliminated conduction through the accessory pathway.

  18. Comparison of pulsed fluoroscopy by direct control using a grid-controlled x-ray tube with pulsed fluoroscopy by primary control

    International Nuclear Information System (INIS)

    Chida, Koichi; Zuguchi, Masayuki; Ito, Daisuke; Sato, Kunihiko; Shimura, Hirotaka; Sasaki, Masatoshi

    2001-01-01

    Interventional radiology (IVR) procedures may involve high radiation doses that are potentially harmful to the patient. In IVR procedures, pulsed fluoroscopy can greatly decrease the radiation that the physician and patient receive. There are two types of pulsed fluoroscopy: direct control and primary (indirect) control. The purpose of this study was to compare pulsed fluoroscopy by direct control, using a grid-controlled x-ray tube, with pulsed fluoroscopy using primary control. For both types of pulsed fluoroscopy, we measured the waveforms (x-ray tube voltage, x-ray tube current, and x-ray output) and the relative radiation dose. In addition, we compared the decrease in radiation during pulsed fluoroscopy using a care filter. The studies were performed using a Siemens Bicor Plus x-ray System (direct control) and a Siemens Multistar Plus x-ray System (primary control). Using primary pulse control, a 50% decrease in the x-ray output waveform took approximately 0.5-1.0 msec, or longer with a lower x-ray tube current. Using direct pulse control, a 50% decrease in the x-ray output waveform took approximately 0.1 msec, and was independent of x-ray tube current. The rate of radiation reduction with primary pulse control using the care filter with a lower x-ray tube current had a slope exceeding 10%. Pulsed fluoroscopy by direct control using a grid-controlled x-ray tube permits an optimal radiation dose. To decrease the radiation in primary pulse control, a care filter must be used, particularly with a lower x-ray tube current. (author)

  19. Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures

    International Nuclear Information System (INIS)

    Sommer, C.M.; Huber, J.; Radeleff, B.A.; Hosch, W.; Stampfl, U.; Loenard, B.M.; Hallscheidt, P.; Haferkamp, A.; Kauczor, H.U.; Richter, G.M.

    2011-01-01

    Aim: To report our experience of combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures. Patients and methods: Eighteen patients (23 kidneys) with non-obstructive uropathy due to urine leaks underwent combined CT- and fluoroscopy-guided nephrostomy. All procedures were indicated as second-line interventions after failed ultrasound-guided nephrostomy. Thirteen males and five females with an age of 62.3 ± 8.7 (40–84) years were treated. Urine leaks developed in majority after open surgery, e.g. postoperative insufficiency of ureteroneocystostomy (5 kidneys). The main reasons for failed ultrasound-guided nephrostomy included anatomic obstacles in the puncture tract (7 kidneys), and inability to identify pelvic structures (7 kidneys). CT-guided guidewire placement into the collecting system was followed by fluoroscopy-guided nephrostomy tube positioning. Procedural success rate, major and minor complication rates, CT-views and needle passes, duration of the procedure and radiation dose were analyzed. Results: Procedural success was 91%. Major and minor complication rates were 9% (one septic shock and one perirenal abscess) and 9% (one perirenal haematoma and one urinoma), respectively. 30-day mortality rate was 6%. Number of CT-views and needle passes were 9.3 ± 6.1 and 3.6 ± 2.6, respectively. Duration of the complete procedure was 87 ± 32 min. Dose-length product and dose-area product were 1.8 ± 1.4 Gy cm and 3.9 ± 4.3 Gy cm 2 , respectively. Conclusions: Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures was feasible with high technical success and a tolerable complication rate.

  20. Reduced medical and occupational exposures by optimizing working procedures in fluoroscopy equipment in the University Hospital of Santa Maria (RS)

    International Nuclear Information System (INIS)

    Weis, Guilherme L.; Claus, Thiago V.; Baumhardt, Tadeu; Shuch, Luiz A.

    2013-01-01

    This work seeks to reduce medical (patient) and occupational (workers) exposure by standardizing resources available in fluoroscopy equipment used in interventional procedures. Such procedures use transportable surgical arch type fluoroscopy equipment, with applications in orthopedics, angiography and pacemaker implantation. Improper use of these devices generates excessive radiation doses in both patients and the medical staff. It is observed that the equipment after being connected to the grid, is pre-selected to work in continuous fluoroscopy and no additional filtration, producing higher doses of radiation. For specific applications, changes in protocols should be undertaken according to medical indication. This work used a fluoroscopy equipment Shimadzu Active Opescope two radiation monitoring equipment, brand Radcal, models 9010 and 9015, two ionization chambers, of 60 cc and 180 cc and a low contrast phantom and a catheter, information that simulate the human body. Incidences were performed by changing the conditions of exposure as frame rates (fps - frames per second) and additional filtration. For each composition parameters was generated and filed an image, with the extent of their respective doses. These images were evaluated by radiologists. In more extreme cases we obtained a reduction of a factor 25 in occupational exposure (medical personnel) using the pulsed with the greatest 2 fps additional filter (0.3 mm Cu) compared to continuous system without any additional filtration. In medical exposure (of patients), decreased by a factor 39, the same conditions described above. With these arguments it is justified the optimization and standardization of the equipment used in fluoroscopy, which besides providing a dose reduction the patient and the medical personnel, increases the life of the X-ray tube while maintaining the quality of medical diagnosis. (author)

  1. Feasibility Study of Needle Placement in Percutaneous Vertebroplasty: Cone-Beam Computed Tomography Guidance Versus Conventional Fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Braak, Sicco J., E-mail: sjbraak@gmail.com [St. Antonius Hospital, Department of Radiology (Netherlands); Zuurmond, Kirsten, E-mail: kirsten.zuurmond@philips.com; Aerts, Hans C. J., E-mail: hans.cj.aerts@philips.com [Philips Medical, Department of Clinical Development (Netherlands); Leersum, Marc van, E-mail: m.van.leersum@antoniusziekenhuis.nl; Overtoom, Timotheus T. Th., E-mail: overtm@knoware.nl; Heesewijk, Johannes P. M. van, E-mail: j.heesewijk@antoniusziekenhuis.nl; Strijen, Marco J. L. van, E-mail: m.van.strijen@antoniusziekenhuis.nl [St. Antonius Hospital, Department of Radiology (Netherlands)

    2013-08-01

    ObjectiveTo investigate the accuracy, procedure time, fluoroscopy time, and dose area product (DAP) of needle placement during percutaneous vertebroplasty (PVP) using cone-beam computed tomography (CBCT) guidance versus fluoroscopy.Materials and MethodsOn 4 spine phantoms with 11 vertebrae (Th7-L5), 4 interventional radiologists (2 experienced with CBCT guidance and two inexperienced) punctured all vertebrae in a bipedicular fashion. Each side was randomization to either CBCT guidance or fluoroscopy. CBCT guidance is a sophisticated needle guidance technique using CBCT, navigation software, and real-time fluoroscopy. The placement of the needle had to be to a specific target point. After the procedure, CBCT was performed to determine the accuracy, procedure time, fluoroscopy time, and DAP. Analysis of the difference between methods and experience level was performed.ResultsMean accuracy using CBCT guidance (2.61 mm) was significantly better compared with fluoroscopy (5.86 mm) (p < 0.0001). Procedure time was in favor of fluoroscopy (7.39 vs. 10.13 min; p = 0.001). Fluoroscopy time during CBCT guidance was lower, but this difference is not significant (71.3 vs. 95.8 s; p = 0.056). DAP values for CBCT guidance and fluoroscopy were 514 and 174 mGy cm{sup 2}, respectively (p < 0.0001). There was a significant difference in favor of experienced CBCT guidance users regarding accuracy for both methods, procedure time of CBCT guidance, and added DAP values for fluoroscopy.ConclusionCBCT guidance allows users to perform PVP more accurately at the cost of higher patient dose and longer procedure time. Because procedural complications (e.g., cement leakage) are related to the accuracy of the needle placement, improvements in accuracy are clinically relevant. Training in CBCT guidance is essential to achieve greater accuracy and decrease procedure time/dose values.

  2. Reference Dose Rates for Fluoroscopy Guided Interventions

    International Nuclear Information System (INIS)

    Geleijns, J.; Broerse, J.J.; Hummel, W.A.; Schalij, M.J.; Schultze Kool, L.J.; Teeuwisse, W.; Zoetelief, J.

    1998-01-01

    The wide diversity of fluoroscopy guided interventions which have become available in recent years has improved patient care. They are being performed in increasing numbers, particularly at departments of cardiology and radiology. Some procedures are very complex and require extended fluoroscopy times, i.e. longer than 30 min, and radiation exposure of patient and medical staff is in some cases rather high. The occurrence of radiation-induced skin injuries on patients has shown that radiation protection for fluoroscopy guided interventions should not only be focused on stochastic effects, i.e. tumour induction and hereditary risks, but also on potential deterministic effects. Reference dose levels are introduced by the Council of the European Communities as an instrument to achieve optimisation of radiation protection in radiology. Reference levels in conventional diagnostic radiology are usually expressed as entrance skin dose or dose-area product. It is not possible to define a standard procedure for complex interventions due to the large inter-patient variations with regard to the complexity of specific interventional procedures. Consequently, it is not realistic to establish a reference skin dose or dose-area product for complex fluoroscopy guided interventions. As an alternative, reference values for fluoroscopy guided interventions can be expressed as the entrance dose rates on a homogeneous phantom and on the image intensifier. A protocol has been developed and applied during a nationwide survey of fluoroscopic dose rate during catheter ablations. From this survey reference entrance dose rates of respectively 30 mGy.min -1 on a polymethylmethacrylate (PMMA) phantom with a thickness of 21 cm, and of 0.8 μGy.s -1 on the image intensifier have been derived. (author)

  3. Comparative study about doses and radiological protection in gastrointestinal fluoroscopy

    International Nuclear Information System (INIS)

    Caneravo, L.V.; Borges, J.C.; Carlos, M.T.; Koch, H.A.

    1996-01-01

    The Radiation Protection and Dosimetry Institute of the National Nuclear Energy Commission (IRD/CNEN) and the Radiodiagnostic Service of the Rio de Janeiro Federal University Hospital, have been engaged in the development of quality control programs applied to radiodiagnostics, one of them concerning gastrointestinal fluoroscopy. Since fluoroscopy examinations normally deal with high doses, they represent an important fraction of public exposure. They deserve special attention and the risks to patients should be considered individually, not only as a population statistics. Another target should be the search for procedures that reduce doses to patients and, therefore, reduce dose to medical staff involved. This work describes steps followed and results obtained in the estimation of doses for patients and physicians. Investigated examinations were esophagography, gastroduodenal seriographic and colon with double contrast media, using conventional equipment with fluorescent screens, carried on by physicians engaged in the first year of medical residence. (authors). 9 refs., 1 fig., 2 tabs

  4. Zero-fluoroscopy permanent pacemaker implantation using Ensite NavX system: Clinical viability or fanciful technique?

    Science.gov (United States)

    Guo, Ping; Qiu, Jie; Wang, Yan; Chen, Guangzhi; Proietti, Riccardo; Fadhle, Al-Selmi; Zhao, Chunxia; Wen Wang, Dao

    2018-02-01

    Fluoroscopy is the imaging modality routinely used for cardiac device implantation and electrophysiological procedures. Due to the rising concern regarding the harmful effects of radiation exposure to both the patients and operation staffs, novel 3D mapping systems have been developed and implemented in electrophysiological procedure for the navigation of catheters inside the heart chambers. Their applicability in cardiac device implantation has been rarely reported. Our aim is to evaluate the feasibility and safety of permanent pacemaker implantation without fluoroscopy. From January 2012 to June 2016, six patients (50 ± 15 years, four of six were female, one of who was at the 25th week of gestation) who underwent permanent pacemaker implantation were included (zero-fluoroscopy group). Data from 20 consecutive cases of implantation performed under fluoroscopy guidance were chosen as a control group (fluoroscopy group). Total implantation procedure time for single-chamber pacemaker was 51.3 ± 13.1 minutes in the zero-fluoroscopy group and 42.6 ± 7.4 minutes in the fluoroscopy group (P  =  0.155). The implantation procedural time for a dual-chamber pacemaker was 88.3 ± 19.6 minutes and 67.3 ± 7.6 minutes in the zero-fluoroscopy and fluoroscopy groups (P  =  0.013), respectively. No complications were observed during the procedure and the follow-up in the two groups, and all pacemakers worked with satisfactory parameters. Ensite NavX system can be used as a reliable and safe zero-fluoroscopy approach for the implantation of single- or dual-chamber permanent pacemakers in specific patients, such as pregnant women or in extreme situations when the x-ray machine is not available. © 2017 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc.

  5. CT and fluoroscopy guided celiac ganglion block

    International Nuclear Information System (INIS)

    Lim, Sun Kyung; Kwon, Dae Ik; Ahn, Hyup; Kim, Jong Il; Kim, Byung Young; Lee, Jong Gil

    1994-01-01

    To evaluate the effects and usefulness of fluoroscopy guided celiac ganglion block after marking of needle path with CT scan. Celiac ganglion block with 100% ethyl alcohol was performed in 50 cancer patients who were inoperable and had intractable abdominal pain. Duration and degree of pain relief after the procedure and its complication were analyzed. Early pain relief was observed in 98% and long term relief in 68% without serious complication. Fluoroscopy guided celiac ganglion block after marking of needle path with CT scan was a safe and valuable procedure in relieving intractable pain in terminal cancer patients and reduced the time in the CT room

  6. Cancer following multiple fluoroscopies

    International Nuclear Information System (INIS)

    Newcombe, H.B.

    1975-08-01

    An epidemiological investigation of persons exposed repeatedly to diagnostic x-rays is proposed. Tuberculosis patients treated in the late 1930's to early 1950's, when artificial pneumothorax was a standard procedure, constitute a suitable large study group; and records of the fluoroscopies of many of these persons still exist. The study is expected to yield needed data on the risks of cancer in irradiated versus unirradiated persons. Computer methods are described by which the fluoroscopy records may be ''linked'' rapidly by machine with the corresponding death registrations, where the patients have died. The proposed computer techniques will make possible the collection of a much larger body of data than could otherwise have been obtained by any of the conventional methods for individual follow-up. (Author)

  7. A simple ergonomic measure reduces fluoroscopy time during ERCP: A multivariate analysis.

    Science.gov (United States)

    Jowhari, Fahd; Hopman, Wilma M; Hookey, Lawrence

    2017-03-01

    Background and study aims  Endoscopic retrograde cholangiopancreatgraphy (ERCP) carries a radiation risk to patients undergoing the procedure and the team performing it. Fluoroscopy time (FT) has been shown to have a linear relationship with radiation exposure during ERCP. Recent modifications to our ERCP suite design were felt to impact fluoroscopy time and ergonomics. This multivariate analysis was therefore undertaken to investigate these effects, and to identify and validate various clinical, procedural and ergonomic factors influencing the total fluoroscopy time during ERCP. This would better assist clinicians with predicting prolonged fluoroscopic durations and to undertake relevant precautions accordingly. Patients and methods  A retrospective analysis of 299 ERCPs performed by 4 endoscopists over an 18-month period, at a single tertiary care center was conducted. All inpatients/outpatients (121 males, 178 females) undergoing ERCP for any clinical indication from January 2012 to June 2013 in the chosen ERCP suite were included in the study. Various predetermined clinical, procedural and ergonomic factors were obtained via chart review. Univariate analyses identified factors to be included in the multivariate regression model with FT as the dependent variable. Results  Bringing the endoscopy and fluoroscopy screens next to each other was associated with a significantly lesser FT than when the screens were separated further (-1.4 min, P  = 0.026). Other significant factors associated with a prolonged FT included having a prior ERCP (+ 1.4 min, P  = 0.031), and more difficult procedures (+ 4.2 min for each level of difficulty, P  < 0.001). ERCPs performed by high-volume endoscopists used lesser FT vs. low-volume endoscopists (-1.82, P = 0.015). Conclusions  Our study has identified and validated various factors that affect the total fluoroscopy time during ERCP. This is the first study to show that decreasing the distance

  8. CT-guided percutaneous lung biopsy: Comparison of conventional CT fluoroscopy to CT fluoroscopy with electromagnetic navigation system in 60 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Grand, David Justin, E-mail: dgrand@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Atalay, Michael A., E-mail: matalay@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Cronan, John J., E-mail: cronan@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Mayo-Smith, William W., E-mail: wmayo-smith@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Dupuy, Damian E., E-mail: ddupuy@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States)

    2011-08-15

    Purpose: To determine if use of an electromagnetic navigation system (EMN) decreases radiation dose and procedure time of CT fluoroscopy guided lung biopsy in lesions smaller than 2.5 cm. Materials/methods: 86 consecutive patients with small lung masses (<2.5 cm) were approached. 60 consented and were randomized to undergo biopsy with CT fluoroscopy (CTF) (34 patients) or EMN (26 patients). Technical failure required conversion to CTF in 8/26 EMN patients; 18 patients completed biopsy with EMN. Numerous biopsy parameters were compared as described below. Results: Average fluoroscopy time using CTF was 28.2 s compared to 35.0 s for EMN (p = 0.1). Average radiation dose was 117 mGy using CTF and 123 mGy for EMN (p = 0.7). Average number of needle repositions was 3.7 for CTF and 4.4 for EMN (p = 0.4). Average procedure time was 15 min for CTF and 20 min for EMN (p = 0.01). There were 7 pneumothoracesin the CTF group and 6 pneumothoraces in the EMN group (p = 0.7). One pneumothorax in the CTF group and 3 pneumothoraces in the EMN group required chest tube placement (p = 0.1). One pneumothorax patient in each group required hospital admission. Diagnostic specimens were obtained in 31/34 patients in the CTF group and 22/26 patients in the EMN group (p = 0.4). Conclusions: EMN was not statistically different than CTF for fluoroscopy time, radiation dose, number of needle repositions, incidence of pneumothorax, need for chest tube, or diagnostic yield. Procedure time was increased with EMN.

  9. Guideline for fluoroscopy of low gastrointestinal tract in pediatrics

    International Nuclear Information System (INIS)

    Chang, Yun Woo; Jeon, Tae Yeon; Kim, Ji Hye; Lee, Mi Jung; Lim, Yun Jung; Yoon, Hye Kyung; Lim, Gye Yeon; Lee, Hee Jung

    2015-01-01

    Although the availability of CT, MRI and endoscopy has resulted in a marked decline in fluoroscopic procedures in adult patients, fluoroscopy remains an important and frequently used procedure in pediatric patients because there is no appropriate choice of diagnostic imaging or treatment modality for certain diseases. The Korean Society of Pediatric Radiology has formulated evidence-based guidelines for fluoroscopy of the lower intestinal tract in the pediatric population (under age 18 including neonates) in order to assist physicians in clinical practice. The guidelines offer standards of examination practice including radiation doses that are as low as reasonably achievable for children under 18 years old, including neonates, for fluoroscopy of the lower intestinal tract, which has typically used relatively high doses. The recommendations of these guidelines should not be used as an absolute standard, and physicians should always refer to methods that do not adhere to the guidelines when those methods are considered more reasonable and beneficial to an individual patient's medical situation

  10. Comparison of Ultrasound-Guided and Fluoroscopy-Assisted Antegrade Common Femoral Artery Puncture Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Slattery, Michael M.; Goh, Gerard S.; Power, Sarah; Given, Mark F.; McGrath, Frank P.; Lee, Michael J., E-mail: mlee@rcsi.ie [Beaumont Hospital, Department of Radiology (Ireland)

    2015-06-15

    PurposeTo prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques.Materials and MethodsHundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture. Time taken from administration of local anaesthetic to vascular sheath insertion in the superficial femoral artery (SFA), patients’ age, body mass index (BMI), fluoroscopy radiation dose, haemostasis method and immediate complications were recorded. Mean and median values were calculated and statistically analysed with unpaired t tests.ResultsSixty-nine male and 31 female patients underwent antegrade puncture (mean age 66.7 years). The mean BMI was 25.7 for the ultrasound-guided (n = 53) and 25.3 for the fluoroscopy-assisted (n = 47) groups. The mean time taken for the ultrasound-guided puncture was 7 min 46 s and for the fluoroscopy-assisted technique was 9 min 41 s (p = 0.021). Mean fluoroscopy dose area product in the fluoroscopy group was 199 cGy cm{sup 2}. Complications included two groin haematomas in the ultrasound-guided group and two retroperitoneal haematomas and one direct SFA puncture in the fluoroscopy-assisted group.ConclusionUltrasound-guided technique is faster and safer for antegrade CFA puncture when compared to the fluoroscopic-assisted technique alone.

  11. Biplanar x-ray fluoroscopy for sacroiliac joint fusion.

    Science.gov (United States)

    Vanaclocha-Vanaclocha, Vicente; Verdú-López, Francisco; Sáiz-Sapena, Nieves; Herrera, Juan Manuel; Rivera-Paz, Marlon

    2016-07-01

    Chronic pain originating from the sacroiliac joint (SI) can cause severe dysfunction. Although many patients respond to conservative management with NSAIDs, some do need further treatment in the form of SI joint fusion (SIJF). To achieve safe and successful SIJF, intraoperative x-ray fluoroscopy is mandatory to avoid serious damages to nearby vascular and neural structures. Each step of the procedure has to be confirmed by anteroposterior (AP) and lateral projections. With a single-arm x-ray, the arch has to be moved back and forth for the AP and lateral projections, and this lengthens the procedure. To achieve the same results in less time, the authors introduced simultaneous biplanar fluoroscopy with 2 x-ray arches. After the patient is positioned prone with the legs spread apart in the so-called Da Vinci position, one x-ray arch for the lateral projection is placed at a right angle to the patient, and a second x-ray machine is placed with its arch between the legs of the patient. This allows simultaneous AP and lateral x-ray projections and, in the authors' hands, markedly speeds up the procedure. Biplanar fluoroscopy allows excellent AP and lateral projections to be made quickly at any time during the surgical procedure. This is particularly useful in cases of bilateral SI joint fusion if both sides are done at the same time. The video can be found here: https://youtu.be/TX5gz8c765M .

  12. Fluoroscopy-guided insertion of nasojejunal tubes in children - setting local diagnostic reference levels

    International Nuclear Information System (INIS)

    Vitta, Lavanya; Raghavan, Ashok; Sprigg, Alan; Morrell, Rachel

    2009-01-01

    Little is known about the radiation burden from fluoroscopy-guided insertions of nasojejunal tubes (NJTs) in children. There are no recommended or published standards of diagnostic reference levels (DRLs) available. To establish reference dose area product (DAP) levels for the fluoroscopy-guided insertion of nasojejunal tubes as a basis for setting DRLs for children. In addition, we wanted to assess our local practice and determine the success and complication rates associated with this procedure. Children who had NJT insertion procedures were identified retrospectively from the fluoroscopy database. The age of the child at the time of the procedure, DAP, screening time, outcome of the procedure, and any complications were recorded for each procedure. As the radiation dose depends on the size of the child, the children were assigned to three different age groups. The sample size, mean, median and third-quartile DAPs were calculated for each group. The third-quartile values were used to establish the DRLs. Of 186 procedures performed, 172 were successful on the first attempt. These were performed in a total of 43 children with 60% having multiple insertions over time. The third-quartile DAPs were as follows for each age group: 0-12 months, 2.6 cGy cm 2 ; 1-7 years, 2.45 cGy cm 2 ; >8 years, 14.6 cGy cm 2 . High DAP readings were obtained in the 0-12 months (n = 4) and >8 years (n = 2) age groups. No immediate complications were recorded. Fluoroscopy-guided insertion of NJTs is a highly successful procedure in a selected population of children and is associated with a low complication rate. The radiation dose per procedure is relatively low. (orig.)

  13. Fluoroscopy-guided lumbar drainage of cerebrospinal fluid for patients in whom a blind beside approach is difficult

    Energy Technology Data Exchange (ETDEWEB)

    Chee, Choong Guen; Lee, Guen Young; Lee, Joon Woo; Lee, Eu Gene; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-08-15

    To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage. This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study. The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal. Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity.

  14. Swiss National Reference Levels in Fluoroscopy

    International Nuclear Information System (INIS)

    Aroua, A.; Baechler, S.; Verdun, F.R.; Rickli, H.; Trueb, Ph.R.; Vock, P.

    2006-01-01

    A nationwide survey was launched in Switzerland in order to investigate the use of fluoroscopy and to establish national reference levels (R.L.) for dose-intensive procedures particularly in interventional radiology. The 2-year investigation covered 5 radiology and 9 cardiology departments in public hospitals and private clinics, and focused on twelve types of examinations: six diagnostic and six interventional. The performance of the fluoroscopy units used in these health-care centres (image quality and dose) was assessed extensively and 1000 examinations were registered. Information on the fluoroscopy time (T), the number of frames (N), the dose-area product (D.A.P.), the difficulty of the case, the age, gender, height and weight of the patient, as well as the experience of the practitioner was provided. The whole set of data was used in relative values (to the mean values for each type of examination) to establish the distributions of T, N and the D.A.P.. From these distributions a set of R.L. values was deduced for the types of examinations investigated using the 3.-quartile method. The R.L. values found are compared to the data published in the literature. (authors)

  15. Detection of electrophysiology catheters in noisy fluoroscopy images.

    Science.gov (United States)

    Franken, Erik; Rongen, Peter; van Almsick, Markus; ter Haar Romeny, Bart

    2006-01-01

    Cardiac catheter ablation is a minimally invasive medical procedure to treat patients with heart rhythm disorders. It is useful to know the positions of the catheters and electrodes during the intervention, e.g. for the automatization of cardiac mapping. Our goal is therefore to develop a robust image analysis method that can detect the catheters in X-ray fluoroscopy images. Our method uses steerable tensor voting in combination with a catheter-specific multi-step extraction algorithm. The evaluation on clinical fluoroscopy images shows that especially the extraction of the catheter tip is successful and that the use of tensor voting accounts for a large increase in performance.

  16. Radiation exposure to the patient during X-ray fluoroscopy and radiography

    International Nuclear Information System (INIS)

    Dimov, A.; Vassileva, J.

    2006-01-01

    Full text: The aim of this study is to assess the patient doses received during conventional and digital X-ray radiography, conventional fluoroscopy of the lungs, and one of the highest dose X-ray procedures - contrast examination of the large intestine (Barium enema examination). The measured quantity is Kerma area product (KAP), registered with a clinical dosimeter DRK-1 (Doza, Russia). A total number of 89 patients are included in the study. The Organ doses and Effective doses were assessed using Monte Carlo calculation code (PCXMC 1.4 (Finland). The measurements took place at the following X-ray units: a CGR (Koch and Sterzel) with two working posts - for radiography and fluoroscopy, a Philips Telediagnost (for barium enema) and an Oldelft N800HF Digidelca (for digital radiography of the chest). The typical KAP per procedure at digital radiography, conventional X-ray radiography and fluoroscopy and Barium enema examination are: 17; 95; 928 and 3630 cGy.cm 2 respectively; the average effective doses are: 0.022; 0.053; 0.728 and 8.0 mSv respectively. Doses to the lungs at digital radiography, conventional radiography and fluoroscopy are: 0.066; 0.136 and 2.412 mSv respectively and the dose to the upper and lower large intestine are: 11.7 and 8.6 mSv respectively. Conclusion: The approach used is applicable for assessment of radiation exposure to the patient during X-ray radiography and fluoroscopy. It needs registration of KAP meter readings when this device is installed on the stationary X-ray units

  17. Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

    International Nuclear Information System (INIS)

    Menachem, S.; Sharfman, Z.T.; Perets, I.; Arami, A.; Eyal, G.; Drexler, M.; Chechik, O.

    2016-01-01

    Aim: To compare the radiographic results of paediatric forearm fracture reduced with and without fluoroscopic enhancement to investigate whether fractures reduced under fluoroscopic guidance would have smaller residual deformities and lower rates of re-reduction and surgery. Materials and methods: A retrospective cohort analysis was conducted comparing paediatric patients with acute forearm fracture in two trauma centres. Demographics and radiographic data from paediatric forearm fractures treated in Trauma Centre A with the aid of a C-arm fluoroscopy were compared to those treated without fluoroscopy in Trauma Centre B. Re-reduction, late displacement, post-reduction deformity, and need for surgical intervention were compared between the two groups. Results: The cohort included 229 children (175 boys and 54 girls, mean age 9.41±3.2 years, range 1–16 years) with unilateral forearm fractures (83 manipulated with fluoroscopy and 146 without). Thirty-four (15%) children underwent re-reduction procedures in the emergency department. Fifty-three (23%) children had secondary displacement in the cast, of which 18 were operated on, 20 were re-manipulated, and the remaining 15 were kept in the cast with an acceptable deformity. Twenty-nine additional children underwent operation for reasons other than secondary displacement. There were no significant differences in re-reduction and surgery rates or in post-reduction deformities between the two groups. Conclusion: The use of fluoroscopy during reduction of forearm fractures in the paediatric population apparently does not have a significant effect on patient outcomes. Reductions performed without fluoroscopy were comparably accurate in correcting deformities in both coronal and sagittal planes. - Highlights: • Compared outcomes of pediatric forearm fracture reduction with and without fluoroscopy. • The use of fluoroscopy during reduction of forearm fractures in the pediatric population apparently does not have a

  18. Combined Fluoroscopy- and CT-Guided Transthoracic Needle Biopsy Using a C-Arm Cone-Beam CT System: Comparison with Fluoroscopy-Guided Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Cheung, Joo Yeon; Kim, Yoo Kyung; Shim, Sung Shine; Lim, Soo Mee [School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2011-02-15

    The aim of this study was to evaluate the usefulness of combined fluoroscopy- and CT-guided transthoracic needle biopsy (FC-TNB) using a cone beam CT system in comparison to fluoroscopy-guided TNB (F-TNB). We retrospectively evaluated 74 FC-TNB cases (group A) and 97 F-TNB cases (group B) to compare their respective diagnostic accuracies according to the size and depth of the lesion, as well as complications, procedure time, and radiation dose. The sensitivity for malignancy and diagnostic accuracy for small (< 30 mm in size) and deep ({>=} 50 mm in depth) lesions were higher in group A (91% and 94%, 92% and 94%) than in group B (73% and 81%, 84% and 88%), however not statistically significant (p > 0.05). Concerning lesions {>=} 30 mm in size and < 50 mm in depth, both groups displayed similar results (group A, 91% and 92%, 80% and 87%: group B, 90% and 92%, 86% and 90%). Pneumothorax occurred 26% of the time in group A and 14% for group B. The mean procedure time and patient skin dose were significantly higher in group A (13.6 {+-} 4.0 minutes, 157.1 {+-} 76.5 mGy) than in group B (9.0 {+-} 3.5 minutes, 21.9 {+-} 15.2 mGy) (p < 0.05). Combined fluoroscopy- and CT-guided TNB allows the biopsy of small (< 30 mm) and deep lesions ({>=} 50 mm) with high diagnostic accuracy and short procedure times, whereas F-TNB is still a useful method for large and superficial lesions with a low radiation dose

  19. Scattered radiation risk to the lens of the eyes for staff involved in using mobile C-arm fluoroscopy unit: Which position is riskiest?

    Energy Technology Data Exchange (ETDEWEB)

    Salleh, H.; Matori, M. K.; Isa, M. J. M. [Agensi Nuklear Malaysia, Bangi, 43000 Kajang, Selangor (Malaysia); Samat, S. B. [Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor (Malaysia)

    2015-09-25

    Cataractogenesis is something to be concerned by radiologist and radiographer who work extensively in fluoroscopy. The increasing use of fluoroscopy or interventional fluoroscopy has to come with safety awareness on scattered radiation risk for staff performing the procedure. This study is looking into the radiation risk to the lens of the eyes for staff involved in fluoroscopy using the mobile C-arm fluoroscopy unit. The Toshiba SXT-1000A and Alderson Rando phantom were used in this study. Based on the results, it is found clearly that over couch (OC) procedure is riskier than under couch (UC) procedure. The cathode bound area is clearly riskier than anode bound area especially for UC procedure. More doses (at least +1,568 % of safest position) are received by the lens of the eyes for staff standing at the cathode bound area especially the position opposite to the x-ray tube.

  20. Scattered radiation risk to the lens of the eyes for staff involved in using mobile C-arm fluoroscopy unit: Which position is riskiest?

    International Nuclear Information System (INIS)

    Salleh, H.; Matori, M. K.; Isa, M. J. M.; Samat, S. B.

    2015-01-01

    Cataractogenesis is something to be concerned by radiologist and radiographer who work extensively in fluoroscopy. The increasing use of fluoroscopy or interventional fluoroscopy has to come with safety awareness on scattered radiation risk for staff performing the procedure. This study is looking into the radiation risk to the lens of the eyes for staff involved in fluoroscopy using the mobile C-arm fluoroscopy unit. The Toshiba SXT-1000A and Alderson Rando phantom were used in this study. Based on the results, it is found clearly that over couch (OC) procedure is riskier than under couch (UC) procedure. The cathode bound area is clearly riskier than anode bound area especially for UC procedure. More doses (at least +1,568 % of safest position) are received by the lens of the eyes for staff standing at the cathode bound area especially the position opposite to the x-ray tube

  1. Endoscopic retrograde JJ-stenting of the ureter without fluoroscopy guidance--an appraisal of outcome.

    Science.gov (United States)

    Shuaibu, S I; Gidado, S; Oseni-Momodu, E

    2013-01-01

    JJ- ureteral stenting is a means of relieving ureteric obstruction. It is done as a retrograde or antegrade procedure, usually under fluoroscopy guidance. We reviewed our results in 2 independent tertiary health centers in Nigeria which lack fluoroscopy units. A 2 year retrospective review of data of patients who had retrograde JJ- ureteric stenting was done. Data relating to age, indication and outcome of procedure were retrieved and analysed. 22 (71%) patients had successful retrograde JJ- ureteric stenting out of 31 patients who were taken for the procedure. These 22 patients had stenting of 27 ureteric units. Mean age was 48.5 years. Commonest indication was carcinoma of the cervix (31.8%). Commonest complication was irritative lower urinary tract symptoms (43.5%). In spite of inherent complications, JJ-stenting is a simple and safe technique. Therefore, the decision to attempt JJ -stenting in carefully selected patients in the absence of fluoroscopy is acceptable.

  2. A novel radiation protection drape reduces radiation exposure during fluoroscopy guided electrophysiology procedures.

    Science.gov (United States)

    Germano, Joseph J; Day, Gina; Gregorious, David; Natarajan, Venkataraman; Cohen, Todd

    2005-09-01

    The purpose of this study was to evaluate a novel disposable lead-free radiation protection drape for decreasing radiation scatter during electrophysiology procedures. In recent years, there has been an exponential increase in the number of electrophysiology (EP) procedures exposing patients, operators and laboratory staff to higher radiation doses. The RADPAD was positioned slightly lateral to the incision site for pectoral device implants and superior to the femoral vein during electrophysiology studies. Each patient served as their own control and dosimetric measurements were obtained at the examiner's elbow and hand. Radiation badge readings for the operator were obtained three months prior to RADPAD use and three months after introduction. Radiation dosimetry was obtained in twenty patients: 7 electrophysiology studies, 6 pacemakers, 5 catheter ablations, and 2 implantable cardioverter-defibrillators. Eleven women and nine men with a mean age of 63 +/- 4 years had an average fluoroscopy time of 2.5 +/- 0.42 minutes per case. Mean dosimetric measurements at the hand were reduced from 141.38 +/- 24.67 to 48.63 +/- 9.02 milliroentgen (mR) per hour using the protective drape (63% reduction; p < 0.0001). Measurements at the elbow were reduced from 78.78 +/- 7.95 mR per hour to 34.50 +/- 4.18 mR per hour using the drape (55% reduction; p < 0.0001). Badge readings for three months prior to drape introduction averaged 2.45 mR per procedure versus 1.54 mR per procedure for 3 months post-initiation (37% reduction). The use of a novel radiation protection surgical drape can significantly reduce scatter radiation exposure to staff and operators during a variety of EP procedures.

  3. Monitoring radiation use in cardiac fluoroscopy imaging procedures

    International Nuclear Information System (INIS)

    Stevens, Nathaniel T.; Steiner, Stefan H.; Smith, Ian R.; MacKay, R. Jock

    2011-01-01

    Purpose: Timely identification of systematic changes in radiation delivery of an imaging system can lead to a reduction in risk for the patients involved. However, existing quality assurance programs involving the routine testing of equipment performance using phantoms are limited in their ability to effectively carry out this task. To address this issue, the authors propose the implementation of an ongoing monitoring process that utilizes procedural data to identify unexpected large or small radiation exposures for individual patients, as well as to detect persistent changes in the radiation output of imaging platforms. Methods: Data used in this study were obtained from records routinely collected during procedures performed in the cardiac catheterization imaging facility at St. Andrew's War Memorial Hospital, Brisbane, Australia, over the period January 2008-March 2010. A two stage monitoring process employing individual and exponentially weighted moving average (EWMA) control charts was developed and used to identify unexpectedly high or low radiation exposure levels for individual patients, as well as detect persistent changes in the radiation output delivered by the imaging systems. To increase sensitivity of the charts, we account for variation in dose area product (DAP) values due to other measured factors (patient weight, fluoroscopy time, and digital acquisition frame count) using multiple linear regression. Control charts are then constructed using the residual values from this linear regression. The proposed monitoring process was evaluated using simulation to model the performance of the process under known conditions. Results: Retrospective application of this technique to actual clinical data identified a number of cases in which the DAP result could be considered unexpected. Most of these, upon review, were attributed to data entry errors. The charts monitoring the overall system radiation output trends demonstrated changes in equipment performance

  4. Monitoring radiation use in cardiac fluoroscopy imaging procedures

    Energy Technology Data Exchange (ETDEWEB)

    Stevens, Nathaniel T.; Steiner, Stefan H.; Smith, Ian R.; MacKay, R. Jock [Department of Statistics and Actuarial Sciences, Business and Industrial Statistics Research Group, University of Waterloo, Waterloo, Ontario N2L 3G1 (Canada); St. Andrew' s Medical Institute, St. Andrew' s War Memorial Hospital, Brisbane, Queensland 4000 (Australia); Department of Statistics and Actuarial Sciences, Business and Industrial Statistics Research Group, University of Waterloo, Waterloo, Ontario N2L 3G1 (Canada)

    2011-01-15

    Purpose: Timely identification of systematic changes in radiation delivery of an imaging system can lead to a reduction in risk for the patients involved. However, existing quality assurance programs involving the routine testing of equipment performance using phantoms are limited in their ability to effectively carry out this task. To address this issue, the authors propose the implementation of an ongoing monitoring process that utilizes procedural data to identify unexpected large or small radiation exposures for individual patients, as well as to detect persistent changes in the radiation output of imaging platforms. Methods: Data used in this study were obtained from records routinely collected during procedures performed in the cardiac catheterization imaging facility at St. Andrew's War Memorial Hospital, Brisbane, Australia, over the period January 2008-March 2010. A two stage monitoring process employing individual and exponentially weighted moving average (EWMA) control charts was developed and used to identify unexpectedly high or low radiation exposure levels for individual patients, as well as detect persistent changes in the radiation output delivered by the imaging systems. To increase sensitivity of the charts, we account for variation in dose area product (DAP) values due to other measured factors (patient weight, fluoroscopy time, and digital acquisition frame count) using multiple linear regression. Control charts are then constructed using the residual values from this linear regression. The proposed monitoring process was evaluated using simulation to model the performance of the process under known conditions. Results: Retrospective application of this technique to actual clinical data identified a number of cases in which the DAP result could be considered unexpected. Most of these, upon review, were attributed to data entry errors. The charts monitoring the overall system radiation output trends demonstrated changes in equipment

  5. Pharyngeal video fluoroscopy: Selected unusual cases

    International Nuclear Information System (INIS)

    Conoley, P.M.; Fox, D.R.

    1987-01-01

    The videotape in this exhibit presents cases illustrative of the use of pharyngeal video fluoroscopy in diagnostic evaluations and therapeutic decision-making in a variety of speech and swallowing disorders of adults and children. Clinical problems addressed include an interesting compensatory speech mechanism in a cleft-palate patient, a preoperative candidate for a Lefort procedure, uncontrolled nasality in a singer, and dysphagia in an antimony worker

  6. Dose reduction in pulsed fluoroscopy by modifying the high-voltage pulse shape

    International Nuclear Information System (INIS)

    Sabau, M.N.; Phelps, G.

    1988-01-01

    This paper presents the dose reduction results in pulsed fluoroscopy by modifying the high-voltage pulse shape (HVPS). Since the HVPS in regular pulsed fluoroscopy has a long tail, the radiation pulse shape (RPS) is similar. Using specially designed circuitry in the high-voltage generator to produce a rectangular HVPS, and consequently a rectangular RPS, it was possible to obtain a reduction of up to 25% of patient exposure. This dose reduction obtained by cutting the long tail of RPS does not damage the image quality

  7. Changing Default Fluoroscopy Equipment Settings Decreases Entrance Skin Dose in Patients.

    Science.gov (United States)

    Canales, Benjamin K; Sinclair, Lindsay; Kang, Diana; Mench, Anna M; Arreola, Manuel; Bird, Vincent G

    2016-04-01

    Proper fluoroscopic education and protocols may reduce the patient radiation dose but few prospective studies in urology have been performed. Using optically stimulated luminescent dosimeters we tested whether fluoroscopy time and/or entrance skin dose would decrease after educational and radiation reduction protocols. At default manufacturer settings fluoroscopy time and entrance skin dose were prospectively measured using optically stimulated luminescent dosimeters in patients undergoing ureteroscopy, retrograde pyelogram/stent or percutaneous nephrolithotomy with access for stone disease. A validated radiation safety competency test was administered to urology faculty and residents before and after web based, hands-on fluoroscopy training. Default fluoroscopy settings were changed from continuous to intermittent pulse rate and from standard to half-dose output. Fluoroscopy time and entrance skin dose were then measured again. The cohorts of 44 pre-protocol and 50 post-protocol patients with stones were similarly matched. The change in mean fluoroscopy time and entrance skin dose from pre-protocol to post-protocol was -0.6 minutes and -11.6 mGy (33%) for percutaneous nephrolithotomy (p = 0.62 and default settings to intermittent pulse rate (12 frames per second) and half-dose lowered the entrance skin dose by 30% across all endourology patients but most significantly during percutaneous nephrolithotomy. To limit patient radiation exposure fluoroscopy default settings should be decreased before all endourology procedures and image equipment manufacturers should consider lowering standard default renal settings. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  8. Safety and outcome using endoscopic dilation for benign esophageal stricture without fluoroscopy

    Directory of Open Access Journals (Sweden)

    E R Siddeshi

    2015-01-01

    Full Text Available Aim : The aim was to investigate the use of Savary-Gilliard marked dilators in tight esophageal strictures without fluoroscopy. Materials and Methods: Four hundred and six patients with significant dysphagia from benign strictures due to a variety of causes were dilated endoscopically. Patients with achalasia, malignant lesions, and external compression were excluded. The procedure consisted of two parts. First, Savary-Gilliard or zebra guide wire was placed through video endoscopy and then dilatation was performed without fluoroscopy. In general, "the rule of three" was followed. Effective treatment was defined as the ability of patients, with or without repeated dilatations, to maintain a solid or semisolid diet for more than 12 months. Results: One thousand and twenty-four dilatations sessions in a total of 408 patients were carried out. The success rate for placement of a guide wire was 100% and for dilatation 97% without the use of fluoroscopy, after 6 months-24 years of follow-up. The number of sessions per patient was between one and seven, with an average of three sessions. The ability of patients, after one or more sessions of dilatations to maintain a solid or semisolid diet for more than 12 months was obtained in 386 patients (95.8%. All patients improved clinically without complications after the endoscopic procedure without fluoroscopy, but we noted 22 failures. Conclusions: Dilatation (dilation using Savary-Gilliard dilators without fluoroscopy are safe and effective in the treatment of very tight esophageal strictures if performed with care.

  9. Patient radiation dose during fluoroscopy testes with contrast medium

    International Nuclear Information System (INIS)

    Darsalih, Abir Abdelrady El noor

    2016-09-01

    The purpose of this study was to assess the patient radiation dose received in fluoroscopy examinations during contrast medium. The cumulative air kerma (Ck), kerma area product (KAP) and fluoroscopy time were measured for sixty ( male and female ) patients undergoing five fluoroscopy examinations KAP metre which was installed for the purpose of this study. The mean kerma area product were found to be 2.681, 5.1561, 9.85529. 5.7974 and 13.09 Gy.cm"2 for HSG, A.S and D.S, GI Track and sonogram tests, respectively. The obtained mean cumulative dose was were 6.31, 13.88, 24.61, 22.56 and 32.14 mGy for HSG, A.S, A.S and D.S , GI Track, respectively, the mean fluoroscopy time were. 0.18, 0.51,0.89,1.57 and 1.75 min, for HSG, A.S, A.S, and D.S, G1 Track and sonogram test respectively. Patient dose is mainly dependent on the patient size, procedure, equipment used exposure factor and user experience. As KV and mA were controlled by the AEC and it was found to be well calibrated, possible optimization could be achieved by radiologist by decreasing the exposure time if possible. (Author)

  10. Effectiveness of fluoroscopy-guided intra-articular steroid injection for hip osteoarthritis

    International Nuclear Information System (INIS)

    Subedi, N.; Chew, N.S.; Chandramohan, M.; Scally, A.J.; Groves, C.

    2015-01-01

    Aim: To demonstrate the benefits of fluoroscopy-guided intra-articular steroid injection in the hip with varying degrees of disease severity, and to investigate the financial aspects of the procedure and impact on waiting time. Materials and methods: A prospective study was undertaken of patients who underwent fluoroscopic intra-articular steroid injection over the 9-month study period. Comparative analysis of the Oxford hip pain score pre- and 6–8 weeks post-intra-articular injection was performed. Hip radiographs of all patients were categorised as normal, mild, moderate, or severe disease (four categories) based on the modified Kellgren–Lawrence severity scale, and improvement on the Oxford hip pain score on each of these four severity categories were assessed. Results: Within the study cohort of 100 patients, the mean increase in post-procedure hip score of 7.32 points confirms statistically significant benefits of the therapy (p<0.001, 95% confidence interval: 5.55–9.09). There was no significant difference in pre-injection hip score or change in score between the four severity categories (p=0.51). Significant improvement in hip score (p<0.05) was demonstrated in each of the four severity categories 6–8 weeks post-injection. No associated complications were observed. Conclusion: The present study confirms that fluoroscopy-guided intra-articular steroid injection is a highly effective therapeutic measure for hip osteoarthritis across all grades of disease severity with significant cost savings and the potential to reduce waiting times. - Highlights: • Comparable clinical effectiveness of fluoroscopy guided and theatre based therapeutic intra-articular hip injections. • Significant cost savings on fluoroscopy guided hip injection performed in a radiology department. • A potential reduction in patients' waiting time for the procedure.

  11. Radiation dose to the operator during fluoroscopically guided spine procedures

    Energy Technology Data Exchange (ETDEWEB)

    Roccatagliata, Luca; Pravata, Emanuele; Cianfoni, Alessandro [Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano (Switzerland); Presilla, Stefano [Unita di Fisica Medica, Ente Ospedaliero Cantonale (EOC), Bellinzona (Switzerland)

    2017-09-15

    Fluoroscopy is widely used to guide diagnostic and therapeutic spine procedures. The purpose of this study was to quantify radiation incident on the operator (operator Air Kerma) during a wide range of fluoroscopy-guided spine procedures and its correlation with the amount of radiation incident on the patient (Kerma Area Product - KAP). We retrospectively included 57 consecutive fluoroscopically guided spine procedures. KAP [Gy cm{sup 2}] and total fluoroscopy time were recorded for each procedure. An electronic dosimeter recorded the operator Air Kerma [μGy] for each procedure. Operator Air Kerma for each procedure, correlation between KAP and operator Air Kerma, and between KAP and fluoroscopy time was obtained. Operator Air Kerma was widely variable across procedures, with median value of 6.4 μGy per procedure. Median fluoroscopy time and median KAP per procedure were 2.6 min and 4.7 Gy cm{sup 2}, respectively. There was correlation between operator Air Kerma and KAP (r{sup 2} = 0.60), with a slope of 1.6 μGy Air Kerma per unit Gy cm{sup 2} KAP incident on the patient and between fluoroscopy time and KAP (r{sup 2} = 0.63). Operator Air Kerma during individual fluoroscopy-guided spine procedures can be approximated from the commonly and readily available information of the total amount of radiation incident on the patient, measured as KAP. (orig.)

  12. Fluoroscopy-Guided Percutaneous Lung Biopsy: A Valuable Alternative to Computed Tomography

    International Nuclear Information System (INIS)

    Kurban, L.A.; Gomersall, L.; Weir, J.; Wade, P.

    2008-01-01

    Background: Computed tomography (CT) fluoroscopy nowadays is the most preferred method of guidance to perform percutaneous lung biopsy of pulmonary masses. Conventional fluoroscopy is an increasingly forgotten technique that still can be used to perform lung biopsies, with many advantages. Purpose: To compare the accuracy, safety, and effective dose (ED) of conventional fluoroscopy-guided needle lung biopsy (FNLB) with CT-guided needle lung biopsy procedures (CTNLB) reported in the literature. Material and Methods: 100 consecutive patients who underwent FNLB were reviewed retrospectively. Using the final histological diagnoses and the clinical and radiological course of the disease as references, the accuracy and sensitivity of FNLB were calculated. The complication rates of FNLB were assessed. Using computer software (XDOSE), the ED was calculated. The accuracy, complication rates, and the ED of FNLB were compared with CTNLB reported in the literature. Results: The overall accuracy rate and sensitivity of FNLB were both 87%, which are comparable to the range of accuracies reported in the literature for CTNLB (74-97%). The complication rates of FNLB were also comparable to the complication rates reported for CTNLB. The commonest complication was pneumothorax, at a rate of 25%. The ED of FNLB was small, significantly lower than reported in the literature for CT-guided procedures. The mean ED of FNLB was 0.029 mSv, which is approximately equivalent to one chest X-ray. Conclusion: Conventional fluoroscopy is an accurate, safe, and low-dose alternative modality to CT to obtain an image-guided histological diagnosis of pulmonary lesions

  13. Laser Guidance in C-Arm Cone-Beam CT-Guided Radiofrequency Ablation of Osteoid Osteoma Reduces Fluoroscopy Time

    Energy Technology Data Exchange (ETDEWEB)

    Kroes, Maarten W., E-mail: Maarten.Kroes@radboudumc.nl; Busser, Wendy M. H.; Hoogeveen, Yvonne L.; Lange, Frank de; Schultze Kool, Leo J. [Radboud University Medical Center, Department of Radiology and Nuclear Medicine (Netherlands)

    2017-05-15

    PurposeTo assess whether laser guidance can reduce fluoroscopy and procedure time of cone-beam computed tomography (CBCT)-guided radiofrequency (RF) ablations of osteoid osteoma compared to freehand CBCT guidance.Materials and Methods32 RF ablations were retrospectively analyzed, 17 laser-guided and 15 procedures using the freehand technique. Subgroup selection of 18 ablations in the hip–pelvic region with a similar degree of difficulty was used for a direct comparison. Data are presented as median (ranges).ResultsComparison of all 32 ablations resulted in fluoroscopy times of 365 s (193–878 s) for freehand and 186 s (75–587 s) for laser-guided procedures (p = 0.004). Corresponding procedure times were 56 min (35–97 min) and 52 min (30–85 min) (p = 0.355). The subgroup showed comparable target sizes, needle path lengths, and number of scans between groups. Fluoroscopy times were lower for laser-guided procedures, 215 s (75–413 s), compared to 384 s (193–878 s) for freehand (p = 0.012). Procedure times were comparable between groups, 51 min (30–72 min) for laser guidance and 58 min (35–79 min) for freehand (p = 0.172).ConclusionAdding laser guidance to CBCT-guided osteoid osteoma RF ablations significantly reduced fluoroscopy time without increasing procedure time.Level of EvidenceLevel 4, case series.

  14. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures

    International Nuclear Information System (INIS)

    Iguchi, Toshihiro; Ogawa, Ken-Ichi; Doi, Takeshi; Munetomo, Kazuo; Miyasho, Koji; Hiraki, Takao; Kanazawa, Susumu; Ozaki, Toshifumi

    2010-01-01

    The purpose of this study was to evaluate retrospectively the safety and effectiveness of the computed tomography (CT) fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Six patients (four women and two men; mean age 55.8 years; range 35-77 years) with unstable posterior pelvic fractures underwent iliosacral screw placement under CT fluoroscopy guidance between November 2007 and August 2008. Unstable pelvic ring injury (AO types B and C) was the indication for this procedure. In all the six patients except one, CT fluoroscopy-guided placement had been technically successful. In one patient, a second screw had been inserted, with a tilt to the caudal site, and slightly advanced into the extrasacral body; afterward, it could be exchanged safely for a shorter screw. Five patients and one patient underwent placement of two screws and one screw, respectively. The mean duration of the procedure was 15.0 min (range 9-30 min) per screw; the duration was 12.3 min and 18.2 min for the first and second screws, respectively. No complications requiring treatment occurred during or after the procedure. The mean clinical and radiologic follow-up period was 14 months (range 6-21 months). All pelvic injuries had healed satisfactorily, without complication, and all patients are now doing well clinically and can walk. CT fluoroscopy-guided placement of iliosacral screws is a safe and effective treatment in patients with unstable posterior pelvic fractures. (orig.)

  15. CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Tomohiro, E-mail: t-matsu@tokai-u.jp; Mine, Takahiko, E-mail: mine@tsc.u-tokai.ac.jp; Hayashi, Toshihiko, E-mail: t.hayashi@tokai.ac.jp [Tokai University School of Medicine, Department of Radiology, Tokai University Hachioji Hospital (Japan); Kamono, Masahiro, E-mail: kamono@tsc.u-tokai.ac.jp; Taoda, Akiko, E-mail: acco@is.icc.u-tokai.ac.jp; Higaki, Megumu, E-mail: higaki@hachioji-hosp.tokai.ac.jp [Tokai University School of Medicine, Department of General Internal Medicine, Tokai University Hachioji Hospital (Japan); Hasebe, Terumitsu, E-mail: hasebe@tokai-u.jp [Tokai University School of Medicine, Department of Radiology, Tokai University Hachioji Hospital (Japan)

    2017-01-15

    PurposeTo retrospectively describe the feasibility and efficacy of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction with a combination of two interventional radiological techniques—CT-guided bone biopsy and abscess drainage.Materials and methodsThree patients with pyogenic spondylodiscitis at the lumbosacral junction were enrolled in this study between July 2013 and December 2015. The procedure of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction was as follows: the sacrum at S1 pedicle was penetrated with an 11-gauge (G) bone biopsy needle to create a path for an 8-French (F) pigtail drainage catheter. The bone biopsy needle was withdrawn, and an 18-G needle was inserted into the intervertebral space of the lumbosacral junction. Then, a 0.038-inch guidewire was inserted into the intervertebral space. Finally, the 8-F pigtail drainage catheter was inserted over the guidewire until its tip reached the intervertebral space. All patients received six-week antibiotics treatment.ResultsSuccessful placement of the drainage catheter was achieved for each patient without procedural complications. The duration of drainage was 17–33 days. For two patients, specific organisms were isolated; thus, definitive medical therapy was possible. All patients responded well to the treatment.ConclusionsCT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction is feasible and can be effective with a combination of two interventional techniques—CT fluoroscopy-guided bone biopsy and abscess drainage.

  16. How Slow Can We Go? 4 Frames Per Second (fps) Versus 7.5 fps Fluoroscopy for Atrial Septal Defects (ASDs) Device Closure.

    Science.gov (United States)

    Hiremath, Gurumurthy; Meadows, Jeffery; Moore, Phillip

    2015-06-01

    Radiation exposure remains a significant concern for ASD device closure. In an effort to reduce radiation exposure, the default fluoroscopy frame rate in our Siemens biplane pediatric catheterization laboratory was reduced to 4 fps in November 2013 from an earlier 7.5 fps fluoro rate. This study aims to evaluate the components contributing to total radiation exposure and compare the procedural success and radiation exposure during ASD device closure using 4 versus 7.5 fps fluoroscopy rates. Twenty ASD device closures performed using 4 fps fluoro rate were weight-matched to 20 ASD closure procedures using 7.5 fps fluoro rate. Baseline characteristics, procedure times and case times were similar in the two groups. Device closure was successful in all but one case in the 4 fps group. The dose area product (DAP), normalized DAP to body weight, total radiation time and fluoro time were lower in the 4 fps group but not statistically different than the 7.5 fps. The number of cine images and cine times were identical in both groups. Fluoroscopy and cineangiography contributed equally to radiation exposure. Fluoroscopy at 4 fps can be safe and effective for ASD device closure in children and adults. There was no increase in procedure time, cine time, fluoro time or complications at this slow fluoro rate. There was a trend toward decreased radiation exposure as measured by indexed DAP although not statistically significant in this small study. Further study with multiple operators using 4 fps fluoroscopy for simple interventional procedures is recommended.

  17. Quality control for some digital fluoroscopy equipment used in Sudan

    International Nuclear Information System (INIS)

    Nayledam, A. I.

    2009-07-01

    The aim of this work was to perform quality control (QC) for six digital fluoroscopy units used for cardiovascular and interventional radiology procedures. Measurement were based on the QC protocol developed in the framework of European Commission (EU) DIMOND111 project. Measurement made included: beam quality (half-value layer, HVL), peak tube voltage (kVp) accuracy, automatic exposure control (Aec) and patient dose in terms of entrance surface air kerma rate plus image intensifier input air kerma rate. Dose measurements were made using Calibrated dose rate meter. Field limitation and source to skin distant measurement in addition to evaluation radiation protection tools for occupation exposure were performed. Image quality was evaluated in terms of spatial resolution and Contrast detail detectability. Patient dose measurements was performed using polymethylmethacrylate (PMMA) patient equivalent phantom whereas image quality was assessed using Haunter Type 53 spatial frequency grating and TO10 contrast detail phantom. The results show that the measured HVL and peak tube voltage were within the recommended limits of 10% in four fluoroscopy units. Entrance surface air kerma rate measured ranged from 6.1 to 250 mGy/min for fluoroscopy units operated in pulsed, continuous and cine mode of operation. These results were obtained using varying thicknesses of PMMA phantom. Most values are in reasonable agreement with internationally established reference levels with exception to one fluoroscopy unit where doses were remarkably high. Field limitation and minimum source to skin distance were well within the recommended limits of 30 cm for all fluoroscopy units. The limiting resolution was ranged from 1.0 to 2.2 Lp /mm for image intensifier field diameters between 7 ad 23 cm. The results of present study can be used as baseline for future quality assurance measurements. (Author)

  18. Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction.

    Science.gov (United States)

    Mellor, F E; Thomas, P; Breen, A

    2014-08-01

    Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) ( n  = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA). The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm 2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm 2 ), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm 2 ) is lower than for four view functional radiography (7.34 Gy cm 2 ). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm 2 ) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased.

  19. Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction

    International Nuclear Information System (INIS)

    Mellor, F.E.; Thomas, P.; Breen, A.

    2014-01-01

    Purpose: Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. Methods: Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA). Results and conclusion: The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm 2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm 2 ), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm 2 ) is lower than for four view functional radiography (7.34 Gy cm 2 ). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm 2 ) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased

  20. Fluoroscopy Learning Curve in Hip Arthroscopy-A Single Surgeon's Experience.

    Science.gov (United States)

    Smith, Kevin M; Duplantier, Neil L; Crump, Kimbelyn H; Delgado, Domenica A; Sullivan, Stephanie L; McCulloch, Patrick C; Harris, Joshua D

    2017-10-01

    To determine if (1) absorbed radiation dose and (2) fluoroscopy time decreased with experience over the first 100 cases of a single surgeon's hip arthroscopy practice. Subjects who underwent hip arthroscopy for symptomatic femoroacetabular impingement and labral injury were eligible for analysis. Inclusion criteria included the first 100 subjects who underwent hip arthroscopy by a single surgeon (December 2013 to December 2014). Subject demographics, procedure details, fluoroscopy absorbed dose (milligray [mGy]), and time were recorded. Subjects were categorized by date of surgery to one of 4 possible groups (25 per group). One-way analysis of variance was used to determine if a significant difference in dose (mGy) or time was present between groups. Simple linear regression analysis was performed to determine the relation between case number and both radiation dose and fluoroscopy time. Subjects underwent labral repair (n = 93), cam osteoplasty (n = 90), and pincer acetabuloplasty (n = 65). There was a significant (P arthroscopy practice learning curve. Level IV, therapeutic, retrospective, noncomparative case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  1. Dose reduction in fluoroscopy with modern DSA equipment

    International Nuclear Information System (INIS)

    Waggershauser, T.; Herrmann, K.; Schaetzl, M.; Reiser, M.

    1995-01-01

    The new Multistar T.O.P. (Siemens) is equipped with various features for dose reduction. In this study pulsed fluoroscopy was tested versus standard continuous fluoroscopy and supervisions. Fluoroscope with 3, 7.5, and 15 pulses/s in the Multistar T.O.P. were compared to standard fluoroscopy and to reduced-dose supervision in a human pelvic phantom. The skin entry dose and pelvic dose were continuously registered. The supervision mode used 58% of the dose used in continuous fluoroscopy. Pulsed fluoroscopy with 15 pulses/s required 54%, 7.5 pulses/s 27% and 3 pulses/s. These provide adequate image quality with only 10% of the standard dose. (orig./MG) [de

  2. Special Blood Donation Procedures

    Science.gov (United States)

    ... Blood Products Special Blood Donation Procedures Precautions and Adverse Reactions During Blood Transfusion (See Overview of Blood Transfusion .) Plateletpheresis (platelet donation) In plateletpheresis, a donor gives only platelets rather than whole blood. Whole ...

  3. Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring.

    Science.gov (United States)

    Sailer, Anna M; Vergoossen, Laura; Paulis, Leonie; van Zwam, Willem H; Das, Marco; Wildberger, Joachim E; Jeukens, Cécile R L P N

    2017-11-01

    Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) µSv/Gy cm 2 versus (phase 2) 0.08 (0.02-0.24) µSv/Gy cm 2 , p = 0.002]. Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions.

  4. Radiation-Induced Alopecia after Endovascular Embolization under Fluoroscopy

    Directory of Open Access Journals (Sweden)

    Vipawee Ounsakul

    2016-01-01

    Full Text Available Radiation-induced alopecia after fluoroscopically guided procedures is becoming more common due to an increasing use of endovascular procedures. It is characterized by geometric shapes of nonscarring alopecia related to the area of radiation. We report a case of a 46-year-old man presenting with asymptomatic, sharply demarcated rectangular, nonscarring alopecic patch on the occipital scalp following cerebral angiography with fistula embolization under fluoroscopy. His presentations were compatible with radiation-induced alopecia. Herein, we also report a novel scalp dermoscopic finding of blue-grey dots in a target pattern around yellow dots and follicles, which we detected in the lesion of radiation-induced alopecia.

  5. Fluoroscopy-guided Sacroiliac Joint Steroid Injection for Low Back Pain in a Patient with Osteogenesis Imperfecta.

    Science.gov (United States)

    Dawson, P U; Rose, R E; Wade, N A

    2015-09-01

    Osteogenesis imperfecta, also known as 'brittle bone disease', is a genetic connective tissue disease. It is characterized by bone fragility and osteopenia (low bone density). In this case, a 57-year old female presented to the University Hospital of the West Indies (UHWI), Physical Medicine and Rehabilitation Clinic with left low back pain rated 6/10 on the numeric rating scale (NRS). Clinically, the patient had sacroiliac joint mediated pain although X-rays did not show the sacroiliac joint changes. Fluoroscopy-guided left sacroiliac joint steroid injection was done. Numeric rating scale and Oswestry Disability Index (ODI) questionnaire were used to evaluate outcome. This was completed at baseline, one week follow-up and at eight weeks post fluoroscopy-guided sacroiliac joint steroid injection. Numeric rating scale improved from 6/10 before the procedure to 0/10 post procedure, and ODI questionnaire score improved from a moderate disability score of 40% to a minimal disability score of 13%. Up to eight weeks, the NRS was 0/10 and ODI remained at minimal disability of 15%. Fluoroscopy-guided sacroiliac joint injection is a known diagnostic and treatment method for sacroiliac joint mediated pain. To our knowledge, this is the first case published on the use of fluoroscopy-guided sacroiliac joint steroid injection in the treatment of sacroiliac joint mediated low back pain in a patient with osteogenesis imperfecta.

  6. Implementation of a competency check-off in diagnostic fluoroscopy for radiology trainees: impact on reducing radiation for three common fluoroscopic exams in children

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Sweta [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); Desouches, Stephane L. [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); St. Luke' s Hospital, Department of Radiology, Kansas City, MO (United States); Lowe, Lisa H.; Kasraie, Nima; Reading, Brenton [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); Children' s Mercy Hospitals and Clinics, Department of Radiology, Kansas City, MO (United States)

    2014-07-24

    Fluoroscopy is an important tool for diagnosis in the pediatric population, but it carries the risk of radiation exposure. Because radiology resident education and experience in the use of fluoroscopy equipment in children vary, we implemented an intervention to standardize fluoroscopy training. The purpose of this study is to determine the impact of implementing a fluoroscopy competency check-off for radiology resident trainees aimed at decreasing radiation exposure in three common pediatric fluoroscopic studies. A fluoroscopy competency check-off form was developed for radiology resident trainees performing pediatric procedures. Techniques used to limit radiation exposure for common pediatric radiologic studies were reviewed as part of the check-off process. Pediatric radiologists supervised each trainee until they demonstrated competence to independently perform three specified procedures. Radiation dose was recorded for the three procedures, upper GI (UGI), voiding cystourethrogram (VCUG) and oropharyngeal (OPM) exams, over 6 months preceding and 6 months following implementation of the competency check-off. The mean cumulative dose for each procedure was compared before and after implementation of competency check-off using a Kruskal-Wallis test. During the 12-month study period doses from 909 fluoroscopic procedures were recorded. In the 6 months preceding competency check-off implementation, procedures were performed by 24 radiology resident trainees including 171 UGI, 176 VCUG and 171 OPM exams. In the 6 months following competency check-off, 23 trainees performed 114 UGI, 145 VCUG and 132 OPM exams. After competency check-off implementation, a statistically significant reduction in average radiation dose was found for all three studies (P < 0.001). Median cumulative doses (mGy) were decreased by 33%, 36% and 13% for UGIs, VCUGs and OPMs, respectively. Implementation of a competency check-off for radiology resident trainees can reduce average radiation

  7. Implementation of a competency check-off in diagnostic fluoroscopy for radiology trainees: impact on reducing radiation for three common fluoroscopic exams in children

    International Nuclear Information System (INIS)

    Shah, Sweta; Desouches, Stephane L.; Lowe, Lisa H.; Kasraie, Nima; Reading, Brenton

    2015-01-01

    Fluoroscopy is an important tool for diagnosis in the pediatric population, but it carries the risk of radiation exposure. Because radiology resident education and experience in the use of fluoroscopy equipment in children vary, we implemented an intervention to standardize fluoroscopy training. The purpose of this study is to determine the impact of implementing a fluoroscopy competency check-off for radiology resident trainees aimed at decreasing radiation exposure in three common pediatric fluoroscopic studies. A fluoroscopy competency check-off form was developed for radiology resident trainees performing pediatric procedures. Techniques used to limit radiation exposure for common pediatric radiologic studies were reviewed as part of the check-off process. Pediatric radiologists supervised each trainee until they demonstrated competence to independently perform three specified procedures. Radiation dose was recorded for the three procedures, upper GI (UGI), voiding cystourethrogram (VCUG) and oropharyngeal (OPM) exams, over 6 months preceding and 6 months following implementation of the competency check-off. The mean cumulative dose for each procedure was compared before and after implementation of competency check-off using a Kruskal-Wallis test. During the 12-month study period doses from 909 fluoroscopic procedures were recorded. In the 6 months preceding competency check-off implementation, procedures were performed by 24 radiology resident trainees including 171 UGI, 176 VCUG and 171 OPM exams. In the 6 months following competency check-off, 23 trainees performed 114 UGI, 145 VCUG and 132 OPM exams. After competency check-off implementation, a statistically significant reduction in average radiation dose was found for all three studies (P < 0.001). Median cumulative doses (mGy) were decreased by 33%, 36% and 13% for UGIs, VCUGs and OPMs, respectively. Implementation of a competency check-off for radiology resident trainees can reduce average radiation

  8. Radiofrequency ablation of hepatocellular carcinoma located in the liver dome under intermittent CT fluoroscopy guidance

    Energy Technology Data Exchange (ETDEWEB)

    Park, Darlene; Cho, Yun Ku; Cho, Hyun Je; KIm, Mi Young [Dept. of Radiology, VHS Medical Center, Seoul (Korea, Republic of)

    2014-02-15

    To evaluate the clinical effectiveness of an intermittent computed tomography (CT) fluoroscopy-guided radiofrequency (RF) ablation of hepatocellular carcinoma located in the liver dome. Between 2005 and 2010 23 patients with hepatocellular carcinoma (HCC) nodules located in the liver dome underwent an intermittent CT fluoroscopy-guided RF ablation. The primary endpoint was the local tumor progression. Procedure-related complications occurred in 3 of 23 patients. To evaluate the prognostic factors for the local tumor progression, univariate and multivariate analyses were performed using the Cox proportional hazards model. The chi-squared test was performed to evaluate the association of access route and procedure-related complication. The study was approved by the Institutional Review Board of our hospital. The Tumor sizes ranged between 1.0 and 2.9 cm. An initial complete ablation was achieved in all patients. The median follow-up period was 31 months and the major complication rate was 4.3%. The cumulative rate of local tumor progression at 3 years was 20%. The univariate analysis revealed that only serum total bilirubin level (p = 0.048) and prior chemoembolization were statistically significant (p = 0.044), but there was no independently significant prognostic factor on multivariate analysis. Procedure-related complications occurred in 3 of 23 patients. For HCC located in the liver dome an intermittent CT fluoroscopy-guided RF ablation could be performed safely and effectively.

  9. Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study.

    Science.gov (United States)

    Consiglieri, Claudia F; Gornals, Joan B; Busquets, Juli; Peláez, Nuria; Secanella, Lluis; De-La-Hera, Meritxell; Sanzol, Resurrección; Fabregat, Joan; Castellote, José

    2018-01-01

    The need for fluoroscopy guidance in patients undergoing endoscopic ultrasound-guided transmural drainage (EUS-TMD) of peripancreatic fluid collections (PFCs) remains unclear. The aim of this study was to compare general outcomes of EUS-TMD of PFCs under fluoroscopy (F) vs fluoroless (FL). This is a comparative study with a retrospective analysis of a prospective and consecutive inclusion database at a tertiary centre, from 2009 to 2015. All patients were symptomatic pseudocyst (PSC) and walled-off pancreatic necrosis (WON). Two groups were assigned depending on availability of fluoroscopy. The groups were heterogeneous in terms of their demographic characteristics, PFCs and procedure. The main outcome measures included technical and clinical success, incidences, adverse events (AEs), and follow-up. Fifty EUS-TMD of PFCs from 86 EUS-guided drainages were included during the study period. Group F included 26 procedures, PSC 69.2%, WON 30.8%, metal stents 61.5% (46.1% lumen-apposing stent) and plastic stents 38.5%. Group FL included 24 procedures, PSC 37.5%, WON 62.5%, and metal stents 95.8% (lumen-apposing stents). Technical success was 100% in both groups, and clinical success was similar (F 88.5%, FL 87.5%). Technical incidences and intra-procedure AEs were only described in group F (7.6% and 11.5%, respectively) and none in group FL. Procedure time was less in group FL (8min, p=0.0341). Fluoroless in the EUS-TMD of PFCs does not involve more technical incidences or intra-procedure AEs. Technical and clinical success was similar in the two groups. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  10. Initial experience with magnetic resonance fluoroscopy in the evaluation of oesophageal motility disorders. Comparison with manometry and barium fluoroscopy

    International Nuclear Information System (INIS)

    Panebianco, Valeria; Anzidei, Michele; Catalano, Carlo; Passariello, Roberto; Habib, Fortunee I.; Tomei, Ernesto; Paolantonio, Pasquale; Laghi, Andrea

    2006-01-01

    The aim of this paper was to assess the diagnostic value of magnetic resonance (MR) fluoroscopy in the study of oesophageal motility disorders and to compare MR fluoroscopy results with those of manometry and barium contrast radiography. Twenty-five subjects referred for dysphagia and three patients in follow-up after pneumatic dilatation of the lower oesophageal sphincter to treat severe achalasia underwent esophageal manometry, barium contrast radiography and MR fluoroscopy. Examinations were performed on a 1.5 T scanner. Dynamic turbo- fast low angle shot (turbo-FLASH) sequences acquired during oral contrast agent administration were used to perform MR fluoroscopy. MR fluoroscopy correctly diagnosed achalasia in nine patients, uncoordination of esophageal body motility in ten and scleroderma oesophagus in one. Diagnostic performance was satisfactory, with a sensitivity of 87.5% and a specificity of 100% in the general depiction of motility alterations. Our work demonstrates that MR fluoroscopic examination in subject affected by oesophageal motility disorders is feasible and can properly depict motility and morphology alterations, achieving correct diagnosis in the majority of cases. Studies on larger populations are necessary to obtain statistically significant results. (orig.)

  11. Initial experience with magnetic resonance fluoroscopy in the evaluation of oesophageal motility disorders. Comparison with manometry and barium fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Panebianco, Valeria; Anzidei, Michele; Catalano, Carlo; Passariello, Roberto [University of Rome ' ' La Sapienza' ' , Department of Radiological Sciences, Rome (Italy); Habib, Fortunee I.; Tomei, Ernesto [University of Rome ' ' La Sapienza' ' , Division of Gastroenterology, Rome (Italy); Paolantonio, Pasquale; Laghi, Andrea [University of Rome ' ' La Sapienza' ' , Department of Radiological Sciences - Polo Didattico Pontino I.C.O.T, Rome (Italy)

    2006-09-15

    The aim of this paper was to assess the diagnostic value of magnetic resonance (MR) fluoroscopy in the study of oesophageal motility disorders and to compare MR fluoroscopy results with those of manometry and barium contrast radiography. Twenty-five subjects referred for dysphagia and three patients in follow-up after pneumatic dilatation of the lower oesophageal sphincter to treat severe achalasia underwent esophageal manometry, barium contrast radiography and MR fluoroscopy. Examinations were performed on a 1.5 T scanner. Dynamic turbo- fast low angle shot (turbo-FLASH) sequences acquired during oral contrast agent administration were used to perform MR fluoroscopy. MR fluoroscopy correctly diagnosed achalasia in nine patients, uncoordination of esophageal body motility in ten and scleroderma oesophagus in one. Diagnostic performance was satisfactory, with a sensitivity of 87.5% and a specificity of 100% in the general depiction of motility alterations. Our work demonstrates that MR fluoroscopic examination in subject affected by oesophageal motility disorders is feasible and can properly depict motility and morphology alterations, achieving correct diagnosis in the majority of cases. Studies on larger populations are necessary to obtain statistically significant results. (orig.)

  12. Digital fluoroscopy: a new development in medical imaging

    International Nuclear Information System (INIS)

    Maher, K.P.; Malone, J.F.; Dublin Inst. of Technology

    1986-01-01

    Medical fluoroscopy is briefly reviewed and video-image digitization is described. Image processing requirements and image processors available for digital fluoroscopy are discussed in detail. Specific reference is made to an application of digital fluoroscopy in the imaging of blood-vessels. This application involves an image substraction technique which is referred to as digital subtraction angiography (DSA). A number of DSA images of relevance to the discussion are included. (author)

  13. CT fluoroscopy-guided renal tumour cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure.

    Science.gov (United States)

    Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu

    2018-01-01

    To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. • CT fluoroscopy-guided renal tumour biopsy has a high diagnostic yield. • CT fluoroscopy-guided renal tumour biopsy is safe. • Small tumour size (≤1.5 cm) is a risk factor for diagnostic failure.

  14. Iso-uncertainty control in an experimental fluoroscopy system

    International Nuclear Information System (INIS)

    Siddique, S.; Fiume, E.; Jaffray, D. A.

    2014-01-01

    Purpose: X-ray fluoroscopy remains an important imaging modality in a number of image-guided procedures due to its real-time nature and excellent spatial detail. However, the radiation dose delivered raises concerns about its use particularly in lengthy treatment procedures (>0.5 h). The authors have previously presented an algorithm that employs feedback of geometric uncertainty to control dose while maintaining a desired targeting uncertainty during fluoroscopic tracking of fiducials. The method was tested using simulations of motion against controlled noise fields. In this paper, the authors embody the previously reported method in a physical prototype and present changes to the controller required to function in a practical setting. Methods: The metric for feedback used in this study is based on the trace of the covariance of the state of the system, tr(C). The state is defined here as the 2D location of a fiducial on a plane parallel to the detector. A relationship between this metric and the tube current is first developed empirically. This relationship is extended to create a manifold that incorporates a latent variable representing the estimated background attenuation. The manifold is then used within the controller to dynamically adjust the tube current and maintain a specified targeting uncertainty. To evaluate the performance of the proposed method, an acrylic sphere (1.6 mm in diameter) was tracked at tube currents ranging from 0.5 to 0.9 mA (0.033 s) at a fixed energy of 80 kVp. The images were acquired on a Varian Paxscan 4030A (2048 × 1536 pixels, ∼100 cm source-to-axis distance, ∼160 cm source-to-detector distance). The sphere was tracked using a particle filter under two background conditions: (1) uniform sheets of acrylic and (2) an acrylic wedge. The measured tr(C) was used in conjunction with a learned manifold to modulate the tube current in order to maintain a specified uncertainty as the sphere traversed regions of varying thickness

  15. Equipment performance and radiation protection status in X-ray fluoroscopy units in Sudan

    International Nuclear Information System (INIS)

    Ahmed, N. A.; Nayl, A. I.; Suliman, I. I.

    2012-01-01

    The number of fluoroscopy and fluoroscopically guided procedures has been substantially growing in developing countries at the same time advanced and sophisticated equipment are used in some hospitals. However, radiation protection requirements are not necessarily well adopted. In this study nine fluoroscopy X-ray units in Sudan were examined for compliance with international standards. The tests included: beam quality, entrance surface air kerma, image quality and radiation field measurements. Staff radiation protection tools such as lead aprons and eye glasses were also visually examined to find out whether international recommendations were fulfilled and to determine the level of staff awareness. The measured peak tube voltage deviation exceeded the recommended tolerance level in 30 % of the measurements. The results of patient doses measurements exceeded the recommended reference dose levels in 43 % of the measurements; however image quality and radiation field generally fulfilled the requirements for most units. The study revealed that a considerable number of fluoroscopy units were not performing according to the international standards and highlights the need of optimisation of radiation protection. (authors)

  16. Patient radiation dose during fluoroscopy examinations in a selected hospital in Sudan

    International Nuclear Information System (INIS)

    Darsalih, Abir Abdelrady Elnoor

    2016-04-01

    The purpose of this study was to assess patient radiation dose during fluoroscopy examinations using contrast media in Sudan. Data was collected from the Department of Radiology of the Military Hospital in Omdurman. The quality control tests on the Fluoroscopy machine indicated that it is performing self-consistently. The patient doses were obtained from measurements made using Kerma Area Product (KAP) meter. Measurements were made on sixty patients. The special examinations considered were hysterosalpinogram (HSG), A sanding (A.S), D.Standing (D.S) , Gastrointestinal (G.I) tract and Sinogram. The KAP meter readings obtained were 2.68 ±1.80 mGy.m 2 ; 5.16 ±3.53 mGy.m 2 ; 9.15 ± 3.53 mGy.m 2 ; 5.80 ±6.22 mGy.m 2 and 10.33 ±10.69 mGy.m 2 respectively. Improved patient protection can be achieved by the adoption of standardized and optimized institutional protocols using equipment with an integrated dose management system. The cumulative reference point air-kerma data, along with KAP, should be routinely recorded in the patient records for trend analysis to provide the means to enhance optimization of patient protection in fluoroscopy practice. (au)

  17. Simulation-based education leads to decreased use of fluoroscopy in diagnostic coronary angiography.

    Science.gov (United States)

    Prenner, Stuart B; Wayne, Diane B; Sweis, Ranya N; Cohen, Elaine R; Feinglass, Joe M; Schimmel, Daniel R

    2017-08-02

    The aim of this study is to determine whether simulation-based education (SBE) translates into reduced procedure time, radiation, and contrast use in actual clinical care. As a high volume procedure often performed by novice cardiology fellows, diagnostic coronary angiography represents an excellent target for SBE. Reports of SBE in interventional cardiology are limited and there is little understanding of the potential downstream clinical impact of these interventions. All diagnostic coronary angiograms performed at a single center between January 1, 2011 and June 30, 2015 were analyzed. Random effects linear regression models were used to compare outcomes between procedures performed by 12 cardiology fellows who underwent simulation-based training and those performed by 20 traditionally trained fellows. Thirty-two cardiology fellows performed 2,783 diagnostic coronary angiograms. Procedures performed by fellows trained with SBE were shorter (mean of 23.98 min vs. 24.94 min, P = 0.034) and were performed with decreased radiation (mean of 56,348 mGycm 2 vs. 66,120 mGycm 2 , P < 0.001). After controlling for year in training, procedure year, access site, and supervising attending physician, training on the simulator was independently associated with 117 fewer seconds of fluoroscopy time per procedure (P = 0.04). Diagnostic coronary angiography SBE is associated with decreased use of fluoroscopy in downstream clinical care. SBE may be a useful tool to reduce radiation exposure in the cardiac catheterization laboratory. © 2017 Wiley Periodicals, Inc.

  18. Fluoroscopy without image intensifier

    International Nuclear Information System (INIS)

    Canevaro, L.; Drexler, G.

    2001-01-01

    The objective of the present work was to evaluate the doses received by patients during fluoroscopy procedures carried out with an equipment without image intensifier. This evaluation is providing dose levels that our patients are presently exposed, and gives the data for epidemiological studies on risk estimate of cancer induction in patients exposed earlier when no image intensifiers existed. Diamentor M4 and E meters were used to measure the product dose-area (DAP). The data were acquired during barium enema, barium meal, barium swallow and histerosalpingographies. The measured values of DAP are considered high. This work intends to call the attention toward the optimization of the radiological protection in facilities that still use equipment without image intensifiers. While this equipment cannot be disabled, the patient exposure monitoring should be an incentive, and the application of radiological protection practices and programs of quality assurance should be of priority. (author)

  19. Is There a Relationship Between Body Mass Index and Fluoroscopy Time During Sacroiliac Joint Injection? A Multicenter Cohort Study.

    Science.gov (United States)

    McCormick, Zachary L; Cushman, Daniel; Lee, David T; Scholten, Paul; Chu, Samuel K; Babu, Ashwin N; Caldwell, Mary; Ziegler, Craig; Ashraf, Humaira; Sundar, Bindu; Clark, Ryan; Gross, Claire; Cara, Jeffrey; McCormick, Kristen; Ross, Brendon; Smith, Clark C; Press, Joel; Smuck, Matthew; Walega, David R

    2016-07-01

    To determine the relationship between BMI and fluoroscopy time during intra-articular sacroiliac joint (SIJ) injections performed for a pain indication. Multicenter retrospective cohort study. Three academic, outpatient pain treatment centers. Patients who underwent fluoroscopy guided SIJ injection with encounter data regarding fluoroscopy time during the procedure and body mass index (BMI). Median and 25-75% Interquartile Range (IQR) fluoroscopy time. 459 SIJ injections (350 patients) were included in this study. Patients had a median age of 57 (IQR 44, 70) years, and 72% were female. The median BMI in the normal weight, overweight, and obese groups were 23 (IQR 21, 24), 27 (IQR 26, 29), and 35 (IQR 32, 40), respectively. There was no significant difference in the median fluoroscopy time recorded between these BMI classes (p = 0.45). First-time SIJ injection (p = 0.53), bilateral injection (p = 0.30), trainee involvement (p = 0.47), and new trainee involvement (trainee participation during the first 2 months of the academic year) (p = 0.85) were not associated with increased fluoroscopy time for any of the three BMI categories. Fluoroscopy time during sacroiliac joint injection is not increased in patients who are overweight or obese, regardless of whether a first-time sacroiliac joint injection was performed, bilateral injections were performed, a trainee was involved, or a new trainee was involved. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. A systematic review of the uses of fluoroscopy in dentistry.

    Science.gov (United States)

    Uzbelger Feldman, Daniel; Yang, Jie; Susin, Cristiano

    2010-01-01

    To determine the quality of the evidence for the uses of fluoroscopy in dentistry. A systematic review using Ovid and MEDLINE was conducted to identify papers showing the uses of fluoroscopy in dentistry published between 1953 and September 2009. Human, animal and phantom/skull/mannequin studies on fluoroscopy with regard to its diagnostic value, research performance, and clinical and safety applications in dentistry were included in this analysis. Studies that were not in English, as well as those that employed fluoroscopy in dentistry without the use of image intensification, were excluded. Articles were evaluated, classified and graded by levels of evidence. Fifty-five out of 139 papers fulfilled the inclusion criteria. Amongst them, 19 were related to diagnosis, 15 to research, 12 to clinical and nine to safety applications. Fluoroscopy has contributed to nine different areas of dentistry. Also, it was used on 895 dental patients, 37 animals and 17 phantoms/skulls/mannequins. Two randomised controlled trials, two cohort studies, two case controls, 48 case reports and one expert opinion were found. Fluoroscopy with image intensification has been a useful, but not consistently used tool in dentistry for over 50 years. Several lines of evidence have shown fluoroscopy's diagnostic potential, research use, and clinical and safety applications in dentistry.

  1. Reduced medical and occupational exposures by optimizing working procedures in fluoroscopy equipment in the University Hospital of Santa Maria (RS); Reducao de exposicao medicas e ocupacionais pela otimizacao de procedimentos de trabalho em equipamento de fluoroscopia no Hospital Universitario de Santa Maria (RS)

    Energy Technology Data Exchange (ETDEWEB)

    Weis, Guilherme L.; Claus, Thiago V.; Baumhardt, Tadeu, E-mail: glweis@gmail.com [Hospital Universitario de Santa Maria, RS (Brazil); Shuch, Luiz A. [Universidade Federal de Santa Maria (UFSM), RS (Brazil). Dept. de Fisica

    2013-08-15

    This work seeks to reduce medical (patient) and occupational (workers) exposure by standardizing resources available in fluoroscopy equipment used in interventional procedures. Such procedures use transportable surgical arch type fluoroscopy equipment, with applications in orthopedics, angiography and pacemaker implantation. Improper use of these devices generates excessive radiation doses in both patients and the medical staff. It is observed that the equipment after being connected to the grid, is pre-selected to work in continuous fluoroscopy and no additional filtration, producing higher doses of radiation. For specific applications, changes in protocols should be undertaken according to medical indication. This work used a fluoroscopy equipment Shimadzu Active Opescope two radiation monitoring equipment, brand Radcal, models 9010 and 9015, two ionization chambers, of 60 cc and 180 cc and a low contrast phantom and a catheter, information that simulate the human body. Incidences were performed by changing the conditions of exposure as frame rates (fps - frames per second) and additional filtration. For each composition parameters was generated and filed an image, with the extent of their respective doses. These images were evaluated by radiologists. In more extreme cases we obtained a reduction of a factor 25 in occupational exposure (medical personnel) using the pulsed with the greatest 2 fps additional filter (0.3 mm Cu) compared to continuous system without any additional filtration. In medical exposure (of patients), decreased by a factor 39, the same conditions described above. With these arguments it is justified the optimization and standardization of the equipment used in fluoroscopy, which besides providing a dose reduction the patient and the medical personnel, increases the life of the X-ray tube while maintaining the quality of medical diagnosis. (author)

  2. CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax.

    Science.gov (United States)

    Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Matsui, Yusuke; Miyoshi, Shinichiro; Kanazawa, Susumu

    2016-01-01

    To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P =0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occur. Complications are usually minor and asymptomatic. A transfissural approach and longer procedure time are significant independent predictors of pneumothorax.

  3. Depth-resolved registration of transesophageal echo to x-ray fluoroscopy using an inverse geometry fluoroscopy system

    Energy Technology Data Exchange (ETDEWEB)

    Hatt, Charles R. [Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Tomkowiak, Michael T.; Dunkerley, David A. P.; Slagowski, Jordan M. [Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Funk, Tobias [Triple Ring Technologies, Inc., Newark, California 94560 (United States); Raval, Amish N. [Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Speidel, Michael A., E-mail: speidel@wisc.edu [Departments of Medical Physics and Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States)

    2015-12-15

    Purpose: Image registration between standard x-ray fluoroscopy and transesophageal echocardiography (TEE) has recently been proposed. Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system designed for cardiac procedures. This study presents a method for 3D registration of SBDX and TEE images based on the tomosynthesis and 3D tracking capabilities of SBDX. Methods: The registration algorithm utilizes the stack of tomosynthetic planes produced by the SBDX system to estimate the physical 3D coordinates of salient key-points on the TEE probe. The key-points are used to arrive at an initial estimate of the probe pose, which is then refined using a 2D/3D registration method adapted for inverse geometry fluoroscopy. A phantom study was conducted to evaluate probe pose estimation accuracy relative to the ground truth, as defined by a set of coregistered fiducial markers. This experiment was conducted with varying probe poses and levels of signal difference-to-noise ratio (SDNR). Additional phantom and in vivo studies were performed to evaluate the correspondence of catheter tip positions in TEE and x-ray images following registration of the two modalities. Results: Target registration error (TRE) was used to characterize both pose estimation and registration accuracy. In the study of pose estimation accuracy, successful pose estimates (3D TRE < 5.0 mm) were obtained in 97% of cases when the SDNR was 5.9 or higher in seven out of eight poses. Under these conditions, 3D TRE was 2.32 ± 1.88 mm, and 2D (projection) TRE was 1.61 ± 1.36 mm. Probe localization error along the source-detector axis was 0.87 ± 1.31 mm. For the in vivo experiments, mean 3D TRE ranged from 2.6 to 4.6 mm and mean 2D TRE ranged from 1.1 to 1.6 mm. Anatomy extracted from the echo images appeared well aligned when projected onto the SBDX images. Conclusions: Full 6 DOF image registration between SBDX and TEE is feasible and accurate to within 5 mm. Future studies will focus on

  4. Depth-resolved registration of transesophageal echo to x-ray fluoroscopy using an inverse geometry fluoroscopy system

    International Nuclear Information System (INIS)

    Hatt, Charles R.; Tomkowiak, Michael T.; Dunkerley, David A. P.; Slagowski, Jordan M.; Funk, Tobias; Raval, Amish N.; Speidel, Michael A.

    2015-01-01

    Purpose: Image registration between standard x-ray fluoroscopy and transesophageal echocardiography (TEE) has recently been proposed. Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system designed for cardiac procedures. This study presents a method for 3D registration of SBDX and TEE images based on the tomosynthesis and 3D tracking capabilities of SBDX. Methods: The registration algorithm utilizes the stack of tomosynthetic planes produced by the SBDX system to estimate the physical 3D coordinates of salient key-points on the TEE probe. The key-points are used to arrive at an initial estimate of the probe pose, which is then refined using a 2D/3D registration method adapted for inverse geometry fluoroscopy. A phantom study was conducted to evaluate probe pose estimation accuracy relative to the ground truth, as defined by a set of coregistered fiducial markers. This experiment was conducted with varying probe poses and levels of signal difference-to-noise ratio (SDNR). Additional phantom and in vivo studies were performed to evaluate the correspondence of catheter tip positions in TEE and x-ray images following registration of the two modalities. Results: Target registration error (TRE) was used to characterize both pose estimation and registration accuracy. In the study of pose estimation accuracy, successful pose estimates (3D TRE < 5.0 mm) were obtained in 97% of cases when the SDNR was 5.9 or higher in seven out of eight poses. Under these conditions, 3D TRE was 2.32 ± 1.88 mm, and 2D (projection) TRE was 1.61 ± 1.36 mm. Probe localization error along the source-detector axis was 0.87 ± 1.31 mm. For the in vivo experiments, mean 3D TRE ranged from 2.6 to 4.6 mm and mean 2D TRE ranged from 1.1 to 1.6 mm. Anatomy extracted from the echo images appeared well aligned when projected onto the SBDX images. Conclusions: Full 6 DOF image registration between SBDX and TEE is feasible and accurate to within 5 mm. Future studies will focus on

  5. Radiofrequency ablation of lung and liver lesions using CT fluoroscopy

    International Nuclear Information System (INIS)

    Chai, A.; Glenn, D.

    2002-01-01

    Full text: Tumour ablation with radiofrequency (RF) energy is a relatively new procedure for the treatment of focal malignant disease. At our institution this is currently being used in the treatment of certain liver and lung lesions with the patients involved being enrolled in clinical trials. The poster describes the technique used at our institution for the placement of the radiofrequency ablation electrode using CT fluoroscopy. Criteria for patient selection are included. Complications from the procedure are described, as well as follow up appearances and results. Our results from the treatment of primary and secondary lesions in the liver correlate well with published literature. Treatment is still not as successful as surgical resection but there is significantly less morbidity. Where this method may be appropriate is when the patient is not a candidate for surgical resection. The treatment of colorectal metastases in the lung shows early promise as a possible second line treatment (as for liver) where the patient is not a candidate for surgery. Preliminary results are soon to be published in conjunction with the Department of Surgery at our institution. RF Electrode placement using CT Fluoroscopy is performed at our institution. While still at its early stages, RF Ablation shows promise as a possible second line treatment (with other adjuvant therapy) for the management of focal malignant disease in the lung and liver. Copyright (2002) Blackwell Science Pty Ltd

  6. Percutaneous Extraction of Cement Leakage After Vertebroplasty Under CT and Fluoroscopy Guidance: A New Technique

    International Nuclear Information System (INIS)

    Amoretti, Nicolas; Huwart, Laurent

    2012-01-01

    Purpose: We report a new minimally invasive technique of extraction of cement leakage following percutaneous vertebroplasty in adults. Methods: Seven adult patients (five women, two men; mean age: 81 years) treated for vertebral compression fractures by percutaneous vertebroplasty had cement leakage into perivertebral soft tissues along the needle route. Immediately after vertebroplasty, the procedure of extraction was performed under computed tomography (CT) and fluoroscopy guidance: a Chiba needle was first inserted using the same route as the vertebroplasty until contact was obtained with the cement fragment. This needle was then used as a guide for an 11-gauge Trocar t’am (Thiebaud, France). After needle withdrawal, a 13-gauge endoscopy clamp was inserted through the cannula to extract the cement fragments. The whole procedure was performed under local anesthesia. Results: In each patient, all cement fragments were withdrawn within 10 min, without complication. Conclusions: This report suggests that this CT- and fluoroscopy-guided percutaneous technique of extraction could reduce the rate of cement leakage-related complications.

  7. 3D reconstruction from X-ray fluoroscopy for clinical veterinary medicine using differential volume rendering

    International Nuclear Information System (INIS)

    Khongsomboon, K.; Hamamoto, Kazuhiko; Kondo, Shozo

    2007-01-01

    3D reconstruction from ordinary X-ray equipment which is not CT or MRI is required in clinical veterinary medicine. Authors have already proposed a 3D reconstruction technique from X-ray photograph to present bone structure. Although the reconstruction is useful for veterinary medicine, the technique has two problems. One is about exposure of X-ray and the other is about data acquisition process. An x-ray equipment which is not special one but can solve the problems is X-ray fluoroscopy. Therefore, in this paper, we propose a method for 3D-reconstruction from X-ray fluoroscopy for clinical veterinary medicine. Fluoroscopy is usually used to observe a movement of organ or to identify a position of organ for surgery by weak X-ray intensity. Since fluoroscopy can output a observed result as movie, the previous two problems which are caused by use of X-ray photograph can be solved. However, a new problem arises due to weak X-ray intensity. Although fluoroscopy can present information of not only bone structure but soft tissues, the contrast is very low and it is very difficult to recognize some soft tissues. It is very useful to be able to observe not only bone structure but soft tissues clearly by ordinary X-ray equipment in the field of clinical veterinary medicine. To solve this problem, this paper proposes a new method to determine opacity in volume rendering process. The opacity is determined according to 3D differential coefficient of 3D reconstruction. This differential volume rendering can present a 3D structure image of multiple organs volumetrically and clearly for clinical veterinary medicine. This paper shows results of simulation and experimental investigation of small dog and evaluation by veterinarians. (author)

  8. Fusion of CT Angiography or MR Angiography with Unenhanced CBCT and Fluoroscopy Guidance in Endovascular Treatments of Aorto-Iliac Steno-Occlusion: Technical Note on a Preliminary Experience

    Energy Technology Data Exchange (ETDEWEB)

    Ierardi, Anna Maria; Duka, Ejona [University of Insubria, Interventional Radiology, Department of Radiology (Italy); Radaelli, Alessandro [Philips Healthcare (Netherlands); Rivolta, Nicola; Piffaretti, Gabriele [University of Insubria, Vascular Surgery Department (Italy); Carrafiello, Gianpaolo, E-mail: gcarraf@gmail.com [University of Insubria, Interventional Radiology, Department of Radiology (Italy)

    2016-01-15

    AimTo evaluate the feasibility of image fusion (IF) of pre-procedural arterial-phase CT angiography or MR angiography with intra-procedural fluoroscopy for road-mapping in endovascular treatment of aorto-iliac steno-occlusive disease.Materials and MethodsBetween September and November, 2014, we prospectively evaluated 5 patients with chronic aorto-iliac steno-occlusive disease, who underwent endovascular treatment in the angiography suite. Fusion image road-mapping was performed using angiographic phase CT images or MR images acquired before and intra-procedural unenhanced cone-beam CT. Radiation dose of the procedure, volume of intra-procedural iodinated contrast medium, fluoroscopy time, and overall procedural time were recorded. Reasons for potential fusion imaging inaccuracies were also evaluated.ResultsImage co-registration and fusion guidance were feasible in all procedures. Mean radiation dose of the procedure was 60.21 Gycm2 (range 55.02–63.75 Gycm2). The mean total procedure time was 32.2 min (range 27–38 min). The mean fluoroscopy time was 12 min and 3 s. The mean procedural iodinated contrast material dose was 24 mL (range 20–40 mL).ConclusionsIF gives Interventional Radiologists the opportunity to use new technologies in order to improve outcomes with a significant reduction of contrast media administration.

  9. Fusion of CT Angiography or MR Angiography with Unenhanced CBCT and Fluoroscopy Guidance in Endovascular Treatments of Aorto-Iliac Steno-Occlusion: Technical Note on a Preliminary Experience

    International Nuclear Information System (INIS)

    Ierardi, Anna Maria; Duka, Ejona; Radaelli, Alessandro; Rivolta, Nicola; Piffaretti, Gabriele; Carrafiello, Gianpaolo

    2016-01-01

    AimTo evaluate the feasibility of image fusion (IF) of pre-procedural arterial-phase CT angiography or MR angiography with intra-procedural fluoroscopy for road-mapping in endovascular treatment of aorto-iliac steno-occlusive disease.Materials and MethodsBetween September and November, 2014, we prospectively evaluated 5 patients with chronic aorto-iliac steno-occlusive disease, who underwent endovascular treatment in the angiography suite. Fusion image road-mapping was performed using angiographic phase CT images or MR images acquired before and intra-procedural unenhanced cone-beam CT. Radiation dose of the procedure, volume of intra-procedural iodinated contrast medium, fluoroscopy time, and overall procedural time were recorded. Reasons for potential fusion imaging inaccuracies were also evaluated.ResultsImage co-registration and fusion guidance were feasible in all procedures. Mean radiation dose of the procedure was 60.21 Gycm2 (range 55.02–63.75 Gycm2). The mean total procedure time was 32.2 min (range 27–38 min). The mean fluoroscopy time was 12 min and 3 s. The mean procedural iodinated contrast material dose was 24 mL (range 20–40 mL).ConclusionsIF gives Interventional Radiologists the opportunity to use new technologies in order to improve outcomes with a significant reduction of contrast media administration

  10. Deterministic effects of interventional radiology procedures

    International Nuclear Information System (INIS)

    Shope, Thomas B.

    1997-01-01

    The purpose of this paper is to describe deterministic radiation injuries reported to the Food and Drug Administration (FDA) that resulted from therapeutic, interventional procedures performed under fluoroscopic guidance, and to investigate the procedure or equipment-related factors that may have contributed to the injury. Reports submitted to the FDA under both mandatory and voluntary reporting requirements which described radiation-induced skin injuries from fluoroscopy were investigated. Serious skin injuries, including moist desquamation and tissues necrosis, have occurred since 1992. These injuries have resulted from a variety of interventional procedures which have required extended periods of fluoroscopy compared to typical diagnostic procedures. Facilities conducting therapeutic interventional procedures need to be aware of the potential for patient radiation injury and take appropriate steps to limit the potential for injury. (author)

  11. Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Arindam Kumar Hazra

    2016-01-01

    Full Text Available Background and Aims: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP. Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. Methods: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg through caudal route either using ultrasound guidance (Group U, n = 25 or fluoroscopy guidance (Group F, n = 25. Pre-procedural visual analogue scale (VAS score and Oswestry Disability Index (ODI were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS score and ODI at the 2nd week and again at the end of 1st and 2nd month. Results: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively,P< 0.001. Significant reduction in VAS score and ODI (clinical improvement was noted in the follow-up time points and comparable between the groups at all time points. Conclusion: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores remains comparable between both the techniques.

  12. SU-F-P-44: A Direct Estimate of Peak Skin Dose for Interventional Fluoroscopy Procedures

    International Nuclear Information System (INIS)

    Weir, V; Zhang, J

    2016-01-01

    Purpose: There is an increasing demand for medical physicist to calculate peak skin dose (PSD) for interventional fluoroscopy procedures. The dose information (Dose-Area-Product and Air Kerma) displayed in the console cannot directly be used for this purpose. Our clinical experience shows that the use of the existing methods may overestimate or underestimate PSD. This study attempts to develop a direct estimate of PSD from the displayed dose metrics. Methods: An anthropomorphic torso phantom was used for dose measurements for a common fluoroscopic procedure. Entrance skin doses were measured with a Piranha solid state point detector placed on the table surface below the torso phantom. An initial “reference dose rate” (RE) measurement was conducted by comparing the displayed dose rate (mGy/min) to the dose rate measured. The distance from table top to focal spot was taken as the reference distance (RD at the RE. Table height was then adjusted. The displayed air kerma and DAP were recorded and sent to three physicists to estimate PSD. An inverse square correction was applied to correct displayed air kerma at various table heights. The PSD estimated by physicists and the PSD by the proposed method were then compared with the measurements. The estimated DAPs were compared to displayed DAP readings (mGycm2). Results: The difference between estimated PSD by the proposed method and direct measurements was less than 5%. For the same set of data, the estimated PSD by each of three physicists is different from measurements by ±52%. The DAP calculated by the proposed method and displayed DAP readings in the console is less than 20% at various table heights. Conclusion: PSD may be simply estimated from displayed air kerma or DAP if the distance between table top and tube focal spot or if x-ray beam area on table top is available.

  13. SU-F-P-44: A Direct Estimate of Peak Skin Dose for Interventional Fluoroscopy Procedures

    Energy Technology Data Exchange (ETDEWEB)

    Weir, V [Baylor Scott and White Healthcare System, Dallas, TX (United States); Zhang, J [University of Kentucky, Lexington, KY (United States)

    2016-06-15

    Purpose: There is an increasing demand for medical physicist to calculate peak skin dose (PSD) for interventional fluoroscopy procedures. The dose information (Dose-Area-Product and Air Kerma) displayed in the console cannot directly be used for this purpose. Our clinical experience shows that the use of the existing methods may overestimate or underestimate PSD. This study attempts to develop a direct estimate of PSD from the displayed dose metrics. Methods: An anthropomorphic torso phantom was used for dose measurements for a common fluoroscopic procedure. Entrance skin doses were measured with a Piranha solid state point detector placed on the table surface below the torso phantom. An initial “reference dose rate” (RE) measurement was conducted by comparing the displayed dose rate (mGy/min) to the dose rate measured. The distance from table top to focal spot was taken as the reference distance (RD at the RE. Table height was then adjusted. The displayed air kerma and DAP were recorded and sent to three physicists to estimate PSD. An inverse square correction was applied to correct displayed air kerma at various table heights. The PSD estimated by physicists and the PSD by the proposed method were then compared with the measurements. The estimated DAPs were compared to displayed DAP readings (mGycm2). Results: The difference between estimated PSD by the proposed method and direct measurements was less than 5%. For the same set of data, the estimated PSD by each of three physicists is different from measurements by ±52%. The DAP calculated by the proposed method and displayed DAP readings in the console is less than 20% at various table heights. Conclusion: PSD may be simply estimated from displayed air kerma or DAP if the distance between table top and tube focal spot or if x-ray beam area on table top is available.

  14. Computed tomography- and fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults: a new technique

    International Nuclear Information System (INIS)

    Amoretti, Nicolas; Huwart, Laurent; Browaeys, Patrick; Nouri, Yasir; Ibba, Caroline; Hauger, Olivier; Marcy, Pierre-Yves; Boileau, Pascal

    2012-01-01

    To evaluate the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous screw fixation for the treatment of low-grade isthmic spondylolisthesis in adults. Ten consecutive adult patients (four men and six women; mean age: 57.1 [range, 44-78 years]) were prospectively treated by percutaneous screw fixation for low-grade (six grade 1 and four grade 2) isthmic spondylolisthesis of L5. For each patient, two 4.0-mm Asnis III cannulated screws were placed to fix the pars interarticularis defects. All procedures were performed under local anaesthesia by using CT and fluoroscopy guidance. Post-operative outcome was assessed using the visual analogue scale and Oswestry Disability Index (ODI) scores. The procedure time ranged from 45 to 60 min. The mean screw length was 27 mm (range, 24-32 mm). The VAS and ODI measurements ± SD decreased from 7.8 ± 0.9 preoperatively to 1.5 ± 1.1 at the last 2-year follow-up, and from 62.3 ± 17.2 to 15.1 ± 6.0, respectively (P < 0.001 in both cases). Neither slip progression nor screw failure was noted. This feasibility study showed that CT- and fluoroscopy-guided percutaneous screw fixation could be a rapid, safe and effective method of treating low-grade isthmic spondylolisthesis. (orig.)

  15. Computed tomography- and fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults: a new technique

    Energy Technology Data Exchange (ETDEWEB)

    Amoretti, Nicolas; Huwart, Laurent; Browaeys, Patrick; Nouri, Yasir; Ibba, Caroline [Hopital Archet 2, Centre Hospitalo-Universitaire de Nice, Department of Radiology, Nice (France); Hauger, Olivier [Hopital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Department of Radiology, Bordeaux (France); Marcy, Pierre-Yves [Antoine Lacassagne Cancer Research Institute, Department of Radiology, Nice (France); Boileau, Pascal [Hopital Archet 2, Centre Hospitalo-Universitaire de Nice, Department of Orthopedic Surgery, Nice (France)

    2012-12-15

    To evaluate the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous screw fixation for the treatment of low-grade isthmic spondylolisthesis in adults. Ten consecutive adult patients (four men and six women; mean age: 57.1 [range, 44-78 years]) were prospectively treated by percutaneous screw fixation for low-grade (six grade 1 and four grade 2) isthmic spondylolisthesis of L5. For each patient, two 4.0-mm Asnis III cannulated screws were placed to fix the pars interarticularis defects. All procedures were performed under local anaesthesia by using CT and fluoroscopy guidance. Post-operative outcome was assessed using the visual analogue scale and Oswestry Disability Index (ODI) scores. The procedure time ranged from 45 to 60 min. The mean screw length was 27 mm (range, 24-32 mm). The VAS and ODI measurements {+-} SD decreased from 7.8 {+-} 0.9 preoperatively to 1.5 {+-} 1.1 at the last 2-year follow-up, and from 62.3 {+-} 17.2 to 15.1 {+-} 6.0, respectively (P < 0.001 in both cases). Neither slip progression nor screw failure was noted. This feasibility study showed that CT- and fluoroscopy-guided percutaneous screw fixation could be a rapid, safe and effective method of treating low-grade isthmic spondylolisthesis. (orig.)

  16. Comparison of measured and estimated maximum skin doses during CT fluoroscopy lung biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Zanca, F., E-mail: Federica.Zanca@med.kuleuven.be [Department of Radiology, Leuven University Center of Medical Physics in Radiology, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium and Imaging and Pathology Department, UZ Leuven, Herestraat 49, Box 7003 3000 Leuven (Belgium); Jacobs, A. [Department of Radiology, Leuven University Center of Medical Physics in Radiology, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium); Crijns, W. [Department of Radiotherapy, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium); De Wever, W. [Imaging and Pathology Department, UZ Leuven, Herestraat 49, Box 7003 3000 Leuven, Belgium and Department of Radiology, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium)

    2014-07-15

    Purpose: To measure patient-specific maximum skin dose (MSD) associated with CT fluoroscopy (CTF) lung biopsies and to compare measured MSD with the MSD estimated from phantom measurements, as well as with the CTDIvol of patient examinations. Methods: Data from 50 patients with lung lesions who underwent a CT fluoroscopy-guided biopsy were collected. The CT protocol consisted of a low-kilovoltage (80 kV) protocol used in combination with an algorithm for dose reduction to the radiology staff during the interventional procedure, HandCare (HC). MSD was assessed during each intervention using EBT2 gafchromic films positioned on patient skin. Lesion size, position, total fluoroscopy time, and patient-effective diameter were registered for each patient. Dose rates were also estimated at the surface of a normal-size anthropomorphic thorax phantom using a 10 cm pencil ionization chamber placed at every 30°, for a full rotation, with and without HC. Measured MSD was compared with MSD values estimated from the phantom measurements and with the cumulative CTDIvol of the procedure. Results: The median measured MSD was 141 mGy (range 38–410 mGy) while the median cumulative CTDIvol was 72 mGy (range 24–262 mGy). The ratio between the MSD estimated from phantom measurements and the measured MSD was 0.87 (range 0.12–4.1) on average. In 72% of cases the estimated MSD underestimated the measured MSD, while in 28% of the cases it overestimated it. The same trend was observed for the ratio of cumulative CTDIvol and measured MSD. No trend was observed as a function of patient size. Conclusions: On average, estimated MSD from dose rate measurements on phantom as well as from CTDIvol of patient examinations underestimates the measured value of MSD. This can be attributed to deviations of the patient's body habitus from the standard phantom size and to patient positioning in the gantry during the procedure.

  17. Comparison of measured and estimated maximum skin doses during CT fluoroscopy lung biopsies

    International Nuclear Information System (INIS)

    Zanca, F.; Jacobs, A.; Crijns, W.; De Wever, W.

    2014-01-01

    Purpose: To measure patient-specific maximum skin dose (MSD) associated with CT fluoroscopy (CTF) lung biopsies and to compare measured MSD with the MSD estimated from phantom measurements, as well as with the CTDIvol of patient examinations. Methods: Data from 50 patients with lung lesions who underwent a CT fluoroscopy-guided biopsy were collected. The CT protocol consisted of a low-kilovoltage (80 kV) protocol used in combination with an algorithm for dose reduction to the radiology staff during the interventional procedure, HandCare (HC). MSD was assessed during each intervention using EBT2 gafchromic films positioned on patient skin. Lesion size, position, total fluoroscopy time, and patient-effective diameter were registered for each patient. Dose rates were also estimated at the surface of a normal-size anthropomorphic thorax phantom using a 10 cm pencil ionization chamber placed at every 30°, for a full rotation, with and without HC. Measured MSD was compared with MSD values estimated from the phantom measurements and with the cumulative CTDIvol of the procedure. Results: The median measured MSD was 141 mGy (range 38–410 mGy) while the median cumulative CTDIvol was 72 mGy (range 24–262 mGy). The ratio between the MSD estimated from phantom measurements and the measured MSD was 0.87 (range 0.12–4.1) on average. In 72% of cases the estimated MSD underestimated the measured MSD, while in 28% of the cases it overestimated it. The same trend was observed for the ratio of cumulative CTDIvol and measured MSD. No trend was observed as a function of patient size. Conclusions: On average, estimated MSD from dose rate measurements on phantom as well as from CTDIvol of patient examinations underestimates the measured value of MSD. This can be attributed to deviations of the patient's body habitus from the standard phantom size and to patient positioning in the gantry during the procedure

  18. 20 CFR 655.102 - Special procedures.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Special procedures. 655.102 Section 655.102 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR TEMPORARY EMPLOYMENT OF... in force until modified by the Administrator. ...

  19. Occurrence of aspiration pneumonia in dysphagic children post video fluoroscopy

    Directory of Open Access Journals (Sweden)

    Lagos, Hellen Nataly Correia

    2011-10-01

    Full Text Available Introduction: The literature reports that when it comes of instrumental assessment of swallowing in children, undoubtedly, video fluoroscopy of swallow offers great advantages over the endoscopic study. Objective: Check the risk of aspiration pneumonia after the study of swallowing by video fluoroscopy, in children with dysphagia. Method: In a study of prospective cutting, participated 16 children aged between 6 months and 10 years, with an average of 5,2 years, referred for study of swallowing by video fluoroscopy. Were tested 4 consistencies, pudding, nectar, honey and liquid. The presences of signs and/or respiratory symptoms were evaluated pre and post study of deglutition by video fluoroscopy, through history and clinical exam. When necessary was asked chest x-ray. Results: Of 16 children, 5 didn't presented dysphagia. In 11 children the exam showed 4 with mild dysphagia, 2 moderate and 5 severe, as classification of OTT (1996 - Classification of severity of dysphagia to the video fluoroscopy. Of the 7 children who aspirated during the exam, only 1 presented respiratory symptoms after the deglutition study, but without signal of pneumonia to the physical examination. Conclusion: In the studied population there were no occurrences of aspiration pneumonia after the study of deglutition was performed by video fluoroscopy, despite the occurrence of aspiration during the exam in about 50% of cases.

  20. Radiation exposure of operator during various interventional procedures

    International Nuclear Information System (INIS)

    Yu, In Kyu; Chung, Jin Wook; Han, Joon Koo; Park, Jae Hyung; Kang, Wee Saing

    1994-01-01

    To investigate the levels of radiation exposure of an operator which may be influenced by the wearing an apron, type of procedure, duration of fluoroscopy and operator's skill during various interventional procedures. Radiation doses were measured both inside and outside the apron(0.5 mm lead equivalent) of the operator by a film badge monitoring method and the duration of fluoroscopy was measured in 96 procedures prospectively. The procedures were 30 transcatheter arterial embolization (TAE), 25 percutaneous transhepatic biliary drainages (PTBD), 16 stone removals (SR), 15 percutaneous needle aspirations (PNCA) and 10 percutaneous nephrostomies(PCN). To assess the difference of exposure by the operator's skill, the procedures of TAE and PTBD were done separately by groups of staffs and residents. Average protective effect of the apron was 72.8%. Average radiation exposure(unit: μ Sv/procedure was 23.3 in PTBD by residents, 10.0 in PTBD by staffs, 10.0 in SR, 8.7 in TAE by residents, 7.3 in TAE by staffs, 9.0 in PCN and 6.0 in PCNA. Average radiation exposure of residents were 1.9 times greater than those of staffs. Radiation exposure was not proportionally related to the duration of fluoroscopy, but influenced by wearing an apron, various types of procedure and operator's skills

  1. Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI.

    Science.gov (United States)

    Ghoshhajra, Brian B; Takx, Richard A P; Stone, Luke L; Girard, Erin E; Brilakis, Emmanouil S; Lombardi, William L; Yeh, Robert W; Jaffer, Farouc A

    2017-06-01

    The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with x-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. • Real-time semi-automated fusion of CTA/fluoroscopy is feasible during CTO PCI. • CTA fusion data can be toggled on/off as desired during CTO PCI • Real-time CT calcium and centreline overlay could benefit antegrade dissection/reentry-based CTO PCI.

  2. Results and complications of CT-guided biopsy with CT fluoroscopy

    International Nuclear Information System (INIS)

    Saika, Yoshinori; Ogura, Yasuharu; Doi, Kenji; Misaki, Toshimasa; Shimizu, Masashi; Narabayashi, Isamu

    2002-01-01

    We studied the results and complications of CT-guided biopsy with CT fluoroscopy performed 66 lesions in 64 patients from March 1999 to February 2001. In addition to the conventional procedure of CT-guided biopsy, we use CT fluoroscopy for confirmation of the location of the tip of the biopsy needle and the accurate contact, in some cases, at the time of puncturing. Examination results showed malignancy in 36 lesions and benign findings in 30 lesions. The sensitivity was 85.7%, specificity was 100.0%, and accuracy was 90.9%. Pneumothorax occurred in 20 out of 64 patients (31.3%). In a study on 26 small lesions (≤2 cm) in 25 patients, the sensitivity was 81.8%, specificity was 100.0%, accuracy was 92.3%. Pneumothorax occurred in 12 out of 25 patients (48.0%), more frequently than in patients with large lesions. In a study on 6 false negative cases, they tended to be intrapulmonary on location, small in diameter, and far from the skin puncture point. Examination results were satisfactory, especially in terms of accuracy in small lesions (≤2 cm). However, when the lesions were small, pneumothorax occurred frequently (48.0%). (author)

  3. Estimating effective dose to pediatric patients undergoing interventional radiology procedures using anthropomorphic phantoms and MOSFET dosimeters.

    Science.gov (United States)

    Miksys, Nelson; Gordon, Christopher L; Thomas, Karen; Connolly, Bairbre L

    2010-05-01

    The purpose of this study was to estimate the effective doses received by pediatric patients during interventional radiology procedures and to present those doses in "look-up tables" standardized according to minute of fluoroscopy and frame of digital subtraction angiography (DSA). Organ doses were measured with metal oxide semiconductor field effect transistor (MOSFET) dosimeters inserted within three anthropomorphic phantoms, representing children at ages 1, 5, and 10 years, at locations corresponding to radiosensitive organs. The phantoms were exposed to mock interventional radiology procedures of the head, chest, and abdomen using posteroanterior and lateral geometries, varying magnification, and fluoroscopy or DSA exposures. Effective doses were calculated from organ doses recorded by the MOSFET dosimeters and are presented in look-up tables according to the different age groups. The largest effective dose burden for fluoroscopy was recorded for posteroanterior and lateral abdominal procedures (0.2-1.1 mSv/min of fluoroscopy), whereas procedures of the head resulted in the lowest effective doses (0.02-0.08 mSv/min of fluoroscopy). DSA exposures of the abdomen imparted higher doses (0.02-0.07 mSv/DSA frame) than did those involving the head and chest. Patient doses during interventional procedures vary significantly depending on the type of procedure. User-friendly look-up tables may provide a helpful tool for health care providers in estimating effective doses for an individual procedure.

  4. Use of intraoperative fluoroscopy during laparotomy to identify fragments of retained Essure microinserts: case report.

    Science.gov (United States)

    Howard, David L; Christenson, Paul J; Strickland, Julie L

    2012-01-01

    In previous case-reports of Essure microinsert perforation, the microinsert was successfully removed at laparoscopy. Herein is discussed the scenario of persistent pelvic pain over several years after an apparently successful laparoscopic retrieval of a perforating right-sided microinsert. In the interim, the patient underwent 2 unsuccessful exploratory laparotomy procedures in an attempt to retrieve additional microinsert fragments that had perforated the uterus. Successful management of Essure microinsert perforation in this patient ultimately required use of intraoperative fluoroscopy. Surgeons performing laparoscopy or laparotomy to retrieve Essure microinserts that have perforated should be aware that these are not always visible to the naked eye, and there should be a low threshold to use intraoperative fluoroscopy to ensure that all perforating fragments have been removed. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

  5. Evaluation of sleep apnea syndrome (SAS) with low field MR fluoroscopy

    International Nuclear Information System (INIS)

    Fukatsu, Hiroshi; Ando, Yoko; Ishigaki, Takeo; Okada, Tamotsu.

    1995-01-01

    Eight cases of clinically diagnosed sleep apnea syndrome (SAS) and two normal volunteers were studied with low field MR fluoroscopy in order to monitor the waking and sleeping status of the upper airway. MR fluoroscopy revealed that only the sleeping patients showed occlusions of the upper airway. This technique provided us with useful information about the level, frequency and duration of occlusion in each case. Four of the eight patients demonstrated simple retropalatal occlusion, whereas the other four demonstrated mixed retropalatal and retropalato-retroglossal occlusion. Thus long-time monitoring, which is only possible with MR fluoroscopy, is needed to appreciate the complex nature of the disease. In addition, the comfortable surroundings and low noise level provided by the low field enabled physiological study to be performed without any tranquilizers in most of the patients, which is again only possible with MR fluoroscopy. MR fluoroscopy may become a tool of great clinical value, providing much important information for disease evaluation and treatment selection. (author)

  6. Evaluation of occupational dose from the special procedures guided by fluoroscopy: cardiac catheterism

    International Nuclear Information System (INIS)

    Silva, Amanda Juliene da

    2011-01-01

    The purpose of this study was to evaluate the dose received by health professionals in the hemodynamic sector of a university hospital in Sao Paulo city. A self-applied questionnaire was used to delineate the profile of health professionals, taking into account sociodemographic variables and variables related to the work with ionizing radiation. The assessment of occupational doses was performed by consulting of the individual dose records of the institution database from 2000 to 2009. A total of 240 records was evaluated, corresponding to 38 active professionals (2009), divided in different professional category: physician, nurses, radiologic technologists and nursing assistants. The annual doses were compared with the limits established by national regulatory authorities. Based on the effective doses received and recorded during the studied period, experimental measures were performed with TL dosimeters in five physicians to evaluate the equivalent dose, in the left hand, during hemodynamic procedures. In addition, the radioprotection measures adopted by health professionals were verified. This study allowed delineating the profile of medical staff that integrates the hemodynamic service as well as knowing the distribution of their doses in relation to limits over the years. (author)

  7. Cold neutron fluoroscopy of operating automotive engines

    International Nuclear Information System (INIS)

    Stewart, P.A.E.; Heritage, J.

    1983-01-01

    The application of neutron fluoroscopy in the automotive industry is a natural extension of previous studies with aircraft engines. This paper describes investigations with two sub-compact car engines. The extent and manner in which lubricants reached the various parts of the engines are compared and contrasted. The paper goes on to describe a study of the deposits inside turbochargers and postulates future topics worthy of investigation. The authors confirm that there is a place for neutron fluoroscopy both as a design tool and for investigations of ''in-service'' phenomena. (Auth.)

  8. Computed tomographic fluoroscopy-guided transthoracic needle biopsy for diagnosis of pulmonary nodules

    International Nuclear Information System (INIS)

    Hirose, Takashi; Mori, Kiyoshi; Machida, Suguru; Tominaga, Keigo; Yokoi, Kohei; Adachi, Mitsuru

    2000-01-01

    The purpose of this study was to evaluate the usefulness of computed tomographic (CT) fluoroscopy-guided transthoracic needle biopsy (TTNB) with an 18-gauge automatic biopsy gun for the diagnosis of pulmonary nodules. Between March 1996 and January 1998, 50 patients in whom pulmonary lesions could not be diagnosed cytopathologically with fiberoptic bronchoscopy or were not clearly visualized with fluoroscopy underwent CT fluoroscopy-guided TTNB. Final pathological diagnoses were 23 lung carcinomas, five pulmonary metastases and 22 benign lesions. Sufficient tissue for analysis was obtained from 48 of the 50 lesions (96%). The overall diagnostic yield of CT fluoroscopy-guided TTNB was 90%. The sensitivity, specificity and accuracy for malignancy were 89%, 100% and 94%, respectively. In 20 of the 22 cases (91%) of benign lesions, histological analysis yielded correct and specific diagnoses. Complications occurred in 22 of the 50 cases (44%). The most common complication was pneumothorax, which occurred in 21 of the 50 cases (42%). Chest tube insertion was required in 6 (12%). Although CT fluoroscopy could not decrease the complication rate, CT fluoroscopy-guided TTNB with an automatic biopsy gun appears to be a promising technique for diagnosing pulmonary lesions, particularly benign lesions. (author)

  9. Real time CT-fluoroscopy: diagnostic and therapeutic applications

    International Nuclear Information System (INIS)

    Mey, J. de; Op de Beeck, B.; Meysman, M.; Noppen, M.; Maeseneer, M. de; Vanhoey, M.; Vincken, W.; Osteaux, M.

    2000-01-01

    The synergetic progression of CT technology and computer hardware has made ultrafast acquisition and image reconstruction possible. This has lead to the availability of CT interactive diagnosis and therapeutic procedures. Making use of our own material (337 intervention procedures during the last 17 months), we have compared our techniques and results to the recent literature data. One of the advantages of the biopsy technique is an improved sensitivity for neoplastic lesions, most certainly in cases of intrapulmonary lesions, surrounded by aerated tissue (now 94% compared to 87% in our previous study). A second advantage is the safety of the technique (only one major complication in our series). Fluid collection drainages, and more complex interventions like local injection of drugs, radio-frequency ablation, wire hook placement and ethanol injection were performed without complication. Yet another interesting feature is the shortening of the procedure time (reduced in average to an 'in-room' time of less than 30 min), which has definite economical implications. Furthermore it increases the patient's comfort and safety, and extends the scope of outpatient procedures (80% outpatient procedures in our material). On the other side the radiation exposure can be raised as an issue, especially when we consider the operator's hands. However, the described technique and the use of dedicated tools can alleviate the problem. As a conclusion, real time CT fluoroscopy has given a new input and broadens the scope of clinical indications of CT-guided diagnostic and therapeutic procedures

  10. Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Yung; Tsauo, Jiaywei; Song, Ho-Young [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Park, Hong Ju; Kang, Woo Seok [University of Ulsan College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, Seoul (Korea, Republic of); Park, Jung-Hoon [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); University of Ulsan College of Medicine, Department of Biomedical Engineering Research Center, Asan Medical Center, Seoul (Korea, Republic of); Wang, Zhe [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Tianjin Medical University General Hospital, Department of Radiology (China)

    2018-03-15

    To prospectively evaluate the technical feasibility and safety of fluoroscopy-guided balloon dilation in patients with Eustachian tube (ET) dysfunction. Patients who could not do a Valsalva manoeuvre for more than 6 months and diagnosed with chronic otitis media or ET dysfunction were prospectively enrolled. A 0.035-in. guide wire and 6-mm long balloon catheter with a diameter of 2 mm were used to dilate the cartilaginous portion of the ET under fluoroscopic guidance. The balloon was inflated by manual injection twice for 1 min each time. Clinical outcomes were assessed by the patient's ability to perform a Valsalva manoeuvre, and symptoms were assessed using the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Balloon dilation was attempted in a total of ten adult patients from October 2016 to March 2017. Technical success was achieved in all procedures (10/10). Ninety percent (9/10) of the balloons were fully dilated without waist deformity. There were no major complications. All patients were able to perform a Valsalva manoeuvre at the time of their last visit and/or improvement of at least one ETDQ-7 score. Fluoroscopy-guided balloon dilation seems to be technically feasible and safe in the treatment of ET dysfunction. (orig.)

  11. Impact of attributed audit on procedural performance in cardiac electrophysiology catheter laboratory.

    Science.gov (United States)

    Sawhney, V; Volkova, E; Shaukat, M; Khan, F; Segal, O; Ahsan, S; Chow, A; Ezzat, V; Finlay, M; Lambiase, P; Lowe, M; Dhinoja, M; Sporton, S; Earley, M J; Hunter, R J; Schilling, R J

    2018-06-01

    Audit has played a key role in monitoring and improving clinical practice. However, audit often fails to drive change as summative institutional data alone may be insufficient to do so. We hypothesised that the practice of attributed audit, wherein each individual's procedural performance is presented will have a greater impact on clinical practice. This hypothesis was tested in an observational study evaluating improvement in fluoroscopy times for AF ablation. Retrospective analyses of fluoroscopy times in AF ablations at the Barts Heart Centre (BHC) from 2012-2017. Fluoroscopy times were compared pre- and post- the introduction of attributed audit in 2012 at St Bartholomew's Hospital (SBH). In order to test the hypothesis, this concept was introduced to a second group of experienced operators from the Heart Hospital (HH) as part of a merger of the two institutions in 2015 and change in fluoroscopy times recorded. A significant drop in fluoroscopy times (33.3 ± 9.14 to 8.95 ± 2.50, p audit. At the time of merger, a significant difference in fluoroscopy times between operators from the two centres was seen in 2015. Each operator's procedural performance was shared openly at the audit meeting. Subsequent audits showed a steady decrease in fluoroscopy times for each operator with the fluoroscopy time (min, mean±SD) decreasing from 13.29 ± 7.3 in 2015 to 8.84 ± 4.8 (p audit can promptsignificant improvement and hence should be adopted in clinical practice.

  12. The study on clinical conditions and skin dose of upper-gastrointestinal x-ray fluoroscopy

    International Nuclear Information System (INIS)

    Kim, Sung Chul; Ahn, Sung Min; Jang, Sang Sup

    2007-01-01

    This study examined present conditions of upper-gastrointestinal X-ray fluoroscopy and patient skin dose. The authors elected 21 equipment to check the X-ray equipment and exposure factor of fluoroscopy and spot exposure in university hospitals, hospitals, and clinics where perform upper-gastrointestinal X-ray fluoroscopy more than five times every day in Incheon areas. The amount of patient's skin dose during upper-gastrointestinal X-ray fluoroscopy was measured by ionization chamber

  13. Operation logic and functionality of automatic dose rate and image quality control of conventional fluoroscopy

    International Nuclear Information System (INIS)

    Lin, Pei-Jan Paul

    2009-01-01

    New generation of fluoroscopic imaging systems is equipped with spectral shaping filters complemented with sophisticated automatic dose rate and image quality control logic called ''fluoroscopy curve'' or ''trajectory''. Such fluoroscopy curves were implemented first on cardiovascular angiographic imaging systems and are now available on conventional fluoroscopy equipment. This study aims to investigate the control logic operations under the fluoroscopy mode and acquisition mode (equivalent to the legacy spot filming) of a conventional fluoroscopy system typically installed for upper-lower gastrointestinal examinations, interventional endoscopy laboratories, gastrointestinal laboratory, and pain clinics.

  14. CT fluoroscopy-guided core needle biopsy of anterior mediastinal masses.

    Science.gov (United States)

    Iguchi, T; Hiraki, T; Matsui, Y; Fujiwara, H; Sakurai, J; Masaoka, Y; Uka, M; Tanaka, T; Gobara, H; Kanazawa, S

    2018-02-01

    To retrospectively evaluate the safety, diagnostic yield, and risk factors of diagnostic failure of computed tomography (CT) fluoroscopy-guided biopsies of anterior mediastinal masses. Biopsy procedures and results of anterior mediastinal masses in 71 patients (32 women/39 men; mean [±standard deviation] age, 53.8±20.0years; range, 14-88years) were analyzed. Final diagnoses were based on surgical outcomes, imaging findings, or clinical follow-up findings. The biopsy results were compared with the final diagnosis, and the biopsy procedures grouped by pathologic findings into diagnostic success and failure groups. Multiple putative risk factors for diagnostic failure were then assessed. Seventy-one biopsies (71 masses; mean size, 67.5±27.3mm; range 8.6-128.2mm) were analyzed. We identified 17 grade 1 and one grade 2 adverse events (25.4% overall) according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Sixty-nine biopsies (97.2%) provided samples fit for pathologic analysis. Diagnostic failure was found for eight (11.3%) masses; the 63 masses diagnosed successfully included thymic carcinoma (n=17), lung cancer (n=14), thymoma (n=12), malignant lymphoma (n=11), germ cell tumor (n=3), and others (n=6). Using a thinner needle (i.e., a 20-gauge needle) was the sole significant risk factor for diagnostic failure (P=0.039). CT fluoroscopy-guided biopsy of anterior mediastinal masses was safe and had a high diagnostic yield; however, using a thinner biopsy needle significantly increased the risk of a failed diagnosis. Copyright © 2017 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  15. Variation in radiation doses in paediatric cardiac catheterisation procedures

    International Nuclear Information System (INIS)

    Al-Haj, A. N.; Lobriguito, A. M.; Rafeh, W.

    2008-01-01

    Paediatric cardiac catheterisation involves diagnostic and therapeutic procedures that range from simple to complex and can subject paediatric patients to varying radiation doses. The study aims to determine the variation in entrance doses in patients in terms of dose-area product (DAP) values and to investigate the methods for optimising radiation protection. A total of 190 paediatric patients belonging to age groups 0, 1, 5 and 10 y who underwent diagnostic and six selected therapeutic procedures at King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia) were included in the study. Therapeutic procedures include coarctation (COA), patent ductus arteriosus (PDA), radiofrequency ablation, pulmonary, embolisation and septostomy. Fluoroscopy and cine radiography were used in all procedures. Patient demography (weight, age, gender and height), radiographic technique factors, fluoroscopy and cine time, frame rate, and DAP values were taken from patients records. Effective doses for each procedure were estimated from the DAP values. The mean DAP per procedure were analysed for correlation with patient equivalent cylindrical diameter, weight, fluoroscopy time and number of frames. Factors influencing the variation in doses were investigated. Initial results show that PDA occlusion has the highest mean DAP value of 23.21 Gy-cm 2 , while the diagnostic and septostomy procedures have the lowest value of 7.77 and 6.95 Gy-cm 2 , respectively. (authors)

  16. Combined ultrasound and fluoroscopy guided port catheter implantation-High success and low complication rate

    International Nuclear Information System (INIS)

    Gebauer, Bernhard; El-Sheik, Michael; Vogt, Michael; Wagner, Hans-Joachim

    2009-01-01

    Purpose: To evaluate peri-procedural, early and late complications as well as patients' acceptance of combined ultrasound and fluoroscopy guided radiological port catheter implantation. Materials and methods: In a retrospective analysis, all consecutive radiological port catheter implantations (n = 299) between August 2002 and December 2004 were analyzed. All implantations were performed in an angio suite under analgosedation and antibiotic prophylaxis. Port insertion was guided by ultrasonographic puncture of the jugular (n = 298) or subclavian (n = 1) vein and fluoroscopic guidance of catheter placement. All data of the port implantation had been prospectively entered into a database for interventional radiological procedures. To assess long-term results, patients, relatives or primary physicians were interviewed by telephone; additional data were generated from the hospital information system. Patients and/or the relatives were asked about their satisfaction with the port implantion procedure and long-term results. Results: The technical success rate was 99% (298/299). There were no major complications according to the grading system of SIR. A total of 23 (0.33 per 1000 catheter days) complications (early (n = 4), late (n = 19)) were recorded in the follow-period of a total of 72,727 indwelling catheter days. Infectious complications accounted for 0.15, thrombotic for 0.07 and migration for 0.04 complications per 1000 catheter days. Most complications were successfully treated by interventional measures. Twelve port catheters had to be explanted due to complications, mainly because of infection (n = 9). Patients' and relatives' satisfaction with the port catheter system was very high, even if complications occurred. Conclusion: Combined ultrasound and fluoroscopy guided port catheter implantation is a very safe and reliable procedure with low peri-procedural, early and late complication rate. The intervention achieves very high acceptance by the patients and

  17. Real-time fusion of coronary CT angiography with X-ray fluoroscopy during chronic total occlusion PCI

    Energy Technology Data Exchange (ETDEWEB)

    Ghoshhajra, Brian B.; Takx, Richard A.P. [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Boston, MA (United States); Stone, Luke L.; Yeh, Robert W.; Jaffer, Farouc A. [Harvard Medical School, Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Boston, MA (United States); Girard, Erin E. [Siemens Healthcare, Princeton, NJ (United States); Brilakis, Emmanouil S. [Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical Center, Dallas, TX (United States); Lombardi, William L. [University of Washington, Cardiology Division, Seattle, WA (United States)

    2017-06-15

    The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with X-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. (orig.)

  18. Operation logic and functionality of automatic dose rate and image quality control of conventional fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Pei-Jan Paul [Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115 (United States)

    2009-05-15

    New generation of fluoroscopic imaging systems is equipped with spectral shaping filters complemented with sophisticated automatic dose rate and image quality control logic called ''fluoroscopy curve'' or ''trajectory''. Such fluoroscopy curves were implemented first on cardiovascular angiographic imaging systems and are now available on conventional fluoroscopy equipment. This study aims to investigate the control logic operations under the fluoroscopy mode and acquisition mode (equivalent to the legacy spot filming) of a conventional fluoroscopy system typically installed for upper-lower gastrointestinal examinations, interventional endoscopy laboratories, gastrointestinal laboratory, and pain clinics.

  19. Still special? Harvesting procedures for industrial hemp

    Directory of Open Access Journals (Sweden)

    Hans-Jörg Gusovius

    2016-01-01

    Full Text Available A multitude of different harvesting procedures is available after the re-approval of hemp growing in Germany about 20 years ago. Established, but as well recent machine developments enable the supply of raw materials for further processing or as food and feed materials. The necessary specialization level results in high but, compared to other established crops, not exceeding procedural costs. In this study, harvesting procedures and technologies are analyzed that are currently used under Northern European cultivation conditions. However, technological enhancements are still needed in order to improve the competitiveness of fibre hemp in the crop rotation as well as of hemp-based semi-finished and finished products.

  20. CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax

    Energy Technology Data Exchange (ETDEWEB)

    Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Matsui, Yusuke; Kanazawa, Susumu [Okayama University Medical School, Departments of Radiology, Okayama (Japan); Miyoshi, Shinichiro [Okayama University Medical School, General Thoracic Surgery, Okayama (Japan)

    2016-01-15

    To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P = 0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. (orig.)

  1. CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax

    International Nuclear Information System (INIS)

    Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Matsui, Yusuke; Kanazawa, Susumu; Miyoshi, Shinichiro

    2016-01-01

    To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P = 0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. (orig.)

  2. Canadian study of cancer following multiple fluoroscopies

    International Nuclear Information System (INIS)

    Howe, G.R.

    1985-01-01

    Records of patients treated in Canadian Sanatoria during the period 1930-1952 have been linked with the National Death Index maintained by Statistics Canada to provide fact and cause of death information for the years 1950-1980. Of 31,710 women known to be under observation on January 1, 1950, 13,795 were exposed to fluoroscopy for control of collapse therapy, while the remaining 17,915 were unexposed. The unexposed had the similar mortality from breast cancer to that expected from general population rates. Those exposed to fluoroscopy had increasing mortality with increasing radiation dose to the breast, the best fit to the dose-response curve being a quadratic function. Estimates of risk at doses above 300 rads were largely derived from patients treated in Nova Scotia, where fluoroscopy was administered antero-posterior, as distinct from the more usual postero-antero practiced elsewhere. There is evidence of age-related susceptibility to radiation-induced breast cancer. The risk was maximal for those who first received fluoroscopy in their teens or twenties, but it was similar to expectation for those first exposed at age 30 or more. The latent period from onset of exposure to first increase in the death rate from breast cancer was 15 years for those first exposed at ages 10-24 and 10 years for those first exposed at ages 25 or more. However, these periods coincide with years when mortality from breast cancer normally rises and may therefore not be a true latent period effect. Estimates of predicted excess deaths from breast cancer per million women first exposed at ages 10-29 vary depending on the model used to represent the effect and whether or not data from the Nova Scotia Series are included in the computations

  3. Usefulness of CT fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy

    International Nuclear Information System (INIS)

    O, Dong Hyun; Cho, Young Jun; Park, Yong Sung; Hwang, Cheol Mok; Kim, Keum Won; Kim, Ji Hyung

    2006-01-01

    When pneumothorax occurs during a percutaneous needle biopsy, the radiologist usually stops the biopsy. We evaluated the usefulness of computed tomographic (CT) fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy. We performed 288 CT fluoroscopy guided percutaneous needle biopsies to diagnose the pulmonary nodules. Twenty two of these patients had pneumothorax that occurred during the biopsy without obtaining an adequate specimen. After pneumothorax occurred, we performed immediate CT fluoroscopy guided percutaneous needle biopsies using an 18-gauge cutting needle. We evaluated the success rate of the biopsies and also whether or not the pneumothorax progressed. We classified these patients into two groups according to whether the pneumothorax progressed (Group 2) or not (Group 1) by measuring the longest distance between the parietal pleura and the visceral pleura both in the early and late pneumothorax. Additionally, we analyzed the relationship between the progression of pneumothorax after biopsy and 1) the depth of the pulmonary nodule; 2) the number of biopsies; 3) the presence or absence of emphysema at the biopsy site; and 4) the size of the pulmonary nodule. Biopsy was successful in 19 of 22 nodules (86.3%). Of the 19 nodules, 12 (63.2%) were malignant and 7 (36.8%) were benign. Twelve patients (54.5%) were classified as group 1 and 10 patients (45.4%) as group 2. The distance between the lung lesion and pleura showed a statistically significant difference between these two groups: ≤ 1 cm in distance for group 1 (81.8%) and group 2 (18.2%), and > 1 cm in distance for group 1 (30%) and group 2 (70%), ρ 0.05). When early pneumothorax occurs during a biopsy, CT fluoroscopy guided percutaneous needle biopsy is an effective and safe procedure. Aggravation of pneumothorax after biopsy is affected by the depth of the pulmonary nodule

  4. Measurements of surgeons' exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy.

    Science.gov (United States)

    Lee, Kisung; Lee, Kyoung Min; Park, Moon Seok; Lee, Boram; Kwon, Dae Gyu; Chung, Chin Youb

    2012-06-15

    Measurement of radiation dose from C-arm fluoroscopy during a simulated intraoperative use in spine surgery. OBJECTIVE.: To investigate scatter radiation doses to specific organs of surgeons during intraoperative use of C-arm fluoroscopy in spine surgery and to provide practical intraoperative guidelines. There have been studies that reported the radiation dose of C-arm fluoroscopy in various procedures. However, radiation doses to surgeons' specific organs during spine surgery have not been sufficiently examined, and the practical intraoperative radioprotective guidelines have not been suggested. Scatter radiation dose (air kerma rate) was measured during the use of a C-arm on an anthropomorphic chest phantom on an operating table. Then, a whole body anthropomorphic phantom was located besides the chest phantom to simulate a surgeon, and scatter radiation doses to specific organs (eye, thyroid, breast, and gonads) and direct radiation dose to the surgeon's hand were measured using 4 C-arm configurations (standard, inverted, translateral, and tube translateral). The effects of rotating the surgeon's head away from the patient and of a thyroid shield were also evaluated. Scatter radiation doses decreased as distance from the patient increased during C-arm fluoroscopy use. The standard and translateral C-arm configurations caused lower scatter doses to sensitive organs than inverted and tube translateral configurations. Scatter doses were highest for breast and lowest for gonads. The use of a thyroid shield and rotating the surgeon's head away from the patient reduced scatter radiation dose to the surgeon's thyroid and eyes. The direct radiation dose was at least 20 times greater than scatter doses to sensitive organs. The following factors could reduce radiation exposure during intraoperative use of C-arm; (1) distance from the patient, (2) C-arm configuration, (3) radioprotective equipments, (4) rotating the surgeons' eyes away from the patient, and (5) avoiding

  5. A Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided Sacral Lateral Branch Blocks.

    Science.gov (United States)

    Finlayson, Roderick J; Etheridge, John-Paul B; Elgueta, Maria Francisca; Thonnagith, Atikun; De Villiers, Frederick; Nelems, Bill; Tran, De Q

    proportional decrease in numerical rating scale between preblock and postblock analgesic testing) was similar in both groups. Furthermore, no statistical differences were found in the proportions of patients achieving complete analgesia at each test site. The level of experience (ie, expert vs novice operator) significantly affected performance time with US but not with fluoroscopy. No procedural complications were recorded with either imaging modality during the 30-day follow-up period. Compared with their fluoroscopic counterparts, US-guided SLB blocks require a shorter performance time as well as fewer needle passes and carry a lower risk of vascular breach.

  6. CT fluoroscopy-guided renal tumour cutting needle biopsy. Retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure

    International Nuclear Information System (INIS)

    Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu

    2018-01-01

    To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. (orig.)

  7. CT fluoroscopy-guided renal tumour cutting needle biopsy. Retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure

    Energy Technology Data Exchange (ETDEWEB)

    Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu [Okayama University Medical School, Department of Radiology, Okayama (Japan)

    2018-01-15

    To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. (orig.)

  8. Classical fluoroscopy criteria poorly predict right ventricular lead septal positioning by comparison with echocardiography.

    Science.gov (United States)

    Squara, Fabien; Scarlatti, Didier; Riccini, Philippe; Garret, Gauthier; Moceri, Pamela; Ferrari, Emile

    2018-03-13

    Fluoroscopic criteria have been described for the documentation of septal right ventricular (RV) lead positioning, but their accuracy remains questioned. Consecutive patients undergoing pacemaker or defibrillator implantation were prospectively included. RV lead was positioned using postero-anterior and left anterior oblique 40° incidences, and right anterior oblique 30° to rule out coronary sinus positioning when suspected. RV lead positioning using fluoroscopy was compared to true RV lead positioning as assessed by transthoracic echocardiography (TTE). Precise anatomical localizations were determined with both modalities; then, RV lead positioning was ultimately dichotomized into two simple clinically relevant categories: RV septal or RV free wall. Accuracy of fluoroscopy for RV lead positioning was then assessed by comparison with TTE. We included 100 patients. On TTE, 66/100 had a septal RV lead and 34/100 had a free wall RV lead. Fluoroscopy had moderate agreement with TTE for precise anatomical localization of RV lead (k = 0.53), and poor agreement for septal/free wall localization (k = 0.36). For predicting septal RV lead positioning, classical fluoroscopy criteria had a high sensitivity (95.5%; 63/66 patients having a septal RV lead on TTE were correctly identified by fluoroscopy) but a very low specificity (35.3%; only 12/34 patients having a free wall RV lead on TTE were correctly identified by fluoroscopy). Classical fluoroscopy criteria have a poor accuracy for identifying RV free wall leads, which are most of the time misclassified as septal. This raises important concerns about the efficacy and safety of RV lead positioning using classical fluoroscopy criteria.

  9. Radiological protection in studies of interventionist fluoroscopy; Proteccion radiologica en estudios de fluoroscopia intervencionista

    Energy Technology Data Exchange (ETDEWEB)

    Juarez R, K.M

    2004-07-01

    The main objective of this study is to determine, if it is necessary or not, to establish appropriate additional procedures of radiological protection for the personal occupationally exposed. The particular objectives are: To evaluate the dose received in different parts of the body, for the personnel occupationally exposed (doctors, technicians and/or nurses) during studies with fluoroscopy. To compare the annual effective dose received by each OEP with the values of the limits settled down by the norms. To recommend protection measures in the event of being necessary. In the chapter 1 an introduction it is presented on the fluoroscopy, the types of studies that are carried out in interventionist fluoroscopy, as well as some characteristics of the equipment, and antecedents of studies carried out so much to patient as to the personnel. The chapter 2 contains the basic concepts of the interaction of the ionizing radiation with the matter, of the dosimetry and of the radiological protection. The characteristics and treatments of the dosemeters, the experimental techniques, devices and used calibration methods, as well as the studies with fluoroscopy and the regions of the body of the OEP for those that the measures of the dose were made are presented in the chapter 3. The chapter 4 contains the such experimental results as the values of the dose, for study in the different parts of the body, for the main doctors, auxiliary and anesthesiologist; the dose, for study, as function of the one time of duration of the study and of the patient's weight, as well as the annual effective dose to whole body, equivalent dose to crystalline, to hands, to feet and to skin, for each doctor and their comparison with the limits. The chapter 5 it contains the conclusions. Finally in the appendix the charts are included of the dose received by the principal doctor, the auxiliary doctor and the anesthesiologist during the carried out studies. (Author)

  10. 29 CFR 1614.308 - Practices and procedures of the Special Panel.

    Science.gov (United States)

    2010-07-01

    ... Systems Protection Board, 1120 Vermont Avenue, NW., Washington, DC 20419. One copy of each submission... 29 Labor 4 2010-07-01 2010-07-01 false Practices and procedures of the Special Panel. 1614.308... Special Panel. (a) Scope. The rules in this subpart apply to proceedings before the Special Panel. (b...

  11. Lightweight bilayer barium sulfate-bismuth oxide composite thyroid collars for superior radiation protection in fluoroscopy-guided interventions: a prospective randomized controlled trial.

    Science.gov (United States)

    Uthoff, Heiko; Benenati, Matthew J; Katzen, Barry T; Peña, Constantino; Gandhi, Ripal; Staub, Daniel; Schernthaner, Melanie

    2014-02-01

    To test whether newer bilayer barium sulfate-bismuth oxide composite (XPF) thyroid collars (TCs) provide superior radiation protection and comfort during fluoroscopy-guided interventions compared with standard 0.5-mm lead-equivalent TCs. Institutional review board approval and written informed consent were obtained for this HIPAA-compliant study, and 144 fluoroscopy-guided vascular interventions were included at one center between October 2011 and July 2012, with up to two operators randomly assigned to wear XPF (n = 135) or standard 0.5-mm lead-equivalent (n = 121) TCs. Radiation doses were measured by using dosimeters placed outside and underneath the TCs. Wearing comfort was assessed at the end of each procedure on a visual analog scale (0-100, with 100 indicating optimal comfort). Adjusted differences in comfort and radiation dose reductions were calculated by using a mixed logistic regression model and the common method of inverse variance weighting, respectively. Patient (height, weight, and body mass index) and procedure (type and duration of intervention, operator, fluoroscopy time, dose-area product, and air kerma) data did not differ between the XPF and standard groups. Comfort was assessed in all 256 measurements. On average, the XPF TCs were 47.6% lighter than the standard TCs (mean weight ± standard deviation, 133 g ± 14 vs 254 g ± 44; P 90; odds ratio, 7.6; 95% confidence interval: 3.0, 19.2; P standard group). The mean radiation dose reductions (ie, radiation protection) provided by XPF and standard TCs were 90.7% and 72.4%, with an adjusted mean difference of 17.9% (95% confidence interval: 7.7%, 28.1%; P standard 0.5-mm lead-equivalent TCs and provide superior radiation protection during fluoroscopy-guided interventions. © RSNA, 2013.

  12. Reference levels in PTCA as a function of procedure complexity

    International Nuclear Information System (INIS)

    Peterzol, A.; Quai, E.; Padovani, R.; Bernardi, G.; Kotre, C. J.; Dowling, A.

    2005-01-01

    The multicentre assessment of a procedure complexity index (CI) for the introduction of reference levels (RLs) in percutaneous transluminal coronary angio-plasties (PTCA) is presented here. PTCAs were investigated based on methodology proposed by Bernardi et al. Multiple linear stepwise regression analysis, including clinical, anatomical and technical factors, was performed to obtain fluoroscopy time predictors. Based on these regression coefficients, a scoring system was defined and CI obtained. CI was used to classify dose values into three groups: low, medium and high complexity procedures, since there was good correlation (r = 0.41; P 2 , and 12, 20 and 27 min for fluoroscopy time, for the three CI groups. (authors)

  13. Fluoroscopy-guided transnasal biopsy of nasopharyngeal carcinoma using a flexible bronchoscopic biopsy forcep

    International Nuclear Information System (INIS)

    Kim, Jai Keun; Chung, Tae Sub; Kim, Dong Ik; Suh, Jung Ho

    1996-01-01

    Otolaryngoscopic biopsy of nasopharyngeal carcinoma is a generalized method which may be associated with inadequate sampling of tissue and patient discomfort. So, we tried fluoroscopy-guided transnasal biopsy using bronchoscopic biopsy forcep and evaluated its safety and efficacy. Prospectively we performed fluoroscopy-guided transnasal biopsy in 11 patients who were radiographically suspected of nasopharyngeal carcinoma. The posterior wall of the nasopharynx was coated with barium sulfate under fluoroscopy. A flexible bronchoscopic biopsy forcep with a steerable guiding catheter which was used in removal of intrahepatic duct stones was inserted through the nare. After localization of the tip of the biopsy forcep at tumor site with fluoroscopy, a tissue specimen was obtained. We also tried CT guided biopsy in initial 2cases. Each patient had otolaryngoscopic biopsy to compare the biopsy result and patient discomfort. We could have sufficient amount of tissue for pathological evaluation in 10 of 11 patients by the first pass with the fluoroscopic technique. Contrarily, otolaryngoscopic biopsy was successful in 7 of 11 patients on single passage. Additionally, 2 patients had complaint in our method comparing with 9 patients in otolaryngoscopic biopsy. Fluoroscopy-guided transnasal biopsy of nasopharyngeal carcinoma using the bronchoscopic biopsy forcep is safe and accurate. It can be a appropriate method competing otolaryngoscopic biopsy

  14. Use of performance curves in estimating number of procedures required to achieve proficiency in coronary angiography

    DEFF Research Database (Denmark)

    Räder, Sune B E W; Jørgensen, Erik; Bech, Bo

    2011-01-01

    .001 for all parameters. To approach the experts' level of DAP and contrast media use, trainees need 394 and 588 procedures, respectively. Performance curves showed large individual differences in the development of competence. Conclusion: On average, trainees needed 300 procedures to reach sufficient level...... needed for trainees to reach recommended reference levels was estimated as 226 and 353, for DAP and use of contrast media, respectively. After 300 procedures, trainees' procedure time, fluoroscopy time, DAP, and contrast media volume were significantly higher compared with experts' performance, P ...Background: Current guidelines in cardiology training programs recommend 100-300 coronary angiography procedures for certification. We aimed to assess the number of procedures needed to reach sufficient proficiency. Methods: Procedure time, fluoroscopy time, dose area product (DAP), and contrast...

  15. Internal qualification and credentialing of radiation oncology physicists to perform patient special procedures

    Directory of Open Access Journals (Sweden)

    Michael D Mills

    2014-01-01

    Full Text Available In the arena of radiation oncology special procedures, medical physicists are often the focus professionals for implementation and administration of advanced and complex technologies. One of the most vexing and challenging aspects of managing complexity concerns the ongoing internal qualification and credentialing of radiation oncology physicists to perform patient special procedures. To demonstrate ongoing qualification, a physicist must a document initial training and successful completion of competencies to implement and perform this procedure, b demonstrate familiarity with all aspects of the commissioning and quality assurance process, c demonstrate continuing education respecting this procedure, d demonstrate the peer-reviewed completion of a minimum number of patient special procedures during a specified time span, and e demonstrate satisfactory overall progress toward maintenance of specialty board certification. In many respects, this information complement is similar to that required by an accredited residency program in therapy physics. In this investigation, we report on the design of a management tool to qualify staff radiation oncology physicists to deliver patient procedures.

  16. Usefulness of fluoroscopy-guided intra-articular injection of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Myung, Jae Sung; Lee, Joon Woo [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Lee, Ji Yeon [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)] (and others)

    2007-06-15

    To determine the accuracy of the intra-articular location of hyaluronic acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injection (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test ({rho} value = 0.14). Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee.

  17. Usefulness of fluoroscopy-guided intra-articular injection of the knee

    International Nuclear Information System (INIS)

    Myung, Jae Sung; Lee, Joon Woo; Lee, Ji Yeon

    2007-01-01

    To determine the accuracy of the intra-articular location of hyaluronic acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injection (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test (ρ value = 0.14). Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee

  18. SU-G-IeP3-13: Real-Time Patient and Staff Dose Monitoring in Fluoroscopy Guided Interventions

    International Nuclear Information System (INIS)

    Vergoossen, L; Sailer, A; Paulis, L; Wildberger, J; Jeukens, C

    2016-01-01

    Purpose: Interventional radiology procedures involve the use of X-rays, which can pose a large radiation burden on both patients and staff. Although some reports on radiation dose are available, most studies focus on limited types of procedures and only report patient dose. In our cathlabs a dedicated real-time patient and staff monitoring system was installed in November 2015. The aim of this study was to investigate the patient and staff dose exposure for different types of interventions. Methods: Radiologists involved in fluoroscopy guided interventional radiology procedures wore personal dose meters (PDM, DoseAware, Philips) on their lead-apron that measured the personal dose equivalent Hp(10), a measure for the effective dose (E). Furthermore, reference PDMs were installed in the C-arms of the fluoroscopy system (Allura XPer, Philips). Patient dose-area-product (DAP) and PDM doses were retrieved from the monitoring system (DoseWise, Philips) for each procedure. A total of 399 procedures performed between November 2015 and February 2016 were analyzed with respect to the type of intervention. Interventions were grouped by anatomy and radiologist position. Results: The mean DAP for the different types of interventions ranged from 2.86±2.96 Gycm"2 (percutaneous gastrostomy) to 147±178 Gycm"2 (aortic repair procedures). The radiologist dose (E) ranged from 5.39±7.38 µSv (cerebral interventions) to 84.7±106 µSv (abdominal interventions) and strongly correlated with DAP (R"2=0.83). The E normalized to DAP showed that the relative radiologist dose was higher for interventions in larger body parts (e.g. abdomen) compared to smaller body parts (e.g. head). Conclusion: Using a real-time dose monitoring system we were able to assess the staff and patient dose revealing that the relative staff dose strongly depended on the type of procedure and patient anatomy. This could be explained by the position of the radiologist with respect to the patient and X-ray tube. To

  19. 32 CFR 989.34 - Special and emergency procedures.

    Science.gov (United States)

    2010-07-01

    ... PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.34 Special and emergency procedures. (a... regulations or this part. If possible, promptly notify HQ USAF/A7CI, for SAF/IEE coordination and CEQ.... Coordination in this instance must take place as soon as practicable. [64 FR 38129, July 15, 1999, as amended...

  20. MO-DE-BRA-04: Hands-On Fluoroscopy Safety Training with Real-Time Patient and Staff Dosimetry

    International Nuclear Information System (INIS)

    Vanderhoek, M; Bevins, N

    2016-01-01

    Purpose: Fluoroscopically guided interventions (FGI) are routinely performed across many different hospital departments. However, many involved staff members have minimal training regarding safe and optimal use of fluoroscopy systems. We developed and taught a hands-on fluoroscopy safety class incorporating real-time patient and staff dosimetry in order to promote safer and more optimal use of fluoroscopy during FGI. Methods: The hands-on fluoroscopy safety class is taught in an FGI suite, unique to each department. A patient equivalent phantom is set on the patient table with an ion chamber positioned at the x-ray beam entrance to the phantom. This provides a surrogate measure of patient entrance dose. Multiple solid state dosimeters (RaySafe i2 dosimetry systemTM) are deployed at different distances from the phantom (0.1, 1, 3 meters), which provide surrogate measures of staff dose. Instructors direct participating clinical staff to operate the fluoroscopy system as they view live fluoroscopic images, patient entrance dose, and staff doses in real-time. During class, instructors work with clinical staff to investigate how patient entrance dose, staff doses, and image quality are affected by different parameters, including pulse rate, magnification, collimation, beam angulation, imaging mode, system geometry, distance, and shielding. Results: Real-time dose visualization enables clinical staff to directly see and learn how to optimize their use of their own fluoroscopy system to minimize patient and staff dose, yet maintain sufficient image quality for FGI. As a direct result of the class, multiple hospital departments have implemented changes to their imaging protocols, including reduction of the default fluoroscopy pulse rate and increased use of collimation and lower dose fluoroscopy modes. Conclusion: Hands-on fluoroscopy safety training substantially benefits from real-time patient and staff dosimetry incorporated into the class. Real-time dose display helps

  1. MO-DE-BRA-04: Hands-On Fluoroscopy Safety Training with Real-Time Patient and Staff Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Vanderhoek, M; Bevins, N [Henry Ford Health System, Detroit, MI (United States)

    2016-06-15

    Purpose: Fluoroscopically guided interventions (FGI) are routinely performed across many different hospital departments. However, many involved staff members have minimal training regarding safe and optimal use of fluoroscopy systems. We developed and taught a hands-on fluoroscopy safety class incorporating real-time patient and staff dosimetry in order to promote safer and more optimal use of fluoroscopy during FGI. Methods: The hands-on fluoroscopy safety class is taught in an FGI suite, unique to each department. A patient equivalent phantom is set on the patient table with an ion chamber positioned at the x-ray beam entrance to the phantom. This provides a surrogate measure of patient entrance dose. Multiple solid state dosimeters (RaySafe i2 dosimetry systemTM) are deployed at different distances from the phantom (0.1, 1, 3 meters), which provide surrogate measures of staff dose. Instructors direct participating clinical staff to operate the fluoroscopy system as they view live fluoroscopic images, patient entrance dose, and staff doses in real-time. During class, instructors work with clinical staff to investigate how patient entrance dose, staff doses, and image quality are affected by different parameters, including pulse rate, magnification, collimation, beam angulation, imaging mode, system geometry, distance, and shielding. Results: Real-time dose visualization enables clinical staff to directly see and learn how to optimize their use of their own fluoroscopy system to minimize patient and staff dose, yet maintain sufficient image quality for FGI. As a direct result of the class, multiple hospital departments have implemented changes to their imaging protocols, including reduction of the default fluoroscopy pulse rate and increased use of collimation and lower dose fluoroscopy modes. Conclusion: Hands-on fluoroscopy safety training substantially benefits from real-time patient and staff dosimetry incorporated into the class. Real-time dose display helps

  2. PA/Lateral chest X-ray is equivalent to cine-fluoroscopy for the detection of conductor externalization in defibrillation leads.

    Science.gov (United States)

    Steinberg, Christian; Sarrazin, Jean-François; Philippon, François; Champagne, Jean; Molin, Franck; Nault, Isabelle; Blier, Louis; Bouchard, Marc-André; Arsenault, Jean; O'Hara, Gilles

    2015-01-01

    Riata™ and Riata ST defibrillation leads (St. Jude Medical, Sylmar, CA, USA) are susceptible to insulation defects with conductor externalization. Cine-fluoroscopy is considered to be the gold standard for the documentation of insulation defects, but similar detection rates have been reported for posterior-anterior (PA)/lateral chest x-ray (CXR) with zooming. Prospective single-center study to assess the diagnostic equivalence of a PA/lateral CXR with zooming for the detection of Riata insulation defects in a direct comparison to cine-fluoroscopy. Seventy-eight consecutive patients underwent 3-view cine-fluoroscopy and a PA/lateral CXR. All CXRs and cine-fluoroscopy images were reviewed by blinded electrophysiologists and staff radiologists. Forty-four of 78 patients had an abnormal cine-fluoroscopy (56%). The diagnostic correlation between PA/lateral CXR and cine-fluoroscopy was excellent (κ = 0.90; 95% confidence interval 0.80-1.00). PA/lateral CXR was equivalent to cine-fluoroscopy for the detection of conductor externalization showing a sensitivity of 97.7% and a specificity of 91.2%. The mean radiation effective dose of CXR was significantly lower compared to cine-fluoroscopy (0.09 millisievert [mSV] vs 0.85 ± 0.47 mSv; P cine-fluoroscopy for the detection of Riata insulation defects and should be considered as the preferred screening method. ©2014 Wiley Periodicals, Inc.

  3. Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: A systematic review

    International Nuclear Information System (INIS)

    Beerekamp, M.S.H.; Sulkers, George S.I.; Ubbink, Dirk T.; Maas, Mario; Schep, Niels W.L.; Goslings, J. Carel

    2012-01-01

    Objectives: The aim of this systematic review was to compare the diagnostic accuracy, subjective image quality and clinical consequences of 3D-fluoroscopy with standard imaging modalities (2D-fluoroscopy, X-ray or CT) during reduction and fixation of intra-articular upper and lower extremity fractures. Methods: A systematic literature search was performed in MEDLINE, EMBASE and the Cochrane library. In total 673 articles were identified (up to March 2012). The 19 included studies described patients/cadavers with intra-articular upper/lower extremity fractures and compared 3D-fluoroscopy to standard imaging. The study was performed in accordance with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines. Diagnostic accuracy was defined by the quality of fracture reduction or implant position and, if possible, expressed as sensitivity and specificity; subjective image quality was determined by the quality of depiction of bone or implants; clinical consequences were defined as corrections in reduction or implant position following 3D-fluoroscopy. Results: Ten cadaver- and nine clinical studies were included. A meta-analysis was not possible, because studies used different scoring protocols to express diagnostic accuracy and reported incomplete data. Based on the individual studies, diagnostic accuracy of 3D-fluoroscopy was better than 2D-fluoroscopy and X-ray, but similar to CT-scanning. Subjective image quality of 3D-fluoroscopy was inferior compared to all other imaging modalities. In 11–40% of the operations additional corrections were performed after 3D-fluoroscopy, while the necessity for these corrections were not recognized based on 2D-fluoroscopic images. Conclusions: Although subjective image quality is rated inferior compared to other imaging modalities, intra-operative use of 3D-fluoroscopy is a helpful diagnostic tool for improving the quality of reduction and implant position in intra-articular fractures.

  4. Eye dose to staff involved in interventional and procedural fluoroscopy

    International Nuclear Information System (INIS)

    McLean, D; Hadaya, D; Tse, J

    2016-01-01

    In 2011 the International Commission on Radiological Protection (ICRP) lowered the occupational eye dose limit from 150 to 20 mSv/yr [1]. While international jurisdictions are in a process of adopting these substantial changes, medical physicists at the clinical level have been advising medical colleagues on specific situations based on dose measurements. Commissioned and calibrated TLDs mounted in commercially available holders designed to simulate the measurement of Hp(3), were applied to staff involved in x-ray procedures for a one month period. During this period clinical procedure data was concurrently collected and subject to audit. The use or not of eye personal protective equipment (PPE) was noted for all staff. Audits were conducted in the cardiac catheterisation laboratory, the interventional angiography rooms and the procedural room where endoscopic retrograde cholangiopancreatography (ERCP) procedures are performed. Significant levels of occupational dose were recorded in the cardiac and interventional procedures, with maximum reading exceeding the new limit for some interventional radiologists. No significant eye doses were measured for staff performing ERCP procedures. One outcome of the studies was increased use of eye PPE for operators of interventional equipment with increased availability also to nursing staff, when standing in close proximity to the patient during procedures. (paper)

  5. Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting

    Energy Technology Data Exchange (ETDEWEB)

    Matsui, Yusuke, E-mail: wckyh140@yahoo.co.jp; Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp; Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp; Iguchi, Toshihiro, E-mail: i10476@yahoo.co.jp; Fujiwara, Hiroyasu, E-mail: hirofujiwar@gmail.com; Kawabata, Takahiro, E-mail: tkhr-kwbt@yahoo.co.jp [Okayama University Medical School, Department of Radiology (Japan); Yamauchi, Takatsugu, E-mail: me9248@hp.okayama-u.ac.jp; Yamaguchi, Takuya, E-mail: me8738@hp.okayama-u.ac.jp [Okayama University Hospital, Central Division of Radiology (Japan); Kanazawa, Susumu, E-mail: susumu@cc.okayama-u.ac.jp [Okayama University Medical School, Department of Radiology (Japan)

    2016-06-15

    IntroductionComputed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking.Materials and MethodsRadiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator’s finger skin was measured using thermoluminescent dosimeter rings.ResultsThe mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator’s finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA.ConclusionRadiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.

  6. Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting.

    Science.gov (United States)

    Matsui, Yusuke; Hiraki, Takao; Gobara, Hideo; Iguchi, Toshihiro; Fujiwara, Hiroyasu; Kawabata, Takahiro; Yamauchi, Takatsugu; Yamaguchi, Takuya; Kanazawa, Susumu

    2016-06-01

    Computed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking. Radiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator's finger skin was measured using thermoluminescent dosimeter rings. The mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator's finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA. Radiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.

  7. Prospective evaluation of MR overlay on real-time fluoroscopy for percutaneous extremity biopsies of bone lesions visible on MRI but not on CT in children in the interventional radiology suite

    International Nuclear Information System (INIS)

    Shellikeri, Sphoorti; Vatsky, Seth; Srinivasan, Abhay; Krishnamurthy, Ganesh; Zhu, Xiaowei; Keller, Marc S.; Cahill, Anne Marie; Setser, Randolph M.

    2018-01-01

    Magnetic resonance imaging (MRI) often provides better visualization of bone marrow abnormalities than computed tomography (CT) or fluoroscopy, but bone biopsies are usually performed using conventional CT or, more recently, C-arm CT guidance. Biopsies of bone lesions solely visible on MRI are often challenging to localize and require the operator to review the MRI on a separate console to correlate with MRI anatomical landmarks during the biopsy. The MR overlay technique facilitates such biopsies in the angiographic suite by allowing the pre-procedural 3-D MRI to be overlaid on intraprocedural 2-D fluoroscopy. This study describes our initial experience with the MR overlay technique in the angiography suite during pediatric percutaneous extremity bone biopsies of lesions visible on MRI but not on CT or fluoroscopy and demonstrates its utility in relevant clinical cases. (orig.)

  8. Prospective evaluation of MR overlay on real-time fluoroscopy for percutaneous extremity biopsies of bone lesions visible on MRI but not on CT in children in the interventional radiology suite

    Energy Technology Data Exchange (ETDEWEB)

    Shellikeri, Sphoorti; Vatsky, Seth; Srinivasan, Abhay; Krishnamurthy, Ganesh; Zhu, Xiaowei; Keller, Marc S.; Cahill, Anne Marie [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Setser, Randolph M. [Siemens Medical Solutions USA, Inc., Hoffman Estates, IL (United States)

    2018-02-15

    Magnetic resonance imaging (MRI) often provides better visualization of bone marrow abnormalities than computed tomography (CT) or fluoroscopy, but bone biopsies are usually performed using conventional CT or, more recently, C-arm CT guidance. Biopsies of bone lesions solely visible on MRI are often challenging to localize and require the operator to review the MRI on a separate console to correlate with MRI anatomical landmarks during the biopsy. The MR overlay technique facilitates such biopsies in the angiographic suite by allowing the pre-procedural 3-D MRI to be overlaid on intraprocedural 2-D fluoroscopy. This study describes our initial experience with the MR overlay technique in the angiography suite during pediatric percutaneous extremity bone biopsies of lesions visible on MRI but not on CT or fluoroscopy and demonstrates its utility in relevant clinical cases. (orig.)

  9. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyung [Sam Anyang Hospital, Anyang (Korea, Republic of)

    2009-04-15

    To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

  10. Comparison of radiation exposure during fluoroscopy-guided transforaminal epidural steroid injections at different vertebral levels

    International Nuclear Information System (INIS)

    Hwang, Yun Mi; Lee, Min Hee; Kim, Seon Jeong; Shin, Myung Jin; Lee, Sang Hoon; Chung, Hye Won; Lee, Sheen Woo

    2015-01-01

    To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels. 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. 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). The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.

  11. Comparison of radiation exposure during fluoroscopy-guided transforaminal epidural steroid injections at different vertebral levels

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Yun Mi; Lee, Min Hee; Kim, Seon Jeong; Shin, Myung Jin; Lee, Sang Hoon; Chung, Hye Won [Dept. of Radiology, and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Lee, Sheen Woo [Dept. of Radiology, Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2015-04-15

    To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels. 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. 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). The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.

  12. 9 CFR 381.107 - Special procedures as to certification of poultry products for export to certain countries.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Special procedures as to certification...; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION POULTRY PRODUCTS... Procedures § 381.107 Special procedures as to certification of poultry products for export to certain...

  13. Narrow Lead Aprons under Medical Fluoroscopy Procedures

    International Nuclear Information System (INIS)

    Ben-Shlomo, A.

    2014-01-01

    Lead aprons are the major protective item of the medical staff whose work involves x-ray exposure. Heart catheterization and angiography procedures represent the most common exposures of the medical staff. The lead equivalent thickness of lead aprons worn by the medical staff is defined by many national standards. The frontal side of the aprons should be 0.25 mm lead equivalent at working conditions under 100 kV, 0.35 mm for working conditions above 100 kV, and 0.5 mm for heart catheterization and angiography. The back side of the body needs less protection and usually is covered by 0.25 mm of lead equivalent. The lead equivalent thickness is defined at the 80 kV level

  14. A filtering method for signal equalization in region-of-interest fluoroscopy

    International Nuclear Information System (INIS)

    Robert, Normand; Komljenovic, Philip T; Rowlands, J. A.

    2002-01-01

    A method to significantly reduce the exposure area product in fluoroscopy using a pre-patient region-of-interest (ROI) attenuator is presented. The attenuator has a thin central region and a gradually increasing thickness away from the center. It is shown that the unwanted brightening artifact caused by the attenuator can be eliminated by attenuating the low spatial frequencies in the detected image using digital image processing techniques. An investigation of the best image processing method to correct for the presence of the attenuator is undertaken. The correction procedure selected is suitable for use with real-time image processors and the ROI attenuator can be permitted to move during image acquisition. Images of an anthropomorphic chest phantom acquired in the presence of the ROI attenuator using an x-ray image intensifier/video chain are corrected to illustrate the clinical feasibility of our approach

  15. An evaluation of the fluoroscopy-guided percutaneous gastrostomy with the pull technique

    International Nuclear Information System (INIS)

    Uhm, Chang Wook; Won, Jong Yun; Yu, Jeong Sik; Ko, Heung Kyu; Lee, Kwang Hun; Lee, Do Yun; Lee, Jong Tae

    2008-01-01

    To evaluate the safety and usefulness of the fluoroscopy-guided percutaneous gastrostomy (FPG) using a large profile gastrostomy tube accompanied with the pull technique, and without the use of an endoscopy or a gastropexy. From March 2005 to February 2007, 25 patients underwent an FPG using a large profile gastrostomy tube accompanied by the pull technique, in which a 24F pull-type tube was inserted into a patient's mouth and was pulled to the upper abdominal puncture site using a snare, under fluoroscopy. The 18 patients with difficulty swallowing due to muscular atrophic lateral sclerosis or transitional myodystrophy included 5 cases of quadriplegia, 1 case of Parkinson's disease, and 1 metastatic mediastinal tumor. The technical success rate, occurrence of complications, and clinical outcomes were examined. The technical success rate was found to be 100%. In addition, the retention periods for the indwelling tube ranged from 1 to 24 months (mean: 6.5 months), with all tubes retained at a normal position with normal function. No procedure-related mortality occurred. One patient (4%) did however develop a complication in the form of ascites and ascitic fluid leakage around the tube, which was of hepatic origin and was ultimately resolved after the drainage of ascites. As a result of this study the FPG, accompanied with the pull technique using a 24F tube, should be considered as a safe and effective method for examining patients. It was found to have a high success rate and a low complication rate

  16. An evaluation of the fluoroscopy-guided percutaneous gastrostomy with the pull technique

    Energy Technology Data Exchange (ETDEWEB)

    Uhm, Chang Wook; Won, Jong Yun; Yu, Jeong Sik; Ko, Heung Kyu; Lee, Kwang Hun; Lee, Do Yun; Lee, Jong Tae [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2008-04-15

    To evaluate the safety and usefulness of the fluoroscopy-guided percutaneous gastrostomy (FPG) using a large profile gastrostomy tube accompanied with the pull technique, and without the use of an endoscopy or a gastropexy. From March 2005 to February 2007, 25 patients underwent an FPG using a large profile gastrostomy tube accompanied by the pull technique, in which a 24F pull-type tube was inserted into a patient's mouth and was pulled to the upper abdominal puncture site using a snare, under fluoroscopy. The 18 patients with difficulty swallowing due to muscular atrophic lateral sclerosis or transitional myodystrophy included 5 cases of quadriplegia, 1 case of Parkinson's disease, and 1 metastatic mediastinal tumor. The technical success rate, occurrence of complications, and clinical outcomes were examined. The technical success rate was found to be 100%. In addition, the retention periods for the indwelling tube ranged from 1 to 24 months (mean: 6.5 months), with all tubes retained at a normal position with normal function. No procedure-related mortality occurred. One patient (4%) did however develop a complication in the form of ascites and ascitic fluid leakage around the tube, which was of hepatic origin and was ultimately resolved after the drainage of ascites. As a result of this study the FPG, accompanied with the pull technique using a 24F tube, should be considered as a safe and effective method for examining patients. It was found to have a high success rate and a low complication rate.

  17. Survey of gonad and bone marrow doses from IUCD fluoroscopy in women of Guangdong province

    International Nuclear Information System (INIS)

    Zeng Xishen; Fan Jincai

    1984-01-01

    The local exposure doses in fluoroscopy for intrauterine contraceptive device (IUCD) were surveyed with TLD in 150 women. The gonad and bone marrow doses were calculated by adopting both the results of radiation experiment on MIXD phantom and related data. The mean gonad and bone marrow doses are 13.6 and 18.7 mrad, respectively. The collective bone marrow dose equivalent was estimated from the numbers of women fitted with IUCD and of women undergoing fluoroscopy, and the census of women of child-bearing age in Guangdong Province. The significance of collective bone marrow dose equivalent by IUCD fluoroscopy is discussed on the basis of the risk estimate of leukemia in ICRP publication No 26. (author)

  18. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD

    Directory of Open Access Journals (Sweden)

    Chun EM

    2015-01-01

    Full Text Available Eun Mi Chun,1 Soo Jeong Han,2 Hitesh N Modi3 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul, Republic of Korea; 2Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea; 3Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Republic of Korea Background: The diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD, using a fluoroscopy-guided chest X-ray.Patients and methods: Among 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds.Results: There were significant improvements (2,022.8±1,548.3 mm² to 3,010.7±1,495.6 mm² and 2,382.4±1,475.9 mm² to 3,315.9±1,883.5 mm²; right side P=0.001 and left side P=0.019, respectively in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation.Conclusion: The study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary

  19. 40 CFR 1601.26 - Special procedures for confidential business information.

    Science.gov (United States)

    2010-07-01

    ... described in paragraph (c) of this section, the CSB shall, to the extent permitted by law, afford a business... business information. 1601.26 Section 1601.26 Protection of Environment CHEMICAL SAFETY AND HAZARD... Requesting and Disclosing Records § 1601.26 Special procedures for confidential business information. (a) In...

  20. Impact of operator experience and training strategy on procedural outcomes with leadless pacing: Insights from the Micra Transcatheter Pacing Study.

    Science.gov (United States)

    El-Chami, Mikhael; Kowal, Robert C; Soejima, Kyoko; Ritter, Philippe; Duray, Gabor Z; Neuzil, Petr; Mont, Lluis; Kypta, Alexander; Sagi, Venkata; Hudnall, John Harrison; Stromberg, Kurt; Reynolds, Dwight

    2017-07-01

    Leadless pacemaker systems have been designed to avoid the need for a pocket and transvenous lead. However, delivery of this therapy requires a new catheter-based procedure. This study evaluates the role of operator experience and different training strategies on procedural outcomes. A total of 726 patients underwent implant attempt with the Micra transcatheter pacing system (TPS; Medtronic, Minneapolis, MN, USA) by 94 operators trained in a teaching laboratory using a simulator, cadaver, and large animal models (lab training) or locally at the hospital with simulator/demo model and proctorship (hospital training). Procedure success, procedure duration, fluoroscopy time, and safety outcomes were compared between training methods and experience (implant case number). The Micra TPS procedure was successful in 99.2% of attempts and did not differ between the 55 operators trained in the lab setting and the 39 operators trained locally at the hospital (P = 0.189). Implant case number was also not a determinant of procedural success (P = 0.456). Each operator performed between one and 55 procedures. Procedure time and fluoroscopy duration decreased by 2.0% (P = 0.002) and 3.2% (P safety outcomes by training method. Among a large group of operators, implantation success was high regardless of experience. While procedure duration and fluoroscopy times decreased with implant number, complications were low and not associated with case number. Procedure and safety outcomes were similar between distinct training methodologies. © 2017 Wiley Periodicals, Inc.

  1. A survey in Portuguese X-ray fluoroscopy equipment: dose rates and image quality

    International Nuclear Information System (INIS)

    Teixeira, Nuno G.; Cunha, Gilda R.; Coutinho, Guilherme M.; Trindade, Hugo R.; Carvoeiras, Pedro P.

    2015-01-01

    X-ray fluoroscopy is essential in both diagnosis and medical intervention, although it may contribute to significant radiation doses to patients that have to be optimised and justified. Therefore, it is crucial to the patient to be exposed to the lowest achievable dose without compromising the image quality. The purpose of this study was to perform an analysis of the quality control measurements, particularly dose rates, contrast and spatial resolution of Portuguese fluoroscopy equipment and also to provide a contribution to the establishment of reference levels for the equipment performance parameters. Measurements carried out between 2007 and 2013 on 143 fluoroscopy equipment distributed by 34 nationwide health units were analysed. The measurements suggest that image quality and dose rates of Portuguese equipment are congruent with other studies, and in general, they are as per the Portuguese law. However, there is still a possibility of improvements intending optimisation at a national level. (authors)

  2. CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients

    Energy Technology Data Exchange (ETDEWEB)

    De Bucourt, Maximilian; Collettini, Federico; Althoff, Christian; Streitparth, Florian; Greupner, Johannes; Hamm, Bernd (Dept. of Radiology, Charite - Univ. Medicine, Berlin (Germany)), Email: mdb@charite.de; Teichgraeber, U.K. (Dept. of Radiology, Jena Univ. (Germany))

    2012-04-15

    Background: In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. Purpose: To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. Material and Methods: A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. Results: The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. Conclusion: Initial results suggest that the described

  3. CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients

    International Nuclear Information System (INIS)

    De Bucourt, Maximilian; Collettini, Federico; Althoff, Christian; Streitparth, Florian; Greupner, Johannes; Hamm, Bernd; Teichgraeber, U.K.

    2012-01-01

    Background: In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. Purpose: To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. Material and Methods: A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. Results: The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. Conclusion: Initial results suggest that the described

  4. Transthoracic Adrenal Biopsy Procedure Using Artificial Carbon Dioxide Pneumothorax as Outpatient Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Favelier, Sylvain [CHU (University Hospital), Department of Radiology (France); Guiu, Severine [Georges-Francois Leclerc Cancer Center, Department of Oncology (France); Cherblanc, Violaine; Cercueil, Jean-Pierre; Krause, Denis; Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr [CHU (University Hospital), Department of Radiology (France)

    2013-08-01

    Many routes have been described for percutaneous adrenal gland biopsy. They require either a complex non-axial path or a long hydrodissection or even pass through an organ thereby increasing complications. We describe here an approach using an artificially-induced carbon dioxide (CO{sub 2}) pneumothorax, performed as an outpatient procedure in a 57-year-old woman. Under local anaesthesia, 200 ml of CO{sub 2} was injected in the pleural space through a Veress needle under computed tomography fluoroscopy, to clear the lung parenchyma from the biopsy route. Using this technique, transthoracic adrenal biopsy can be performed under simple local anaesthesia as an safely outpatient procedure.

  5. A standardized and safe method of sterile field maintenance during intra-operative horizontal plane fluoroscopy

    Directory of Open Access Journals (Sweden)

    Kaska Serge C

    2010-12-01

    Full Text Available Abstract Background Intra-operative fluoroscopy for orthopaedic procedures frequently involves imaging in the horizontal plane, which requires the lower portion of the C-arm (x-ray tube to be rotated from an unsterile zone (beneath the table into the sterile field. To protect the integrity of the sterile field the C-arm must be draped repeatedly throughout the surgical case. The current, un-standardized, practice employs draping procedures which violate the Association of peri-Operative Registered Nurses (AORN Standards and Recommended Practices, waste time and material, and pose an increased risk for surgical site infection. Presentation of the hypothesis Use of a novel sterile C-arm drape (C-armor that maintains the integrity of the sterile field, will improve operating room efficiency and reduce surgical site infection risk factors. This reduction in risk factors may potentially reduce surgical site infections in orthopaedic surgical cases requiring repeated horizontal x-ray imaging. Testing the Hypothesis Savings in time and material and the reduction in surgical site infection risk factors afforded by using C-armor are intuitive to those skilled in the practice of orthopaedic surgery. Testing for a reduction in the number of microorganisms introduced to the surgical site by improved C-arm draping would be challenging due to the multiple confounding factors during a surgical operation. Determination of an absolute reduction in surgical site infections may be possible, but will require accounting for many confounding variables and a large study sample in order to achieve statistical significance. Implications of the Hypothesis Improved intraoperative workflow, healthcare savings and a reduction in surgical site infection risk factors will be achieved by utilizing a standardized and safe method of sterile field maintenance during intra-operative horizontal plane fluoroscopy.

  6. Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: A systematic review

    NARCIS (Netherlands)

    Beerekamp, M. S. H. Suzan; Sulkers, George S. I.; Ubbink, Dirk T.; Maas, Mario; Schep, Niels W. L.; Goslings, J. Carel

    2012-01-01

    Objectives: The aim of this systematic review was to compare the diagnostic accuracy, subjective image quality and clinical consequences of 3D-fluoroscopy with standard imaging modalities (2D-fluoroscopy, X-ray or CT) during reduction and fixation of intra-articular upper and lower extremity

  7. Diaphragmatic paralysis evaluated by phrenic nerve stimulation during fluoroscopy or real-time ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    McCauley, R.G.K.; Labib, K.B.

    1984-10-01

    Stimulation of the phrenic nerve by supplying an electrical impulse to the neck during fluoroscopy or real-time ultrasound (sonoscopy) of the diaphragm allows more precise functional evaluation than fluoroscopy and/or sonoscopy alone. This is especially true of patients who are unable to cooperate because the are on a ventilator, unconscious, or very young. The authors cite cases in which diaphragmatic paralysis was diagnosed by conventional methods but stimulation of the phrenic nerve demonstrated good diaphragmatic motion, leading to a change in prognosis in some cases and a change in therapy in others.

  8. Diaphragmatic paralysis evaluated by phrenic nerve stimulation during fluoroscopy or real-time ultrasound

    International Nuclear Information System (INIS)

    McCauley, R.G.K.; Labib, K.B.

    1984-01-01

    Stimulation of the phrenic nerve by supplying an electrical impulse to the neck during fluoroscopy or real-time ultrasound (sonoscopy) of the diaphragm allows more precise functional evaluation than fluoroscopy and/or sonoscopy alone. This is especially true of patients who are unable to cooperate because the are on a ventilator, unconscious, or very young. The authors cite cases in which diaphragmatic paralysis was diagnosed by conventional methods but stimulation of the phrenic nerve demonstrated good diaphragmatic motion, leading to a change in prognosis in some cases and a change in therapy in others

  9. Interventional spinal procedures guided and controlled by a 3D rotational angiographic unit.

    Science.gov (United States)

    Pedicelli, Alessandro; Verdolotti, Tommaso; Pompucci, Angelo; Desiderio, Flora; D'Argento, Francesco; Colosimo, Cesare; Bonomo, Lorenzo

    2011-12-01

    The aim of this paper is to demonstrate the usefulness of 2D multiplanar reformatting images (MPR) obtained from rotational acquisitions with cone-beam computed tomography technology during percutaneous extra-vascular spinal procedures performed in the angiography suite. We used a 3D rotational angiographic unit with a flat panel detector. MPR images were obtained from a rotational acquisition of 8 s (240 images at 30 fps), tube rotation of 180° and after post-processing of 5 s by a local work-station. Multislice CT (MSCT) is the best guidance system for spinal approaches permitting direct tomographic visualization of each spinal structure. Many operators, however, are trained with fluoroscopy, it is less expensive, allows real-time guidance, and in many centers the angiography suite is more frequently available for percutaneous procedures. We present our 6-year experience in fluoroscopy-guided spinal procedures, which were performed under different conditions using MPR images. We illustrate cases of vertebroplasty, epidural injections, selective foraminal nerve root block, facet block, percutaneous treatment of disc herniation and spine biopsy, all performed with the help of MPR images for guidance and control in the event of difficult or anatomically complex access. The integrated use of "CT-like" MPR images allows the execution of spinal procedures under fluoroscopy guidance alone in all cases of dorso-lumbar access, with evident limitation of risks and complications, and without need for recourse to MSCT guidance, thus eliminating CT-room time (often bearing high diagnostic charges), and avoiding organizational problems for procedures that need, for example, combined use of a C-arm in the CT room.

  10. Interventional spinal procedures guided and controlled by a 3D rotational angiographic unit

    International Nuclear Information System (INIS)

    Pedicelli, Alessandro; Verdolotti, Tommaso; Desiderio, Flora; D'Argento, Francesco; Colosimo, Cesare; Bonomo, Lorenzo; Pompucci, Angelo

    2011-01-01

    The aim of this paper is to demonstrate the usefulness of 2D multiplanar reformatting images (MPR) obtained from rotational acquisitions with cone-beam computed tomography technology during percutaneous extra-vascular spinal procedures performed in the angiography suite. We used a 3D rotational angiographic unit with a flat panel detector. MPR images were obtained from a rotational acquisition of 8 s (240 images at 30 fps), tube rotation of 180 and after post-processing of 5 s by a local work-station. Multislice CT (MSCT) is the best guidance system for spinal approaches permitting direct tomographic visualization of each spinal structure. Many operators, however, are trained with fluoroscopy, it is less expensive, allows real-time guidance, and in many centers the angiography suite is more frequently available for percutaneous procedures. We present our 6-year experience in fluoroscopy-guided spinal procedures, which were performed under different conditions using MPR images. We illustrate cases of vertebroplasty, epidural injections, selective foraminal nerve root block, facet block, percutaneous treatment of disc herniation and spine biopsy, all performed with the help of MPR images for guidance and control in the event of difficult or anatomically complex access. The integrated use of ''CT-like'' MPR images allows the execution of spinal procedures under fluoroscopy guidance alone in all cases of dorso-lumbar access, with evident limitation of risks and complications, and without need for recourse to MSCT guidance, thus eliminating CT-room time (often bearing high diagnostic charges), and avoiding organizational problems for procedures that need, for example, combined use of a C-arm in the CT room. (orig.)

  11. Interventional spinal procedures guided and controlled by a 3D rotational angiographic unit

    Energy Technology Data Exchange (ETDEWEB)

    Pedicelli, Alessandro; Verdolotti, Tommaso; Desiderio, Flora; D' Argento, Francesco; Colosimo, Cesare; Bonomo, Lorenzo [Catholic University of Rome, A. Gemelli Hospital, Department of Bioimaging and Radiological Sciences, Rome (Italy); Pompucci, Angelo [Catholic University of Rome, A. Gemelli Hospital, Department of Neurotraumatology, Rome (Italy)

    2011-12-15

    The aim of this paper is to demonstrate the usefulness of 2D multiplanar reformatting images (MPR) obtained from rotational acquisitions with cone-beam computed tomography technology during percutaneous extra-vascular spinal procedures performed in the angiography suite. We used a 3D rotational angiographic unit with a flat panel detector. MPR images were obtained from a rotational acquisition of 8 s (240 images at 30 fps), tube rotation of 180 and after post-processing of 5 s by a local work-station. Multislice CT (MSCT) is the best guidance system for spinal approaches permitting direct tomographic visualization of each spinal structure. Many operators, however, are trained with fluoroscopy, it is less expensive, allows real-time guidance, and in many centers the angiography suite is more frequently available for percutaneous procedures. We present our 6-year experience in fluoroscopy-guided spinal procedures, which were performed under different conditions using MPR images. We illustrate cases of vertebroplasty, epidural injections, selective foraminal nerve root block, facet block, percutaneous treatment of disc herniation and spine biopsy, all performed with the help of MPR images for guidance and control in the event of difficult or anatomically complex access. The integrated use of ''CT-like'' MPR images allows the execution of spinal procedures under fluoroscopy guidance alone in all cases of dorso-lumbar access, with evident limitation of risks and complications, and without need for recourse to MSCT guidance, thus eliminating CT-room time (often bearing high diagnostic charges), and avoiding organizational problems for procedures that need, for example, combined use of a C-arm in the CT room. (orig.)

  12. Special procedural measures and the protection of human rights General report

    NARCIS (Netherlands)

    Vervaele, J.A.E.

    2009-01-01

    The aim of the general report is to conduct a comparative analysis of the national reports in order to trace transformation processes in domestic criminal justice systems, in particular criminal process, as special procedural measures are introduced to deal with terrorism and organised crime, and to

  13. Radiation protection at urological fluoroscopy working stations

    International Nuclear Information System (INIS)

    Forster, D.; Mohr, H.

    1979-01-01

    Two newly developed radiation protection devices for urological working stations are presented. The local dose to which doctor and assisting personnel are exposed during fluoroscopy and radiography was measured and the radiation burden with and without radiation protection determined. The studies show that without these devices organs such as the eyes are exposed, at a normal working distance from the table, to such an amount of scattered radiation as to reduce the permitted number of examinations per week. (Auth.)

  14. A pilot study of radiation exposures arising from interventional radiology procedures

    International Nuclear Information System (INIS)

    Pellet, S.; Giczi, F.; Gaspardy, G.; Temesi, A.; Ballay, L.

    2006-01-01

    Full text of publication follows: In the past 25 years, considerable number of new therapeutic procedures have been worked out and adopted in radiology. These interventional procedures are mainly based on angiographic methods. During these procedures the exposure of patients and staff are usually greater than of conventional radiography and fluoroscopy as a consequence of longer fluoroscopy times and great number of cine-radiography. In the latest years radiation-induced skin injuries occurred in some patients. Injuries to physicians and staff performing interventional procedures have also been observed. In our days interventional procedures are widely used and more sophisticated procedures are worked out and adopted. Consequently, there is a need for the protection of the patient and the staff on a higher level. Radiation protection of intervention radiology deserves a distinguish attention. In Hungary interventional radiology were performed in 36 laboratories in 2003. According to statistical data the gross number of interventional radiological procedures were 19442. The most frequently performed procedures were the P.T.C.A., the coronary and ilio-femoral stent implantation and chemo-embolization. In 2004, the National Research Institute for Radiobiology and Radio-hygiene and the National Patient Dose Evaluation Program started a pilot study of radiation exposures arising from interventional radiology procedures. During the study the patient exposure were measured by D.A.P.-meters. The patient skin dose and the staff dose were performed by thermoluminescent chips. In their presentation the authors present the most important results of the study. (authors)

  15. Training for Radiation Protection in Interventional Radiology

    International Nuclear Information System (INIS)

    Bartal, G.; Sapoval, M.; Ben-Shlomo, A.

    1999-01-01

    Program in radiological equipment has incorporated more powerful x-ray sources into the standard Fluoroscopy and CT systems. Expanding use of interventional procedures carries extensive use of fluoroscopy and CT which are both associated with excessive radiation exposure to the patient and personnel. During cases of Intravenous CT Angiography and direct Intraarterial CT Angiography, one may substitute a substantial number of diagnostic angiography checks. Basic training in interventional radiology hardly includes some of the fundamentals of radiation protection. Radiation Protection in Interventional Radiology must be implemented in daily practice and become an integral part of procedure planning strategy in each and every case. Interventional radiological most master all modern imaging modalities in order to choose the most effective, but least hazardous one. In addition, one must be able to use various imaging techniques (Fluoroscopy, CTA, MM and US) as a stand-alone method, as well as combine two techniques or more. Training programs for fellows: K-based simulation of procedures and radiation protection. Special attention should be taken in the training institutions and a basic training in radiation protection is advised before the trainee is involved in the practical work. Amendment of techniques for balloon and stent deployment with minimal use of fluoroscopy. Attention to the differences between radiation protection in cardiovascular and nonvascular radiology with special measures that must be taken for each one of them (i.e., peripheral angiography vs. stenting, Endo luminal Aortic Stent Graft, or nonvascular procedures such as biliary or endo urological stenting or biliary intervention). A special emphasis should be put on the training techniques of Interventional Radiologists, both beginners and experienced. Patient dose monitoring by maintaining records of fluoroscopic time is better with non-reset timer, but is optional. Lee of automated systems that

  16. 14 CFR 11.38 - What public comment procedures does the FAA follow for Special Conditions?

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false What public comment procedures does the FAA... § 11.38 What public comment procedures does the FAA follow for Special Conditions? Even though the Administrative Procedure Act does not require notice and comment for rules of particular applicability, FAA does...

  17. Direct percutaneous endoscopic jejunostomy using single-balloon enteroscopy without fluoroscopy: a case series

    Directory of Open Access Journals (Sweden)

    Carlos Bernardes

    Full Text Available Background: Direct percutaneous endoscopic jejunostomy (DPEJ is a useful method to provide enteral nutrition to individuals when gastric feeding is not possible or contraindicated. The aim of this study was to analyze the efficacy and safety of DPEJ tube placement with the Gauderer-Ponsky technique by the pull method, using single-balloon enteroscopy (SBE without fluoroscopy. Methods: This is a retrospective analysis of patients undergoing SBE for DPEJ placement in a referral hospital between January 2010 and March 2016. Technical success, clinical success and procedure related complications were recorded. Results: Twenty-three patients were included (17 males, median age 71 years, range 37-93 years. The most frequent indications for DPEJ were gastroesophageal cancer (n = 10 and neurological disease (n = 8. Eighty-seven percent of the patients had a contraindication to percutaneous endoscopic gastrostomy (PEG and PEG was unsuccessful in the remaining patients. The technical success rate was 83% (19/23, transillumination was not possible in three patients and an accidental exteriorization of the bumper resulting in a jejunal perforation occurred in one patient. The clinical success was 100% (19/19. The median follow-up was five months (range 1-35 months. Apart from the case of jejunal perforation and the two cases of accidental exteriorization, there were no other complications during follow-up. The 6-month survival was 65.8% and the 1-year survival was 49.3%. Conclusion: DPEJ can be carried out successfully via SBE without fluoroscopy with a low rate of significant adverse events. Although, leaving the overtube in place during the bumper pulling can be useful for distal jejunal loops, it can be safely removed in proximal loops to minimize complications.

  18. CT Fluoroscopy-Guided Core Biopsy for Diagnosis of Small ({<=} 20 mm) Pulmonary Nodules

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hye Larn; Kim, Yoon Kyung; Woo, Ok Hee; Yong, Hwan Seok; Kang, Eun Young [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Hyun Koo [Dept. of Thoracic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Shin, Bong Kyung [Dept. of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2011-10-15

    To evaluate the efficacy of CT fluoroscopy-guided core biopsy of small pulmonary nodules. This study included 62 patients (35 men, 27 women; age range, 36-85 years) that had a small ({<=} 20 mm) pulmonary nodule and underwent CT fluoroscopy-guided core biopsy. The overall diagnostic accuracy and complication rate were calculated. The diagnostic accuracy was compared between two groups according to the nodule size ({<=} 10 mm vs. > 10 mm), and nodule density (solid vs. subsolid). Malignant or premalignant lesions were finally diagnosed in 39 patients; 36 true-positive and three false-negative findings (sensitivity, 92%). A benign lesion was finally diagnosed in 23 patients, with no false-positive results (specificity, 100%). The overall diagnostic accuracy was 95%. The sensitivity and diagnostic accuracy were 85% and 91% for nodules {<=} 10 mm, and 96% and 97% for nodules > 10 mm (p > 0.05). The sensitivity and diagnostic accuracy were 93% and 96% in the solid group and 90% and 92% in the subsolid group (p > 0.05). Seventeen (27%) patients had a pneumothorax and two (3%) required a closed thoracostomy. CT fluoroscopy-guided core biopsy of small pulmonary nodules yields high diagnostic accuracy with acceptable complication rates.

  19. Dose level investigation in tests with gastrointestinal fluoroscopy as a part of a quality control program

    International Nuclear Information System (INIS)

    Canevaro, L.V.; Borges, J.C.; Kocj, H.A.

    1995-01-01

    The Radiation Protection and Dosimetry Institute of the National Nuclear Energy Commission (IRD/CNEN) Brazilian and the Radiodiagnostic Service of the Rio de Janeiro Federal University Hospital, (Brazil), have been engaged in the development of quality control programs applied to radiodiagnostics, one of them concerning gastrointestinal fluoroscopy. Since fluoroscopic examinations normally deals with high doses, they represent an important fraction of public exposure. They deserve special attention and risks to patients should be considered individually, not only as a population statistics. This work describes steps followed and results obtained in the estimation of doses for patients and physicians. Examinations investigated were esofagography, gastroduodenal seriography and colon with double contrast media, using conventional equipment with fluorescent screens, carried on by physicians engaged in the first year of medical residence. (author). 14 refs., 2 tabs

  20. Influence of heart rhythm, breathing and arm position during computed tomography scanning on the registration accuracy of electro anatomical map (EAM) images, left atrium three-dimensional computed tomography angiography images, and fluoroscopy time during ablation to treat atrial fibrillation

    International Nuclear Information System (INIS)

    Chono, Taiki; Shimoshige, Shinya; Yoshikawa, Kenta; Mizonobe, Kazuhusa; Ogura, Keishi

    2013-01-01

    In CARTOMERGE for treatment of atrial fibrillation (AF) by ablation, by integrating electro anatomical map (EAM) and left atrium three-dimensional computed tomography angiography (3D-CTA) images, identification of the ablation points is simplified and the procedure can be made carried out more rapidly. However, the influence that heart rhythm, breathing and arm position during CT scanning have on registration accuracy and fluoroscopy time is not clear. To clarify the influence on registration accuracy and fluoroscopy time of heart rhythm, breathing and arm position during CT scanning. The patients were CT-scanned during both sinus rhythm (SR) and AF in each study subject. We evaluated the registration accuracy of images reconstructed between the cardiac cycle and assessed the registration accuracy and fluoroscopy time of images obtained during inspiratory breath-hold, expiratory breath-hold and up and down position of the arm. Although the registration accuracy of the EAM image and left atrium 3D-CTA image showed a significant difference during SR, no significant difference was seen during AF. Expiratory breath-hold and down position of the arm resulted in the highest registration accuracy and the shortest fluoroscopy time. However, arm position had no significant effect on registration accuracy. Heart rhythm and breathing during CT scanning have a significant effect on the registration accuracy of EAM images, left atrium 3D-CTA images, and fluoroscopy time. (author)

  1. Evaluation of the occupational dose in hemodynamic procedures

    International Nuclear Information System (INIS)

    Silva, Amanda J. da; Fernandes, Ivani M.; Sordi, Gian Maria A.A.; Carneiro, Janete C. Gaburo

    2010-01-01

    The purpose of this study was to evaluate the dose received by health professionals in a hemodynamic service. It was necessary to know the profile of these professional, to carry out a survey the occupational external doses during the years 2000 to 2009 and to evaluate the distribution of the effective dose from the special procedures guided by fluoroscopy. A self-applied questionnaire was used to delineate the profile of health professionals, taking into account variables such as gender, age, individual monitoring time, number of jobs and tasks performed in the sector. In addition, it was performed an examination of the external individual monitoring doses from the records of the institution. The sample was composed of 35 professionals, 11 males and 24 females, with mean age of (43.0 +- 10.4) years. The average monitoring time of individuals analyzed within the institution was (11.3 +- 9.1) years, considering the period before the study. The minimum record dose level was 0.2 mSv and the maximum dose was 22.7 mSv. Doctors and nursing assistants were the professionals more exposed to radiation, due probably remaining closer to the examination table and X-ray tube during the interventional procedure. (author)

  2. Novel real-time tumor-contouring method using deep learning to prevent mistracking in X-ray fluoroscopy.

    Science.gov (United States)

    Terunuma, Toshiyuki; Tokui, Aoi; Sakae, Takeji

    2018-03-01

    Robustness to obstacles is the most important factor necessary to achieve accurate tumor tracking without fiducial markers. Some high-density structures, such as bone, are enhanced on X-ray fluoroscopic images, which cause tumor mistracking. Tumor tracking should be performed by controlling "importance recognition": the understanding that soft-tissue is an important tracking feature and bone structure is unimportant. We propose a new real-time tumor-contouring method that uses deep learning with importance recognition control. The novelty of the proposed method is the combination of the devised random overlay method and supervised deep learning to induce the recognition of structures in tumor contouring as important or unimportant. This method can be used for tumor contouring because it uses deep learning to perform image segmentation. Our results from a simulated fluoroscopy model showed accurate tracking of a low-visibility tumor with an error of approximately 1 mm, even if enhanced bone structure acted as an obstacle. A high similarity of approximately 0.95 on the Jaccard index was observed between the segmented and ground truth tumor regions. A short processing time of 25 ms was achieved. The results of this simulated fluoroscopy model support the feasibility of robust real-time tumor contouring with fluoroscopy. Further studies using clinical fluoroscopy are highly anticipated.

  3. Fluoroscopically guided transforaminal epidural steroid injections at a quaternary-care teaching institution: effect of trainee involvement and patient body mass index on fluoroscopy time and patient dose

    International Nuclear Information System (INIS)

    Tiegs-Heiden, C.A.; Murthy, N.S.; Geske, J.R.; Diehn, F.E.; Schueler, B.A.; Wald, J.T.; Kaufmann, T.J.; Lehman, V.T.; Carr, C.M.; Amrami, K.K.; Morris, J.M.; Thielen, K.R.; Maus, T.P.

    2016-01-01

    Aim: To investigate whether there are differences in fluoroscopy time and patient dose for fluoroscopically guided lumbar transforaminal epidural steroid injections (TFESIs) performed by staff radiologists versus with trainees and to evaluate the effect of patient body mass index (BMI) on fluoroscopy time and patient dose, including their interactions with other variables. Materials and methods: Single-level lumbar TFESIs (n=1844) between 1 January 2011 and 31 December 2013 were reviewed. Fluoroscopy time, reference point air kerma (K_a_,_r), and kerma area product (KAP) were recorded. BMI and trainee involvement were examined as predictors of fluoroscopy time, K_a_,_r, and KAP in models adjusted for age and gender in multivariable linear models. Stratified models of BMI groups by trainee presence were performed. Results: Increased age was the only significant predictor of increased fluoroscopy time (p<0.0001). K_a_,_r and KAP were significantly higher in patients with a higher BMI (p<0.0001 and p=0.0009). When stratified by BMI, longer fluoroscopy time predicted increased K_a_,_r and KAP in all groups (p<0.0001). Trainee involvement was not a statistically significant predictor of fluoroscopy time or K_a_,_r in any BMI category. KAP was lower with trainees in the overweight group (p=0.0009) and higher in male patients for all BMI categories (p<0.02). Conclusion: Trainee involvement did not result in increased fluoroscopy time or patient dose. BMI did not affect fluoroscopy time; however, overweight and obese patients received significantly higher K_a_,_r and KAP. Male patients received a higher KAP in all BMI categories. Limiting fluoroscopy time and good collimation practices should be reinforced in these patients. - Highlights: • Trainee involvement did not contribute to increased fluoroscopy time or dose. • BMI did not affect fluoroscopy time. • Overweight and obese patients received significantly higher Ka,r and KAP.

  4. Radiation exposure of medical staff from interventional x-ray procedures: a multicentre study

    International Nuclear Information System (INIS)

    Haeusler, Uwe; Brix, Gunnar; Czarwinski, Renate

    2009-01-01

    The purpose of this study was to analyse the radiation exposure of medical staff from interventional x-ray procedures. Partial-body dose measurements were performed with thermoluminescent dosimeters (TLD) in 39 physicians and nine assistants conducting 73 interventional procedures of nine different types in 14 hospitals in Germany. Fluoroscopy time and the dose-area product (DAP) were recorded too. The median (maximum) equivalent body dose per procedure was 16 (2,500) μSv for an unshielded person; the partial-body dose per procedure was 2.8 (240) μSv to the eye lens, 4.1 (730) μSv to the thyroid, 44 (1,800) μSv to one of the feet and 75 (13,000) μSv to one of the hands. A weak correlation between fluoroscopy time or DAP and the mean TLD dose was observed. Generally, the doses were within an acceptable range from a radiation hygiene point of view. However, relatively high exposures were measured to the hand in some cases and could cause a partial-body dose above the annual dose limit of 500 mSv. Thus, the use of finger dosimeters is strongly recommended. (orig.)

  5. Fluoroscopy time - an overestimated factor for patient radiation exposure in invasive cardiology

    International Nuclear Information System (INIS)

    Kuon, E.; Robinson, D.M.; Empen, K.; Dahm, J.B.

    2005-01-01

    Purpose: to analyze the effects of an optimized fluoroscopy time on patient radiation exposure in the course of coronary angiography (CA) and percutaneous coronary interventions (PTCA), in comparison to those with consistent collimation to the region of interest (ROI). Furthermore, to analyze efforts concerning reduction of radiographic frames as well as concerning adequate instead of best possible image quality. Material and methods: for 3,115 elective CAs and 1,713 PTCA performed by one interventionist since 1997, we documented the radiographic dose-area products (DAP R ) and fluoroscopic dose-area products (DAP F ), the number of radiographic frames and the fluoroscopy times during selected 2-month intervals. Under conditions of constant image intensifier entrance dose, levels of DAP R /frame and DAP F /s represent valid parameters for consistent collimation. Results: in 1997, the mean baseline values of DAP for elective CA and PTCA amounted to 37.1 and 31.6 Gy x cm 2 , respectively. A reduction of mean fluoroscopy times from 264 to 126 seconds for CA and from 630 to 449 seconds for PCI, both resulted in an overall DAP-reduction of merely 20%. Optimization of mean radiographic frames from 543 to 98 for CA and from 245 to 142 for PTCA enabled reductions of 53 and 13%, respectively. By restriction to adequate instead of best-possible image quality for coronary angiography in clinical routine, we achieved an optimized radiographic DAP/frame of 30.3 to 13.3 mGy x cm 2 , which enabled a 45% reduction of overall DAP. Most efficient however was a consistent collimation to the ROI, which resulted in a remarkable radiation reduction by 46% for CA and by 65% for PTCA. Conclusions: radiation-reducing educational efforts in the clinical routine of invasive cardiology should - against widely held opinion - focus less exclusively toward a reduction of fluoroscopy time but more efficiently toward consistent collimation to the region of interest, reduction of radiographic

  6. Acceptability of Functional Behavioral Assessment Procedures to Special Educators and School Psychologists

    Science.gov (United States)

    O'Neill, Robert E.; Bundock, Kaitlin; Kladis, Kristin; Hawken, Leanne S.

    2015-01-01

    This survey study assessed the acceptability of a variety of functional behavioral assessment (FBA) procedures (i.e., functional assessment interviews, rating scales/questionnaires, systematic direct observations, functional analysis manipulations) to a national sample of 123 special educators and a state sample of 140 school psychologists.…

  7. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

    Medline Plus

    Full Text Available ... complex and lengthy procedures requiring extended fluoroscopy use) death (rare) top of page What are the limitations ... and treatments have special pediatric considerations. The teddy bear denotes child-specific content. Related Articles and Media ...

  8. X-ray fluoroscopy spatio-temporal filtering with object detection

    International Nuclear Information System (INIS)

    Aufrichtig, R.; Wilson, D.L.; University Hospitals of Cleveland, OH

    1995-01-01

    One potential way to reduce patient and staff x-ray fluoroscopy dose is to reduce the quantum exposure to the detector and compensate the additional noise with digital filtering. A new filtering method, spatio-temporal filtering with object detection, is described that reduces noise while minimizing motion and spatial blur. As compared to some conventional motion-detection filtering schemes, this object-detection method incorporates additional a priori knowledge of image content; i.e. much of the motion occurs in isolated long thin objects (catheters, guide wires, etc.). The authors create object-likelihood images and use these to control spatial and recursive temporal filtering such as to reduce blurring the objects of interest. They use automatically computed receiver operating characteristic (ROC) curves to optimize the object-likelihood enhancement method and determine that oriented matched filter kernels with 4 orientations are appropriate. The matched filter kernels are simple projected cylinders. The authors demonstrate the method on several representative x-ray fluoroscopy sequences to which noise is added to simulate very low dose acquisitions. With processing, they find that noise variance is significantly reduced with slightly less noise reduction near moving objects. They estimate an effective exposure reduction greater than 80%

  9. Assessing patient dose in interventional fluoroscopy using patient-dependent hybrid phantoms

    Science.gov (United States)

    Johnson, Perry Barnett

    Interventional fluoroscopy uses ionizing radiation to guide small instruments through blood vessels or other body pathways to sites of clinical interest. The technique represents a tremendous advantage over invasive surgical procedures, as it requires only a small incision, thus reducing the risk of infection and providing for shorter recovery times. The growing use and increasing complexity of interventional procedures, however, has resulted in public health concerns regarding radiation exposures, particularly with respect to localized skin dose. Tracking and documenting patient-specific skin and internal organ dose has been specifically identified for interventional fluoroscopy where extended irradiation times, multiple projections, and repeat procedures can lead to some of the largest doses encountered in radiology. Furthermore, inprocedure knowledge of localized skin doses can be of significant clinical importance to managing patient risk and in training radiology residents. In this dissertation, a framework is presented for monitoring the radiation dose delivered to patients undergoing interventional procedures. The framework is built around two key points, developing better anthropomorphic models, and designing clinically relevant software systems for dose estimation. To begin, a library of 50 hybrid patient-dependent computational phantoms was developed based on the UF hybrid male and female reference phantoms. These phantoms represent a different type of anthropomorphic model whereby anthropometric parameters from an individual patient are used during phantom selection. The patient-dependent library was first validated and then used in two patient-phantom matching studies focused on cumulative organ and local skin dose. In terms of organ dose, patient-phantom matching was shown most beneficial for estimating the dose to large patients where error associated with soft tissue attenuation differences could be minimized. For small patients, inherent difference

  10. Mediation and Other Alternative Dispute Resolution Procedures in Special Education. Final Report.

    Science.gov (United States)

    Schrag, Judy A.

    This report discusses the use of mediation and alternative dispute resolution approaches in special education disagreements between the school and the parents of a child with a disability. The procedural safeguards and due process provisions of the Individuals with Disabilities Education Act (IDEA) are explained. The report notes alternative…

  11. Patient radiation dose in diagnostic and interventional procedures for intracranial aneurysms: Experience at a single center

    International Nuclear Information System (INIS)

    Chun, Chang Woo; Kim, Bum Soo; Lee, Cheol Hyoun; Ihn, Yon Kwon; Shin, Yong Sam

    2014-01-01

    To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms in a large sample size from a single center. We studied a sample of 439 diagnostic and 149 therapeutic procedures for intracranial aneurysms in 480 patients (331 females, 149 males; median age, 57 years; range, 21-88 years), which were performed in 2012 with a biplane unit. Parameters including fluoroscopic time, dose-area product (DAP), and total angiographic image frames were obtained and analyzed. Mean fluoroscopic time, total mean DAP, and total image frames were 12.6 minutes, 136.6 +/- 44.8 Gy-cm 2 , and 251 +/- 49 frames for diagnostic procedures, 52.9 minutes, 226.0 +/- 129.2 Gy-cm 2 , and 241 frames for therapeutic procedures, and 52.2 minutes, 334.5 +/- 184.6 Gy-cm 2 , and 408 frames for when both procedures were performed during the same session. The third quartiles for diagnostic reference levels (DRLs) were 14.0, 61.1, and 66.1 minutes for fluoroscopy time, 154.2, 272.8, and 393.8 Gy-cm 2 for DAP, and 272, 276, and 535 for numbers of image frames in diagnostic, therapeutic, and both procedures in the same session, respectively. The proportions of fluoroscopy in DAP for the procedures were 11.4%, 50.5%, and 36.1%, respectively, for the three groups. The mean DAP for each 3-dimensional rotational angiographic acquisition was 19.2 +/- 3.2 Gy-cm 2 . On average, rotational angiography was used 1.4 +/- 0.6 times/session (range, 1-4; n = 580). Radiation dose in our study as measured by DAP, fluoroscopy time and image frames did not differ significantly from other reported DRL studies for cerebral angiography, and DAP was lower with fewer angiographic image frames for embolization. A national registry of radiation-dose data is a necessary next step to refine the dose reference level.

  12. Acquiring Multiview C-Arm Images to Assist Cardiac Ablation Procedures

    Directory of Open Access Journals (Sweden)

    Fallavollita Pascal

    2010-01-01

    Full Text Available CARTO XP is an electroanatomical cardiac mapping system that provides 3D color-coded maps of the electrical activity of the heart; however it is expensive and it can only use a single costly magnetic catheter for each patient intervention. Our approach consists of integrating fluoroscopic and electrical data from the RF catheters into the same image so as to better guide RF ablation, shorten the duration of this procedure, increase its efficacy, and decrease hospital cost when compared to CARTO XP. We propose a method that relies on multi-view C-arm fluoroscopy image acquisition for (1 the 3D reconstruction of the anatomical structure of interest, (2 the robust temporal tracking of the tip-electrode of a mapping catheter between the diastolic and systolic phases and (3 the 2D/3D registration of color coded isochronal maps directly on the 2D fluoroscopy image that would help the clinician guide the ablation procedure much more effectively. The method has been tested on canine experimental data.

  13. Radiation doses to patients in haemodynamic procedures

    International Nuclear Information System (INIS)

    Canadillas-Perdomo, B.; Catalan-Acosta, A.; Hernandez-Armas, J.; Perez-Martin, C.; Armas-Trujillo, D. de

    2001-01-01

    Interventional radio-cardiology gives high doses to patients due to high values of fluoroscopy times and large series of radiographic images. The main objective of the present work is the determination of de dose-area product (DAP) in patients of three different types of cardiology procedures with X-rays. The effective doses were estimated trough the organ doses values measured with thermoluminescent dosimeters (TLDs-100), suitable calibrated, placed in a phantom type Rando which was submitted to the same radiological conditions corresponding to the procedures made on patients. The values for the effective doses in the procedures CAD Seldinger was 6.20 mSv on average and 1.85mSv for pacemaker implants. (author)

  14. Radiation doses to patients in haemodynamic procedures

    Energy Technology Data Exchange (ETDEWEB)

    Canadillas-Perdomo, B; Catalan-Acosta, A; Hernandez-Armas, J [Servicio de Fisica Medica, Hospital Universitario de Canarias, La Laguna, Tenerife (Spain); Perez-Martin, C [Servicio de Ingenieria Biomedica, Hospital Universitario de Canarias, La Laguna, Tenerife (Spain); Armas-Trujillo, D de [Servicio de Cardiologia, Hospital Universitario de Canarias, La Laguna, Tenerife (Spain)

    2001-03-01

    Interventional radio-cardiology gives high doses to patients due to high values of fluoroscopy times and large series of radiographic images. The main objective of the present work is the determination of de dose-area product (DAP) in patients of three different types of cardiology procedures with X-rays. The effective doses were estimated trough the organ doses values measured with thermoluminescent dosimeters (TLDs-100), suitable calibrated, placed in a phantom type Rando which was submitted to the same radiological conditions corresponding to the procedures made on patients. The values for the effective doses in the procedures CAD Seldinger was 6.20 mSv on average and 1.85mSv for pacemaker implants. (author)

  15. Validation of single-plane fluoroscopy and 2D/3D shape-matching for quantifying shoulder complex kinematics.

    Science.gov (United States)

    Lawrence, Rebekah L; Ellingson, Arin M; Ludewig, Paula M

    2018-02-01

    Fluoroscopy and 2D/3D shape-matching has emerged as the standard for non-invasively quantifying kinematics. However, its accuracy has not been well established for the shoulder complex when using single-plane fluoroscopy. The purpose of this study was to determine the accuracy of single-plane fluoroscopy and 2D/3D shape-matching for quantifying full shoulder complex kinematics. Tantalum markers were implanted into the clavicle, humerus, and scapula of four cadaveric shoulders. Biplane radiographs were obtained with the shoulder in five humerothoracic elevation positions (arm at the side, 30°, 60°, 90°, maximum). Images from both systems were used to perform marker tracking, while only those images acquired with the primary fluoroscopy system were used to perform 2D/3D shape-matching. Kinematics errors due to shape-matching were calculated as the difference between marker tracking and 2D/3D shape-matching and expressed as root mean square (RMS) error, bias, and precision. Overall RMS errors for the glenohumeral joint ranged from 0.7 to 3.3° and 1.2 to 4.2 mm, while errors for the acromioclavicular joint ranged from 1.7 to 3.4°. Errors associated with shape-matching individual bones ranged from 1.2 to 3.2° for the humerus, 0.5 to 1.6° for the scapula, and 0.4 to 3.7° for the clavicle. The results of the study demonstrate that single-plane fluoroscopy and 2D/3D shape-matching can accurately quantify full shoulder complex kinematics in static positions. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  16. Radiofrequency Ablation Combined with Chemoembolization for Intermediate-Sized (3-5 cm) Hepatocellular Carcinomas Under Dual Guidance of Biplane Fluoroscopy and Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Min, Ji Hye; Lee, Min Woo; Cha, Dong Ik [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Jeon, Yong Hwan [Department of Radiology, Kangwon National University College of Medicine, Chuncheon 200-722 (Korea, Republic of); Shin, Sung Wook; Cho, Sung Ki; Rhim, Hyunchul; Lim, Hyo K. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)

    2013-07-01

    To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US). Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method. Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively. RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment.

  17. Pediatric and staff dose evaluation in fluoroscopy upper gastrointestinal series

    Energy Technology Data Exchange (ETDEWEB)

    Filipov, Danielle; Nascimento, Eduarda X. do; Lacerda, Camila M., E-mail: diilipov@utfpr.edu.br [Universidade Tecnologica Federal do Parana (UFTPR), Curitiba, PR (Brazil); Schelin, Hugo R.; Ledesma, Jorge A.; Denyak, Valeriy; Legnani, Adriano, E-mail: ledesmajorgealberto@gmail.com [Instituto de Pesquisa Pele Pequeno Principe, Curitiba, PR (Brazil)

    2014-07-01

    Fluoroscopy upper GI series are widely used for the diagnosis of gastroesophageal reflux disease in children. Pediatric radiological procedures bring concern due to the high life expectancy and radiosensitivity on children, as well as the risks to the exposed staff Important studies present the mean KAP values on patients and the European Commission (EC) recommends specific techniques for these procedures. For the occupational expositions, staffs doses must be within the annual limit, according to the CNEN 3.01. Based on those data, the aims of the current study are: analyzing the upper GI procedure; determining the KAP on the patient and estimating the annual equivalent dose on the staff's crystalline. LiF :Mg,Ti TLDs were positioned on the patient upper chest center, so that the entrance surface air kerma could be determined. The field size on the patient s surface and the kerma were multiplied so that the KAP was obtained. LiF:Mg,Cu,P dosimeters were used to estimate the equivalent dose on the staff s crystalline. The results showed discrepancy in the kVp range and in the exposure time when compared to the EC data. The mean KAP values for the 0-1,1-3 and 3-10 years old patients were, respectively: 102 ± 19 cGy.cm2, 142 ± 25 cGy.cm2 and 323 ± 39 cGy.cm2; which are higher than the KAPs presented in the studies used for comparison. The estimated annual equivalent dose in the staff s crystalline would be approximately 85% higher than the limit set by the CNEN. Analyzing the data, it becomes clear that an optimization implementation is necessary in order to reduce the radiation levels. (author)

  18. Pediatric and staff dose evaluation in fluoroscopy upper gastrointestinal series

    International Nuclear Information System (INIS)

    Filipov, Danielle; Nascimento, Eduarda X. do; Lacerda, Camila M.; Schelin, Hugo R.; Ledesma, Jorge A.; Denyak, Valeriy; Legnani, Adriano

    2014-01-01

    Fluoroscopy upper GI series are widely used for the diagnosis of gastroesophageal reflux disease in children. Pediatric radiological procedures bring concern due to the high life expectancy and radiosensitivity on children, as well as the risks to the exposed staff Important studies present the mean KAP values on patients and the European Commission (EC) recommends specific techniques for these procedures. For the occupational expositions, staffs doses must be within the annual limit, according to the CNEN 3.01. Based on those data, the aims of the current study are: analyzing the upper GI procedure; determining the KAP on the patient and estimating the annual equivalent dose on the staff's crystalline. LiF :Mg,Ti TLDs were positioned on the patient upper chest center, so that the entrance surface air kerma could be determined. The field size on the patient s surface and the kerma were multiplied so that the KAP was obtained. LiF:Mg,Cu,P dosimeters were used to estimate the equivalent dose on the staff s crystalline. The results showed discrepancy in the kVp range and in the exposure time when compared to the EC data. The mean KAP values for the 0-1,1-3 and 3-10 years old patients were, respectively: 102 ± 19 cGy.cm2, 142 ± 25 cGy.cm2 and 323 ± 39 cGy.cm2; which are higher than the KAPs presented in the studies used for comparison. The estimated annual equivalent dose in the staff s crystalline would be approximately 85% higher than the limit set by the CNEN. Analyzing the data, it becomes clear that an optimization implementation is necessary in order to reduce the radiation levels. (author)

  19. Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation: A comparison of 2 versus 4 frame rate.

    Science.gov (United States)

    Lee, Ji Hyun; Kim, Jun; Kim, Minsu; Hwang, Jongmin; Hwang, You Mi; Kang, Joon-Won; Nam, Gi-Byoung; Choi, Kee-Joon; Kim, You-Ho

    2017-06-01

    Despite the technological advance in 3-dimensional (3D) mapping, radiation exposure during catheter ablation of atrial fibrillation (AF) continues to be a major concern in both patients and physicians. Previous studies reported substantial radiation exposure (7369-8690 cGy cm) during AF catheter ablation with fluoroscopic settings of 7.5 frames per second (FPS) under 3D mapping system guidance. We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF.Retrospective analysis of data on 133 patients who underwent AF catheter ablation with 3-D electro-anatomic mapping at our institute from January 2014 to May 2015 was performed. Since January 2014, fluoroscopy frame rate of 4-FPS was implemented at our institute, which was further decreased to 2-FPS in September 2014. We compared the radiation exposure quantified as dose area product (DAP) and effective dose (ED) between the 4-FPS (n = 57) and 2-FPS (n = 76) groups.The 4-FPS group showed higher median DAP (599.9 cGy cm; interquartile range [IR], 371.4-1337.5 cGy cm vs. 392.0 cGy cm; IR, 289.7-591.4 cGy cm; P FPS group. No major procedure-related complications such as cardiac tamponade were observed in either group. Over follow-up durations of 331 ± 197 days, atrial tachyarrhythmia recurred in 20 patients (35.1%) in the 4-FPS group and in 27 patients (35.5%) in the 2-FPS group (P = .96). Kaplan-Meier survival analysis revealed no significant different between the 2 groups (log rank, P = .25).In conclusion, both the 4-FPS and 2-FPS settings were feasible and emitted a relatively low level of radiation compared with that historically reported for DAP in a conventional fluoroscopy setting.

  20. A new technique for localization of hepatic tumors that are poorly visible with CT fluoroscopy

    International Nuclear Information System (INIS)

    Arrive, Lionel; Azizi, Louisa; Monnier-Cholley, Laurence; Lewin, Maite; Tubiana, Jean-Michel; Rosmorduc, Olivier; Beaussier, Marc

    2006-01-01

    The purpose of this study was to report a new technique for localization of hepatic tumors that are poorly visible with CT fluoroscopy. Forty-three hepatocellular carcinomas were not visible with CT fluoroscopy. A 22-gauge Chiba end-hole needle was inserted in the approximate location of a lesion estimated on the basis of anatomical landmarks demonstrated on both previous MR and CT images. We injected 3 ml of a mixture of nonionic contrast material and saline solution. Following the first injection, contrast solution filled the hepatic lesion in 29 of 43 cases. In 8 of 43 cases, contrast solution was distributed in the normal surrounding liver. In 7 of these 8 cases, repositioning allowed us to adjust the needle in the tumor. In the other 6 of 43 cases, contrast solution spread within capsule or pseudocapsule (pattern 3). In all 6 cases, repositioning allowed to adjust the needle in the tumor. This new technique allows an accurate localization of hepatic tumors that are poorly visible with CT fluoroscopy. (orig.)

  1. Evaluation of radiation dose to pediatric patients during certain special procedures

    International Nuclear Information System (INIS)

    Sulieman, A.; Alzimami, K.; Elhag, B.; Babikir, E.; Alsafi, K.

    2014-01-01

    This study was intended to measure pediatric entrance surface air kerma (ESAK) and effective dose during micturating cystourethrography (MCU), intravenous urography (IVU) and barium studies (barium meal, enema, and swallow) and to propose a local diagnostic reference level (DRL). ESAK was measured for patients using calibrated thermoluminescent dosimeters (TLDs, GR200A). Effective doses (E) were calculated using the National Radiological Protection Board (NRPB) software. A total of 236 special pediatric procedures were investigated. 21.7% of the sample comprised barium procedures, 18.6% were MCU procedures while 59.5% of the sample were IVU procedures. The mean ESAK measurements (mGy) were 2.1±0.8, 3.0±23 and 1.2±0.2 for barium meal, enema and swallow in the same order. The mean patient dose for IVU procedures was 12.4±8.7 mGy per procedure and the mean patient dose per MCU procedure was 5.8±7 mGy. Local DRLs were proposed for all procedures. The patient doses in this study are within the reported values, suggesting that pediatric patients are adequately protected. - Highlights: • Pediatric radiation dose has been evaluated for three of the most common fluoroscopic procedures. • Radiation doses were measured using calibrated TLD GR200A. • Pediatric patients of concern and ESAK doses showed large variations. • The patient doses in this study are within the reported studies suggesting that the pediatric patients are adequately protected

  2. SU-E-I-58: Experiences in Setting Up An Online Fluoroscopy Tracking System in a Large Healthcare System

    Energy Technology Data Exchange (ETDEWEB)

    Fisher, R; Wunderle, K; Lingenfelter, M [The Cleveland Clinic, Cleveland, OH (United States)

    2015-06-15

    Purpose: Transitioning from a paper based to an online system for tracking fluoroscopic case information required by state regulation and to conform to NCRP patient dose tracking suggestions. Methods: State regulations require documentation of operator, equipment, and some metric of tube output for fluoroscopy exams. This information was previously collected in paper logs, which was cumbersome and inefficient for the large number of fluoroscopic units across multiple locations within the system. The “tech notes” feature within Siemens’ Syngo workflow RIS was utilized to create an entry form for technologists to input case information, which was sent to a third party vendor for archiving and display though an online web based portal. Results: Over 55k cases were logged in the first year of implementation, with approximately 6,500 cases per month once fully online. A system was built for area managers to oversee and correct data, which has increased the accuracy of inputted values. A high-dose report was built to automatically send notifications when patients exceed trigger levels. In addition to meeting regulatory requirements, the new system allows for larger scale QC in fluoroscopic cases by allowing comparison of data from specific procedures, locations, equipment, and operators so that instances that fall outside of reference levels can be identified for further evaluation. The system has also drastically improved identification of operators without documented equipment specific training. Conclusion: The transition to online fluoroscopy logs has improved efficiency in meeting state regulatory requirements as well as allowed for identification of particular procedures, equipment, and operators in need of additional attention in order to optimize patient and personnel doses, while high dose alerts improve patient care and follow up. Future efforts are focused on incorporating case information from outside of radiology, as well as on automating processes for

  3. SU-E-I-58: Experiences in Setting Up An Online Fluoroscopy Tracking System in a Large Healthcare System

    International Nuclear Information System (INIS)

    Fisher, R; Wunderle, K; Lingenfelter, M

    2015-01-01

    Purpose: Transitioning from a paper based to an online system for tracking fluoroscopic case information required by state regulation and to conform to NCRP patient dose tracking suggestions. Methods: State regulations require documentation of operator, equipment, and some metric of tube output for fluoroscopy exams. This information was previously collected in paper logs, which was cumbersome and inefficient for the large number of fluoroscopic units across multiple locations within the system. The “tech notes” feature within Siemens’ Syngo workflow RIS was utilized to create an entry form for technologists to input case information, which was sent to a third party vendor for archiving and display though an online web based portal. Results: Over 55k cases were logged in the first year of implementation, with approximately 6,500 cases per month once fully online. A system was built for area managers to oversee and correct data, which has increased the accuracy of inputted values. A high-dose report was built to automatically send notifications when patients exceed trigger levels. In addition to meeting regulatory requirements, the new system allows for larger scale QC in fluoroscopic cases by allowing comparison of data from specific procedures, locations, equipment, and operators so that instances that fall outside of reference levels can be identified for further evaluation. The system has also drastically improved identification of operators without documented equipment specific training. Conclusion: The transition to online fluoroscopy logs has improved efficiency in meeting state regulatory requirements as well as allowed for identification of particular procedures, equipment, and operators in need of additional attention in order to optimize patient and personnel doses, while high dose alerts improve patient care and follow up. Future efforts are focused on incorporating case information from outside of radiology, as well as on automating processes for

  4. Echocardiographic and Fluoroscopic Fusion Imaging for Procedural Guidance: An Overview and Early Clinical Experience.

    Science.gov (United States)

    Thaden, Jeremy J; Sanon, Saurabh; Geske, Jeffrey B; Eleid, Mackram F; Nijhof, Niels; Malouf, Joseph F; Rihal, Charanjit S; Bruce, Charles J

    2016-06-01

    There has been significant growth in the volume and complexity of percutaneous structural heart procedures in the past decade. Increasing procedural complexity and accompanying reliance on multimodality imaging have fueled the development of fusion imaging to facilitate procedural guidance. The first clinically available system capable of echocardiographic and fluoroscopic fusion for real-time guidance of structural heart procedures was approved by the US Food and Drug Administration in 2012. Echocardiographic-fluoroscopic fusion imaging combines the precise catheter and device visualization of fluoroscopy with the soft tissue anatomy and color flow Doppler information afforded by echocardiography in a single image. This allows the interventionalist to perform precise catheter manipulations under fluoroscopy guidance while visualizing critical tissue anatomy provided by echocardiography. However, there are few data available addressing this technology's strengths and limitations in routine clinical practice. The authors provide a critical review of currently available echocardiographic-fluoroscopic fusion imaging for guidance of structural heart interventions to highlight its strengths, limitations, and potential clinical applications and to guide further research into value of this emerging technology. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  5. New ultrasound stone locking system in extracorporeal lithotripsy: Decreased duration of fluoroscopy and radiation doses

    International Nuclear Information System (INIS)

    Abid, N.; Ravier, E.; Codas, R.; Crouzet, S.; Martin, X.

    2013-01-01

    Extracorporeal shock wave lithotripsy is the most common method of treatment for kidney stones. Both fluoroscopy and ultrasound imaging can be used to locate stones, but fluoroscopy is more frequently employed. Evaluation of a new stereotaxic navigational system: the stone was located using an ultrasound probe, and its 3D location was saved. The table automatically moved to position the stone at the focal point. A real-time follow-up was possible during treatment. Our objective was to demonstrate a decrease in the use of fluoroscopy to locate kidney stones for extracorporeal shock wave lithotripsy through the use of a 3D ultrasound stone locking system. Prospective analysis of the case records of the 20 patients preceding and the 20 patients succeeding the arrival of the ultrasound stone locking system Visio-Track (EDAP-TMS). We used a Student test to compare age, BMI, kidney stone size, number of shock waves and administered energy. Patient characteristics were comparable. The average age was 55 years old and the average kidney stone size was 10.7 mm. Radiation duration was 174.8 seconds in the group without Visio-Track versus 57.1 seconds in the group with it (P < 0.0001). A similar result was observed for radiation doses: 5197.25 mGy.cm 2 for the group without versus 1987.6 mGy.cm 2 for the group with Visio-Track (P ≡ 0.0033). The stone locking system Visio-Track reduced fluoroscopy in our first group of patients, which decreased the patient's individual absorbed irradiation dose. (authors)

  6. 5 CFR 335.106 - Special selection procedures for certain veterans under merit promotion.

    Science.gov (United States)

    2010-01-01

    ... veterans under merit promotion. 335.106 Section 335.106 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROMOTION AND INTERNAL PLACEMENT General Provisions § 335.106 Special selection procedures for certain veterans under merit promotion. Preference eligibles or veterans who have...

  7. A kinematic assessment of knee prosthesis from fluoroscopy images

    International Nuclear Information System (INIS)

    Hossain, Mohammad Abrar; Fukunaga, Michihiko; Hirokawa, Shunji

    2008-01-01

    We have developed a technique for estimation 3D motion of knee prosthesis from its 2D perspective projections. Our estimation algorithm includes some innovations such as a two-step estimation algorithm, incorporative use of a geometric articulation model and a new method to solve two silhouettes' overlapping problem. Computer model simulations and experiments results demonstrated that our algorithms give sufficient accuracy. Next, with the cooperation of medical surgeons, we assessed the algorithm's clinical performance by applying it to moving fluoroscopy images of patients who had just undergone total knee arthroplasty (TKA) recently. Our experiments were done in four steps; first we have taken the moving X-ray pictures called fluoroscopy images of the knee prosthesis at different knee motions; second, introduced the absolute positions/orientations for both components, third, introduced the relative positions/orientations between the femoral and the tibial components and finally, introduced the contact points trajectories between the femur and the tibial insert. We drew the estimation results graphically and made the computer-aided detection (CAD) model pictures of the prosthesis, thereby helping us to assess how the relative motions between the femoral and the tibial components were generated. Estimation results of the clinical applications demonstrated that our algorithm worked well as like as theoretical. (author)

  8. An interactive Web-based radiation protection course in fluoroscopy

    International Nuclear Information System (INIS)

    Aldrich, J.

    2001-01-01

    The teaching of radiation protection to a large group of physicians, who are separated geographically and have complicated schedules, is a formidable problem. Therefore a Web-based solution is attractive, allowing access to the material at any time and place. In this implementation the didactic material is presented in a Web-based format. Subsequently, students attend a practical demonstration in one of the departments' fluoroscopy rooms. Because of local experience with distance education, WebCT was chosen to present the material. WebCT (Web Course Tools) was developed by the University of British Columbia (UBC) to allow educators, with or without technical expertise, to create a sophisticated Web-base. Authors use a standard Web browser to create courses, and students use their browsers to access course material. WebCT provides a wide variety of tools and features that can be added to a course. Among the most useful tools used in this fluoroscopy course are the glossary, multiple-choice questions for each section, and a final test which is scored by the computer. As with all Web-based material the courses can be viewed in the traditional linear fashion or in any random way through the use of linkages. (author)

  9. Patient doses in interventional cardiology procedures

    International Nuclear Information System (INIS)

    Domienik, J.; Papierz, S.; Jankowski, J.; Peruga, J.Z.

    2008-01-01

    In most countries of European Union legislation requires the determination of the total skin dose to patient resulting from interventional procedures to assess the risk of deterministic effect. To this end, various dose indicators like dose area product (DAP), cumulative dose (CD) and entrance dose at the patient plane (EFD) are used in clinical practice. The study aims at relating those dose indicators with doses ascribe to the most irradiated areas of the patient skin usually expressed in terms of local maximal skin dose (MSD). For the study the local MSD and related to their areas are investigated and compared for coronary angiography CA and intervention (PCI). Two methods implying radiographic films Kodak EDR2 and matrixes of thermoluminescent dosimeters (TLDs) are applied for direct measurements of dose distribution for selected procedures. Both methods are compared. Additionally, for patient dosimetry the following data: MSD, CD, EFD, fluoroscopy time (FT), number of acquired images, total DAP, fluoro-DAP and record-DAP were collected for randomly selected procedure. The statistical quantities like: median, 3 rd quartile, mean and standard deviation for all dosimetric parameters are determined. Preliminary study showed that the values of data collected for coronary procedures are in the ranges 0,7 - 27,3 min for fluoroscopy time, 50 - 350 Gy cm 2 for total DAP, 300 - 2000 mGy for CD, 140 - 2000 mGy for EFD and 100 - 1500 mGy for local maximal skin dose. For interventions the ranges are, accordingly 3,0 - 43,6 min , 25 - 450 Gy cm 2 , 270 - 6600 mGy, 80 - 2600 mGy and 80 - 1500 mGy. As a result of the study the correlations between dose indicators and local MSD are analyzed. The concentration of dose on irradiated films are going to be investigated in some detail as well. (author)

  10. Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series

    International Nuclear Information System (INIS)

    Wallace, Adam N.; Pacheco, Rafael A.; Tomasian, Anderanik; Hsi, Andy C.; Long, Jeremiah; Chang, Randy O.; Jennings, Jack W.

    2016-01-01

    BackgroundA novel coaxial biopsy system powered by a handheld drill has recently been introduced for percutaneous bone biopsy. This technical note describes our initial experience performing fluoroscopy-guided vertebral body biopsies with this system, compares the yield of drill-assisted biopsy specimens with those obtained using a manual technique, and assesses the histologic adequacy of specimens obtained with drill assistance.MethodsMedical records of all single-level, fluoroscopy-guided vertebral body biopsies were reviewed. Procedural complications were documented according to the Society of Interventional Radiology classification. The total length of bone core obtained from drill-assisted biopsies was compared with that of matched manual biopsies. Pathology reports were reviewed to determine the histologic adequacy of specimens obtained with drill assistance.ResultsTwenty eight drill-assisted percutaneous vertebral body biopsies met study inclusion criteria. No acute complications were reported. Of the 86 % (24/28) of patients with clinical follow-up, no delayed complications were reported (median follow-up, 28 weeks; range 5–115 weeks). The median total length of bone core obtained from drill-assisted biopsies was 28 mm (range 8–120 mm). This was longer than that obtained from manual biopsies (median, 20 mm; range 5–45 mm; P = 0.03). Crush artifact was present in 11 % (3/28) of drill-assisted biopsy specimens, which in one case (3.6 %; 1/28) precluded definitive diagnosis.ConclusionsA drill-assisted, coaxial biopsy system can be used to safely obtain vertebral body core specimens under fluoroscopic guidance. The higher bone core yield obtained with drill assistance may be offset by the presence of crush artifact

  11. Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, Adam N., E-mail: wallacea@mir.wustl.edu; Pacheco, Rafael A., E-mail: pachecor@mir.wustl.edu; Tomasian, Anderanik, E-mail: tomasiana@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Hsi, Andy C., E-mail: hsia@path.wustl.edu [Washington University School of Medicine, Division of Anatomic Pathology, Department of Pathology & Immunology (United States); Long, Jeremiah, E-mail: longj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Chang, Randy O., E-mail: changr@wusm.wustl.edu [Washington University School of Medicine (United States); Jennings, Jack W., E-mail: jenningsj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States)

    2016-02-15

    BackgroundA novel coaxial biopsy system powered by a handheld drill has recently been introduced for percutaneous bone biopsy. This technical note describes our initial experience performing fluoroscopy-guided vertebral body biopsies with this system, compares the yield of drill-assisted biopsy specimens with those obtained using a manual technique, and assesses the histologic adequacy of specimens obtained with drill assistance.MethodsMedical records of all single-level, fluoroscopy-guided vertebral body biopsies were reviewed. Procedural complications were documented according to the Society of Interventional Radiology classification. The total length of bone core obtained from drill-assisted biopsies was compared with that of matched manual biopsies. Pathology reports were reviewed to determine the histologic adequacy of specimens obtained with drill assistance.ResultsTwenty eight drill-assisted percutaneous vertebral body biopsies met study inclusion criteria. No acute complications were reported. Of the 86 % (24/28) of patients with clinical follow-up, no delayed complications were reported (median follow-up, 28 weeks; range 5–115 weeks). The median total length of bone core obtained from drill-assisted biopsies was 28 mm (range 8–120 mm). This was longer than that obtained from manual biopsies (median, 20 mm; range 5–45 mm; P = 0.03). Crush artifact was present in 11 % (3/28) of drill-assisted biopsy specimens, which in one case (3.6 %; 1/28) precluded definitive diagnosis.ConclusionsA drill-assisted, coaxial biopsy system can be used to safely obtain vertebral body core specimens under fluoroscopic guidance. The higher bone core yield obtained with drill assistance may be offset by the presence of crush artifact.

  12. [Fluoroscopy dose reduction of computed tomography guided chest interventional radiology using real-time iterative reconstruction].

    Science.gov (United States)

    Hasegawa, Hiroaki; Mihara, Yoshiyuki; Ino, Kenji; Sato, Jiro

    2014-11-01

    The purpose of this study was to evaluate the radiation dose reduction to patients and radiologists in computed tomography (CT) guided examinations for the thoracic region using CT fluoroscopy. Image quality evaluation of the real-time filtered back-projection (RT-FBP) images and the real-time adaptive iterative dose reduction (RT-AIDR) images was carried out on noise and artifacts that were considered to affect the CT fluoroscopy. The image standard deviation was improved in the fluoroscopy setting with less than 30 mA on 120 kV. With regard to the evaluation of artifact visibility and the amount generated by the needle attached to the chest phantom, there was no significant difference between the RT-FBP images with 120 kV, 20 mA and the RT-AIDR images with low-dose conditions (greater than 80 kV, 30 mA and less than 120 kV, 20 mA). The results suggest that it is possible to reduce the radiation dose by approximately 34% at the maximum using RT-AIDR while maintaining image quality equivalent to the RT-FBP images with 120 V, 20 mA.

  13. Placement of iliosacral screws using 3D image-guided (O-Arm) technology and Stealth Navigation: comparison with traditional fluoroscopy.

    Science.gov (United States)

    Theologis, A A; Burch, S; Pekmezci, M

    2016-05-01

    We compared the accuracy, operating time and radiation exposure of the introduction of iliosacral screws using O-arm/Stealth Navigation and standard fluoroscopy. Iliosacral screws were introduced percutaneously into the first sacral body (S1) of ten human cadavers, four men and six women. The mean age was 77 years (58 to 85). Screws were introduced using a standard technique into the left side of S1 using C-Arm fluoroscopy and then into the right side using O-Arm/Stealth Navigation. The radiation was measured on the surgeon by dosimeters placed under a lead thyroid shield and apron, on a finger, a hat and on the cadavers. There were no neuroforaminal breaches in either group. The set-up time for the O-Arm was significantly longer than for the C-Arm, while total time for placement of the screws was significantly shorter for the O-Arm than for the C-Arm (p = 0.001). The mean absorbed radiation dose during fluoroscopy was 1063 mRad (432.5 mRad to 4150 mRad). No radiation was detected on the surgeon during fluoroscopy, or when he left the room during the use of the O-Arm. The mean radiation detected on the cadavers was significantly higher in the O-Arm group (2710 mRem standard deviation (sd) 1922) than during fluoroscopy (11.9 mRem sd 14.8) (p Cite this article: Bone Joint J 2016;98-B:696-702. ©2016 The British Editorial Society of Bone & Joint Surgery.

  14. Radiographic implications of procedures involving cardiac implantable electronic devices (CIEDs – Selected aspects

    Directory of Open Access Journals (Sweden)

    Roman Steckiewicz

    2017-06-01

    Full Text Available Background: Some cardiac implantable electronic device (CIED implantation procedures require the use of X-rays, which is reflected by such parameters as total fluoroscopy time (TFT and dose-area product (DAP – defined as the absorbed dose multiplied by the area irradiated. Material and Methods: This retrospective study evaluated 522 CIED implantation (424 de novo and 98 device upgrade and new lead placement procedures in 176 women and 346 men (mean age 75±11 years over the period 2012–2015. The recorded procedure-related parameters TFT and DAP were evaluated in the subgroups specified below. The group of 424 de novo procedures included 203 pacemaker (PM and 171 implantable cardioverter-defibrillator (ICD implantation procedures, separately stratified by single-chamber and dual-chamber systems. Another subgroup of de novo procedures involved 50 cardiac resynchronization therapy (CRT devices. The evaluated parameters in the group of 98 upgrade procedures were compared between 2 subgroups: CRT only and combined PM and ICD implantation procedures. Results: We observed differences in TFT and DAP values between procedure types, with PM-related procedures showing the lowest, ICD – intermediate (with values for single-chamber considerably lower than those for dual-chamber systems and CRT implantation procedures – highest X-ray exposure. Upgrades to CRT were associated with 4 times higher TFT and DAP values in comparison to those during other upgrade procedures. Cardiac resynchronization therapy de novo implantation procedures and upgrades to CRT showed similar mean values of these evaluated parameters. Conclusions: Total fluoroscopy time and DAP values correlated progressively with CIED implantation procedure complexity, with CRT-related procedures showing the highest values of both parameters. Med Pr 2017;68(3:363–374

  15. CT Fluoroscopy-Guided Lung Biopsy with Novel Steerable Biopsy Canula: Ex-Vivo Evaluation in Ventilated Porcine Lung Explants

    International Nuclear Information System (INIS)

    Schaefer, Philipp J.; Fabel, Michael; Bolte, Hendrik; Schaefer, Fritz K. W.; Jahnke, Thomas; Heller, Martin; Lammer, Johannes; Biederer, Juergen

    2010-01-01

    The purpose was to evaluate ex-vivo a prototype of a novel biopsy canula under CT fluoroscopy-guidance in ventilated porcine lung explants in respiratory motion simulations. Using an established chest phantom for porcine lung explants, n = 24 artificial lesions consisting of a fat-wax-Lipiodol mixture (approx. 70HU) were placed adjacent to sensible structures such as aorta, pericardium, diaphragm, bronchus and pulmonary artery. A piston pump connected to a reservoir beneath a flexible silicone reconstruction of a diaphragm simulated respiratory motion by rhythmic inflation and deflation of 1.5 L water. As biopsy device an 18-gauge prototype biopsy canula with a lancet-like, helically bended cutting edge was used. The artificial lesions were punctured under CT fluoroscopy-guidance (SOMATOM Sensation 64, Siemens, Erlangen, Germany; 30mAs/120 kV/5 mm slice thickness) implementing a dedicated protocol for CT fluoroscopy-guided lung biopsy. The mean-diameter of the artificial lesions was 8.3 ± 2.6 mm, and the mean-distance of the phantom wall to the lesions was 54.1 ± 13.5 mm. The mean-displacement of the lesions by respiratory motion was 14.1 ± 4.0 mm. The mean-duration of CT fluoroscopy was 9.6 ± 5.1 s. On a 4-point scale (1 = central; 2 = peripheral; 3 = marginal; 4 = off target), the mean-targeted precision was 1.9 ± 0.9. No misplacement of the biopsy canula affecting adjacent structures could be detected. The novel steerable biopsy canula proved to be efficient in the ex-vivo set-up. The chest phantom enabling respiratory motion and the steerable biopsy canula offer a feasible ex-vivo system for evaluating and training CT fluoroscopy-guided lung biopsy adapted to respiratory motion.

  16. MO-G-18A-01: Radiation Dose Reducing Strategies in CT, Fluoroscopy and Radiography

    International Nuclear Information System (INIS)

    Mahesh, M; Gingold, E; Jones, A

    2014-01-01

    Advances in medical x-ray imaging have provided significant benefits to patient care. According to NCRP 160, there are more than 400 million x-ray procedures performed annually in the United States alone that contributes to nearly half of all the radiation exposure to the US population. Similar growth trends in medical x-ray imaging are observed worldwide. Apparent increase in number of medical x-ray imaging procedures, new protocols and the associated radiation dose and risk has drawn considerable attention. This has led to a number of technological innovations such as tube current modulation, iterative reconstruction algorithms, dose alerts, dose displays, flat panel digital detectors, high efficient digital detectors, storage phosphor radiography, variable filters, etc. that are enabling users to acquire medical x-ray images at a much lower radiation dose. Along with these, there are number of radiation dose optimization strategies that users can adapt to effectively lower radiation dose in medical x-ray procedures. The main objectives of this SAM course are to provide information and how to implement the various radiation dose optimization strategies in CT, Fluoroscopy and Radiography. Learning Objectives: To update impact of technological advances on dose optimization in medical imaging. To identify radiation optimization strategies in computed tomography. To describe strategies for configuring fluoroscopic equipment that yields optimal images at reasonable radiation dose. To assess ways to configure digital radiography systems and recommend ways to improve image quality at optimal dose

  17. 75 FR 6560 - Financial Crimes Enforcement Network; Expansion of Special Information Sharing Procedures To...

    Science.gov (United States)

    2010-02-10

    ...; Expansion of Special Information Sharing Procedures To Deter Money Laundering and Terrorist Activity AGENCY... continuing effort to increase the efficiency and effectiveness of its anti-money laundering and counter...-5332, to promote the prevention, detection, and prosecution of international money laundering and the...

  18. Fluoroscopy of spontaneous breathing is more sensitive than phrenic nerve stimulation for detection of right phrenic nerve injury during cryoballoon ablation of atrial fibrillation.

    Science.gov (United States)

    Linhart, Markus; Nielson, Annika; Andrié, René P; Mittmann-Braun, Erica L; Stöckigt, Florian; Kreuz, Jens; Nickenig, Georg; Schrickel, Jan W; Lickfett, Lars M

    2014-08-01

    Right phrenic nerve palsy (PNP) is a typical complication of cryoballoon ablation of the right-sided pulmonary veins (PVs). Phrenic nerve function can be monitored by palpating the abdomen during phrenic nerve pacing from the superior vena cava (SVC pacing) or by fluoroscopy of spontaneous breathing. We sought to compare the sensitivity of these 2 techniques during cryoballoon ablation for detection of PNP. A total of 133 patients undergoing cryoballoon ablation were monitored with both SVC pacing and fluoroscopy of spontaneous breathing during ablation of the right superior PV. PNP occurred in 27/133 patients (20.0%). Most patients (89%) had spontaneous recovery of phrenic nerve function at the end of the procedure or on the following day. Three patients were discharged with persistent PNP. All PNP were detected first by fluoroscopic observation of diaphragm movement during spontaneous breathing, while diaphragm could still be stimulated by SVC pacing. In patients with no recovery until discharge, PNP occurred at a significantly earlier time (86 ± 34 seconds vs. 296 ± 159 seconds, P < 0.001). No recovery occurred in 2/4 patients who were ablated with a 23 mm cryoballoon as opposed to 1/23 patients with a 28 mm cryoballoon (P = 0.049). Fluoroscopic assessment of diaphragm movement during spontaneous breathing is more sensitive for detection PNP as compared to SVC pacing. PNP as assessed by fluoroscopy is frequent (20.0%) and carries a high rate of recovery (89%) until discharge. Early onset of PNP and use of 23 mm cryoballoon are associated with PNP persisting beyond hospital discharge. © 2014 Wiley Periodicals, Inc.

  19. Radiation-protective effect with screens of fluoroscopy

    International Nuclear Information System (INIS)

    Kitagawa, H.; Sasaki, Y.; Chaya, K.; Furui, Y.

    1991-01-01

    In a fluoroscopic situation supposing heartworm removal using flexible alligator forceps, the radiationprotective effect of lead-containing screens was examined. Regarding measurements using a gamma-survey meter, X-ray exposure to the operator was reduced from 24.6±7.5 micro-Sievert (μSv)/hr to 0.47±0.08μSv/hr by using protective screens at position A, which corresponds to the operator's face level. At position B, which corresponds to the position of operator's left-hand fingers, the exposure level decreased from 33.1±1.37μSv/hr to 3.01±1.23μSv/hr when screens were used, and decreased more to 0.44±0.16μSv/ hr with the use of protective gloves. At position C, which was at the operator's foot, the exposure level decreased from 0.65±0.27μSv/hr to 0.24±0.10μSv/hr. Regarding measurements using a film badge for 20 experimental dogs, in which each dog was fluoroscopied for 20 sec×15 times, the operator would be totally exposed to 0.1 mSv in H 3mm , dose equivalent value against the eye lens and H 70μm , dose equivalent value against the skin at position B, but below the minimal limit for detection of X-ray (0.1 mSv) in H 1cm , effective dose-equivalent value. Exposure levels were below the minimal limit at positions A and C and at all positions which were protected with screens. Also, dogs were exposed to X-ray 2.20±0.96 mSv on fluoroscopy for 20 sec x 15 times. (author)

  20. Value of Examination Under Fluoroscopy for the Assessment of Sacroiliac Joint Dysfunction.

    Science.gov (United States)

    Eskander, Jonathan P; Ripoll, Juan G; Calixto, Frank; Beakley, Burton D; Baker, Jeffrey T; Healy, Patrick J; Gunduz, O H; Shi, Lizheng; Clodfelter, Jamie A; Liu, Jinan; Kaye, Alan D; Sharma, Sanjay

    2015-01-01

    Pain emanating from the sacroiliac (SI) joint can have variable radiation patterns. Single physical examination tests for SI joint pain are inconsistent with multiple tests increasing both sensitivity and specificity. To evaluate the use of fluoroscopy in the diagnosis of SI joint pain. Prospective double blind comparison study. Pain clinic and radiology setting in urban Veterans Administration (VA) in New Orleans, Louisiana. Twenty-two adult men, patients at a southeastern United States VA interventional pain clinic, presented with unilateral low back pain of more than 2 months' duration. Patients with previous back surgery were excluded from the study. Each patient was given a Gapping test, Patrick (FABERE) test, and Gaenslen test. A second blinded physician placed each patient prone under fluoroscopic guidance, asking each patient to point to the most painful area. Pain was provoked by applying pressure with the heel of the palm in that area to determine the point of maximum tenderness. The area was marked with a radio-opaque object and was placed on the mark with a fluoroscopic imgage. A site within 1 cm of the SI joint was considered as a positive test. This was followed by a diagnostic injection under fluoroscopy with 1 mL 2% lidocaine. A positive result was considered as more than 2 hours of greater than 75% reduction in pain. Then, in 2-3 days this was followed by a therapeutic injection under fluoroscopy with 1 mL 0.5% bupivacaine and 40 mg methylprednisolone. Each patient was reassessed after 6 weeks. The sensitivity and specificity in addition to the positive and negative predictive values were determined for both the conventional examinations, as well as the examination under fluoroscopy. Finally, a receiver operating characteristic (ROC) curve was constructed to evaluate test performance. The sensitivity and specificity of the fluoroscopic examination were 0.82 and 0.80 respectively; Positive predictive value and negative predictive value were 0.93 and

  1. CT fluoroscopy-guided vs. multislice CT biopsy mode-guided lung biopsies: Accuracy, complications and radiation dose

    International Nuclear Information System (INIS)

    Prosch, Helmut; Stadler, Alfred; Schilling, Matthias; Bürklin, Sandra; Eisenhuber, Edith; Schober, Ewald; Mostbeck, Gerhard

    2012-01-01

    Background: The aim of this retrospective study was to compare the diagnostic accuracy, the frequency of complications, the duration of the interventions and the radiation doses of CT fluoroscopy (CTF) guided biopsies of lung lesions with those of multislice CT (MS-CT) biopsy mode-guided biopsies. Methods: Data and images from 124 consecutive patients undergoing CTF-guided lung biopsy (group A) and 132 MS-CT-biopsy mode-guided lung biopsy (group B) were reviewed. CTF-guided biopsies were performed on a Siemens Emotion 6 CT scanner with intermittent or continuous CT-fluoroscopy, MS-CT biopsy mode-guided biopsies were performed on a Siemens Emotion 16 CT scanner. All biopsies were performed with a coaxial needle technique. Results: The two groups (A vs. B) did not differ significantly regarding sensitivity (95.5% vs. 95.9%), specificity (96.7% vs. 95.5%), negative predictive value (87.9% vs. 84%) or positive predictive value (98.8% vs. 98.9%). Pneumothorax was observed in 30.0% and 32.5% of the patients, respectively. Chest tube placement was necessary in 4% (group A) and 13% (group B) of the patients. The duration of the intervention was significantly longer in group A (median 37 min vs. 32 min, p = 0.04). The mean CT dose index (CTDI) was 422 in group A and 36.3 in group B (p < 0.001). Conclusion: Compared to CTF-guided biopsies, chest biopsies using the MS-CT biopsy mode show dramatically lower CTDI levels. Although the diagnostic yield of the procedures do not differ significantly, biopsies using the MS-CT-biopsy mode have a three-fold higher rate of chest tube placement.

  2. Preliminary assessment of the dose to the interventional radiologist in fluoro-CT-guided procedures

    International Nuclear Information System (INIS)

    Pereira, M. F.; Alves, J. G.; Sarmento, S.; Santos, J. A. M.; Sousa, M. J.; Gouvea, M.; Oliveira, A. D.; Cardoso, J. V.; Santos, L. M.

    2011-01-01

    A preliminary assessment of the occupational dose to the intervention radiologist received in fluoroscopy computerised tomography (CT) used to guide the collection of lung and bone biopsies is presented. The main aim of this work was to evaluate the capability of the reading system as well as of the available whole-body (WB) and extremity dosemeters used in routine monthly monitoring periods to measure per procedure dose values. The intervention radiologist was allocated 10 WB detectors (LiF: Mg, Ti, TLD-100) placed at chest and abdomen levels above and below the lead apron, and at both right and left arms, knees and feet. A special glove was developed with casings for the insertion of 11 extremity detectors (LiF:Mg, Cu, P, TLD-100H) for the identification of the most highly exposed fingers. The H p (10) dose values received above the lead apron (ranged 0.20-0.02 mSv) depend mainly on the duration of the examination and on the placement of physician relative to the beam, while values below the apron are relatively low. The left arm seems to receive a higher dose value. H p (0.07) values to the hand (ranged 36.30-0.06 mSv) show that the index, middle and ring fingers are the most highly exposed. In this study, the wrist dose was negligible compared with the finger dose. These results are preliminary and further studies are needed to better characterise the dose assessment in CT fluoroscopy. (authors)

  3. CT fluoroscopy-assisted puncture of thoracic and abdominal masses: a randomized trial.

    Science.gov (United States)

    Kirchner, Johannes; Kickuth, Ralph; Laufer, Ulf; Schilling, Esther Maria; Adams, Stephan; Liermann, Dieter

    2002-03-01

    We investigated the benefit of real-time guidance of interventional punctures by means of computed tomography fluoroscopy (CTF) compared with the conventional sequential acquisition guidance. In a prospective randomized trial, 75 patients underwent either CTF-guided (group A, n = 50) or sequential CT-guided (group B, n = 25) punctures of thoracic (n = 29) or abdominal (n = 46) masses. CTF was performed on the CT machine (Somatom Plus 4 Power, Siemens Corp., Forchheim, Germany) equipped with the C.A.R.E. Vision application (tube voltage 120 kV, tube current 50 mA, rotational time 0.75 s, slice thickness 10 mm, 8 frames/s). The average procedure time showed a statistically significant difference between the two study groups (group A: 564 s, group B 795 s, P = 0.0032). The mean total mAs was 7089 mAs for the CTF and 4856 mAs for the sequential image-guided intervention, respectively. The sensitivity was 71% specificity 100% positive predictive value 100% and negative predictive value 60% for the CTF-guided puncture, and 68, 100, 100 and 50% for sequential CT, respectively. CTF guidance realizes a time-saving but increases the radiation exposure dosage.

  4. Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures

    International Nuclear Information System (INIS)

    Romanova, K.; Alyakov, M.; Vassileva, J.

    2015-01-01

    The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/ shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. (authors)

  5. Time of fluoroscopy and number of gastrointestinal tract by doctors in the ten years. On the annual transition of patients, age groups and risks

    International Nuclear Information System (INIS)

    Iba, Shozo; Hirose, Kouichi; Hirano, Masato; Kawarada, Akira; Futami, Tsutomu.

    1997-01-01

    On the period ranging from May, 1986 to March, 1996. We investigated the actual conditions by doctors on the time while examining by X-ray fluoroscopy and the number of radiograph for the gastrointestinal tract examination using barium contrast medium. The time of fluoroscopy and the number of radiograph per X-ray examination of the stomach were about 8.5 minutes, 25 radiographs. On the patients of examination of barium enema were about 11 minutes, 19 radiographs. The time of fluoroscopy and the number of radiograph for diagnosis, there are observed the difference in the average value of several years. The time of fluoroscopy and the number of radiograph for X-ray examination of stomach by doctors have not always seen decreasing in proportion to their experience. We were estimated somatic individual risks from X-ray examination of gastrointestinal tract using a human body phantom. (author)

  6. Gated Treatment Delivery Verification With On-Line Megavoltage Fluoroscopy

    International Nuclear Information System (INIS)

    Tai An; Christensen, James D.; Gore, Elizabeth; Khamene, Ali; Boettger, Thomas; Li, X. Allen

    2010-01-01

    Purpose: To develop and clinically demonstrate the use of on-line real-time megavoltage (MV) fluoroscopy for gated treatment delivery verification. Methods and Materials: Megavoltage fluoroscopy (MVF) image sequences were acquired using a flat panel equipped for MV cone-beam CT in synchrony with the respiratory signal obtained from the Anzai gating device. The MVF images can be obtained immediately before or during gated treatment delivery. A prototype software tool (named RTReg4D) was developed to register MVF images with phase-sequenced digitally reconstructed radiograph images generated from the treatment planning system based on four-dimensional CT. The image registration can be used to reposition the patient before or during treatment delivery. To demonstrate the reliability and clinical usefulness, the system was first tested using a thoracic phantom and then prospectively in actual patient treatments under an institutional review board-approved protocol. Results: The quality of the MVF images for lung tumors is adequate for image registration with phase-sequenced digitally reconstructed radiographs. The MVF was found to be useful for monitoring inter- and intrafractional variations of tumor positions. With the planning target volume contour displayed on the MVF images, the system can verify whether the moving target stays within the planning target volume margin during gated delivery. Conclusions: The use of MVF images was found to be clinically effective in detecting discrepancies in tumor location before and during respiration-gated treatment delivery. The tools and process developed can be useful for gated treatment delivery verification.

  7. Evaluation of the dosimetric performance characteristic of fluoroscopy system used in medicine

    International Nuclear Information System (INIS)

    Qi Xuesong; Wei Kedao; Cheng Yuxi; Zhou Qifu; Ge Lijuan; Hou Changsong

    2001-01-01

    Objective: To discuss establishment of diagnostic reference dose value in fluoroscopic examinations for survey of 16 different types of fluoroscopy systems. Methods: Choosing dosimetric characteristic parameters including: IIESDR, ESDR (typical value) and ESDR max (ESDR maximum), and DAP, which was calibrated in situ on the X-ray unit. Results: Results of dose survey are summarized in three tables, from these we could get wide changes in accordance with those in many other countries resulting from maximum and minimum of IIESDR, ESDR and ESDRmax when measurements were performed at same entrance field size on I.I. Image Intensifier of the 15 fluoroscopy systems and under conditions of ABC. And also we could get less changes of DAP mean values, though differences for patient weight, technological parameters of fluoroscopic exam setting, fluoroscopic time and number of film were more remarkable. Conclusions: Measurements on IIESDR, ESDR (typical value) and ESDRmax (ESDR maximum) are not satisfied as diagnostic reference level. But it is suggested that DAP values, in fluoroscopic exam, are used as a tool to achieve this. (author)

  8. Patient dose assessment in various Interventional radiology and cardiology procedures in Algeria (IAEA regional project results)

    International Nuclear Information System (INIS)

    Khelassi-Toutaoui, Nadia; Merad, Ahmed; Toutaoui, A.E.K.; Bairi, Souad

    2008-01-01

    Full text: Purpose: To evaluate patient doses in Interventional Radiology (IR) and Cardiology (IC) procedures in Algeria, within the framework of an International Atomic Energy Agency (IAEA) regional project on radiation protection of patients and medical exposure control (RAF 9033). Materials and Methods: Three public hospitals (CHU Bab el Oued, CHU Parnet and CHU Mustapha) and one specialised Cardiology Service (Clinique Maouche) were chosen for the study. For Maximum Skin Dose (MSD) evaluation, gafchromic films XR type R were used, placed on patient's back before the procedure. The Dose Area Product (DAP) and MSD were measured in 57 IR and IC procedures, either diagnostic or therapeutic. Results: The results revealed large variations in MSD (0.06-3.3 Gy) and DAP (5.5-332 mGycm 2 ). Mean MSD was 0.227 Gy in cerebral angiography, 0.202 Gy in coronary angiography, 1.162 Gy in Percutaneus Transluminal Coronary Angioplasty (PTCA) and 0.128 in abdominal angiography. The correlation of DAP and MSD was significant (r = 0.7). The correlation was DAP and fluoroscopy time was also significant (r = 0.8). Conclusion: The highest MSD values were found in PTCA which is a therapeutic procedure. Two PTCAs out of the 57 procedures measured in total had MSD over the threshold of 2 Gy for deterministic effects (MSD 1 = 3.0 Gy and MSD 2 3.3 Gy). The large variations in MSD reveal the need to continuously monitor patient doses in IR and IC procedures with special emphasis in PTCA procedure. (author)

  9. New image-processing and noise-reduction software reduces radiation dose during complex endovascular procedures.

    Science.gov (United States)

    Kirkwood, Melissa L; Guild, Jeffrey B; Arbique, Gary M; Tsai, Shirling; Modrall, J Gregory; Anderson, Jon A; Rectenwald, John; Timaran, Carlos

    2016-11-01

    A new proprietary image-processing system known as AlluraClarity, developed by Philips Healthcare (Best, The Netherlands) for radiation-based interventional procedures, claims to lower radiation dose while preserving image quality using noise-reduction algorithms. This study determined whether the surgeon and patient radiation dose during complex endovascular procedures (CEPs) is decreased after the implementation of this new operating system. Radiation dose to operators, procedure type, reference air kerma, kerma area product, and patient body mass index were recorded during CEPs on two Philips Allura FD 20 fluoroscopy systems with and without Clarity. Operator dose during CEPs was measured using optically stimulable, luminescent nanoDot (Landauer Inc, Glenwood, Ill) detectors placed outside the lead apron at the left upper chest position. nanoDots were read using a microStar ii (Landauer Inc) medical dosimetry system. For the CEPs in the Clarity group, the radiation dose to surgeons was also measured by the DoseAware (Philips Healthcare) personal dosimetry system. Side-by-side measurements of DoseAware and nanoDots allowed for cross-calibration between systems. Operator effective dose was determined using a modified Niklason algorithm. To control for patient size and case complexity, the average fluoroscopy dose rate and the dose per radiographic frame were adjusted for body mass index differences and then compared between the groups with and without Clarity by procedure. Additional factors, for example, physician practice patterns, that may have affected operator dose were inferred by comparing the ratio of the operator dose to procedural kerma area product with and without Clarity. A one-sided Wilcoxon rank sum test was used to compare groups for radiation doses, reference air kermas, and operating practices for each procedure type. The analysis included 234 CEPs; 95 performed without Clarity and 139 with Clarity. Practice patterns of operators during

  10. Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-08-01

    Full Text Available Juraj Artner, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: The sacroiliac (SI joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement. The following study presents a comparison of radiation doses, calculated for fluoroscopy and CT-guided SI joint injections in standard and low-dose protocol and presents the technical possibility of CT-guidance with maximum radiation dose reduction to levels of fluoroscopic-guidance for a precise intra-articular injection technique.Objective: To evaluate the possibility of dose reduction in CT-guided sacroiliac joint injections to pulsed-fluoroscopy-guidance levels and to compare the doses of pulsed-fluoroscopy-, CT-guidance, and low-dose CT-guidance for intra-articular SI joint injections.Study design: Comparative study with technical considerations.Methods: A total of 30 CT-guided intra-articular SI joint injections were performed in January 2012 in a developed low-dose mode and the radiation doses were calculated. They were compared to 30 pulsed-fluoroscopy-guided SI joint injections, which were performed in the month before, and to five injections, performed in standard CT-guided biopsy mode for spinal interventions. The statistical significance was calculated with the SPSS software using the Mann–Whitney U-Test. Technical details and anatomical considerations were provided.Results: A significant dose reduction of average 94.01% was achieved using the low-dose protocol for CT-guided SI joint injections. The radiation dose could be approximated to pulsed-fluoroscopy-guidance levels.Conclusion: Radiation dose of CT-guided SI joint injections can be

  11. Evaluation of percutaneous vertebroplasty in osteoporotic vertebral fractures using a combination of CT fluoroscopy and conventional lateral fluoroscopy; Perkutane Vertebroplastie osteoporosebedingter Wirbelkoerperfrakturen: Erfahrungen mit der CT-Fluoroskopie

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Schneider, J.; Brecher, B.; Herber, S.; Mohr, W.; Thelen, M. [Klinik fuer Radiologie, Universitaetskliniken Mainz (Germany); Drees, P.; Eckardt, A.; Heine, J. [Klinik fuer Orthopaedie, Universitaetskliniken Mainz (Germany)

    2004-07-01

    Purpose: Evaluation of vertebroplasty using a combination of CT-fluoroscopy and conventional lateral fluoroscopy in patients with osteoporotic vertebral fractures. Materials and Methods: Fifty-eight patients (23male, 35 women, age 69.7 {+-} 10.2 years) with painful osteoporotic vertebral fractures were treated with vertebroplasty in conscious sedation and local anesthesia. Spiral-CT with sagittal reconstructions of the respective vertebral bodies was used for classification of the fracture. The cannula was placed under CT-guidance in the ventral third of the respective vertebral bodies and cement instilled under CT fluoroscopy and lateral fluoroscopy. When cement migrated towards the vertebral canal, the injection was immediately stopped for 30-60 seconds. After polymerization in this location, the injection was continued until sufficient filling of the vertebra. Results were documented by spiral CT with sagittal reconstructions. Results: A total of 123 vertebral bodies were treated, comprising 39 thoracic and 84 lumbar vertebral bodies, with a mean of 2.1 {+-} 1.3 (range 1 to 6) vertebral bodies in each patient and a maximum of 3 vertebral bodies per session. All interventions were successfully completed in conscious sedation and local anesthesia. A mean volume of 5.9 {+-} 0.6 ml (range 2 to 14 ml) cement was applied for each vertebra, with 79.7% of procedures performed using a unilateral access. To achieve a sufficient cement deposit, a bilateral access was used in 20.3%. The dorsal wall of the vertebra was included in 23.6% of the fractures. In one case, cement migration into the spinal canal was detected, reducing the diameter of the canal by 30%. In two other cases, cement leakage was seen at the puncture site of the vertebra (one intercostotransversally in the 10{sup th} thoracic vertebra and one dorsolaterally in the 1{sup st} lumbar vertebra) with retrograde cement migration through the neuroforamen into the epidural space. In one of these cases, the

  12. Comparative study between NCRP-49 and NCRP-147 methodologies for shielding calculus to fluoroscopy rooms

    International Nuclear Information System (INIS)

    Ferreira, Christiano Eduardo Martins

    2011-01-01

    The walls of a fluoroscopy room must be shielded to prevent unnecessary exposures to technicians and public individuals. Thus this dissertation aims to describe the methodologies contained in two documents which are references for the calculation of shielding those rooms. They are the National Council on Radiation Protection and Measurements Report No. 49 (NCRP Report No. 49) and No. 147 (NCRP Report No. 147), the latter being more recent publication. And based on such description was made a comparative study between the two methodologies, using for this, as a benchmark, spreadsheets computer program developed by Wolfram Mathematica 6. With that we could reach the final thickness of the barriers to a Standard Plan for a fluoroscopy room (provided by Siemens) and noted that the NCRP-49 presents a methodology with results more conservative. (author)

  13. Anterior celiac plexus block for interventional biliary procedures

    International Nuclear Information System (INIS)

    Benenati, J.F.; Widlus, D.M.; Venbrux, A.C.; Lynch-Nyhan, A.; Osterman, F.A.; Taylor, D.R.; Tewes, P.A.; Cassidy, F.P.

    1989-01-01

    This paper reports temporary celiac ganglion block for pain relief during biliary procedures performed without complication in 65 patients. The block was given from an anterior approach, with 30 mL of bupivacaine injected over the right T-12 pedicle. Fluoroscopy was used to guide the needle 2 cm anterior to the spine. Patients were assigned to one of three groups based on degree of anesthesia. In group 1, there was no benefit (20%); in group 2, moderate regional anesthesia (22%); and in group 3, excellent anesthesia (58%). The procedure may be performed at the start of or any time during the examination and provides satisfactory regional anesthesia in 80% of patients

  14. Evaluation of the radiation levels in different surgical procedures

    International Nuclear Information System (INIS)

    Silva Santos, M.C.P. da; Almeida, A. de; Belluci, A.D.; Ghilardi Neto, T.

    1989-01-01

    The exposure of a medical team to radiation during surgical procedures evidently depends on the duration and difficulties of the particular procedure. We have made a dosimetric study of the average equivalent doses received by the surgical teams during 10 different surgical procedures over a period of one month. Our results demonstrate that the levels of ionizing radiation that the members of the teams receive typically do not surpass the limits stipulated for the following surgical procedures: nefrolithotomy, percutaneous ureterolithomy, ureteroscoy connected with removal of stones in the inferior third of the ureter, osteosynthesis of the tibial plateau together with a articular toalet and minireconstruction of the knee. For compound surgical procedures, for example, osteosynthesis of a femur fracture together with biopsy of an exposed femur or percutaneous nefrolithotomy (complex cases), the dose limits have been surpassed owing to the additional fluoroscopy needed in those p rocedures. (author) [pt

  15. Ultrasound-guided versus fluoroscopy-guided sacroiliac joint intra-articular injections in the noninflammatory sacroiliac joint dysfunction: a prospective, randomized, single-blinded study.

    Science.gov (United States)

    Jee, Haemi; Lee, Ji-Hae; Park, Ki Deok; Ahn, Jaeki; Park, Yongbum

    2014-02-01

    To compare the short-term effects and safety of ultrasound (US)-guided sacroiliac joint (SIJ) injections with fluoroscopy (FL)-guided SIJ injections in patients with noninflammatory SIJ dysfunction. Prospective, randomized controlled trial. University hospital. Patients (N=120) with noninflammatory sacroiliac arthritis were enrolled. All procedures were performed using an FL or US apparatus. Subjects were randomly assigned to either the FL or US group. Immediately after the SIJ injections, fluoroscopy was applied to verify the correct placement of the injected medication and intravascular injections. Treatment effects and functional improvement were compared at 2 and 12 weeks after the procedures. The verbal numeric pain scale and Oswestry Disability Index improved at 2 and 12 weeks after the injections without statistical significances between groups. Of 55 US-guided injections, 48 (87.3%) were successful and 7 (12.7%) were missed. The FL-guided SIJ approach exhibited a greater accuracy (98.2%) than the US-guided approach. Vascularization around the SIJ was seen in 34 of 55 patients. Among the 34 patients, 7 had vascularization inside the joint, 23 had vascularization around the joint, and 4 had vascularization both inside and around the joint. Three cases of intravascular injections occurred in the FL group. The US-guided approach may facilitate the identification and avoidance of the critical vessels around or within the SIJ. Function and pain relief significantly improved in both groups without significant differences between groups. The US-guided approach was shown to be as effective as the FL-guided approach in treatment effects. However, diagnostic application in the SIJ may be limited because of the significantly lower accuracy rate (87.3%). Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Effectiveness of imaging-guided intra-articular injection: a comparison study between fluoroscopy and ultrasound.

    Science.gov (United States)

    Furtado, Rita Nely Vilar; Pereira, Daniele Freitas; da Luz, Karine Rodrigues; dos Santos, Marla Francisca; Konai, Monique Sayuri; Mitraud, Sonia de Aguiar Vilela; Rosenfeld, Andre; Fernandes, Artur da Rocha Correa; Natour, Jamil

    2013-01-01

    Compare the effectiveness of ultrasound and fluoroscopy to guide intra-articular injections (IAI) in selected cases. A prospective study in our outpatient clinics at the Rheumatology Division at Universidade Federal de São Paulo (UNIFESP), Brazil, was conducted to compare the short-term (4 weeks) effectiveness of ultrasound and fluoroscopy-guided IAI in patients with rheumatic diseases. Inclusion criteria were: adults with refractory synovitis undergoing IAI with glucocorticoid. All patients had IAI performed with triamcinolone hexacetonide (20mg/ml) with varying doses according to the joint injected. A total of 71 rheumatic patients were evaluated (52 women, 44 whites). Mean age was 51.9 ± 13 years and 47 of them (66.2%) were on regular DMARD use. Analysis of the whole sample (71 patients) and hip sub-analysis (23 patients) showed that significant improvement was observed for both groups in terms of pain (P < 0.001). Global analysis also demonstrated better outcomes for patients in the FCG in terms of joint flexion (P < 0.001) and percentage change in joint flexion as compared to the USG. Likert scale score analyses demonstrated better results for the patients in the USG as compared to the FCG at the end of the study (P < 0.05). No statistically significant difference between groups was observed for any other study variable. Imaging-guided IAI improves regional pain in patients with various types of synovitis in the short term. For the vast majority of variables, no significant difference in terms of effectiveness was observed between fluoroscopy and ultrasound guided IAI.

  17. From analogue to apps--developing an app to prepare children for medical imaging procedures.

    Science.gov (United States)

    Williams, Gigi; Greene, Siobhan

    2015-01-01

    The Royal Children's Hospital (RCH) in Melbourne has launched a world-first app for children that will help reduce anxiety and the need for anesthesia during medical imaging procedures. The free, game-based app, "Okee in Medical Imaging", helps children aged from four to eight years to prepare for all medical imaging procedures--X-ray, CT, MRI, ultrasound, nuclear medicine, and fluoroscopy. The app is designed to reduce anticipatory fear of imaging procedures, while helping to ensure that children attend imaging appointments equipped with the skills required for efficient and effective scans to be performed. This paper describes how the app was developed.

  18. Diagnostic impact of thallium scintigraphy and cardiac fluoroscopy when the exercise ECG is strongly positive

    International Nuclear Information System (INIS)

    Chaitman, B.R.; Brevers, G.; Dupras, G.; Lesperance, J.; Bourassa, M.G.

    1984-01-01

    We studied 83 men, who had a chest pain syndrome, no prior history of myocardial infarction, and exercise-induced horizontal or downsloping ST segment depression greater than or equal to 0.2 mV. The 38 patients unable to complete Bruce stage II had a significant increased risk of coronary (0.97 vs 0.71) and multivessel (0.88 vs 0.61) disease (p less than 0.01) compared to the pretest risk; data obtained from exercise-reperfusion thallium scintigraphy and cardiac fluoroscopy did not alter the risk of coronary or multivessel disease. The 45 patients who had ST depression greater than or equal to 0.2 mV and a peak work capacity greater than or equal to Bruce stage III did not have a significant increased risk of coronary (0.76) or multivessel disease (0.44). When both exercise-reperfusion thallium scintigraphy and cardiac fluoroscopy were abnormal in this latter patient subgroup, the post-test risk of multivessel disease was increased from 0.44 to 0.82 (p less than 0.03); when both tests were normal, none of the patients had multivessel disease (p less than 0.03) and only 0.18 had coronary artery disease. Thus, cardiac fluoroscopy and exercise thallium scintigraphy increase the diagnostic content of the strongly positive exercise ECG, particularly in men who have a peak work capacity greater than or equal to Bruce stage III

  19. Estimation of effective dose during hysterosalpingography procedures

    International Nuclear Information System (INIS)

    Alzimamil, K.; Babikir, E.; Alkhorayef, M.; Sulieman, A.; Alsafi, K.; Omer, H.

    2014-08-01

    Hysterosalpingography (HSG) is the most frequently used diagnostic tool to evaluate the endometrial cavity and fallopian tube by using conventional x-ray or fluoroscopy. Determination of the patient radiation doses values from x-ray examinations provides useful guidance on where best to concentrate efforts on patient dose reduction in order to optimize the protection of the patients. The aims of this study were to measure the patients entrance surface air kerma doses (ESA K), effective doses and to compare practices between different hospitals in Sudan. ESA K were measured for patient using calibrated thermo luminance dosimeters (TLDs, Gr-200A). Effective doses were estimated using National Radiological Protection Board (NRPB) software. This study was conducted in five radiological departments: Two Teaching Hospitals (A and D), two private hospitals (B and C) and one University Hospital (E). The mean ESD was 20.1 mGy, 28.9 mGy, 13.6 mGy, 58.65 mGy, 35.7, 22.4 and 19.6 mGy for hospitals A,B,C,D, and E), respectively. The mean effective dose was 2.4 mSv, 3.5 mSv, 1.6 mSv, 7.1 mSv and 4.3 mSv in the same order. The study showed wide variations in the ESDs with three of the hospitals having values above the internationally reported values. Number of x-ray images, fluoroscopy time, operator skills x-ray machine type and clinical complexity of the procedures were shown to be major contributors to the variations reported. Results demonstrated the need for standardization of technique throughout the hospital. The results also suggest that there is a need to optimize the procedures. Local DRLs were proposed for the entire procedures. (author)

  20. Reduction of Radiation Exposure Using Dynamic Trace Digital Angiography and Spot Fluoroscopy During Adrenal Venous Sampling

    International Nuclear Information System (INIS)

    Morita, Satoru; Endo, Kenji; Suzaki, Shingo; Ishizaki, Umiko; Yamazaki, Hiroshi; Nishina, Yu; Sakai, Shuji

    2017-01-01

    PurposeTo compare radiation exposure of adrenal venous sampling (AVS) using dynamic trace digital angiography (DTDA) and spot fluoroscopy with that using conventional methods.Materials and MethodsAVS was performed in 11 patients using DTDA and spot fluoroscopy (Group A) and 11 patients using conventional digital subtraction angiography (DSA) with collimation (Group B). Radiation exposure and image quality of adrenal venography using a five-point scale were compared between the groups.ResultsThe acquisition dose–area product (DAP) using DTDA and fluoro-DAP using spot fluoroscopy in Group A were lower than those using conventional DSA (5.3 ± 3.7 vs. 29.1 ± 20.1 Gy cm"2, p < 0.001) and collimation (33.3 ± 22.9 vs. 59.1 ± 35.7 Gy cm"2, p = 0.088) in Group B. The total DAP in Group A was significantly lower than that in Group B (38.6 ± 25.9 vs. 88.2 ± 53.6 Gy cm"2, p = 0.006). The peak skin dose for patients and operator radiation exposure in Group A were significantly lower than those in Group B (403 ± 340 vs. 771 ± 416 mGy, p = 0.030, and 17.1 ± 14.8 vs. 36.6 ± 21.7 μSv, p = 0.013). The image quality of DTDA (4.4 ± 0.6) was significantly higher than that of digital angiography (3.8 ± 0.9, p = 0.011) and equivalent to that of DSA (4.3 ± 0.8, p = 0.651).ConclusionsRadiation exposure during AVS can be reduced by approximately half for both patients and operators by using DTDA and spot fluoroscopy without sacrificing image quality.

  1. Reduction of Radiation Exposure Using Dynamic Trace Digital Angiography and Spot Fluoroscopy During Adrenal Venous Sampling

    Energy Technology Data Exchange (ETDEWEB)

    Morita, Satoru, E-mail: i@imodey.com; Endo, Kenji; Suzaki, Shingo; Ishizaki, Umiko; Yamazaki, Hiroshi; Nishina, Yu; Sakai, Shuji [Tokyo Women’s Medical University Hospital, Department of Diagnostic Imaging and Nuclear Medicine (Radiology) (Japan)

    2017-05-15

    PurposeTo compare radiation exposure of adrenal venous sampling (AVS) using dynamic trace digital angiography (DTDA) and spot fluoroscopy with that using conventional methods.Materials and MethodsAVS was performed in 11 patients using DTDA and spot fluoroscopy (Group A) and 11 patients using conventional digital subtraction angiography (DSA) with collimation (Group B). Radiation exposure and image quality of adrenal venography using a five-point scale were compared between the groups.ResultsThe acquisition dose–area product (DAP) using DTDA and fluoro-DAP using spot fluoroscopy in Group A were lower than those using conventional DSA (5.3 ± 3.7 vs. 29.1 ± 20.1 Gy cm{sup 2}, p < 0.001) and collimation (33.3 ± 22.9 vs. 59.1 ± 35.7 Gy cm{sup 2}, p = 0.088) in Group B. The total DAP in Group A was significantly lower than that in Group B (38.6 ± 25.9 vs. 88.2 ± 53.6 Gy cm{sup 2}, p = 0.006). The peak skin dose for patients and operator radiation exposure in Group A were significantly lower than those in Group B (403 ± 340 vs. 771 ± 416 mGy, p = 0.030, and 17.1 ± 14.8 vs. 36.6 ± 21.7 μSv, p = 0.013). The image quality of DTDA (4.4 ± 0.6) was significantly higher than that of digital angiography (3.8 ± 0.9, p = 0.011) and equivalent to that of DSA (4.3 ± 0.8, p = 0.651).ConclusionsRadiation exposure during AVS can be reduced by approximately half for both patients and operators by using DTDA and spot fluoroscopy without sacrificing image quality.

  2. Fluoroscopy-guided hydrostatic reduction of intussusception in infancy: role of pharmacological premedication.

    Science.gov (United States)

    Esposito, Francesco; Ambrosio, Concetta; De Fronzo, Simona; Panico, Maria Rita; D'Aprano, Marilena; Giugliano, Anna Marcella; Noviello, Domenico; Oresta, Patrizia

    2015-06-01

    Intussusception is one of the most common causes of paediatric emergency. Fluoroscopy-guided hydrostatic reduction is a common nonoperative management strategy for the treatment of intussusception. The role of pharmacological premedication in increasing the success rate of hydrostatic reduction is still controversial. The purpose of this study was to verify the presence of a possible correlation between pharmacological premedication and the percentage of hydrostatic reduction of intussusception in paediatric patients. This study considered children with a diagnosis of idiopathic intussusception treated at our hospital between January 2007 and June 2013. One group of patients underwent hydrostatic reduction by barium enema without any preliminary therapy. A second group of patients received pharmacological premedication with both a sedative and an anti-oedematous agent before the procedure. A total of 398 patients were treated with barium enema for therapeutic purposes. In the group of patients who received no premedication (n = 254), 165 (65 %) children achieved hydrostatic reduction of the intussusception. Among the patients who received pharmacological premedication prior to barium enema (n = 144), 122 (85 %) children achieved resolution of the intussusception. Our study shows that the use of pharmacological premedication is effective for the reduction of the intussusception, as its limit patient stress, fluoroscopic time and radiation dose.

  3. Time cycle calculation procedure for the special crew during the mining mobile machine complex operation

    International Nuclear Information System (INIS)

    Shmurygin, V; Lukyanov, V; Maslovsky, A

    2015-01-01

    The relevance of the research is specified by the necessity to optimize the delft mobile tunneling equipment operation. Target of the research is tunneling time cycle justification for the special crew during the mining mobile machine complex operation. Methods of the research included the consideration of operation organization schemes in the drifting face and effective use of the mobile equipment during mine exploratory working operations. Time cycle calculation procedures for major processes have been considered. This has been done for the special crew during the mobile machine complex operations for several working faces and various organization schemes

  4. SU-G-JeP4-12: Real-Time Organ Motion Monitoring Using Ultrasound and KV Fluoroscopy During Lung SBRT Delivery

    International Nuclear Information System (INIS)

    Omari, E; Tai, A; Li, X; Cooper, D; Lachaine, M

    2016-01-01

    Purpose: Real-time ultrasound monitoring during SBRT is advantageous in understanding and identifying motion irregularities which may cause geometric misses. In this work, we propose to utilize real-time ultrasound to track the diaphragm in conjunction with periodical kV fluoroscopy to monitor motion of tumor or landmarks during SBRT delivery. Methods: Transabdominal Ultrasound (TAUS) b-mode images were collected from 10 healthy volunteers using the Clarity Autoscan System (Elekta). The autoscan transducer, which has a center frequency of 5 MHz, was utilized for the scans. The acquired images were contoured using the Clarity Automatic Fusion and Contouring workstation software. Monitoring sessions of 5 minute length were observed and recorded. The position correlation between tumor and diaphragm could be established with periodic kV fluoroscopy periodically acquired during treatment with Elekta XVI. We acquired data using a tissue mimicking ultrasound phantom with embedded spheres placed on a motion stand using ultrasound and kV Fluoroscopy. MIM software was utilized for image fusion. Correlation of diaphragm and target motion was also validated using 4D-MRI and 4D-CBCT. Results: The diaphragm was visualized as a hyperechoic region on the TAUS b-mode images. Volunteer set-up can be adjusted such that TAUS probe will not interfere with treatment beams. A segment of the diaphragm was contoured and selected as our tracking structure. Successful monitoring sessions of the diaphragm were recorded. For some volunteers, diaphragm motion over 2 times larger than the initial motion has been observed during tracking. For the phantom study, we were able to register the 2D kV Fluoroscopy with the US images for position comparison. Conclusion: We demonstrated the feasibility of tracking the diaphragm using real-time ultrasound. Real-time tracking can help in identifying such irregularities in the respiratory motion which is correlated to tumor motion. We also showed the

  5. Radiation doses in endoscopic interventional procedures

    International Nuclear Information System (INIS)

    Tsapaki, V.; Paraskeva, K.; Mathou, N.; Aggelogiannopoulou, P.; Triantopoulou, C.; Karagianis, J.; Giannakopoulos, A.; Paspatis, G.; Voudoukis, E.; Athanasopoulos, N.; Lydakis, I.; Scotiniotis, H.; Georgopoulos, P.; Finou, P.; Kadiloru, E.

    2012-01-01

    Purpose: Extensive literature exists on patient radiation doses in various interventional procedures. This does not stand for endoscopic retrograde cholangiopancreatography (ERCP) where the literature is very limited. This study compares patient dose during ERCP procedures performed with different types of X-ray systems. Methods and Materials: Four hospitals participated in the study with the following X-ray systems: A) X-ray conventional system (X-ray tube over table), 137 pts, B) X-ray conventional system (X-ray tube under table), 114 pts, C) C-arm system, 79 pts, and D) angiography system, 57 pts. A single experienced endoscopist performed the ERCP in each hospital. Kerma Area Product (KAP), fluoroscopy time (T) and total number of X-ray films (F) were collected. Results: Median patient dose was 6.2 Gy.cm 2 (0.02-130.2 Gy.cm 2 ). Medium linear correlation between KAP and T (0.6) and F (0.4) were observed. Patient doses were 33 % higher than the reference value in UK (4.15 Gy.cm 2 with a sample of 6089 patients). Median KAP for each hospital was: A) 3.1, B) 9.2, C) 3.9 and D) 6.2 Gy.cm 2 . Median T was: A) 2.6, B) 4.1, C) 2.8 and D) 3.4 min. Median F was: A) 2, B) 7, C) 2 and D) 2 films. Conclusion: Patient radiation dose during ERCP depends on: a) fluoroscopy time and films taken, b) the type of the X-ray system used, with the C arm and the conventional over the couch systems carrying the lower patient radiation dose and the angiography system the higher. (authors)

  6. CT fluoroscopy guided transpleural cutting needle biopsy of small ({<=}2.5 cm) subpleural pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, Helmut; Oschatz, Elisabeth; Eisenhuber, Edith; Wohlschlager, Helmut [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria); Mostbeck, Gerhard H., E-mail: gerhard.mostbeck@wienkav.at [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria)

    2011-01-15

    Purpose: Small subpleural pulmonary lesions are difficult to biopsy. While the direct, short needle path has been reported to have a lower rate of pneumothorax, the indirect path provides a higher diagnostic yield. Therefore, we tried to optimize the needle pathway and minimize the iatrogenic pneumothorax risk by evaluating a CT fluoroscopy guided direct approach to biopsy subpleural lesions. Material and methods: Between 01/2005 and 01/2007, CT fluoroscopy guided core biopsies were performed in 24 patients. Using our technique, the tip of the guide needle remains outside the visceral pleura (17 G coaxial guide needle, 18 G Biopsy-gun, 15 or 22 mm needle path). The position of the lesion relative to the needle tip can be optimized using CT fluoroscopy by adjusting the breathing position of the patient. The Biopty gun is fired with the needle tip still outside the pleural space. Cytological smears are analyzed by a cytopathologist on-site, and biopsies are repeated as indicated with the coaxial needle still outside the pleura. Results: Median nodule size was 1.6 cm (0.7-2.3 cm). A definitive diagnosis was obtained in 22 patients by histology and/or cytology. In one patient, only necrotic material could be obtained. In another patient, the intervention had to be aborted as the dyspnoic patient could not follow breathing instructions. An asymptomatic pneumothorax was present in seven patients; chest tube placement was not required. Conclusion: The presented biopsy approach has a high diagnostic yield and is especially advantageous for biopsies of small subpleural lesions in the lower lobes.

  7. A cost effective and high fidelity fluoroscopy simulator using the Image-Guided Surgery Toolkit (IGSTK)

    Science.gov (United States)

    Gong, Ren Hui; Jenkins, Brad; Sze, Raymond W.; Yaniv, Ziv

    2014-03-01

    The skills required for obtaining informative x-ray fluoroscopy images are currently acquired while trainees provide clinical care. As a consequence, trainees and patients are exposed to higher doses of radiation. Use of simulation has the potential to reduce this radiation exposure by enabling trainees to improve their skills in a safe environment prior to treating patients. We describe a low cost, high fidelity, fluoroscopy simulation system. Our system enables operators to practice their skills using the clinical device and simulated x-rays of a virtual patient. The patient is represented using a set of temporal Computed Tomography (CT) images, corresponding to the underlying dynamic processes. Simulated x-ray images, digitally reconstructed radiographs (DRRs), are generated from the CTs using ray-casting with customizable machine specific imaging parameters. To establish the spatial relationship between the CT and the fluoroscopy device, the CT is virtually attached to a patient phantom and a web camera is used to track the phantom's pose. The camera is mounted on the fluoroscope's intensifier and the relationship between it and the x-ray source is obtained via calibration. To control image acquisition the operator moves the fluoroscope as in normal operation mode. Control of zoom, collimation and image save is done using a keypad mounted alongside the device's control panel. Implementation is based on the Image-Guided Surgery Toolkit (IGSTK), and the use of the graphics processing unit (GPU) for accelerated image generation. Our system was evaluated by 11 clinicians and was found to be sufficiently realistic for training purposes.

  8. Reduction of radiation exposure and image quality using dose reduction tool on computed tomography fluoroscopy

    International Nuclear Information System (INIS)

    Sakabe, Daisuke; Tochihara, Syuichi; Ono, Michiaki; Tokuda, Masaki; Kai, Noriyuki; Nakato, Kengo; Hashida, Masahiro; Funama, Yoshinori; Murazaki, Hiroo

    2012-01-01

    The purpose of our study was to measure the reduction rate of radiation dose and variability of image noise using the angular beam modulation (ABM) on computed tomography (CT) fluoroscopy. The Alderson-Rando phantom and the homemade phantom were used in our study. These phantoms were scanned at on-center and off-center positions at -12 cm along y-axis with and without ABM technique. Regarding the technique, the x-ray tube is turned off in a 100-degree angle sector at the center of 12 o'clock, 10 o'clock, and 2 o'clock positions during CT fluoroscopy. CT fluoroscopic images were obtained with tube voltages, 120 kV; tube current-time product per reconstructed image, 30 mAs; rotation time, 0.5 s/rot; slice thickness, 4.8 mm; and reconstruction kernel B30s in each scanning. After CT scanning, radiation exposure and image noise were measured and the image artifacts were evaluated with and without the technique. The reduction rate for radiation exposure was 75-80% with and without the technique at on-center position regardless of each angle position. In the case of the off-center position at -12 cm, the reduction rate was 50% with and without the technique. In contrast, image noise remained constant with and without the technique. Visual inspection for image artifacts almost have the same scores with and without the technique and no statistical significance was found in both techniques (p>0.05). ABM is an appropriate tool for reducing radiation exposure and maintaining image-noise and artifacts during CT fluoroscopy. (author)

  9. Intraoperative intermittent blocking of the common iliac arteries in cases of placenta percreta without the use of fluoroscopy

    International Nuclear Information System (INIS)

    Heinze, S.; Klinikum Oldenburg; Filsinger, B.; Kastenholz, G.; Schroeder, R.J.

    2016-01-01

    The number of patients with placenta accreta, percreta and increta is increasing. The morbidity and mortality are higher mostly due to hemorrhage. Therefore, new methods to reduce the risk of severe bleeding are necessary. Three patients were treated in collaboration by obstetricians, urologists, anesthesiologists, and radiologists. An MRI of the pelvis was performed and the diameters and lengths of the iliac arteries were measured to avoid fluoroscopy during the preoperative placement of catheter balloons into the iliac arteries. During the operational procedure the balloons were inflated and deflated depending on the operative site and the occurrence of bleeding. In comparison to the literature, severe bleeding was clearly reduced. No complications of the intervention were observed. The presented method to reduce severe bleeding might represent significant progress in the management of abnormal placenta implantation. Nevertheless, further controlled studies are needed in order to establish evidence-based recommendations.

  10. Evaluation of the Quality Control Program for Diagnostic Radiography and Fluoroscopy Devices in Syria during 2005-2013

    Directory of Open Access Journals (Sweden)

    M. H. Kharita

    2017-06-01

    Full Text Available Introduction: Extensive use of diagnostic radiology is the largest contributor to total population radiation doses. Thus, appropriate equipment and safe practice are necessary for good-quality images with optimal doses. This study aimed to perform quality control (QC audit for radiography and fluoroscopy devices owned by private sector in Syria (2005-2013 to verify compliance of performance of X-ray machines with the regulatory requirements stipulated by the national regulatory body. Materials and Methods: In this study, QC audit included 487 X-ray diagnostic machines, (363 radiography and 124 fluoroscopy devices, installed in 306 medical diagnostic radiology centers in 14 provinces in Syria. We employed an X-ray beam analyzer device (NERO model 8000, Victoreen, USA, which was tested and calibrated at the National Secondary Standard Dosimetry Laboratory traceable to the IAEA Network of Secondary Standard Dosimetry Laboratories. Standard QC tool kits were used to evaluate tube and generator of the X-ray machines, which constituted potential (kVp, timer accuracy, radiation output consistency, tube filtration, small and large focal spot sizes, X-ray beam collimation and alignment, as well as high- and low-resolution and entrance surface dose in fluoroscopy. Results: According to our results, most of the assessed operating parameters were in compliance with the standards stipulated by the National Regulatory Authority. In cases of noncompliance for the assessed parameters, maximum value (28.77% pertained to accuracy of kVp calibration for radiography units, while the lowest value (2.42% belonged to entrance surface dose in fluoroscopy systems. Conclusion: Effective QC program in diagnostic radiology leads to obtaining information regarding quality of radiology devices used for medical diagnosis and minimizing the doses received by patients and medical personnel. The findings of this QC program, as the main part of QA program, illustrated that most

  11. Breast cancer incidence and mortality in the Canadian fluoroscopy study

    International Nuclear Information System (INIS)

    Howe, G.R.

    1993-03-01

    This report describes the formation of the National Cancer Incidence Reporting System in a data base format suitable for computerized record linkage, and the linkage of the data from the Canadian study of cancer following multiple fluoroscopies to that database and to the Canadian National Mortality Data Base between 1940 and 1987. A comprehensive statistical analysis of the breast cancer mortality data occurring among female members of the cohort between 1950 and 1987 with respect to exposure to low-LET radiation is reported, together with a parallel analysis of the breast cancer incidence data between 1975 and 1983. The Canadian fluoroscopy study is a cohort study of tuberculosis patients first treated in Canadian institutions between 1930 and 1952. The present mortality analysis relates to the breast cancer mortality experience between 1950 and 1987. A total of 677 deaths from breast cancer was observed in this period. The most appropriate dose-response relationship appears to be a simple linear one. There is a strong modifying influence of age at first exposure; women first exposed past the age of 30 have little excess risk due to radiation exposure. The breast cancer incidence analysis is based upon 628 cases observed between 1975 and 1983. Again a simple linear model appears to provide an adequate fit to the data. There is a suggestion of time dependency under the additive model, but this is not statistically significant. The results from this latest analysis continue to be reassuring in terms of radiation risk from mammography. (L.L.) 15 refs., figs., tabs

  12. Medical imaging using ionizing radiation: Optimization of dose and image quality in fluoroscopy

    International Nuclear Information System (INIS)

    Jones, A. Kyle; Balter, Stephen; Rauch, Phillip; Wagner, Louis K.

    2014-01-01

    The 2012 Summer School of the American Association of Physicists in Medicine (AAPM) focused on optimization of the use of ionizing radiation in medical imaging. Day 2 of the Summer School was devoted to fluoroscopy and interventional radiology and featured seven lectures. These lectures have been distilled into a single review paper covering equipment specification and siting, equipment acceptance testing and quality control, fluoroscope configuration, radiation effects, dose estimation and measurement, and principles of flat panel computed tomography. This review focuses on modern fluoroscopic equipment and is comprised in large part of information not found in textbooks on the subject. While this review does discuss technical aspects of modern fluoroscopic equipment, it focuses mainly on the clinical use and support of such equipment, from initial installation through estimation of patient dose and management of radiation effects. This review will be of interest to those learning about fluoroscopy, to those wishing to update their knowledge of modern fluoroscopic equipment, to those wishing to deepen their knowledge of particular topics, such as flat panel computed tomography, and to those who support fluoroscopic equipment in the clinic

  13. Thermoluminescent dosimetry in fluoroscopy of pediatric patients

    International Nuclear Information System (INIS)

    Garcia V, E.; Azorin N, J.; Hidalgo T, S.; Dies S, P.

    2016-10-01

    The use of thermoluminescent dosimeters in the area of medical physics and especially in radiology is of paramount importance to guarantee the quality of a particular study, which for this reason the need to verify by means of measurements of peripheral dose in studies of esophagogastroduodenal series by fluoroscopy using TLD of LiF:Mg, Ti. For this the necessary measurements were carried out directly in patients of the Children s Hospital of Mexico Federico Gomez. Previously characterized the dosimeters were used the graphs of the linear equation to obtain the absorbed dose of each dosimeter and was found that the values of the absorbed dose in each patient changes for various reasons like the anatomy, thickness of the tissues, age and exposure time during the study and was verify that none of the studies performed on patients exceeded dose levels that could affect healthy organs. (Author)

  14. Monte Carlo estimation for pediatric barium meal procedures

    International Nuclear Information System (INIS)

    Filipov, D.; Schelin, H.R.; Denyak, V.; Legnani, A.; Ledesma, J.A.; Paschuk, S.A.; Sauzen, J.; Yagui, A.; Hoff, G.; Khoury, H.J.

    2015-01-01

    Fluoroscopic barium meal (BM) series involve an X-ray examination of the esophagus, stomach, and duodenum, by the use of a contrast media – the barium sulfate (BaSO4). They are widely used to observe digestive functions or to diagnose abnormalities such as ulcers; tumors; inflammation of the esophagus, stomach, and duodenum; malrotations; vascular rings; and gastroesophageal reflux disease (a common ailment in children). However, this procedure uses long fluoroscopy times and multiple radiographies, resulting in high effective doses to pediatric patients, whose radiosensitivity and life expectancy are higher than in adults. Based on those data, the aims of the current study are to: determine the P K,A (kerma-area product) values, on the patient chest area, and the effective doses to 5 and 10 years old children. Thirty-seven different pediatric patients were studied and stratified into two group sizes: 5 and 10 years old. For each procedure, the following data was recorded: sex, age and upper chest thickness, from the patients; technical parameters of the procedure (kV, fluoroscopy time and number of radiographies); distances (focus-detector and focus-table) and field size on the examination table. Three pairs of LiF:Mg,Ti thermoluminescent dosimeters were positioned at the center of the child´s sternum. After that, upper chest thickness was subtracted from focus-table distance, so focus-patient distance was obtained. Using the field size on the table and applying similar triangles concepts, the field size on the patient was measured, which was multiplied by the mean kerma (from the dosimeters), so that P K,A could be determined. To estimate the effective dose, P K,A and technical parameters of the procedure (kV, total filtration, focus-detector distance and field size on the patient) were written in a Monte Carlo software simulation. The results of P K,A and effective doses were higher than studies used for comparison, which shows the importance of an

  15. Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance

    Energy Technology Data Exchange (ETDEWEB)

    Hinrichs, Jan B. [Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany); Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover (Germany); Renne, Julius; Wacker, Frank K.; Meyer, Bernhard C. [Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany); Hoeper, Marius M.; Olsson, Karen M. [Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany)

    2016-11-15

    To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA). Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test). The overall intervention time was approximately 2 h in both groups (p = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy (p = 0.38), while DAP related to DSA was slightly higher in G3D (p = 0.048). Overall, DAP was significantly higher in G3D (p = 0.002). The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions. (orig.)

  16. Novel System for Real-Time Integration of 3-D Echocardiography and Fluoroscopy for Image-Guided Cardiac Interventions: Preclinical Validation and Clinical Feasibility Evaluation

    Science.gov (United States)

    Housden, R. James; Ma, Yingliang; Rajani, Ronak; Gao, Gang; Nijhof, Niels; Cathier, Pascal; Bullens, Roland; Gijsbers, Geert; Parish, Victoria; Kapetanakis, Stamatis; Hancock, Jane; Rinaldi, C. Aldo; Cooklin, Michael; Gill, Jaswinder; Thomas, Martyn; O'neill, Mark D.; Razavi, Reza; Rhode, Kawal S.

    2014-01-01

    Real-time imaging is required to guide minimally invasive catheter-based cardiac interventions. While transesophageal echocardiography allows for high-quality visualization of cardiac anatomy, X-ray fluoroscopy provides excellent visualization of devices. We have developed a novel image fusion system that allows real-time integration of 3-D echocardiography and the X-ray fluoroscopy. The system was validated in the following two stages: 1) preclinical to determine function and validate accuracy; and 2) in the clinical setting to assess clinical workflow feasibility and determine overall system accuracy. In the preclinical phase, the system was assessed using both phantom and porcine experimental studies. Median 2-D projection errors of 4.5 and 3.3 mm were found for the phantom and porcine studies, respectively. The clinical phase focused on extending the use of the system to interventions in patients undergoing either atrial fibrillation catheter ablation (CA) or transcatheter aortic valve implantation (TAVI). Eleven patients were studied with nine in the CA group and two in the TAVI group. Successful real-time view synchronization was achieved in all cases with a calculated median distance error of 2.2 mm in the CA group and 3.4 mm in the TAVI group. A standard clinical workflow was established using the image fusion system. These pilot data confirm the technical feasibility of accurate real-time echo-fluoroscopic image overlay in clinical practice, which may be a useful adjunct for real-time guidance during interventional cardiac procedures. PMID:27170872

  17. Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now

    Energy Technology Data Exchange (ETDEWEB)

    Messina, Carmelo [Universita degli Studi di Milano, Scuola di Specializzazione in Radiodiagnostica, Milano (Italy); Banfi, Giuseppe [IRCCS Istituto Ortopedico Galeazzi, Milano (Italy); Universita Vita-Salute San Raffaele, Milano (Italy); Aliprandi, Alberto [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); Mauri, Giovanni [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); Istituto Europeo di Oncologia, Unita di Radiologia Interventistica, Milano (Italy); Secchi, Francesco; Sardanelli, Francesco; Sconfienza, Luca Maria [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); IRCCS Policlinico San Donato, Servizio di Radiologia, San Donato, Milanese (Italy)

    2016-05-15

    Magnetic resonance (MR) imaging has been definitively established as the reference standard in the evaluation of joints in the body. Similarly, magnetic resonance arthrography has emerged as a technique that has been proven to increase significantly the diagnostic performance if compared with conventional MR imaging, especially when dealing with fibrocartilage and articular cartilage abnormalities. Diluted gadolinium can be injected in the joint space using different approaches: under palpation using anatomic landmarks or using an imaging guidance, such as fluoroscopy, computed tomography, or ultrasound. Fluoroscopy has been traditionally used, but the involvement of ionizing radiation should represent a remarkable limitation of this modality. Conversely, ultrasound has emerged as a feasible, cheap, quick, and radiation-free modality that can be used to inject joints, with comparable accuracy of fluoroscopy. In the present paper, we discuss the advantages and disadvantages of using fluoroscopy or ultrasound in injecting gadolinium-based contrast agents in joints to perform magnetic resonance arthrography, also in view of the new EuroSAFE Imaging initiative promoted by the European Society of Radiology and the recent updates to the European Atomic Energy Community 2013/59 directive on the medical use of ionizing radiation. (orig.)

  18. Predicting factors for conversion from fluoroscopy guided Percutaneous transthoracic needle biopsy to cone-beam CT guided Percutaneous transthoracic needle biopsy

    International Nuclear Information System (INIS)

    Lee, Kang Ji; Han, Young Min; Jin, Gong Yong; Song, Ji Soo

    2015-01-01

    To evaluate the predicting factors for conversion from fluoroscopy guided percutaneous transthoracic needle biopsy (PTNB) to cone-beam CT guided PTNB. From January 2011 to December 2012, we retrospectively identified 38 patients who underwent cone-beam CT guided PTNB with solid pulmonary lesions, and 76 patients who underwent fluoroscopy guided PTNB were matched to the patients who underwent cone-beam CT guided PTNB for age, sex, and lesion location. We evaluated predicting factors such as, long-axis diameter, short-axis diameter, anterior-posterior diameter, and CT attenuation value of the solid pulmonary lesion affecting conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB. Pearson χ 2 test, Fisher exact test, and independent t test were used in statistical analyses; in addition, we also used receiver operating characteristics curve to find the proper cut-off values affecting the conversion to cone-beam CT guided PTNB. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent fluoroscopy guided PTNB were 2.70 ± 1.57 cm, 3.40 ± 1.92 cm, 3.06 ± 1.81 cm, and 35.67 ± 15.70 Hounsfield unit (HU), respectively. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent cone-beam CT guided PTNB were 1.60 ± 1.30 cm, 2.20 ± 1.45 cm, 1.91 ± 1.99 cm, and 18.32 ± 23.11 HU, respectively. Short-axis, long-axis, anterior-posterior diameter, and CT attenuation value showed a significantly different mean value between the 2 groups (p = 0.001, p < 0.001, p = 0.003, p < 0.001, respectively). Odd ratios of CT attenuation value and short-axis diameter of the solid pulmonary lesion were 0.952 and 0.618, respectively. Proper cut-off values affecting the conversion to cone-beam CT guided PTNB were 1.65 cm (sensitivity 68.4%, specificity 71.1%) in short-axis diameter and 29.50 HU (sensitivity 65.8%, specificity 65.8%) in

  19. Fluoroscopy- vs ultrasound-guided aspiration techniques in the management of periprosthetic joint infection: which is the best?

    Science.gov (United States)

    Randelli, Filippo; Brioschi, Marco; Randelli, Pietro; Ambrogi, Federico; Sdao, Silvana; Aliprandi, Alberto

    2018-01-01

    Fluid samples obtained from an affected joint still play a central role in the diagnosis of periprosthetic joint infection (PJI). It is the only preoperative test able to discover the causative microbiological agent. In the hip, fluid aspiration can be performed through fluoroscopy, ultrasound, or, less commonly, computed tomography. However, there is still a lack of consensus on which method is preferable in terms of efficacy and costbenefit. We, therefore, asked whether (1) the benefits in terms of sensitivity and specificity and (2) the costs were comparable between fluoroscopy- and ultrasound-guided joint aspirations in a suspicious of hip PJI. Between 2013 and 2016, 52 hip aspirations were performed on 49 patients with clinical, radiological, or serological suspicion of PJI, waiting for a revision surgery. The patients were divided in two groups: fluoroscopy- (n = 26) vs ultrasound-guided hip aspiration group (n = 26). These groups were also divided in control and infected patients. The criteria of MusculoSkeletal Infection Society (MSIS) were used, as gold standard, to define PJI. (1) Ultrasound-guided aspiration revealed valid sensitivity (89% vs 60%) and specificity (94% vs 81%) in comparison with fluoroscopic-guided aspiration. (2) The cost analysis was also in favor of ultrasound-guided aspiration (125.30€) than fluoroscopic-guided aspiration (343.58€). We concluded that ultrasound-guided hip aspiration could represent a valid, safe, and less expensive diagnostic alternative to fluoroscopic-guided aspiration in hip PJI.

  20. Evaluation of F/E·DOI method as an approximate estimate of skin dose during percutaneous coronary intervention procedure

    International Nuclear Information System (INIS)

    Nakahara, Makoto; Yoshino, Akira; Kitano, K.; Yamaguchi, M.; Morone, Takayuki; Tani, K.

    2005-01-01

    The purpose of this study was to evaluate the efficacy of fluoroscopy time/total exposure times exposure times · in direction of interest (F/E·DOI) method as an approximate estimate of skin dose during percutaneous coronary intervention (PCI) procedure. Up to March 10, 2004, fifty-seven patients (male: 46 cases, female: 11 cases, age range 38-85 years; mean age 67±11 years) had undergone PCI and 157 directions of exposure was measured using X-ray films (KONICA MINOLTA SR-DUP) placed under the back of each patient during the procedure. The fluoroscopy time (minutes), the times of exposure in each direction during the procedure, and the thickness of chest (cm) was recorded. The relation of the skin dose to fluoroscopic time, exposure times in direction of interest, and F/E·DOI was assessed. The relationship between fluoroscopy time and skin dose was shown as y=0.02x+0.22 (r=0.54, p<0.0001, m.e=0.00±0.71 Gy, e.a=-2.19∼l.53 Gy). In addition, the relation of skin dose to exposure times in the direction of interest was y=0.07x+0.27 (r=0.77, p<0.0001, m.e=-0.00±0.53 Gy, e.a=-2.45∼1.76 Gy). The relationship between skin dose and F/E·DOI was y=0.06x+0.30 (r=0.85, p<0.0001, m.e=-0.00±0.44 Gy, e.a=-1.28∼1.06 Gy). Moreover, the relationship between skin dose and (F/E·DOI x 0.06+0.30) x coefficient of direction x coefficient in thickness of chest was y=0.99x-0.02 (r=0.89, p<0.0001, m.e=0.00±0.38 Gy, e.a=-1.12∼l.27 Gy). The calculated results corresponded to the skin dose during the procedure. F/E·DOI method was simple and effective, moreover, that enabled us to inform the skin dose during the PCI procedure to the interventionalist easily. (authors)

  1. A method to reduce patient's eye lens dose in neuro-interventional radiology procedures

    International Nuclear Information System (INIS)

    Safari, M.J.; Wong, J.H.D.; Kadir, K.A.A.; Sani, F.M.; Ng, K.H.

    2016-01-01

    Complex and prolonged neuro-interventional radiology procedures using the biplane angiography system increase the patient's risk of radiation-induced cataract. Physical collimation is the most effective way of reducing the radiation dose to the patient's eye lens, but in instances where collimation is not possible, an attenuator may be useful in protecting the eyes. In this study, an eye lens protector was designed and fabricated to reduce the radiation dose to the patients’ eye lens during neuro-interventional procedures. The eye protector was characterised before being tested on its effectiveness in a simulated aneurysm procedure on an anthropomorphic phantom. Effects on the automatic dose rate control (ADRC) and image quality are also evaluated. The eye protector reduced the radiation dose by up to 62.1% at the eye lens. The eye protector is faintly visible in the fluoroscopy images and increased the tube current by a maximum of 3.7%. It is completely invisible in the acquisition mode and does not interfere with the clinical procedure. The eye protector placed within the radiation field of view was able to reduce the radiation dose to the eye lens by direct radiation beam of the lateral x-ray tube with minimal effect on the ADRC system. - Highlights: • The eye protector can considerably reduce the patient's eye lens dose during neuro-interventional procedures. • This protector does not significantly perturb the fluoroscopy image and was completely invisible on the acquisition image due to image subtraction. • The eye protector does not significantly change the exposure parameters (kV and mAs).

  2. Software for the estimation of organ equivalent and effective doses from diagnostic radiology procedures

    International Nuclear Information System (INIS)

    Osei, Ernest K; Barnett, Rob

    2009-01-01

    Diagnostic radiological imaging such as conventional radiography, fluoroscopy and computed tomography (CT) examinations will continue to provide tremendous benefits in modern healthcare. The benefit derived by the patient should far outweigh the risk associated with a properly conducted imaging examination. Nonetheless, it is very important to be able to quantify the risk associated with any radiological examination of patients, and effective dose has been considered a useful indicator of patient exposure. Quantification of the risks associated with radiological imaging is very important as such information will be helpful to physicians and their patients for comparing risks from various imaging examinations and for making informed decisions whenever there is a need for any radiological imaging. The determination of equivalent and effective doses in diagnostic radiology is of interest as a basis for estimates of risk from medical exposures. In this paper we describe a simple computer program OrgDose, which calculates the doses to 27 organs in the body and then calculates the organ equivalent and effective doses and the risk from various procedures in the radiology department including conventional radiography, fluoroscopy and computed tomography examinations. The program will be a useful tool for the medical and paramedical personnel who are involved with assessing organ and effective doses and risks from diagnostic radiology procedures.

  3. Endovascular aneurysm repair simulation can lead to decreased fluoroscopy time and accurately delineate the proximal seal zone.

    Science.gov (United States)

    Kim, Ann H; Kendrick, Daniel E; Moorehead, Pamela A; Nagavalli, Anil; Miller, Claire P; Liu, Nathaniel T; Wang, John C; Kashyap, Vikram S

    2016-07-01

    The use of simulators for endovascular aneurysm repair (EVAR) is not widespread. We examined whether simulation could improve procedural variables, including operative time and optimizing proximal seal. For the latter, we compared suprarenal vs infrarenal fixation endografts, right femoral vs left femoral main body access, and increasing angulation of the proximal aortic neck. Computed tomography angiography was obtained from 18 patients who underwent EVAR at a single institution. Patient cases were uploaded to the ANGIO Mentor endovascular simulator (Simbionix, Cleveland, Ohio) allowing for three-dimensional reconstruction and adapted for simulation with suprarenal fixation (Endurant II; Medtronic Inc, Minneapolis, Minn) and infrarenal fixation (C3; W. L. Gore & Associates Inc, Newark, Del) deployment systems. Three EVAR novices and three experienced surgeons performed 18 cases from each side with each device in randomized order (n = 72 simulations/participant). The cases were stratified into three groups according to the degree of infrarenal angulation: 0° to 20°, 21° to 40°, and 41° to 66°. Statistical analysis used paired t-test and one-way analysis of variance. Mean fluoroscopy time for participants decreased by 48.6% (P time decreased by 33.8% (P zone coverage in highly angulated aortic necks was significantly decreased. The infrarenal device resulted in mean aortic neck zone coverage of 91.9%, 89.4%, and 75.4% (P zone coverage. The side of femoral access for the main body did not influence proximal seal zone coverage regardless of infrarenal angulation. Simulation of EVAR leads to decreased fluoroscopy times for novice and experienced operators. Side of femoral access did not affect precision of proximal endograft landing. The angulated aortic neck leads to decreased proximal seal zone coverage regardless of infrarenal or suprarenal fixation devices. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  4. Radiation protection for an intraoperative X-ray source compared to C-arm fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, Frank; Clausen, Sven; Jahnke, Anika; Steil, Volker; Wenz, Frederik [Heidelberg Univ., University Medical Center Mannheim (Germany). Dept. of Radiation Oncology; Bludau, Frederic; Obertacke, Udo [Heidelberg Univ., University Medical Center Mannheim (Germany). Dept. of Trauma Surgery; Suetterlin, Marc [Heidelberg Univ., University Medical Center Mannheim (Germany). Dept. of Obstetrics and Gynaecology

    2014-10-01

    Background: Intraoperative radiotherapy (IORT) using the INTRABEAM {sup registered} system promises a flexible use regarding radiation protection compared to other approaches such as electron treatment or HDR brachytherapy with {sup 192}Ir or {sup 60}Co. In this study we compared dose rate measurements of breast- and Kypho-IORT with C-arm fluoroscopy which is needed to estimate radiation protection areas. Materials and Methods: C-arm fluoroscopy, breast- and Kypho-IORTs were performed using phantoms (silicon breast or bucket of water). Dose rates were measured at the phantom's surface, at 30 cm, 100 cm and 200 cm distance. Those measurements were confirmed during 10 Kypho-IORT and 10 breast-IORT patient treatments. Results: The measured dose rates were in the same magnitude for all three paradigms and ranges from 20 μSv/h during a simulated breast-IORT at two meter distance up to 64 mSv/h directly at the surface of a simulated Kypho-IORT. Those measurements result in a circle of controlled area (yearly doses > 6 mSv) for each paradigm of about 4 m ± 2 m. Discussion/Conclusions: All three paradigms show comparable dose rates which implies that the radiation protection is straight forward and confirms the flexible use of the INTRABEAM {sup registered} system. (orig.)

  5. Occupational radiation doses during interventional procedures

    International Nuclear Information System (INIS)

    Nuraeni, N; Hiswara, E; Kartikasari, D; Waris, A; Haryanto, F

    2016-01-01

    Digital subtraction angiography (DSA) is a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. The use of DSA procedures has been increased quite significantly in the Radiology departments in various cities in Indonesia. Various reports showed that both patients and medical staff received a noticeable radiation dose during the course of this procedure. A study had been carried out to measure these doses among interventionalist, nurse and radiographer. The results show that the interventionalist and the nurse, who stood quite close to the X-ray beams compared with the radiographer, received radiation higher than the others. The results also showed that the radiation dose received by medical staff were var depending upon the duration and their position against the X-ray beams. Compared tothe dose limits, however, the radiation dose received by all these three medical staff were still lower than the limits. (paper)

  6. Paediatric pelvic imaging: optimisation of dose and technique using digital grid-controlled pulsed fluoroscopy.

    Science.gov (United States)

    Waugh, R; McCallum, H M; McCarty, M; Montgomery, R; Aszkenasy, M

    2001-05-01

    An audit of paediatric pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique. A technique using grid-controlled fluoroscopy (GCF), with hard copy images in frame grab and digital spot image (DSI) format was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and Developmental Hip Dysplasia (DDH) attending for pelvic radiography. Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability. Both fluoroscopic techniques gave considerably less radiation than conventional non-grid radiography (67-83%, P < 0.05). The frame grab technique gave less radiation than DSI (P < 0.05). There was no significant difference in the clinical acceptability scores of the DSI and frame grab images. Fluoroscopy acquired images are now used since the fluoroscopic techniques give much less dose than conventional radiography and provide images of sufficient quality for clinical assessment. Indeed, as there was no significant difference in clinical usefulness between the frame grab and DSI techniques, it is planned to use frame grab alone, thus gaining additional dose saving.

  7. Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures

    Science.gov (United States)

    Tejwani, R.; Wang, H-H. S.; Young, B. J.; Greene, N. H.; Wolf, S.; Wiener, J. S.; Routh, J. C.

    2016-01-01

    Summary Introduction Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown. Objectives To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used. Study Design The NIS (1998–2009) was retrospectively reviewed for pediatric (≤18 years) admissions, using ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) inpatient postoperative complications. Degree of pediatric sub-specialization was calculated using a Pediatric Proportion Index (PPI), defined as the ratio of children to total patients operated on by each provider. The providers were grouped into PPI quartiles: Q1, 0–25% specialization; Q2, 25–50%; Q3, 50–75%; Q4, 75–100%. Weighted multivariate analysis was performed to test for associations between PPI and surgical complications. Results A total of 71,479 weighted inpatient admissions were identified. Patient age decreased with increasing specialization: Q1, 7.9 vs Q2, 4.8 vs Q3, 4.8 vs Q4, 4.6 years, PSpecialization was not associated with race (P>0.20), gender (P>0.50), or comorbidity scores (P=0.10). Mortality (1.5% vs 0.2% vs 0.3% vs 0.4%, Pspecialization. Patients treated by more highly specialized surgeons incurred slightly higher costs (Q2, +4%; Q3, +1%; Q4 + 2%) but experienced shorter length of hospital stay (Q2, –5%; Q3, –10%; Q4, –3%) compared with the least specialized providers. A greater proportion of patients treated by Q1 and Q3 specialized urologists had CCS ≥2 than those seen by Q2 or Q4 urologists (12.5% and 12.2%, respectively vs 8.4% and 10.9%, respectively, P=0.04). Adjusting for confounding effects

  8. Digital tumor fluoroscopy (DTF)--a new direct imaging system in the therapy planning for brain tumors.

    Science.gov (United States)

    Herbst, M; Fröder, M

    1990-01-01

    Digital Tumor Fluoroscopy is an expanded x-ray video chain optimized to iodine contrast with an extended Gy scale up to 64000 Gy values. Series of pictures are taken before and after injection of contrast medium. With the most recent unit, up to ten images can be taken and stored. The microprogrammable processor allows the subtraction of images recorded at any moment of the examination. Dynamic views of the distribution of contrast medium in the intravasal and extravasal spaces of brain and tumor tissue are gained by the subtraction of stored images. Tumors can be differentiated by studying the storage and drainage behavior of the contrast medium during the period of examination. Meningiomas store contrast medium very intensively during the whole time of investigation, whereas astrocytomas grade 2-3 pick it up less strongly at the beginning and release it within 2 min. Glioblastomas show a massive but delayed accumulation of contrast medium and a decreased flow-off-rate. In comparison with radiography and MR-imaging the most important advantage of Digital Tumor Fluoroscopy is that direct information on tumor localization is gained in relation to the skull-cap. This enables the radiotherapist to mark the treatment field directly on the skull. Therefore it is no longer necessary to calculate the tumor volume from several CT scans for localization. In radiotherapy Digital Tumor Fluoroscopy a unit combined with a simulator can replace CT planning. This would help overcome the disadvantages arising from the lack of a collimating system, and the inaccuracies which result from completely different geometric relationships between a CT unit and a therapy machine.

  9. Efficacy of Lower-Body Shielding in Computed Tomography Fluoroscopy-Guided Interventions

    International Nuclear Information System (INIS)

    Mahnken, Andreas H.; Sedlmair, Martin; Ritter, Christine; Banckwitz, Rosemarie; Flohr, Thomas

    2012-01-01

    Purpose: Computed tomography (CT) fluoroscopy-guided interventions pose relevant radiation exposure to the interventionalist. The goal of this study was to analyze the efficacy of lower-body shielding as a simple structural method for decreasing radiation dose to the interventionalist without limiting access to the patient. Material and Methods: All examinations were performed with a 128-slice dual source CT scanner (12 × 1.2-mm collimation; 120 kV; and 20, 40, 60, and 80 mAs) and an Alderson-Rando phantom. Scatter radiation was measured with an ionization chamber and a digital dosimeter at standardized positions and heights with and without a lower-body lead shield (0.5-mm lead equivalent; Kenex, Harlow, UK). Dose decreases were computed for the different points of measurement. Results: On average, lower-body shielding decreased scatter radiation by 38.2% within a 150-cm radius around the shielding. This decrease is most significant close to the gantry opening and at low heights of 50 and 100 cm above the floor with a maximum decrease of scatter radiation of 95.9% close to the scanner’s isocentre. With increasing distance to the gantry opening, the effect decreased. There is almost no dose decrease effect at ≥150 above the floor. Scatter radiation and its decrease were linearly correlated with the tube current-time product (r 2 = 0.99), whereas percent scatter radiation decrease was independent of the tube current-time product. Conclusion: Lower-body shielding is an effective way to decrease radiation exposure to the interventionalist and should routinely be used in CT fluoroscopy-guided interventions.

  10. Patients exposure from fluoroscopic guided pacemaker implantation procedures

    International Nuclear Information System (INIS)

    Alkhorayef, M.; Babikir, E.; Sulieman, A.; Daar, E.; Alnaaimi, M.; Alduaij, M.; Bradley, D.

    2016-10-01

    A pacemaker, which is used for heart re synchronization with electrical impulses, is used to manage many clinical conditions. Recently, the frequency of the pacemaker implantation procedures increased 50% worldwide. During this procedure, patients and staff can be exposed to excessive radiation exposure. Wide range of doses was reported in previous studies, suggesting that optimization of this procedure is not fulfilled yet. This study aims to evaluate the patient and staff radiation doses during cardiac pacemaker procedure and quantify the patient effective dose. A total of 145 procedures were performed for five pacemakers procedures (VVI, VVIR, VVD, VVDR and DDDR) two hospitals were evaluated. Patients doses were measured using the kerma-area product meter. Effective doses were estimated using software based on Monte Carlo simulation from National Radiological Protection Board. The effective dose values were used to estimate the cancer risk from pacemaker procedure. Patients demographic data, exposure parameters for both fluoroscopy and radiography were quantified. The mean patients doses (Gy. cm 2 ) for VVI, VVIR, VVD, VVDR and DDDR was 1.52±0.13 (1.43-1.61), 3.28±2.34 (0.29-8.73), 3.04±1.67 (1.57-4.86), 6.04±2.326 and 19.2±3.6 (5.43-30.2), respectively, per procedure. The overall patients effective dose is 1.1 mSv per procedure. (Author)

  11. Patients exposure from fluoroscopic guided pacemaker implantation procedures

    Energy Technology Data Exchange (ETDEWEB)

    Alkhorayef, M.; Babikir, E. [King Saud University, College of Applied Sciences, Radiological Sciences Department, P. O. Box 10219, Riyadh 11433 (Saudi Arabia); Sulieman, A. [Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P. O. Box 422, Alkharj 11942 (Saudi Arabia); Daar, E. [University of Jordan, Faculty of Science, Department of Physics, Amman 11942 (Jordan); Alnaaimi, M.; Alduaij, M. [Kuwait Cancer Control Centre, Department of Nuclear Medicine, Shwiekh (Kuwait); Bradley, D., E-mail: malkhorayef@ksu.edu.sa [University of Surrey, Centre for Nuclear and Radiation Physics, Guildford, Surrey, GU2 7XH (United Kingdom)

    2016-10-15

    A pacemaker, which is used for heart re synchronization with electrical impulses, is used to manage many clinical conditions. Recently, the frequency of the pacemaker implantation procedures increased 50% worldwide. During this procedure, patients and staff can be exposed to excessive radiation exposure. Wide range of doses was reported in previous studies, suggesting that optimization of this procedure is not fulfilled yet. This study aims to evaluate the patient and staff radiation doses during cardiac pacemaker procedure and quantify the patient effective dose. A total of 145 procedures were performed for five pacemakers procedures (VVI, VVIR, VVD, VVDR and DDDR) two hospitals were evaluated. Patients doses were measured using the kerma-area product meter. Effective doses were estimated using software based on Monte Carlo simulation from National Radiological Protection Board. The effective dose values were used to estimate the cancer risk from pacemaker procedure. Patients demographic data, exposure parameters for both fluoroscopy and radiography were quantified. The mean patients doses (Gy. cm{sup 2}) for VVI, VVIR, VVD, VVDR and DDDR was 1.52±0.13 (1.43-1.61), 3.28±2.34 (0.29-8.73), 3.04±1.67 (1.57-4.86), 6.04±2.326 and 19.2±3.6 (5.43-30.2), respectively, per procedure. The overall patients effective dose is 1.1 mSv per procedure. (Author)

  12. 26 CFR 1.852-9 - Special procedural requirements applicable to designation under section 852(b)(3)(D).

    Science.gov (United States)

    2010-04-01

    ... notice by the Internal Revenue Service that the regulated investment company has failed to comply with... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Special procedural requirements applicable to designation under section 852(b)(3)(D). 1.852-9 Section 1.852-9 Internal Revenue INTERNAL REVENUE SERVICE...

  13. The radiation protective devices for interventional procedures using computed tomography

    International Nuclear Information System (INIS)

    Iida, Hiroji; Chabatake, Mitsuhiro; Shimizu, Mitsuru; Tamura, Sakio

    2002-01-01

    A scattered dose and a surface dose from phantom measurements during interventional procedures with computed tomography (IVR-CT) were evaluated. To reduce the personnel exposure in IVR-CT, the new protective devices were developed and its effect evaluated. Two radiation protection devices were experimentally made using a lead vinyl sheet with lead equivalent 0.125 mmPb. The first device is a lead curtain which shields the space of CT-gantry and phantom for the CT examination. The second device is a lead drape which shields on the phantom surface adjacent to the scanning plane for the CT-fluoroscopy. Scattered dose and phantom surface dose were measured with an abdominal phantom during Cine-CT (130 kV, 150 mA, 5 seconds, 10 mm section thickness). They were measured by using ionization chamber dosimeter. They were measured with and without a lead curtain and a lead drape. Scattered dose rate was measured at distance of 50-150 cm from the scanning plane. And, surface dose was measured at distance of 4-21 cm from the scanning plane on the phantom. On operator's standing position, scattered dose rates were from 8.4 to 11.6 μGy/sec at CT examination. The lead curtain and the lead drape reduced scattered dose rate at distance of 50 cm from the scanning plane by 66% and 58.3% respectively. Surface dose rate were 118 μGy/sec at distance of 5 cm from the scanning plane at CT-fluoroscopy. The lead drape reduced the surface dose by 60.5%. High scattered exposure to personnel may occur during interventional procedures using CT. They were considerably reduced during CT-arteriography by attaching the lead curtain in CT equipment. And they were substantially reduced during CT-fluoroscopy by placing the lead drape adjacent to the scanning plane, in addition, operator's hand would be protected from unnecessary radiation scattered by phantom. It was suggested that the scattered exposure to personnel could be sufficiently reduced by using radiation protection devices in IVR-CT. The

  14. Percutaneous Transhepatic Catheterization of the Portal Vein: A Combined CT- and Fluoroscopy-Guided Technique

    International Nuclear Information System (INIS)

    Weimar, Bernd; Rauber, Klaus; Brendel, Mathias D.; Bretzel, Reinhard G.; Rau, Wigbert S.

    1999-01-01

    Combined CT- and fluoroscopy-guided transhepatic portal vein catheterization was performed in 44 patients selected for pancreatic islet cell transplantation. The method allowed catheterization with a single puncture attempt in 39 patients. In four patients two attempts and in one patient four attempts were necessary. One minor hematoma of the liver capsule occurred that required no further treatment. Compared with other methods the average number of puncture attempts was reduced

  15. Cone beam computed tomography and its image guidance technology during percutaneous nucleoplasty procedures at L5/S1 lumbar level

    Energy Technology Data Exchange (ETDEWEB)

    Ierardi, Anna Maria; Piacentino, Filippo; Giorlando, Francesca [University of Insubria, Unit of Interventional Radiology, Department of Radiology, Varese (Italy); Magenta Biasina, Alberto; Carrafiello, Gianpaolo [University of Milan, San Paolo Hospital, Department of Diagnostic and Interventional Radiology, Milan (Italy); Bacuzzi, Alessandro [University of Insubria, Anaesthesia and Palliative Care, Varese (Italy); Novario, Raffaele [University of Insubria, Medical Physics Department, Varese (Italy)

    2016-12-15

    To demonstrate the feasibility of percutaneous nucleoplasty procedures at L5/S1 level using cone beam CT (CBCT) and its associated image guidance technology for the treatment of lumbar disc herniation (LDH). We retrospectively reviewed 25 cases (20 men, 5 women) of LDH at L5/S1 levels. CBCT as guidance imaging was chosen after a first unsuccessful fluoroscopy attempt that was related to complex anatomy (n = 15), rapid pathological changes due to degenerative diseases (n = 7) or both (n = 3). Technical success, defined as correct needle positioning in the target LDH, and safety were evaluated; overall procedure time and radiation dose were registered. A visual analog scale (VAS) was used to evaluate pain and discomfort pre-intervention after 1 week and 1, 3, and 6 months after the procedure. Technical success was 100 %; using CBCT as guidance imaging the needle was correctly positioned at the first attempt in 20 out of 25 patients. Neither major nor minor complications were registered during or after the procedure. The average procedure time was 11 min and 56 s (range, 9-15 min), whereas mean procedural radiation dose was 46.25 Gy.cm{sup 2} (range 38.10-52.84 Gy.cm{sup 2}), and mean fluoroscopy time was 5 min 34 s (range 3 min 40 s to 6 min 55 s). The VAS pain score decreased significantly from 7.6 preoperatively to 3.9 at 1 week, 2.8 at 1 month, 2.1 at 3 months, and 1.6 at 6 months postoperatively. CBCT-guided percutaneous nucleoplasty is a highly effective technique for LDH with acceptable procedure time and radiation dose. (orig.)

  16. Radiation Dose Reduction in CT Fluoroscopy-Guided Cervical Transforaminal Epidural Steroid Injection by Modifying Scout and Planning Steps

    Energy Technology Data Exchange (ETDEWEB)

    Paik, Nam Chull, E-mail: pncspine@gmail.com [Arumdaun Wooldul Spine Hospital, Department of Radiology (Korea, Republic of)

    2016-04-15

    Background and PurposeIn CT fluoroscopy (CTF)-guided cervical transforaminal epidural steroid injection (TFESI), the majority of radiation dose is contributed by the planning CT scan rather than the CTF procedure itself. We replaced the planning helical CT with a spot CTF and accordingly changed the patient posture during scout and planning scans. The aim of this study was to test whether radiation dose reduction would be achieved by this protocol modification while still maintaining technical performance.MethodsOverall, 338 consecutive procedures before (control group: n = 163) and after (study group: n = 175) instituting the above-mentioned protocol modification were analyzed retrospectively, comparing patient characteristics (age, sex, neck diameter, and level injected) and technical performance [technical success rate, dose-length product (DLP), inadvertent contrast flow incidence, number of CTF acquisitions, and procedural time] between the two groups.ResultsAll injections were technically successful at every level from C3–C4 to C7–T1 without serious complications in both groups. The median DLP of the study group (7.92 mGy·cm) was significantly reduced compared to that of the control group (39.05 mGy·cm, P < 0.001). There were no significant differences between the two groups regarding the incidence of inadvertent contrast flow (20.6 vs. 17.2 %, P = 0.426), number of CTF acquisitions (median 5 vs. 4, P = 0.123), and the procedural time (median 6.62 vs. 6.90 min, P = 0.100).ConclusionsWhen conducting CTF-guided cervical TFESIs, a significant radiation dose reduction (median 79.7 % in DLP) can be achieved by modifying scout and planning steps, without compromising the technical performance.

  17. Radiologist and angiographic procedures. Absorbed radiation dose

    International Nuclear Information System (INIS)

    Tryhus, M.; Mettler, F.A. Jr.; Kelsey, C.

    1987-01-01

    The radiation dose absorbed by the angiographer during angiographic procedures is of vital importance to the radiologist. Nevertheless, most articles on the subject are incomplete, and few measure gonadal dose. In this study, three TLDs were used for each of the following sites: radiologist's eyes, thyroid, gonads with and without shielding apron, and hands. The average dose during carotid angiograms was 2.6, 4.1, 0.4, 4.7, and 7.1 mrads to the eyes, thyroid, gonads with and without .5 mm of lead shielding, and hands, respectively. Average dose during abdominal and peripheral vascular angiographic procedures was 5.2, 7.5, 1.2, 8.5, and 39.9 mrads to the eyes, thyroid, gonads with and without shielding, and hands, respectively. A literature review demonstrates a significant reduction in radiation dose to the angiographer after the advent of automated injectors. Our measured doses for carotid angiography are compatible with contemporary reported values. There was poor correlation with fluoroscopy time and measured dose to the angiographer

  18. 2D-3D Registration of CT Vertebra Volume to Fluoroscopy Projection: A Calibration Model Assessment

    Directory of Open Access Journals (Sweden)

    P. Bifulco

    2010-01-01

    Full Text Available This study extends a previous research concerning intervertebral motion registration by means of 2D dynamic fluoroscopy to obtain a more comprehensive 3D description of vertebral kinematics. The problem of estimating the 3D rigid pose of a CT volume of a vertebra from its 2D X-ray fluoroscopy projection is addressed. 2D-3D registration is obtained maximising a measure of similarity between Digitally Reconstructed Radiographs (obtained from the CT volume and real fluoroscopic projection. X-ray energy correction was performed. To assess the method a calibration model was realised a sheep dry vertebra was rigidly fixed to a frame of reference including metallic markers. Accurate measurement of 3D orientation was obtained via single-camera calibration of the markers and held as true 3D vertebra position; then, vertebra 3D pose was estimated and results compared. Error analysis revealed accuracy of the order of 0.1 degree for the rotation angles of about 1 mm for displacements parallel to the fluoroscopic plane, and of order of 10 mm for the orthogonal displacement.

  19. Mediation and Due Process Procedures in Special Education: An Analysis of State Policies. Final Report. Project FORUM.

    Science.gov (United States)

    Ahearn, Eileen M.

    This survey of 50 states and 3 of 10 non-state U.S. jurisdictions concerning state due process procedures focuses mainly on the use of mediation as a form of dispute resolution that offers an alternative to due process hearings in special education. A background section discusses the definition of mediation and the mediation process. Survey…

  20. Paediatric pelvic imaging: optimisation of dose and technique using digital grid-controlled pulsed fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Waugh, R.; McCarty, M. [Div. of Radiology, South Cleveland Hospital, South Tees Acute Hospitals NHS Trust, Marton Road, Middlesbrough, Cleveland (United Kingdom); McCallum, H.M. [Regional Medical Physics Dept., South Cleveland Hospital, Middlesbrough (United Kingdom); Montgomery, R. [Dept. of Orthopaedics, South Tees Hospitals NITS Trust, Middlesbrough (United Kingdom); Aszkenasy, M. [Tees and North East Yorkshire NHS Trust, West Lane Hospital, Middlesbrough (United Kingdom)

    2001-05-01

    Background. An audit of paediatric pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique. Objective. A technique using grid-controlled fluoroscopy (GCF), with hard copy images in frame grab and digital spot image (DSI) format was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and Developmental Hip Dysplasia (DDH) attending for pelvic radiography. Materials and methods. Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability. Results. Both fluoroscopic techniques gave considerably less radiation than conventional non-grid radiography (67-83 %, P < 0.05). The frame grab technique gave less radiation than DSI (P < 0.05). There was no significant difference in the clinical acceptability scores of the DSI and frame grab images. Conclusion. Fluoroscopy acquired images are now used since the fluoroscopic techniques give much less dose than conventional radiography and provide images of sufficient quality for clinical assessment. Indeed, as there was no significant difference in clinical usefulness between the frame grab and DSI techniques, it is planned to use frame grab alone, thus gaining additional dose saving. (orig.)

  1. Paediatric pelvic imaging: optimisation of dose and technique using digital grid-controlled pulsed fluoroscopy

    International Nuclear Information System (INIS)

    Waugh, R.; McCarty, M.; McCallum, H.M.; Montgomery, R.; Aszkenasy, M.

    2001-01-01

    Background. An audit of paediatric pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique. Objective. A technique using grid-controlled fluoroscopy (GCF), with hard copy images in frame grab and digital spot image (DSI) format was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and Developmental Hip Dysplasia (DDH) attending for pelvic radiography. Materials and methods. Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability. Results. Both fluoroscopic techniques gave considerably less radiation than conventional non-grid radiography (67-83 %, P < 0.05). The frame grab technique gave less radiation than DSI (P < 0.05). There was no significant difference in the clinical acceptability scores of the DSI and frame grab images. Conclusion. Fluoroscopy acquired images are now used since the fluoroscopic techniques give much less dose than conventional radiography and provide images of sufficient quality for clinical assessment. Indeed, as there was no significant difference in clinical usefulness between the frame grab and DSI techniques, it is planned to use frame grab alone, thus gaining additional dose saving. (orig.)

  2. Management of pediatric radiation dose using Philips fluoroscopy systems DoseWise: perfect image, perfect sense

    International Nuclear Information System (INIS)

    Stueve, Dick

    2006-01-01

    Although image quality (IQ) is the ultimate goal for accurate diagnosis and treatment, minimizing radiation dose is equally important. This is especially true when pediatric patients are examined, because their sensitivity to radiation-induced cancer is two to three times greater than that of adults. DoseWise is an ALARA-based philosophy within Philips Medical Systems that is active at every level of product design. It encompasses a set of techniques, programs and practices that ensures optimal IQ while protecting people in the X-ray environments. DoseWise methods include management of the X-ray beam, less radiation-on time and more dose information for the operator. Smart beam management provides automatic customization of the X-ray beam spectrum, shape, and pulse frequency. The Philips-patented grid-controlled fluoroscopy (GCF) provides grid switching of the X-ray beam in the X-ray tube instead of the traditional generator switching method. In the examination of pediatric patients, DoseWise technology has been scientifically documented to reduce radiation dose to <10% of the dose of traditional continuous fluoroscopy systems. The result is improved IQ at a significantly lower effective dose, which contributes to the safety of patients and staff. (orig.)

  3. Skeletal imaging following reconstruction of the posterior cruciate ligament: in vivo comparison of fluoroscopy, radiography, and computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Osti, Michael; Benedetto, Karl Peter [Academic Hospital Feldkirch, Department for Trauma Surgery and Sports Traumatology, Feldkirch (Austria); Krawinkel, Alessa [Academic Hospital Feldkirch, Department for Radiology, Feldkirch (Austria)

    2014-12-15

    Intra- and postoperative validation of anatomic footprint replication in posterior cruciate ligament (PCL) reconstruction can be conducted using fluoroscopy, radiography, or computed tomography (CT) scans. However, effectiveness and exposure to radiation of these imaging modalities are unknown. The objective of this study was to evaluate the comparative effectiveness of fluoroscopy, radiography, and CT in detecting femoral and tibial tunnel positions following an all-inside reconstruction of the PCL ligament in vivo. The study design was a retrospective case series. Intraoperative fluoroscopic images, postoperative radiographs, and CT scans were obtained in 50 consecutive patients following single-bundle PCL reconstruction. The centers of the tibial and femoral tunnel apertures were identified and correlated to measurement grid systems. The results of fluoroscopic, radiographic, and CT measurements were compared to each other and accumulated radiation dosages were calculated. Comparing the imaging groups, no statistically significant difference could be detected for the reference of the femoral tunnel to the intercondylar depth and height, for the reference of the tibial tunnel to the mediolateral diameter of the tibial plateau and for the superoinferior distance of the tibial tunnel entry to the tibial plateau and to the former physis line. Effective doses resulting from fluoroscopic, radiographic, and CT exposure averaged 2.9 mSv, standard deviation (±SD) 4.1 mSv, to 1.3 ± 0.8 mSv and to 3.6 ± 1.0 mSv, respectively. Fluoroscopy, radiography, and CT yield approximately equal effectiveness in detecting parameters used for quality validation intra- and postoperatively. An accumulating exposure to radiation must be considered. (orig.)

  4. Patient radiation exposure in right versus left trans-radial approach for coronary procedures

    Energy Technology Data Exchange (ETDEWEB)

    Rigattieri, Stefano; Di Russo, Cristian; Cera, Maria; Fedele, Silvio; Sciahbasi, Alessandro [Interventional Cardiology Unit, Sandro Pertini Hospital, Rome (Italy); Pugliese, Francesco Rocco [Emergency Department Sandro Pertini Hospital, Rome (Italy)

    2015-01-15

    Objectives: The aim of this study was to compare radiation exposure, assessed by dose-area product (DAP), in right trans-radial approach (RR) versus left trans-radial approach (LR) for coronary procedures. Background: In LR the catheter course is more similar to trans-femoral approach, thus allowing an easier negotiation of coronary ostia which, in turn, might translate into reduced fluoroscopy time (FT) and radiation exposure as compared to RR. Methods: We retrospectively selected diagnostic and interventional procedures (PCI) performed by RR or LR at our center from May 2009 to May 2014. We only included in the analysis the procedures in which DAP values were available. Results: We analyzed 1464 procedures, 1175 of which performed by RR (80.3%) and 289 by LR (19.7%). Median DAP values were significantly higher in RR as compared to LR for diagnostic and interventional procedures (4482 vs. 3540 cGy.cm{sup 2} and 11523 vs. 10086 cGy.cm{sup 2}, respectively; p < 0.05). No significant differences were observed in FT and in contrast volume (CV). In the propensity-matched cohort, consisting of 269 procedures for each group, no significant differences between LR and RR were observed in median DAP values for both diagnostic and interventional procedures (3990 vs. 3542 cGy.cm{sup 2} and 9964 vs. 10216 cGy.cm{sup 2}, respectively; p = ns); FT and CV were also similar. At multiple linear regression analysis laterality of trans-radial approach was not associated with DAP. Conclusions: In an experienced trans-radial center LR is not associated with a reduction in radiation exposure, FT or CV as compared to RR. - Highlights: • Right trans-radial approach is by far more commonly used than left trans-radial approach. • Left trans-radial approach has the advantage of an easier catheter manipulation, more similar to trans-femoral approach. • This could reduce fluoroscopy time and radiation exposure. • We conducted a retrospective study to investigate patient radiation

  5. Gadolinium Use in Spine Pain Management Procedures for Patients with Contrast Allergies: Results in 527 Procedures

    International Nuclear Information System (INIS)

    Safriel, Yair; Ang, Roberto; Ali, Muhammed

    2008-01-01

    Introduction. To review the safety and efficacy of gadolinium in spine pain management procedures in patients at high risk for a contrast reaction and who are not suitable candidates for the use of standard non-ionic contrast. Methods. We reviewed records over a 61-month period of all image-guided spinal pain management procedures where patients had allergies making them unsuitable candidates for standard non-ionic contrast and where gadolinium was used to confirm needle tip placement prior to injection of medication. Results. Three hundred and four outpatients underwent 527 procedures. A spinal needle was used in all but 41 procedures. Gadolinium was visualized using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. The gadolinium dose ranged from 0.2 to 10 ml per level. The highest dose received by one patient was 15.83 ml intradiscally during a three-level discogram. Three hundred and one patients were discharged without complication or known delayed complications. One patient had documented intrathecal injection but without sequelae and 2 patients who underwent cervical procedures experienced seizures requiring admission to the intensive care unit. Both the latter patients were discharged without any further complications. Conclusion. Based on our experience we recommend using gadolinium judiciously for needle tip confirmation. We feel more confident using gadolinium in the lumbar spine and in cervical nerve blocks. Gadolinium should probably not be used as an injectate volume expander. The indications for gadolinium use in cervical needle-guided spine procedures are less clear and use of a blunt-tipped needle should be considered

  6. Determination of Gastrointestinal Transit Times in Barred Owls ( Strix varia ) by Contrast Fluoroscopy.

    Science.gov (United States)

    Doss, Grayson A; Williams, Jackie M; Mans, Christoph

    2017-06-01

    Contrast imaging studies are routinely performed in avian patients when an underlying abnormality of the gastrointestinal (GI) tract is suspected. Fluoroscopy offers several advantages over traditional radiography and can be performed in conscious animals with minimal stress and restraint. Although birds of prey are commonly encountered as patients, little is known about GI transit times and contrast imaging studies in these species, especially owls. Owls are commonly encountered in zoological, educational, and wildlife settings. In this study, 12 adult barred owls ( Strix varia ) were gavage fed a 30% weight-by-volume barium suspension (25 mL/kg body weight). Fluoroscopic exposures were recorded at 5, 15, 30, 60, 120, 180, 240, and 300 minutes after administration. Overall GI transit time and transit times of various GI organs were recorded. Median (interquartile range [IQR]) overall GI transit time was 60 minutes (IQR: 19-60 minutes) and ranged from 5-120 minutes. Ventricular and small intestinal contrast filling was rapid. Ventricular emptying was complete by a median of 60 minutes (IQR: 30-120 minutes; range: 30-240 minutes), whereas small intestinal emptying was not complete in 9/12 birds by 300 minutes. Median small intestinal contraction rate was 15 per minute (IQR: 13-16 minutes; range: 10-19 minutes). Median overall GI transit time in barred owls is more rapid than mean transit times reported for psittacine birds and red-tailed hawks ( Buteo jamaicensis ). Fluoroscopy is a safe, suitable method for investigating GI motility and transit in this species.

  7. Evaluation of RSA set-up from a clinical biplane fluoroscopy system for 3D joint kinematic analysis.

    Science.gov (United States)

    Bonanzinga, Tommaso; Signorelli, Cecilia; Bontempi, Marco; Russo, Alessandro; Zaffagnini, Stefano; Marcacci, Maurilio; Bragonzoni, Laura

    2016-01-01

    dinamic roentgen stereophotogrammetric analysis (RSA), a technique currently based only on customized radiographic equipment, has been shown to be a very accurate method for detecting three-dimensional (3D) joint motion. The aim of the present work was to evaluate the applicability of an innovative RSA set-up for in vivo knee kinematic analysis, using a biplane fluoroscopic image system. To this end, the Authors describe the set-up as well as a possible protocol for clinical knee joint evaluation. The accuracy of the kinematic measurements is assessed. the Authors evaluated the accuracy of 3D kinematic analysis of the knee in a new RSA set-up, based on a commercial biplane fluoroscopy system integrated into the clinical environment. The study was organized in three main phases: an in vitro test under static conditions, an in vitro test under dynamic conditions reproducing a flexion-extension range of motion (ROM), and an in vivo analysis of the flexion-extension ROM. For each test, the following were calculated, as an indication of the tracking accuracy: mean, minimum, maximum values and standard deviation of the error of rigid body fitting. in terms of rigid body fitting, in vivo test errors were found to be 0.10±0.05 mm. Phantom tests in static and kinematic conditions showed precision levels, for translations and rotations, of below 0.1 mm/0.2° and below 0.5 mm/0.3° respectively for all directions. the results of this study suggest that kinematic RSA can be successfully performed using a standard clinical biplane fluoroscopy system for the acquisition of slow movements of the lower limb. a kinematic RSA set-up using a clinical biplane fluoroscopy system is potentially applicable and provides a useful method for obtaining better characterization of joint biomechanics.

  8. Fluoroscopy-controlled voiding cystourethrography in infants and children: Are the radiation risks trivial?

    International Nuclear Information System (INIS)

    Perisinakis, Kostas; Damilakis, John; Stratakis, John; Raissaki, Maria; Neratzoulakis, John; Gourtsoyiannis, Nicholas

    2006-01-01

    The purpose of this study was to determine the gonadal dose, effective dose and relevant radiogenic risks associated with pediatric patients undergoing voiding cystourethrography (VCUG). Exposure parameters were monitored in 118 consecutive children undergoing VCUG. The entrance surface dose (ESD) was determined by thermoluminescent dosimeters (TLDs). For male patients, the gonadal dose was determined by TLDs attached on the anterior scrotum. For female patients, the gonadal dose was estimated by converting ESD to the ovarian dose. ESD-to-ovarian dose conversion factors were determined by thermoluminescence dosimetry and physical anthropomorphic phantoms representing newborn and 1-, 5- and 10-year-old individuals. The effective dose was estimated by using ESD and data obtained from the literature. The mean fluoroscopy time and number of radiographs during VCUG were 0.73 min and 2.3 for female and 0.91 min and 3.0 for male pediatric patients, respectively. The gonadal dose range was 0.34-5.17 mGy in boys and 0.36-2.57 mGy in girls. The corresponding ranges of effective dosage were 0.12-1.67 mSv and 0.15-1.45 mSv. Mean radiation risks for genetic anomalies and carcinogenesis following VCUG during childhood were estimated to be up to 15 per million and 125 per million, respectively. Radiation risks associated with pediatric patients undergoing VCUG should not be disregarded if such a procedure is to be justified adequately. (orig.)

  9. Prospective randomized comparison between fluoroscopy-guided ureteroscopy versus ureteroscopy with real-time ultrasonography for the management of ureteral stones

    Directory of Open Access Journals (Sweden)

    Vishwajeet Singh

    2016-01-01

    Conclusions: Ultrasound-guided ureteroscopy is safe and effectively for ureteric stone. Fluoroscopy can be avoided during ureteroscopy for uncomplicated stone. No radiation ureteroscopy is feasible with good success and minimal complication. Larger sample size with multicentric trial needed for its greater applicability.

  10. Distribution of isodose curves in urological surgical procedures

    International Nuclear Information System (INIS)

    Lanfredi, M.P.; Dias, J.H.; Ravazio, R.C.; Anés, M.; Bacelar, A.; Lykawka, R.

    2017-01-01

    During urological surgical procedures with fluoroscopy, the doses of the care team may be significant. However, the knowledge of the occupational exposure of these professionals is still very incipient in the national surgical centers. The objective of the study is to determine the isodose curves of the urological surgical procedures, in order to estimate the exposure of the personnel involved. The equipment used was a Arco-C BV Philips Bracelet. Patients with thicknesses of 20 and 28 cm were simulated using acrylic plates. The dose rates were measured with RaySafe i2 Unfors dosimeters positioned in a 50 x 50 cm mesh at three different heights of the floor: 95, 125 and 165 centimeters respectively corresponding to the gonadal, thoracic and crystalline regions of a typical adult . The isodose curves applied to the distribution of the surgical team suggest that the exposures are in the following descending order of intensity: primary physician, auxiliary physician, scrub nurse, anesthetist and nurse

  11. The Medical Exposure to Ionizing Radiation and Protection of the Patient in Medical Imaging Procedures for Diagnostic and Therapeutic Purposes (Excluding Radiotherapy) using X-Rays in Israel - Risk - Cost and Benefit

    International Nuclear Information System (INIS)

    Ben-Shlomo, A.

    1998-10-01

    Diagnostic and therapeutic radiology is playing a major role in modern medicine. The utilization of devices emitting ionizing radiation for medical diagnostic and therapeutic purposes is classified into three categories: a. Radiotherapy procedures for the treatment of malignant and benign tumors. b. Nuclear medicine procedures using radiopharmaceuticals that are introduced into the patient's body for diagnostic and therapeutic purposes. c. Diagnostic and therapeutic x-ray imaging procedures. This group includes conventional radiography, conventional fluoroscopy, cardiac catheterization, angiography, CT, mammography, dental, and fluoroscopy operation procedures. A survey was carried out on a sample of three major Israeli hospitals in order to: 1. Determine the status of radiation protection of patients in Israel with regard to the use of x-rays in medical imaging and interventional radiology. 2. Assess the extent of exposure of the population to medical x-rays, and assess the collective risk in Israel in this relation (based on Icr-60). 3. Carry out a cost-benefit optimization procedure related to the means that should be used to reduce the exposure of Israeli patients under x-ray procedures. 4. Establish a of practical recommendations to reduce the x-ray radiation exposure of patients and to increase the image quality. 5. Establish a number of basic rules to be utilized by health policy makers in Israel

  12. The Medical Exposure to Ionizing Radiation and Protection of the Patient in Medical Imaging Procedures for Diagnostic and Therapeutic Purposes (Excluding Radiotherapy) using X-Rays in Israel - Risk - Cost and Benefit

    Energy Technology Data Exchange (ETDEWEB)

    Ben-Shlomo, A

    1998-10-01

    Diagnostic and therapeutic radiology is playing a major role in modern medicine. The utilization of devices emitting ionizing radiation for medical diagnostic and therapeutic purposes is classified into three categories: a. Radiotherapy procedures for the treatment of malignant and benign tumors. b. Nuclear medicine procedures using radiopharmaceuticals that are introduced into the patient's body for diagnostic and therapeutic purposes. c. Diagnostic and therapeutic x-ray imaging procedures. This group includes conventional radiography, conventional fluoroscopy, cardiac catheterization, angiography, CT, mammography, dental, and fluoroscopy operation procedures. A survey was carried out on a sample of three major Israeli hospitals in order to: 1. Determine the status of radiation protection of patients in Israel with regard to the use of x-rays in medical imaging and interventional radiology. 2. Assess the extent of exposure of the population to medical x-rays, and assess the collective risk in Israel in this relation (based on Icr-60). 3. Carry out a cost-benefit optimization procedure related to the means that should be used to reduce the exposure of Israeli patients under x-ray procedures. 4. Establish a of practical recommendations to reduce the x-ray radiation exposure of patients and to increase the image quality. 5. Establish a number of basic rules to be utilized by health policy makers in Israel.

  13. [Assessment of the surgeon radiation exposure during a minimally invasive TLIF: Comparison between fluoroscopy and O-arm system].

    Science.gov (United States)

    Grelat, M; Zairi, F; Quidet, M; Marinho, P; Allaoui, M; Assaker, R

    2015-08-01

    Transforaminal lumbar interbody fusion with a minimally invasive approach (MIS TLIF) has become a very popular technique in the treatment of degenerative diseases of the lumbar spine, as it allows a decrease in muscle iatrogenic. However, iterative radiological controls inherent to this technique are responsible for a significant increase in exposure to ionizing radiation for the surgeon. New techniques for radiological guidance (O-arm navigation-assisted) would overcome this drawback, but this remains unproven. To analyze the exposure of the surgeon to intraoperative X-ray during a MIS TLIF under fluoroscopy and under O-arm navigation-assisted. This prospective study was conducted at the University Hospital of Lille from February to May 2013. Twelve patients underwent a MIS TLIF for the treatment of low-grade spondylolisthesis; six under standard fluoroscopy (group 1) and six under O-arm system (group 2). Passive dosimeters (rings and glasses) and active dosimeters for thorax were used to measure the radiation exposure of the surgeon. For group 1, the average time of fluoroscopy was 3.718 minutes (3.13-4.56) while no radioscopy was perform on group 2. For the first group, the average exposure dose was 12 μSv (5-20 μSv) on the thorax, 1168 μSv (510-2790 μSv) on the main hand and 179 μSv (103-486 μSv) on the lens. The exposure dose was measured zero on the second group. The maximum recommended doses can be reached, mainly for the lens. In addition to the radioprotection measures, O-arm navigation systems are safe alternatives to significantly reduce surgeon exposure. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Pediatric radiation dose during cardiac catheterization procedures in Sudan

    International Nuclear Information System (INIS)

    Ahmed, Nada A.; Nayel, A. I.

    2017-01-01

    Children are more radio sensitive than adult. This study aims to assess radiation doses and the associated hazards to pediatric during cardiac catheterization procedures. Radiation dose for 112 patients was estimated in the biggest cardiac center in Sudan. The median KAP in Gy cm"2, CK in mGy, number of frames and fluoroscopy time in minutes were (4.6, 29.0, 340.4, 13.5) and (6.0, 35.0, 318, 9.8) for the diagnostic and therapeutic cardiac procedures, respectively. The median (KAP in Gy cm"2, effective dose in mSv) for different age groups in the intervals of less than 1 year, 1-<5 years, 5-<10 years and 10- 15 years old were (2.2, 4.4), (2.5, 5.0), (4.2, 5.1) and (8.5, 4.1) respectively. Including all the procedures using the multiplicative model of ICRP 60, the mean attributable lifetime risk for stochastic effect was 0.08 and 0.05% for girls and boys, respectively. Training is needed to raise staff awareness about radiation protection. (authors)

  15. Radiologic evaluation of adenoids and tonsils in children with obstructive sleep apnea: Plain films and fluoroscopy

    International Nuclear Information System (INIS)

    Kreplick Fernbach, S.; Brouillette, T.; Riggs, T.W.; Hunt, C.E.

    1983-01-01

    Twenty-six children with obstructive sleep apnea were evaluated by lateral neck radiographs during wakefulness, and by polygraphic monitoring and upper airway fluoreoscopy during natural sleep. Children with craniofacial abnormalities, palatal surgery, and central nervous system disease were excluded from the study. Moderate or marked enlargement of tonsils and adenoids was noted on lateral neck radiographs of 18 of 26 patients. An objective measure of adenoidal enlargement, the adenoidal-nasopharyngeal ratio, correlated well with subjective judgment of adenoidal size but was not generally more useful than subjective estimation. Upper airway fluroescopy demonstrated the site and mechanism of obstruction in all patients. Because all children with moderate to marked adenotonsillar enlargement demonstrated obstruction at the adenoidal or tonsillar level on fluoroscopy, we now screen children with suspected sleep apnea with lateral airway radiographs and polysomnography. Fluoroscopy is reserved for children with mild adenotosillar enlargement, craniofacial dysplasia, prior cleft palate repair, or neuromuscular disorders. These results suggest that the pathogenesis of obstuctive sleep apnea in children involve anatomic factors which narrow the upper airway, sleep-related hypotonia of pharyngeal dilator musculature, and compensatory mechanisms to prevent or alleviate asphyxia. (orig.)

  16. Influence of phantom and tube voltage in fluoroscopy on image intensifier (I.I.) incident dose rate

    International Nuclear Information System (INIS)

    Seguchi, Shigenobu; Ishikawa, Yoshinobu; Kuwahara, Kazuyoshi; Morita, Miki; Mizuno, Shouta; Nakamura, Akio

    1999-01-01

    We examined the influence of phantoms and tube voltage in fluoroscopy on the image intensifier (I.I.) conversion factor. We used 20-cm-thick acrylic resin, 20 mm aluminum, and 1.5 mm copper, which are generally used as phantoms in the measurement of I.I. incident dose rate. We measured I.I. incident dose rate and conversion factor under conditions in which the range of tube voltage was from 60 kV to 120 kV. The result showed that the conversion factor is influenced by the type of phantom, with copper showing the highest value, aluminum second, and acrylic the smallest under the same condition of aluminum at half value layer. It was determined that conversion factor depends on tube voltage and has peaks from 80-100 kV. The location and height of the peak are influenced by the type of phantom. Therefore, I.I. incident dose rate is influenced by both the type of phantom and tube voltage under automatic brightness control fluoroscopy. Unification of phantoms and tube voltage is necessary for long-term evaluation of I.I. incident dose rate. (author)

  17. Radiologic evaluation of adenoids and tonsils in children with obstructive sleep apnea: Plain films and fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Kreplick Fernbach, S.; Brouillette, T.; Riggs, T.W.; Hunt, C.E.

    1983-07-01

    Twenty-six children with obstructive sleep apnea were evaluated by lateral neck radiographs during wakefulness, and by polygraphic monitoring and upper airway fluoreoscopy during natural sleep. Children with craniofacial abnormalities, palatal surgery, and central nervous system disease were excluded from the study. Moderate or marked enlargement of tonsils and adenoids was noted on lateral neck radiographs of 18 of 26 patients. An objective measure of adenoidal enlargement, the adenoidal-nasopharyngeal ratio, correlated well with subjective judgment of adenoidal size but was not generally more useful than subjective estimation. Upper airway fluroescopy demonstrated the site and mechanism of obstruction in all patients. Because all children with moderate to marked adenotonsillar enlargement demonstrated obstruction at the adenoidal or tonsillar level on fluoroscopy, we now screen children with suspected sleep apnea with lateral airway radiographs and polysomnography. Fluoroscopy is reserved for children with mild adenotosillar enlargement, craniofacial dysplasia, prior cleft palate repair, or neuromuscular disorders. These results suggest that the pathogenesis of obstuctive sleep apnea in children involve anatomic factors which narrow the upper airway, sleep-related hypotonia of pharyngeal dilator musculature, and compensatory mechanisms to prevent or alleviate asphyxia.

  18. The role of the MR-fluoroscopy in the diagnosis and staging of the pelvic organ prolapse

    International Nuclear Information System (INIS)

    Etlik, Oemer; Arslan, Halil; Odabasi, Oner; Odabasi, Hulya; Harman, Mustafa; Celebi, Hacer; Sakarya, M. Emin

    2005-01-01

    Introduction: The aim of the study is to investigate the efficacy of the magnetic resonance fluoroscopy in the diagnosis and staging of the pelvic prolapse. Materials and methods: The study consisted of 46 patients who were known to have pelvic prolapses from their vaginal examination. Thirty women who underwent vaginal exam and shown not have pelvic prolapse were selected as a control group. Firstly, pelvic sagittal FSE T2 weighted images of all the women were acquired in 0.3 T open MR equipment than sagittal MR-fluoroscopic images using spoiled gradient echo sequences were obtained during pelvic strain. Physical examination and MR-fluoroscopic findings were compared. The relationship between the stages of prolapse established by both of the methods was evaluated statistically with Pearson's correlation analysis. Results: Physical examination and MR findings were very concordant in the diagnosis of pelvic prolapse and statistical correlations in the stages of prolapse were established between both of the methods (P<0.01 for anterior and middle comportment, P<0.05 for posterior comportment). Conclusion: We conclude that MR-fluoroscopy is a non-invasive, easily applied, dynamic useful method without contrast agent in the diagnosis and staging of pelvic organ prolapse

  19. Zero-fluoroscopy cryothermal ablation of atrioventricular nodal re-entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial).

    Science.gov (United States)

    Luani, Blerim; Zrenner, Bernhard; Basho, Maksim; Genz, Conrad; Rauwolf, Thomas; Tanev, Ivan; Schmeisser, Alexander; Braun-Dullaeus, Rüdiger C

    2018-01-01

    Stochastic damage of the ionizing radiation to both patients and medical staff is a drawback of fluoroscopic guidance during catheter ablation of cardiac arrhythmias. Therefore, emerging zero-fluoroscopy catheter-guidance techniques are of great interest. We investigated, in a prospective pilot study, the feasibility and safety of the cryothermal (CA) slow-pathway ablation in patients with symptomatic atrioventricular-nodal-re-entry-tachycardia (AVNRT) using solely intracardiac echocardiography (ICE) for endovascular and endocardial catheter visualization. Twenty-five consecutive patients (mean age 55.6 ± 12.0 years, 17 female) with ECG-documentation or symptoms suggesting AVNRT underwent an electrophysiology study (EPS) in our laboratory utilizing ICE for catheter navigation. Supraventricular tachycardia was inducible in 23 (92%) patients; AVNRT was confirmed by appropriate stimulation maneuvers in 20 (80%) patients. All EPS in the AVNRT subgroup could be accomplished without need for fluoroscopy, relying solely on ICE-guidance. CA guided by anatomical location and slow-pathway potentials was successful in all patients, median cryo-mappings = 6 (IQR:3-10), median cryo-ablations = 2 (IQR:1-3). Fluoroscopy was used to facilitate the trans-septal puncture and localization of the ablation substrate in the remaining 3 patients (one focal atrial tachycardia and two atrioventricular-re-entry-tachycardias). Mean EPS duration in the AVNRT subgroup was 99.8 ± 39.6 minutes, ICE guided catheter placement 11.9 ± 5.8 minutes, time needed for diagnostic evaluation 27.1 ± 10.8 minutes, and cryo-application duration 26.3 ± 30.8 minutes. ICE-guided zero-fluoroscopy CA in AVNRT patients is feasible and safe. Real-time visualization of the true endovascular borders and cardiac structures allow for safe catheter navigation during the ICE-guided EPS and might be an alternative to visualization technologies using geometry reconstructions. © 2017 Wiley Periodicals, Inc.

  20. Real-time x-ray fluoroscopy-based catheter detection and tracking for cardiac electrophysiology interventions

    Energy Technology Data Exchange (ETDEWEB)

    Ma Yingliang; Housden, R. James; Razavi, Reza; Rhode, Kawal S. [Division of Imaging Sciences and Biomedical Engineering, King' s College London, London SE1 7EH (United Kingdom); Gogin, Nicolas; Cathier, Pascal [Medisys Research Group, Philips Healthcare, Paris 92156 (France); Gijsbers, Geert [Interventional X-ray, Philips Healthcare, Best 5680 DA (Netherlands); Cooklin, Michael; O' Neill, Mark; Gill, Jaswinder; Rinaldi, C. Aldo [Department of Cardiology, Guys and St. Thomas' Hospitals NHS Foundation Trust, London SE1 7EH (United Kingdom)

    2013-07-15

    Purpose: X-ray fluoroscopically guided cardiac electrophysiology (EP) procedures are commonly carried out to treat patients with arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of a three-dimensional (3D) roadmap derived from preprocedural volumetric images can be used to add anatomical information. It is useful to know the position of the catheter electrodes relative to the cardiac anatomy, for example, to record ablation therapy locations during atrial fibrillation therapy. Also, the electrode positions of the coronary sinus (CS) catheter or lasso catheter can be used for road map motion correction.Methods: In this paper, the authors present a novel unified computational framework for image-based catheter detection and tracking without any user interaction. The proposed framework includes fast blob detection, shape-constrained searching and model-based detection. In addition, catheter tracking methods were designed based on the customized catheter models input from the detection method. Three real-time detection and tracking methods are derived from the computational framework to detect or track the three most common types of catheters in EP procedures: the ablation catheter, the CS catheter, and the lasso catheter. Since the proposed methods use the same blob detection method to extract key information from x-ray images, the ablation, CS, and lasso catheters can be detected and tracked simultaneously in real-time.Results: The catheter detection methods were tested on 105 different clinical fluoroscopy sequences taken from 31 clinical procedures. Two-dimensional (2D) detection errors of 0.50 {+-} 0.29, 0.92 {+-} 0.61, and 0.63 {+-} 0.45 mm as well as success rates of 99.4%, 97.2%, and 88.9% were achieved for the CS catheter, ablation catheter, and lasso catheter, respectively. With the tracking method, accuracies were increased to 0.45 {+-} 0.28, 0.64 {+-} 0.37, and 0.53 {+-} 0.38 mm and success rates increased to 100%, 99

  1. Special procedural measures and the protection of human rights
    General report

    Directory of Open Access Journals (Sweden)

    John A.E. Vervaele

    2009-10-01

    Full Text Available The aim of the general report is to conduct a comparative analysis of the national reports in order to trace transformation processes in domestic criminal justice systems, in particular criminal process, as special procedural measures are introduced to deal with terrorism and organised crime, and to map whether this has led countries to depart from their own fundamental rules, procedures, principles and applicable human rights standards. Starting from the premise that the integrated system of criminal law has three dimensions – the protection of individuals (the shield dimension, the provision of instruments of law enforcement (the sword dimension, and of checks and balances/trias politica (the constitutional dimension – the report provides a comprehensive overview of interrelated transformations, mostly in the pre-trial setting, that have affected all three in three waves of ‘war’ (on drugs, organised crime and terrorism. In many countries, procedural guarantees and principles that protect against the infringement of fair trial rights are considered a burden to the efficiency of serious crime enforcement. These reforms have resulted in a clear expansion of the punitive state and a blurring of classic distinctions, and do not favour the rule of law. The focus on public security and preventive coercive investigation undermines the criminal justice system. With the criminal justice system increasingly used as an instrument to regulate the present and/or the future rather than to punish past behaviour, and a criminal process in which pre-trial investigation is not about truth-finding related to committed crime, but about the construction and de-construction of social dangerousness, the interests of national security may be said to be prevailing over justice and to be threatening due process and the protection of human rights – notwithstanding that general principles of criminal procedure seem to have become more important in the reporting

  2. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

    International Nuclear Information System (INIS)

    Kim, Young Hwan; Kim, Yong Joo; Shin, Tae Beom

    2011-01-01

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

  3. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

    2011-04-15

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

  4. Rigorous accuracy assessment for 3D reconstruction using time-series Dual Fluoroscopy (DF) image pairs

    Science.gov (United States)

    Al-Durgham, Kaleel; Lichti, Derek D.; Kuntze, Gregor; Ronsky, Janet

    2017-06-01

    High-speed biplanar videoradiography, or clinically referred to as dual fluoroscopy (DF), imaging systems are being used increasingly for skeletal kinematics analysis. Typically, a DF system comprises two X-ray sources, two image intensifiers and two high-speed video cameras. The combination of these elements provides time-series image pairs of articulating bones of a joint, which permits the measurement of bony rotation and translation in 3D at high temporal resolution (e.g., 120-250 Hz). Assessment of the accuracy of 3D measurements derived from DF imaging has been the subject of recent research efforts by several groups, however with methodological limitations. This paper presents a novel and simple accuracy assessment procedure based on using precise photogrammetric tools. We address the fundamental photogrammetry principles for the accuracy evaluation of an imaging system. Bundle adjustment with selfcalibration is used for the estimation of the system parameters. The bundle adjustment calibration uses an appropriate sensor model and applies free-network constraints and relative orientation stability constraints for a precise estimation of the system parameters. A photogrammetric intersection of time-series image pairs is used for the 3D reconstruction of a rotating planar object. A point-based registration method is used to combine the 3D coordinates from the intersection and independently surveyed coordinates. The final DF accuracy measure is reported as the distance between 3D coordinates from image intersection and the independently surveyed coordinates. The accuracy assessment procedure is designed to evaluate the accuracy over the full DF image format and a wide range of object rotation. Experiment of reconstruction of a rotating planar object reported an average positional error of 0.44 +/- 0.2 mm in the derived 3D coordinates (minimum 0.05 and maximum 1.2 mm).

  5. The design and imaging characteristics of dynamic, solid-state, flat-panel x-ray image detectors for digital fluoroscopy and fluorography

    International Nuclear Information System (INIS)

    Cowen, A.R.; Davies, A.G.; Sivananthan, M.U.

    2008-01-01

    Dynamic, flat-panel, solid-state, x-ray image detectors for use in digital fluoroscopy and fluorography emerged at the turn of the millennium. This new generation of dynamic detectors utilize a thin layer of x-ray absorptive material superimposed upon an electronic active matrix array fabricated in a film of hydrogenated amorphous silicon (a-Si:H). Dynamic solid-state detectors come in two basic designs, the indirect-conversion (x-ray scintillator based) and the direct-conversion (x-ray photoconductor based). This review explains the underlying principles and enabling technologies associated with these detector designs, and evaluates their physical imaging characteristics, comparing their performance against the long established x-ray image intensifier television (TV) system. Solid-state detectors afford a number of physical imaging benefits compared with the latter. These include zero geometrical distortion and vignetting, immunity from blooming at exposure highlights and negligible contrast loss (due to internal scatter). They also exhibit a wider dynamic range and maintain higher spatial resolution when imaging over larger fields of view. The detective quantum efficiency of indirect-conversion, dynamic, solid-state detectors is superior to that of both x-ray image intensifier TV systems and direct-conversion detectors. Dynamic solid-state detectors are playing a burgeoning role in fluoroscopy-guided diagnosis and intervention, leading to the displacement of x-ray image intensifier TV-based systems. Future trends in dynamic, solid-state, digital fluoroscopy detectors are also briefly considered. These include the growth in associated three-dimensional (3D) visualization techniques and potential improvements in dynamic detector design

  6. Using biplanar fluoroscopy to guide radiopaque vascular injections: a new method for vascular imaging.

    Directory of Open Access Journals (Sweden)

    Haley D O'Brien

    Full Text Available Studying vascular anatomy, especially in the context of relationships with hard tissues, is of great interest to biologists. Vascular studies have provided significant insight into physiology, function, phylogenetic relationships, and evolutionary patterns. Injection of resin or latex into the vascular system has been a standard technique for decades. There has been a recent surge in popularity of more modern methods, especially radiopaque latex vascular injection followed by CT scanning and digital "dissection." This technique best displays both blood vessels and bone, and allows injections to be performed on cadaveric specimens. Vascular injection is risky, however, because it is not a standardizable technique, as each specimen is variable with regard to injection pressure and timing. Moreover, it is not possible to view the perfusion of injection medium throughout the vascular system of interest. Both data and rare specimens can therefore be lost due to poor or excessive perfusion. Here, we use biplanar video fluoroscopy as a technique to guide craniovascular radiopaque latex injection. Cadaveric domestic pigs (Sus scrofa domestica and white-tailed deer (Odocoileus virginianus were injected with radiopaque latex under guidance of fluoroscopy. This method was found to enable adjustments, in real-time, to the rate, location, and pressure at which latex is injected in order to avoid data and specimen loss. In addition to visualizing the injection process, this technique can be used to determine flow patterns, and has facilitated the development of consistent markers for complete perfusion.

  7. A method for measuring three-dimensional mandibular kinematics in vivo using single-plane fluoroscopy

    Science.gov (United States)

    Chen, C-C; Lin, C-C; Chen, Y-J; Hong, S-W; Lu, T-W

    2013-01-01

    Objectives Accurate measurement of the three-dimensional (3D) motion of the mandible in vivo is essential for relevant clinical applications. Existing techniques are either of limited accuracy or require the use of transoral devices that interfere with jaw movements. This study aimed to develop further an existing method for measuring 3D, in vivo mandibular kinematics using single-plane fluoroscopy; to determine the accuracy of the method; and to demonstrate its clinical applicability via measurements on a healthy subject during opening/closing and chewing movements. Methods The proposed method was based on the registration of single-plane fluoroscopy images and 3D low-radiation cone beam CT data. It was validated using roentgen single-plane photogrammetric analysis at static positions and during opening/closing and chewing movements. Results The method was found to have measurement errors of 0.1 ± 0.9 mm for all translations and 0.2° ± 0.6° for all rotations in static conditions, and of 1.0 ± 1.4 mm for all translations and 0.2° ± 0.7° for all rotations in dynamic conditions. Conclusions The proposed method is considered an accurate method for quantifying the 3D mandibular motion in vivo. Without relying on transoral devices, the method has advantages over existing methods, especially in the assessment of patients with missing or unstable teeth, making it useful for the research and clinical assessment of the temporomandibular joint and chewing function. PMID:22842637

  8. Intervertebral anticollision constraints improve out-of-plane translation accuracy of a single-plane fluoroscopy-to-CT registration method for measuring spinal motion

    International Nuclear Information System (INIS)

    Lin, Cheng-Chung; Tsai, Tsung-Yuan; Hsu, Shih-Jung; Lu, Tung-Wu; Shih, Ting-Fang; Wang, Ting-Ming

    2013-01-01

    Purpose: The study aimed to propose a new single-plane fluoroscopy-to-CT registration method integrated with intervertebral anticollision constraints for measuring three-dimensional (3D) intervertebral kinematics of the spine; and to evaluate the performance of the method without anticollision and with three variations of the anticollision constraints via an in vitro experiment. Methods: The proposed fluoroscopy-to-CT registration approach, called the weighted edge-matching with anticollision (WEMAC) method, was based on the integration of geometrical anticollision constraints for adjacent vertebrae and the weighted edge-matching score (WEMS) method that matched the digitally reconstructed radiographs of the CT models of the vertebrae and the measured single-plane fluoroscopy images. Three variations of the anticollision constraints, namely, T-DOF, R-DOF, and A-DOF methods, were proposed. An in vitro experiment using four porcine cervical spines in different postures was performed to evaluate the performance of the WEMS and the WEMAC methods. Results: The WEMS method gave high precision and small bias in all components for both vertebral pose and intervertebral pose measurements, except for relatively large errors for the out-of-plane translation component. The WEMAC method successfully reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five degrees of freedom (DOF) more or less unaltered. The means (standard deviations) of the out-of-plane translational errors were less than −0.5 (0.6) and −0.3 (0.8) mm for the T-DOF method and the R-DOF method, respectively. Conclusions: The proposed single-plane fluoroscopy-to-CT registration method reduced the out-of-plane translation errors for intervertebral kinematic measurements while keeping the measurement accuracies for the other five DOF more or less unaltered. With the submillimeter and subdegree accuracy, the WEMAC method was

  9. Comparison of fluoroscopy-guided pull-type percutaneous radiological gastrostomy (pull-type-PRG) with conventional percutaneous radiological gastrostomy (push-type-PRG): clinical results in 253 patients

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Yang; Schneider, J.; Dueber, C.; Pitton, M.B. [University Medical Center of the Johannes Gutenberg University Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany)

    2011-11-15

    To analyze the clinical results and complications of fluoroscopy guided internal-external pull-type percutaneous radiological gastrostomy (pull-type-PRG) and conventional external-internal percutaneous radiological gastrostomy (push-type-PRG). A total of 253 patients underwent radiological gastrostomy between January 2002 and January 2010. Data were collected retrospectively from radiology reports, Chart review of clinical notes, procedure reports, discharge summaries and subsequent hospital visits. Statistical analysis was performed to compare the two methods for gastrostomy with respect to peri-interventional aspects and clinical results. 128 patients received the Pull-type-PRG whereas the other 125 patients were served with the Push-type-PRG. Indications for gastrostomy were similar in these two groups. The most frequent indications for the both methods were stenotic oesophageal tumors or head/neck tumors (54.7% in pull-type-PRG, 68% in push-type-PRG). Gastrostomy procedures were successful in 98.3% in pull-type-PRG compared to 92% in push-type-PRG. There was no procedure-related mortality. Compared to Push-type-PRG, the peri-interventional complication rate was significantly reduced in pull-type-PRG (14.8% versus 34.4%, P = 0.002). Compared to the external-internal push-type-PRG, the internal-external Pull-type-PRG showed a high primary success rate and a decreased incidence of peri-interventional complications. (orig.)

  10. Comparison of fluoroscopy-guided pull-type percutaneous radiological gastrostomy (pull-type-PRG) with conventional percutaneous radiological gastrostomy (push-type-PRG): clinical results in 253 patients

    International Nuclear Information System (INIS)

    Yang, Yang; Schneider, J.; Dueber, C.; Pitton, M.B.

    2011-01-01

    To analyze the clinical results and complications of fluoroscopy guided internal-external pull-type percutaneous radiological gastrostomy (pull-type-PRG) and conventional external-internal percutaneous radiological gastrostomy (push-type-PRG). A total of 253 patients underwent radiological gastrostomy between January 2002 and January 2010. Data were collected retrospectively from radiology reports, Chart review of clinical notes, procedure reports, discharge summaries and subsequent hospital visits. Statistical analysis was performed to compare the two methods for gastrostomy with respect to peri-interventional aspects and clinical results. 128 patients received the Pull-type-PRG whereas the other 125 patients were served with the Push-type-PRG. Indications for gastrostomy were similar in these two groups. The most frequent indications for the both methods were stenotic oesophageal tumors or head/neck tumors (54.7% in pull-type-PRG, 68% in push-type-PRG). Gastrostomy procedures were successful in 98.3% in pull-type-PRG compared to 92% in push-type-PRG. There was no procedure-related mortality. Compared to Push-type-PRG, the peri-interventional complication rate was significantly reduced in pull-type-PRG (14.8% versus 34.4%, P = 0.002). Compared to the external-internal push-type-PRG, the internal-external Pull-type-PRG showed a high primary success rate and a decreased incidence of peri-interventional complications. (orig.)

  11. A search for improved technique factors in paediatric fluoroscopy

    International Nuclear Information System (INIS)

    Tapiovaara, M.J.; Sandborg, M.; Dance, D.R.

    1999-01-01

    A Monte Carlo computational model of a fluoroscopic imaging chain was used for deriving optimal technique factors for paediatric fluoroscopy. The optimal technique was defined as the one that minimizes the absorbed dose (or dose rate) in the patient with a constraint of constant image quality. Image quality was assessed for the task of detecting a detail in the image of a patient-simulating phantom, and was expressed in terms of the ideal observer's signal-to-noise ratio (SNR) for static images and in terms of the accumulating rate of the square of SNR for dynamic imaging. The entrance air kerma (or air kerma rate) and the mean absorbed dose (or dose rate) in the phantom quantified radiation detriment. The calculations were made for homogeneous phantoms simulating newborn, 3-, 10- and 15-year-old patients, barium and iodine contrast material details, several x-ray spectra, and for imaging with or without an antiscatter grid. The image receptor was modelled as a CsI x-ray image intensifier (XRII). For the task of detecting low- or moderate-contrast iodine details, the optimal spectrum can be obtained by using an x-ray tube potential near 50 kV and filtering the x-ray beam heavily. The optimal tube potential is near 60 kV for low- or moderate-contrast barium details, and 80-100 kV for high-contrast details. The low-potential spectra above require a high tube load, but this should be acceptable in paediatric fluoroscopy. A reasonable choice of filtration is the use of an additional 0.25 mm Cu, or a suitable K-edge filter. No increase in the optimal tube potential was found as phantom thickness increased. With the constraint of constant low-contrast detail detectability, the mean absorbed doses obtained with the above spectra are approximately 50% lower than those obtained with the reference conditions of 70 kV and 2.7 mm Al filter. For the smallest patient and x-ray field size, not using a grid was slightly more dose-efficient than using a grid, but when the patient

  12. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients - a white paper executive summary

    International Nuclear Information System (INIS)

    Strauss, Keith J.; Kaste, Sue C.

    2006-01-01

    ALARA represents a practice mandate adhering to the principle of keeping radiation doses to patients and personnel As Low As Reasonably Achievable. This concept is strongly endorsed by the Society for Pediatric Radiology, particularly in the use of procedures and modalities involving higher radiation doses such as CT and fluoroscopic examinations of pediatric patients. There is no doubt that medical imaging, which has undergone tremendous technological advances in recent decades, is integral to patient care. However, these technological advances generally precede the knowledge of end-users concerning the optimal use and correct operation of the resulting imaging equipment, and such knowledge is essential to minimizing potential risks to the patients. Current imaging methods must be optimized for radiation dose reduction in pediatric patients who might be as much as ten times more radiosensitive than adults. Unlike straightforward radiographic examinations, radiation dose to the patient during fluoroscopy is dependent on the operator's training, experience with the fluoroscope, and efficiency in completing a diagnostic study. The range of pediatric radiation doses from fluoroscopy is wide because this examination is performed not only by pediatric radiologists but also by general radiologists who occasionally care for children, interventional cardiologists, gastroenterologists, urologists and others. Thus, a venue where multidisciplinary interaction by this variety of operators can occur serves to improve pediatric patient care

  13. Circulatory disease mortality in the Massachusetts tuberculosis fluoroscopy cohort study

    International Nuclear Information System (INIS)

    Little, Mark P.; Zablotska, Lydia B.; Brenner, Alina V.; Lipshultz, Steven E.

    2016-01-01

    High-dose ionizing radiation is associated with circulatory disease. Risks from lower-dose fractionated exposures, such as from diagnostic radiation procedures, remain unclear. In this study we aimed to ascertain the relationship between fractionated low-to-medium dose radiation exposure and circulatory disease mortality in a cohort of 13,568 tuberculosis patients in Massachusetts, some with fluoroscopy screenings, between 1916 and 1961 and follow-up until the end of 2002. Analysis of mortality was in relation to cumulative thyroid (cerebrovascular) or lung (all other circulatory disease) radiation dose via Poisson regression. Over the full dose range, there was no overall radiation-related excess risk of death from circulatory disease (n = 3221; excess relative risk/Gy −0.023; 95 % CI −0.067, 0.028; p = 0.3574). Risk was somewhat elevated in hypertensive heart disease (n = 89; excess relative risk/Gy 0.357; 95 % CI −0.043, 1.030, p = 0.0907) and slightly decreased in ischemic heart disease (n = 1950; excess relative risk/Gy −0.077; 95 % CI −0.130, −0.012; p = 0.0211). However, under 0.5 Gy, there was a borderline significant increasing trend for all circulatory disease (excess relative risk/Gy 0.345; 95 % CI −0.032, 0.764; p = 0.0743) and for ischemic heart disease (excess relative risk/Gy 0.465; 95 % CI, −0.032, 1.034, p = 0.0682). Pneumolobectomy increased radiation–associated risk (excess relative risk/Gy 0.252; 95 % CI 0.024, 0.579). Fractionation of dose did not modify excess risk. In summary, we found no evidence of radiation-associated excess circulatory death risk overall, but there are indications of excess circulatory death risk at lower doses (<0.5 Gy). Although consistent with other radiation-exposed groups, the indications of higher risk at lower doses are unusual and should be confirmed against other data.

  14. Patient dose in PTCA as a function of the complexity of the procedure

    International Nuclear Information System (INIS)

    Peterzol, A.; Kotre, J.

    2002-01-01

    This work focused attention on the relationship between patient irradiation parameters and the complexity of the procedure in percutaneous transluminal coronary angioplasty (PTCA). It continued the study performed by, whose aim was to evaluate the relationships of clinical (CFs), anatomic (AFs), and technical factors (TFs) versus fluoroscopy time (FT), the number of cine frames (NCF) acquired during cine angiography, and the dose/area product (DAP). There are several papers, being some of them, proving the connection of success, complications rates and clinical events at follow-up to the factors above mentioned. On the contrary, few studies have investigated how the complexity of PTCA affects patient radiation exposure. Like, all three works showed an increase in screening time and patient dose related to an increase in procedure complexity, which was mainly expressed by the number of lesions treated and the devices used (number of catheters, number of stents). In particular, examined the relation of lesion factors and procedural factors versus FT, NCF and DAP, producing an overall grade of 1-3 related to the procedure complexity

  15. Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation.

    Science.gov (United States)

    Sills, E Scott; Palermo, Gianpiero D

    2016-07-01

    We describe the successful removal of a pelvic contraceptive coil in a symptomatic 46-year-old patient who had Essure devices for four years, using a combined hysteroscopy-laparoscopy-fluoroscopy approach. Following normal hysteroscopy, at laparoscopy the right Essure implant was disrupted and its outer nitinol coil had perforated the fallopian tube. However, the inner rod (containing polyethylene terephthalate) had migrated to an extrapelvic location, near the proximal colon. In contrast, the left implant was situated within the corresponding tube. Intraoperative fluoroscopy was used to confirm complete removal of the device, which was further verified by postoperative computed tomography. The patient's condition improved after surgery and she continues to do well. This is the first report to describe this technique in managing Essure complications remote from time of insertion. Our case highlights the value and limitations of preoperative and intraoperative imaging to map Essure fragment location before surgery.

  16. Patient and staff doses and relationships between them in fluoroscopically guided procedures

    International Nuclear Information System (INIS)

    Avramova-Cholakova, S.; Christova-Popova, Y.; Sagorska, A.

    2015-01-01

    Full text: Medical exposure has the main contribution to man-made sources of exposures to the population in developed countries. Fluoroscopically guided procedures in interventional cardiology, gastroenterology, urology, orthopaedics and others may be related to high doses to both patients and staff. The main risk for both groups is the radiation carcinogenesis and it is increasing with dose. However deterministic effects are also possible: severe patient skin injuries occur sometimes. There are such cases in Bulgarian radiological practice. For the medical staff, involved in the procedures, radiation induced cataract is observed occasionally. Learning objective: In many cases there is direct correlation between patient and staff doses. Several simple rules must be observed in order to decrease exposure. Rules related to patient: Patient dose (dose-area product (DAP), fluoroscopy time, number of series,number of images) should be recorded for every patient; The patient should be positioned as far away as possible from the x-ray tube and as closer as possible to the image intensifier/digital image receptor; Fluoroscopy time should be minimized; Pulsed fluoroscopy with the lowest dose rate and the lowest frame rate providing acceptable image quality should be used; Different skin areas should be exposed in different projections; Oblique projections increase the dose - they should be avoided; Magnification also increases the dose several times and should be avoided; The acquisition mode should be avoided; it delivers dozens of times higher doses. Minimal number of frames and cine runs should be used. Use of “last image hold” is encouraged; The x-ray beam should be collimated to the area of interest. Rules related to staff: The staff receives scattered radiation from patient’s body. Every measure to decrease patient’s dose decreases staff dose as well; Every available protective device should be used (lead apron, thyroid collar, lead glasses, screens). They

  17. Quantitative image quality evaluation of pixel-binning in a flat-panel detector for x-ray fluoroscopy

    International Nuclear Information System (INIS)

    Srinivas, Yogesh; Wilson, David L.

    2004-01-01

    X-ray fluoroscopy places stringent design requirements on new flat-panel (FP) detectors, requiring both low-noise electronics and high data transfer rates. Pixel-binning, wherein data from more that one detector pixel are collected simultaneously, not only lowers the data transfer rate but also increases x-ray counts and pixel signal-to-noise ratio (SNR). In this study, we quantitatively assessed image quality of image sequences from four acquisition methods; no-binning and three types of binning; in synthetic images using a clinically relevant task of detecting an extended guidewire in a four-alternative forced-choice paradigm. Binning methods were conventional data-line (D) and gate-line (G) binning, and a novel method in which alternate frames in an image sequence used D and G binning. Two detector orientations placed the data lines either parallel or perpendicular to the guide wire. At a low exposure of 0.6 μR (1.548x10 -10 C/kg) per frame, irrespective of detector orientation, D binning with its reduced electronic noise was significantly (p -10 C/kg) per frame, with data lines parallel to the guidewire, detection with D binning was significantly (p<0.1) better than G binning. However, with data lines perpendicular to the guidewire, G binning was significantly (p<0.1) better than D binning because the partial area effect was reduced. Alternate binning was the best binning method when results were averaged over both orientations, and it was as good as the best binning method at either orientation. In addition, at low and high exposures, alternate binning gave a temporally fused image with a smooth guidewire, an important image quality feature not assessed in a detection experiment. While at high exposure, detection with no binning was as good, or better, than the best binning method, it might be impractical at fluoroscopy imaging rates. A computational observer model based on signal detection theory successfully fit data and was used to predict effects of

  18. Deformable 3D–2D registration for CT and its application to low dose tomographic fluoroscopy

    International Nuclear Information System (INIS)

    Flach, Barbara; Brehm, Marcus; Sawall, Stefan; Kachelrieß, Marc

    2014-01-01

    Many applications in medical imaging include image registration for matching of images from the same or different modalities. In the case of full data sampling, the respective reconstructed images are usually of such a good image quality that standard deformable volume-to-volume (3D–3D) registration approaches can be applied. But research in temporal-correlated image reconstruction and dose reductions increases the number of cases where rawdata are available from only few projection angles. Here, deteriorated image quality leads to non-acceptable deformable volume-to-volume registration results. Therefore a registration approach is required that is robust against a decreasing number of projections defining the target position. We propose a deformable volume-to-rawdata (3D–2D) registration method that aims at finding a displacement vector field maximizing the alignment of a CT volume and the acquired rawdata based on the sum of squared differences in rawdata domain. The registration is constrained by a regularization term in accordance with a fluid-based diffusion. Both cost function components, the rawdata fidelity and the regularization term, are optimized in an alternating manner. The matching criterion is optimized by a conjugate gradient descent for nonlinear functions, while the regularization is realized by convolution of the vector fields with Gaussian kernels. We validate the proposed method and compare it to the demons algorithm, a well-known 3D–3D registration method. The comparison is done for a range of 4–60 target projections using datasets from low dose tomographic fluoroscopy as an application example. The results show a high correlation to the ground truth target position without introducing artifacts even in the case of very few projections. In particular the matching in the rawdata domain is improved compared to the 3D–3D registration for the investigated range. The proposed volume-to-rawdata registration increases the robustness

  19. Treatment of intervertebral disc degenerative disease using percutaneous nucleotomy–an overview of less invasive procedures

    Directory of Open Access Journals (Sweden)

    Miran Jeromel

    2014-04-01

    Full Text Available Background: Less invasive treatment methods for intervertebral disc disease and decompression of neural structures as a consequence of contained disc herniation represent an alternative to surgical procedure. Percutaneus nucleotomy uses a percutaneous approach to the intervertebral disc. The article presents the evolution of numerous procedureds in clinical practice.Methods: Percutaneous nucleoplasty is a fluoroscopy-guided procedure which enables controlled and safe entrance into the intervertebral disc. The procedure is performed under strict aseptic conditions, using a local anaesthesia with the patient under analgosedation. Based on the principle of therapeutic intradiscal action, the procedures can be divided into three groups: chemical (chemonucleolysis with chimopapain, alcohol, ozone, mechanical (automated percutaneous lumbar discectomy – APLD, arthroscopic discectomy and thermical methods (laser, radiofrequency ablation, intradiscal electrothermal annuloplasty – IDET, Coblation®.Results: Percutaneous nucleotomy by the majority of the mentioned procedures results in a therapeutic effect (reduction of pain and decompression of neural structures. Fast recovery represents a major advantage of less invasive treatment.Conclusions: Less invasive method (nucleotomy using different procedures represents a successful alternative approach to surgical discectomy. Proper patient selection and safe technique are mandatory in order to achieve a good clinical outcome.

  20. Real-time x-ray fluoroscopy-based catheter detection and tracking for cardiac electrophysiology interventions

    International Nuclear Information System (INIS)

    Ma Yingliang; Housden, R. James; Razavi, Reza; Rhode, Kawal S.; Gogin, Nicolas; Cathier, Pascal; Gijsbers, Geert; Cooklin, Michael; O'Neill, Mark; Gill, Jaswinder; Rinaldi, C. Aldo

    2013-01-01

    Purpose: X-ray fluoroscopically guided cardiac electrophysiology (EP) procedures are commonly carried out to treat patients with arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of a three-dimensional (3D) roadmap derived from preprocedural volumetric images can be used to add anatomical information. It is useful to know the position of the catheter electrodes relative to the cardiac anatomy, for example, to record ablation therapy locations during atrial fibrillation therapy. Also, the electrode positions of the coronary sinus (CS) catheter or lasso catheter can be used for road map motion correction.Methods: In this paper, the authors present a novel unified computational framework for image-based catheter detection and tracking without any user interaction. The proposed framework includes fast blob detection, shape-constrained searching and model-based detection. In addition, catheter tracking methods were designed based on the customized catheter models input from the detection method. Three real-time detection and tracking methods are derived from the computational framework to detect or track the three most common types of catheters in EP procedures: the ablation catheter, the CS catheter, and the lasso catheter. Since the proposed methods use the same blob detection method to extract key information from x-ray images, the ablation, CS, and lasso catheters can be detected and tracked simultaneously in real-time.Results: The catheter detection methods were tested on 105 different clinical fluoroscopy sequences taken from 31 clinical procedures. Two-dimensional (2D) detection errors of 0.50 ± 0.29, 0.92 ± 0.61, and 0.63 ± 0.45 mm as well as success rates of 99.4%, 97.2%, and 88.9% were achieved for the CS catheter, ablation catheter, and lasso catheter, respectively. With the tracking method, accuracies were increased to 0.45 ± 0.28, 0.64 ± 0.37, and 0.53 ± 0.38 mm and success rates increased to 100%, 99.2%, and 96

  1. Dosimetry in medical specialist in procedures of interventionist radiology

    International Nuclear Information System (INIS)

    Gaona, E.; Vazquez V, J. A.; Rivera M, T.; Izeta G, A. C.; Azorin V, J. C.; Arreola, M.

    2014-08-01

    In this work are presented the experimental results of determining the dose in different body parts, measured by thermoluminescent dosimeters, to medical specialists of implantation procedures of definitive cardiac pacemaker. The medical personnel in ten intervention procedures were controlled according to the procedure type, pathological indication, fluoroscopy time and machine generating estimates of the patient doses. The doses to the extremities of the cardiologist were measured by means of thermoluminescent dosimeters (TLD). The domains of first level in the hand are in the index finger of the left and the right hand. The medium doses of the skin in the eyes, a report of the dose received during each type of intervention procedure in the glandular thyroid and fingers of the cardiologists is made. The results represent the integrated dose to the cardiologist, received during the implantation procedures of definitive cardiac pacemaker in the same patient. By a half time of detection of 70 minutes for patient, the half dose of the skin, received for the right and left hand, ascended to 1,4 mSv, under the glove. In conclusion, the dose average for the dosimeters of the thyroid gland and forehead was varied from 0,41 up to 1,14 mSv for study. The exposure to the X-rays is a topic to consider, more important every time on the development of systematic procedures little invasive, including the angiography, catheter, worker and patient. (Author)

  2. 46 CFR 201.7 - Information; special instructions.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Information; special instructions. 201.7 Section 201.7 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION POLICY, PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE General Information (Rule 1) § 201.7 Information; special instructions. Information...

  3. Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France

    International Nuclear Information System (INIS)

    Etard, Cecile; Bigand, Emeline; Salvat, Cecile; Vidal, Vincent; Beregi, Jean Paul; Hornbeck, Amaury; Greffier, Joel

    2017-01-01

    A national retrospective survey on patient doses was performed by the French Society of Medical physicists to assess reference levels (RLs) in interventional radiology as required by the European Directive 2013/59/Euratom. Fifteen interventional procedures in neuroradiology, vascular radiology and osteoarticular procedures were analysed. Kerma area product (KAP), fluoroscopy time (FT), reference air kerma and number of images were recorded for 10 to 30 patients per procedure. RLs were calculated as the 3rd quartiles of the distributions. Results on 4600 procedures from 36 departments confirmed the large variability in patient dose for the same procedure. RLs were proposed for the four dosimetric estimators and the 15 procedures. RLs in terms of KAP and FT were 90 Gm.cm 2 and 11 mins for cerebral angiography, 35 Gy.cm 2 and 16 mins for biliary drainage, 75 Gy.cm 2 and 6 mins for lower limbs arteriography and 70 Gy.cm 2 and 11 mins for vertebroplasty. For these four procedures, RLs were defined according to the complexity of the procedure. For all the procedures, the results were lower than most of those already published. This study reports RLs in interventional radiology based on a national survey. Continual evolution of practices and technologies requires regular updates of RLs. (orig.)

  4. Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France

    Energy Technology Data Exchange (ETDEWEB)

    Etard, Cecile [Institut de Radioprotection et de Surete Nucleaire, Fontenay-aux-Roses (France); French Society of Medical Physicists (SFPM), Paris (France); Bigand, Emeline [French Society of Medical Physicists (SFPM), Paris (France); La Timone University Hospital, Department of Radiology, Marseille Cedex (France); Salvat, Cecile [French Society of Medical Physicists (SFPM), Paris (France); Lariboisiere Hospital, Department of Medical Physics and Radiation Protection, Paris (France); Vidal, Vincent [La Timone University Hospital, Department of Radiology, Marseille Cedex (France); French Society of Radiology (SFR) - Interventional Radiology Federation (FRI), Paris (France); Beregi, Jean Paul [French Society of Radiology (SFR) - Interventional Radiology Federation (FRI), Paris (France); Nimes University Hospital, Medical Imaging Group Nimes, Department of Radiology, Nimes (France); Hornbeck, Amaury [French Society of Medical Physicists (SFPM), Paris (France); Trousseau University Hospital, Department of Pediatric Radiology, Paris (France); Greffier, Joel [French Society of Medical Physicists (SFPM), Paris (France); Nimes University Hospital, Medical Imaging Group Nimes, Department of Radiology, Nimes (France)

    2017-10-15

    A national retrospective survey on patient doses was performed by the French Society of Medical physicists to assess reference levels (RLs) in interventional radiology as required by the European Directive 2013/59/Euratom. Fifteen interventional procedures in neuroradiology, vascular radiology and osteoarticular procedures were analysed. Kerma area product (KAP), fluoroscopy time (FT), reference air kerma and number of images were recorded for 10 to 30 patients per procedure. RLs were calculated as the 3rd quartiles of the distributions. Results on 4600 procedures from 36 departments confirmed the large variability in patient dose for the same procedure. RLs were proposed for the four dosimetric estimators and the 15 procedures. RLs in terms of KAP and FT were 90 Gm.cm{sup 2} and 11 mins for cerebral angiography, 35 Gy.cm{sup 2} and 16 mins for biliary drainage, 75 Gy.cm{sup 2} and 6 mins for lower limbs arteriography and 70 Gy.cm{sup 2} and 11 mins for vertebroplasty. For these four procedures, RLs were defined according to the complexity of the procedure. For all the procedures, the results were lower than most of those already published. This study reports RLs in interventional radiology based on a national survey. Continual evolution of practices and technologies requires regular updates of RLs. (orig.)

  5. Arthrography

    Medline Plus

    Full Text Available ... MRI) or fluoroscopy – a form of real-time x-ray. Your preparation may vary depending on which imaging ... a joint often uses a special form of x-ray called fluoroscopy to guide and evaluate the injection ...

  6. Spline-procedures

    International Nuclear Information System (INIS)

    Schmidt, R.

    1976-12-01

    This report contains a short introduction to spline functions as well as a complete description of the spline procedures presently available in the HMI-library. These include polynomial splines (using either B-splines or one-sided basis representations) and natural splines, as well as their application to interpolation, quasiinterpolation, L 2 -, and Tchebycheff approximation. Special procedures are included for the case of cubic splines. Complete test examples with input and output are provided for each of the procedures. (orig.) [de

  7. Assessment of eye lens doses for workers during interventional radiology procedures

    International Nuclear Information System (INIS)

    Urboniene, A.; Sadzeviciene, E.; Ziliukas, J.

    2015-01-01

    The assessment of eye lens doses for workers during interventional radiology (IR) procedures was performed using a new eye lens dosemeter. In parallel, the results of routine individual monitoring were analysed and compared with the results obtained from measurements with a new eye lens dosemeter. The eye lens doses were assessed using H p (3) measured at the level of the eyes and were compared with H p (10) measured with the whole-body dosemeter above the lead collar. The information about use of protective measures, the number of performed interventional procedures per month and their fluoroscopy time was also collected. The assessment of doses to the lens of the eye was done for 50 IR workers at 9 Lithuanian hospitals for the period of 2012-2013. If the use of lead glasses is not taken into account, the estimated maximum annual dose equivalent to the lens of the eye was 82 mSv. (authors)

  8. A set of X-ray test objects for quality control in television fluoroscopy

    International Nuclear Information System (INIS)

    Hay, G.A.; Clarke, O.F.; Coleman, N.J.; Cowen, A.R.

    1985-01-01

    The history of performance testing in Leeds of television fluoroscopic systems is briefly outlined. Using the visual, physical and technological requirements as a basis, a set of nine test objects for quality control in television fluoroscopy is described. The factors measured by the test objects are listed in the introduction; the test objects and their function are fully described in the remainder of the paper. The test objects, in conjunction with a television oscilloscope, give both subjective and objective information about the X-ray system. Three of the test objects enable the physicist or engineer to adjust certain aspects of the performance of the X-ray system. The set of nine test objects is available commercially. (author)

  9. Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver

    International Nuclear Information System (INIS)

    Cornelis, F.; Takaki, H.; Laskhmanan, M.; Durack, J. C.; Erinjeri, J. P.; Getrajdman, G. I.; Maybody, M.; Sofocleous, C. T.; Solomon, S. B.; Srimathveeravalli, G.

    2015-01-01

    PurposeTo compare CT fluoroscopy-guided manual and CT-guided robotic positioning system (RPS)-assisted needle placement by experienced IR physicians to targets in swine liver.Materials and MethodsManual and RPS-assisted needle placement was performed by six experienced IR physicians to four 5 mm fiducial seeds placed in swine liver (n = 6). Placement performance was assessed for placement accuracy, procedure time, number of confirmatory scans, needle manipulations, and procedure radiation dose. Intra-modality difference in performance for each physician was assessed using paired t test. Inter-physician performance variation for each modality was analyzed using Kruskal–Wallis test.ResultsPaired comparison of manual and RPS-assisted placements to a target by the same physician indicated accuracy outcomes was not statistically different (manual: 4.53 mm; RPS: 4.66 mm; p = 0.41), but manual placement resulted in higher total radiation dose (manual: 1075.77 mGy/cm; RPS: 636.4 mGy/cm; p = 0.03), required more confirmation scans (manual: 6.6; RPS: 1.6; p < 0.0001) and needle manipulations (manual: 4.6; RPS: 0.4; p < 0.0001). Procedure time for RPS was longer than manual placement (manual: 6.12 min; RPS: 9.7 min; p = 0.0003). Comparison of inter-physician performance during manual placement indicated significant differences in the time taken to complete placements (p = 0.008) and number of repositions (p = 0.04) but not in other study measures (p > 0.05). Comparison of inter-physician performance during RPS-assisted placement suggested statistically significant differences in procedure time (p = 0.02) and not in other study measures (p > 0.05).ConclusionsCT-guided RPS-assisted needle placement reduced radiation dose, number of confirmatory scans, and needle manipulations when compared to manual needle placement by experienced IR physicians, with equivalent accuracy

  10. Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver

    Energy Technology Data Exchange (ETDEWEB)

    Cornelis, F.; Takaki, H. [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States); Laskhmanan, M. [Perfint Healthcare Inc (India); Durack, J. C.; Erinjeri, J. P.; Getrajdman, G. I.; Maybody, M.; Sofocleous, C. T.; Solomon, S. B.; Srimathveeravalli, G., E-mail: srimaths@mskcc.org [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States)

    2015-10-15

    PurposeTo compare CT fluoroscopy-guided manual and CT-guided robotic positioning system (RPS)-assisted needle placement by experienced IR physicians to targets in swine liver.Materials and MethodsManual and RPS-assisted needle placement was performed by six experienced IR physicians to four 5 mm fiducial seeds placed in swine liver (n = 6). Placement performance was assessed for placement accuracy, procedure time, number of confirmatory scans, needle manipulations, and procedure radiation dose. Intra-modality difference in performance for each physician was assessed using paired t test. Inter-physician performance variation for each modality was analyzed using Kruskal–Wallis test.ResultsPaired comparison of manual and RPS-assisted placements to a target by the same physician indicated accuracy outcomes was not statistically different (manual: 4.53 mm; RPS: 4.66 mm; p = 0.41), but manual placement resulted in higher total radiation dose (manual: 1075.77 mGy/cm; RPS: 636.4 mGy/cm; p = 0.03), required more confirmation scans (manual: 6.6; RPS: 1.6; p < 0.0001) and needle manipulations (manual: 4.6; RPS: 0.4; p < 0.0001). Procedure time for RPS was longer than manual placement (manual: 6.12 min; RPS: 9.7 min; p = 0.0003). Comparison of inter-physician performance during manual placement indicated significant differences in the time taken to complete placements (p = 0.008) and number of repositions (p = 0.04) but not in other study measures (p > 0.05). Comparison of inter-physician performance during RPS-assisted placement suggested statistically significant differences in procedure time (p = 0.02) and not in other study measures (p > 0.05).ConclusionsCT-guided RPS-assisted needle placement reduced radiation dose, number of confirmatory scans, and needle manipulations when compared to manual needle placement by experienced IR physicians, with equivalent accuracy.

  11. SPECIAL RULES OF MITIGATION OF PUNISHMENT IN CASE OF THE CONCLUSION OF THE PRE-TRIAL COOPERATION AGREEMENT, AT THE SPECIAL PROCEDURE OF FOR THE TRIAL AND AT THE SHORTENED ORDER OF INQUIRY

    Directory of Open Access Journals (Sweden)

    Tatiana Nepomnyashchaya

    2017-01-01

    Full Text Available The subject. The article analyzes the rules for the appointment of punishment in the case of a pre-trial cooperation agreement, with a special procedure for the trial and with a shortened procedure of conducting inquiry, regulated by art. 62 of the RF Criminal Code “Turning out a Sentence when Mitigating Circumstances Exist”. The authors give an answer to two questions: 1 Does the legal nature of these institutions correspond to the legal nature of mitigating circumstances; 2 Is it advisable to consolidate in a one article of the law different legal regulations.Methodology. Authors use such researching methods as analysis and synthesis, formally legal, comparative legal.Results. Rules for the appointment of punishment in the conclusion of a pre-trial cooperation agreement, stipulated by the pt. 2, 4 of art. 62 of the RF Criminal Code, regulate not the order of accounting for mitigating circumstances, but the legal consequences associated with the promotion of a person, which concluded and executed a pre-trial cooperation agreement, that does not correspond to the legal nature of the pt. 1, 3 of art. 62 of the RF Criminal Code.The legal nature of the rules for the appointment of punishment, established in pt. 5 of art. 62 of the RF Criminal Code, also does not correspond to the legal nature of the rules for the imposition of punishment in the presence of mitigating circumstances, because mitigation of punishment occurs on criminal procedural grounds, which are not mitigating circumstances.Conclusions. In authors opinion, fastening in art. 62 of the RF Criminal Code of three independent rules for the imposition of punishment, namely, the rules for the imposition of punishment in the presence of mitigating circumstances (pt. 1, 3 of art. 62 of the Criminal Code, at the conclusion of a pre-trial cooperation agreement (pt. 2, 4 of art. 62 of the Crim-inal Code, with a special order of the trial and a shortened procedure for conducting an inquiry

  12. Performance evaluation of flat panel detector in x-ray fluoroscopy

    International Nuclear Information System (INIS)

    Grewal, R.K.; Mclean, I.D.

    2004-01-01

    Full text: Flat panel detectors are currently replacing the conventional image intensifiers in R-F imaging. We evaluated the performance of a biplane cardiac imaging system (Siemens Axiom Artis dBC), the image acquisition was based on a 25 cm diagonal digital fiat panel detector. Performance characteristics included image quality, typical patient entrance dose and measurement of input to the surface of flat detector. The results were compared with conventional image intensifier systems (Siemens Hicor Unit and Toshiba DPF 2000 A Biplane Unit) used in cardiac imaging at Westmead. Image quality and dose measurements were performed following standard protocols using Westmead test object and 20 cm solid water as absorber in the beam. For measurement of input to the surface of flat detector, 2 mm copper was placed on the collimator. Radcal 3cc and 180 cc ion chambers were used for dose measurements. Image quality: Our measurements on flat panel system indicate that high contrast resolution and threshold contrast is not affected by changing field size. This is expected due to minimum loss of signal in the imaging chain of digital systems and the independence of detector pixel size with change in field of view. While low contrast resolution was found to be similar to conventional systems, high contrast resolution was significantly superior using flat detector system for large and intermediate field of view (25-28 1p/cm against 18-20). Typical patient dose as measured using flat detector system was similar to the conventional Toshiba pulsed fluoroscopy system( ∼ 3 - 8 mGy/min depending on the field size). This was 40-50 % lower than our old Siemens hicore unit. Input to the surface of flat detector was found to vary with field size as is the case with a conventional II system. As described elsewhere, although there is no necessity to increase exposure or video gain in a digital magnification, digital data interpolation process introduces noise. As a result system

  13. Evaluation of radiation doses in patient and medical staff during endoscopic retrograde cholangio-pancreatography procedures

    International Nuclear Information System (INIS)

    Seo, Deoknam; Kim, Kie Hwan; Park, Kyung; Kim, Jung-Su; Han, Seonggyu; Kim, Jungmin

    2016-01-01

    The radiation exposure dose must be optimised because the hazard resulting from an interventional radiology procedure is long term depending on the patient. The aim of this study was to measure the radiation doses received by the patients and medical staff during endoscopic retrograde cholangio-pancreatography (ERCP) procedures. Data were collected during 126 ERCP procedures, including the dose-area product (DAP), entrance dose (ED), effective dose (E), fluoroscopy time (T) and number of digital radiographs (F). The medical staff members each wore a personal thermoluminescence dosemeter to monitor exposure during ERCP procedures. The mean DAP, ED, E and T were 47.06 Gy cm 2 , 196.06 mGy, 8.93 mSv, 7.65 min and 9.21 images, respectively. The mean dose to the staff was 0.175 mSv and that to the assistant was 0.069 mSv. The dose to the medical staff was minimal when appropriate protective measures were used. The large variation in the patient doses must be further investigated. (authors)

  14. Patient dose in CT fluoroscopy examinations

    International Nuclear Information System (INIS)

    Ito, Yusuke; Kobayashi, Masanao; Kataoka, Yumi; Ida, Yoshihiro; Kato, Ryoichi; Katada, Kazuhiro; Asada, Yasuki; Suzuki, Shoichi

    2008-01-01

    CT fluoroscopy(CTF) results in a high dose for the area under investigation in comparison with other types of examination. On the basis of data from April 2005 to March 2008, we measured the X-ray doses at the target site in CTF of the lungs, lumbar vertebrae, and pelvis as well as the X-ray dose to the female reproductive organs, and calculated the effective dose. The CT equipment used was an Aquilion 16. TLDs were inserted into an anthropomorphic phantom in positions corresponding to the target sites and the reproductive organs. Standard tube voltage and tube current were used as measurement conditions, and the scanning time used was the average value for each type of examination during the two years. Dose measurements were taken in the following order: scanography, helical scan, CTF, helical scan. X-ray element calibration was carried out through reciprocal comparison made between an ionization chamber dosimeter corrected according to government standards and the TLD for each tube voltage used for measurement. Dose estimation software was used to calculate the effective doses. During the two years there were 136 CTF examinations. These included 43 scans of the lungs, 13 of lumbar vertebrae, and 18 of the pelvis. The X-ray doses were 0.1 mGy at both the ovaries and the uterus for lung scans, 2 mGy at the ovaries and 1 mGy at the uterus for lumbar vertebrae scans, and 40 mGy at the ovaries and 20 mGy at the uterus for pelvic scans. The effective dose was highest for the lumbar vertebrae, followed by the lungs and finally the pelvis. (author)

  15. A motion-compensated image filter for low-dose fluoroscopy in a real-time tumor-tracking radiotherapy system

    International Nuclear Information System (INIS)

    Miyamoto, Naoki; Ishikawa, Masayori; Sutherland, Kenneth

    2015-01-01

    In the real-time tumor-tracking radiotherapy system, a surrogate fiducial marker inserted in or near the tumor is detected by fluoroscopy to realize respiratory-gated radiotherapy. The imaging dose caused by fluoroscopy should be minimized. In this work, an image processing technique is proposed for tracing a moving marker in low-dose imaging. The proposed tracking technique is a combination of a motion-compensated recursive filter and template pattern matching. The proposed image filter can reduce motion artifacts resulting from the recursive process based on the determination of the region of interest for the next frame according to the current marker position in the fluoroscopic images. The effectiveness of the proposed technique and the expected clinical benefit were examined by phantom experimental studies with actual tumor trajectories generated from clinical patient data. It was demonstrated that the marker motion could be traced in low-dose imaging by applying the proposed algorithm with acceptable registration error and high pattern recognition score in all trajectories, although some trajectories were not able to be tracked with the conventional spatial filters or without image filters. The positional accuracy is expected to be kept within ±2 mm. The total computation time required to determine the marker position is a few milliseconds. The proposed image processing technique is applicable for imaging dose reduction. (author)

  16. Organ doses in interventional radiology procedures: Evaluation of software

    International Nuclear Information System (INIS)

    Tort, I.; Ruiz-Cruces, R.; Perez-Martinez, M.; Carrera, F.; Ojeda, C.; Diez de los Rios, A.

    2001-01-01

    Interventional Radiology (IR) procedures require large fluoroscopy times and important number of radiological images, so the levels of radiation to patient are high, which leads us to calculate the organ doses. The objective of this work is to estimate and make a comparison of the results given by the different software that we have to do the calculation of organ doses in complex procedures of IR. To do this, 28 patients have been selected, distributed in the 3 procedures with highest doses. The determination of organ doses and effective doses has been made using the projections utilized and different software based on Monte Carlo Methods: Eff-dose, PCXMC and Diasoft. We have obtained very high dispersion in the average organ dose between the 3 programs. In many cases, it is higher than 25% and in some particular cases, it is greater than 100%. Dispersion obtained in effective doses is not so high, being under 20% in all cases. This shows that a better solution is needed to solve the problem of the organ doses calculation; a more accurate method is necessary that brings us to a trustworthy approach to reality, and, at the moment, that we do not dispose of it. (author)

  17. Estimation of effective dose during hysterosalpingography procedures; Estimación de dosis efectiva durante los procedimientos hysterosalpingography

    Energy Technology Data Exchange (ETDEWEB)

    Alzimamil, K.; Babikir, E.; Alkhorayef, M. [King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P. O. Box 10219, Riyadh 11433, (Saudi Arabia); Sulieman, A. [Salman bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P. O. Box 422, Alkharj (Saudi Arabia); Alsafi, K. [King Abdulaziz University, Faculty of Medicine, Radiology Department, Jeddah 22254 (Saudi Arabia); Omer, H., E-mail: kalzimami@ksu.edu.sa [Dammam University, Faculty of Medicine, Dammam Khobar Coastal Rd, Khobar 31982 (Saudi Arabia)

    2014-08-15

    Hysterosalpingography (HSG) is the most frequently used diagnostic tool to evaluate the endometrial cavity and fallopian tube by using conventional x-ray or fluoroscopy. Determination of the patient radiation doses values from x-ray examinations provides useful guidance on where best to concentrate efforts on patient dose reduction in order to optimize the protection of the patients. The aims of this study were to measure the patients entrance surface air kerma doses (ESA K), effective doses and to compare practices between different hospitals in Sudan. ESA K were measured for patient using calibrated thermo luminance dosimeters (TLDs, Gr-200A). Effective doses were estimated using National Radiological Protection Board (NRPB) software. This study was conducted in five radiological departments: Two Teaching Hospitals (A and D), two private hospitals (B and C) and one University Hospital (E). The mean ESD was 20.1 mGy, 28.9 mGy, 13.6 mGy, 58.65 mGy, 35.7, 22.4 and 19.6 mGy for hospitals A,B,C,D, and E), respectively. The mean effective dose was 2.4 mSv, 3.5 mSv, 1.6 mSv, 7.1 mSv and 4.3 mSv in the same order. The study showed wide variations in the ESDs with three of the hospitals having values above the internationally reported values. Number of x-ray images, fluoroscopy time, operator skills x-ray machine type and clinical complexity of the procedures were shown to be major contributors to the variations reported. Results demonstrated the need for standardization of technique throughout the hospital. The results also suggest that there is a need to optimize the procedures. Local DRLs were proposed for the entire procedures. (author)

  18. C-arm fluoroscopy: a reliable modality for retrieval of foreign bodies in the maxillofacial region.

    Science.gov (United States)

    Pandyan, Deepak; Nandakumar, N; Qayyumi, Burhanuddin N; Kumar, Santosh

    2013-11-01

    The anatomic complexity of the maxillofacial region makes the retrieval of foreign bodies a daunting task for the maxillofacial Surgeon. Moreover the inability of 2-dimensional imaging to precisely locate foreign bodies makes it challenging. The anatomic proximity of critical structures and esthetic considerations limits the access and thus poses a greater challenge for the surgeon in cases of foreign body retrieval. Hereby we propose a simple technique and a case report to support, the retrieval of small (mobile C arm Fluoroscopy and a needle triangulation method to precisely locate a loosened miniplate screw in the mandibular angle region.

  19. Improvement of image quality and dose management in CT fluoroscopy by iterative 3D image reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Grosser, Oliver S.; Kupitz, Dennis; Powerski, Maciej; Mohnike, Konrad; Ricke, Jens [University Hospital Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); Wybranski, Christian [University Hospital Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne (Germany); Pech, Maciej [University Hospital Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); Medical University of Gdansk, Second Department of Radiology, Gdansk (Poland); Amthauer, Holger [University Hospital Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); Charite, Department of Nuclear Medicine, Berlin (Germany)

    2017-09-15

    The objective of this study was to assess the influence of an iterative CT reconstruction algorithm (IA), newly available for CT-fluoroscopy (CTF), on image noise, readers' confidence and effective dose compared to filtered back projection (FBP). Data from 165 patients (FBP/IA = 82/74) with CTF in the thorax, abdomen and pelvis were included. Noise was analysed in a large-diameter vessel. The impact of reconstruction and variables (e.g. X-ray tube current I) influencing noise and effective dose were analysed by ANOVA and a pairwise t-test with Bonferroni-Holm correction. Noise and readers' confidence were evaluated by three readers. Noise was significantly influenced by reconstruction, I, body region and circumference (all p ≤ 0.0002). IA reduced the noise significantly compared to FBP (p = 0.02). The effect varied for body regions and circumferences (p ≤ 0.001). The effective dose was influenced by the reconstruction, body region, interventional procedure and I (all p ≤ 0.02). The inter-rater reliability for noise and readers' confidence was good (W ≥ 0.75, p < 0.0001). Noise and readers' confidence were significantly better in AIDR-3D compared to FBP (p ≤ 0.03). Generally, IA yielded a significant reduction of the median effective dose. The CTF reconstruction by IA showed a significant reduction in noise and effective dose while readers' confidence increased. (orig.)

  20. Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: a multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Hung, J.; Chaitman, B.R.; Lam, J.; Lesperance, J.; Dupras, G.; Fines, P.; Bourassa, M.G.

    1984-01-01

    Several diagnostic noninvasive tests to detect coronary and multivessel coronary disease are available for women. However, all are imperfect and it is not yet clear whether one particular test provides substantially more information than others. The aim of this study was to evaluate clinical findings, exercise electrocardiography, exercise thallium myocardial scintigraphy and cardiac fluoroscopy in 92 symptomatic women without previous infarction and determine which tests were most useful in determining the presence of coronary disease and its severity. Univariate analysis revealed two clinical, eight exercise electrocardiographic, seven myocardial scintigraphic and seven fluoroscopic variables predictive of coronary or multivessel disease with 70% or greater stenosis. The multivariate discriminant function analysis selected a reversible thallium defect, coronary calcification and character of chest pain syndrome as the variables most predictive of presence or absence of coronary disease. The ranked order of variables most predictive of multivessel disease were cardiac fluoroscopy score, thallium score and extent of ST segment depression in 14 electrocardiographic leads. Each provided statistically significant information to the model. The estimate of predictive accuracy was 89% for coronary disease and 97% for multivessel coronary disease. The results suggest that cardiac fluoroscopy or thallium scintigraphy provide significantly more diagnostic information than exercise electrocardiography in women over a wide range of clinical patient subsets

  1. Occupational exposure of diagnostic radiology staff in Israel during 1994-1996

    International Nuclear Information System (INIS)

    Biran, T.; Malchi, S.; Shamai, Y.

    1997-01-01

    Personnel who perform interventional radiological procedures which involve long fluoroscopy times and with a high workload, may receive radiation doses comparable to one of the dose limits suggested by the International Commission on Radiological protection. It is therefore important to monitor accurately the radiation dose to every staff member. who is involved in fluoroscopy procedures. (authors)

  2. Experimental determination of blurring in x-ray fluoroscopy last image hold due to patient movement and its repercussion to patient doses

    International Nuclear Information System (INIS)

    Guibelalde, E.; Gonzalez, L.; Vano, E.; Fernandez, J.M.; Alberdi, J.; Molinero, A.

    2001-01-01

    Significant dose reduction can be achieved in fluoroscopy and interventional radiology by using the last image hold (LIH). This feature in modern digital fluoroscopy x-ray units usually works with frame or temporal averaging techniques to reduce noise. This image quality works quite well for objects without motion but it could be a serious limitation in presence of motion blur. With an in-house developed robotic device, the authors have experimentally determined the image quality degradation introduced by normal physiological movements (i.e., respiratory and cardiac pulse movements). FAXIL test objects TO.10 and 18FG from Leeds University have been used for spatial resolution limit and threshold contrast detail detectability. Seven X-ray equipment with last image hold features from three different manufacturers were analysed. Although results show that motion blur affects LIH to different extends depending on equipment, magnification, entrance dose and detail size, it can be estimated that, on average for all equipment and analysed conditions, it represents 30% degradation in image quality parameters in comparison with static images. (author)

  3. Breast cancer after multiple chest fluoroscopies: second follow-up of Massachusetts women with tuberculosis

    International Nuclear Information System (INIS)

    Hrubec, Z.; Boice, J.D. Jr.; Monson, R.R.; Rosenstein, M.

    1989-01-01

    A second follow-up was conducted of 1742 women with tuberculosis who were treated in one of two sanatoria in Massachusetts between 1930 and 1956. One hospital treated only children under the age of 17. Patient follow-up was extended from 1975 through 1980, and an additional 18 breast cancers were identified from hospital records, death certificates, and responses to a mailed questionnaire. Vital status was established for 97% of the subjects. Among 1044 women who were examined an average of 101 times with X-ray fluoroscopies during lung collapse therapy, 55 breast cancers were observed in contrast to 35.8 expected, based on incidence rates from the general population. No excess was found for 698 women treated by other means (19 observed versus 22.8 expected). Excess breast cancer risk did not appear until 15 years after initial exposure and was present at the end of 50 years of observation. Risk appeared to decrease with increasing age at exposure. Estimates of radiation dose to the breast for individuals (mean = 96 rad) were based on the most current information for the numbers of fluoroscopies, reconstruction of exposure conditions, and absorbed dose calculations. The relation between dose and breast cancer risk was consistent with linearity up to 400 rads (4 Gy). For 10-year survivors, the absolute excess risk was 5.5/1 million woman-year-rad, the excess relative risk per rad was 0.73%, and the relative risk at 100 rad was 1.7. These data indicate that a woman's lifetime risk of breast cancer is influenced by events occurring in early reproductive life, that low-dose fractionated exposures are as effective as single exposures of the same total dose in inducing breast cancer, and that risk of radiogenic breast cancer persists for many years, and perhaps for life

  4. Fluoroscopy-guided barium marking for localizing small pulmonary lesions before video-assisted thoracoscopic surgery

    International Nuclear Information System (INIS)

    Yamada, Takahiro; Koyama, Yasunori; Masui, Asami

    2009-01-01

    Small pulmonary lesions not previously seen on chest radiographs will likely be detected with increasing frequency because of the spread of CT screening. For the diagnosis and treatment of such lesions, we frequently perform resection by video-assisted thoracoscopic surgery (VATS). We performed fluoroscopy-guided barium marking for localization of small peripheral pulmonary lesions before VATS resection, and examined its reliability, safety, and usefulness. We studied 46 patients with peripheral pulmonary lesions 20 mm or less in diameter who were scheduled to undergo VATS resection. The average diameter of the lesions was 10.2±0.5 mm (mean±standard error), and the average distance from the pleural surface was 10.1±0.8 mm. The optimal site for the catheter tip was decided on chest radiographs using CT scans for reference beforehand, and a catheter was inserted bronchoscopically into the target segment and guided to the presumed lesion. A 50% (weight/volume) barium sulfate suspension was instilled into the bronchus through the catheter, and the site of barium marking was checked by CT scanning. The average instilled volume of barium was 0.36±0.03 ml. On CT scans, barium spots were superimposed on the target lesions in 35 of the 46 patients and were only 15 mm from the lesions in the other patients. Barium was well recognized in all patients at the time of VATS resection, and we could confirm the diagnosis in all patients. A mild cough persisted for about 1 week in 1 patient, but the other patients had no specific complications. Fluoroscopy-guided barium marking is a safe, convenient, and reliable method for localization of small pulmonary lesions before VATS resection. (author)

  5. Radiation dose reduction in fluoroscopic procedures: left varicocele embolization as a model

    Energy Technology Data Exchange (ETDEWEB)

    Verstandig, Anthony G.; Shraibman, Vladimir [Shaare Zedek Medical Center, Department of Radiology, Interventional Radiology Unit, POB 3235, Jerusalem (Israel); Shamieh, Bashar [St. Joseph Hospital, Department of Radiology, Jerusalem (Israel); Raveh, David [Shaare Zedek Medical Center, Infectious Diseases Unit, POB 3235, Jerusalem (Israel)

    2015-06-01

    To investigate the effect of a radiation reduction program on total dose, fluoroscopy dose per second corrected for body habitus and degree of collimation in left varicocele embolizations (LVE). A radiation reduction program for LVE was implemented, consisting of a technique minimizing fluoroscopy time, using low-dose presets, virtual collimation, and virtual patient positioning. Height, weight, fluoroscopy time, kerma area product (KAP) and reference air kerma (Ka,r) were recorded for 100 consecutive cases satisfying the inclusion criteria. For each patient, a device specific dose correction factor, determined using a phantom, was used to standardize the KAP to that of the cylindrical diameter of the standard man and a collimation index was derived from the KAP and Ka,r. Median fluoroscopy time was 3 minutes (mean 4.5, range 1-23.8). Median KAP was 0.54 Gy/cm{sup 2} (mean 0.82, range 0.12-6.52). There was a significant decrease in KAP/second corrected for cylindrical diameter (p < 0.001) and the collimation index (p < 0.001) over time. This study shows that a dedicated dose reduction program can achieve very low total radiation dose rates for LVE. The significant decrease in collimation index and standardized KAP per second during this study suggest a learning curve for collimation. (orig.)

  6. Evaluation of additional lead shielding in protecting the physician from radiation during cardiac interventional procedures

    International Nuclear Information System (INIS)

    Chida, Koichi; Zuguchi, Masayuki; Morishima, Yoshiaki; Katahira, Yoshiaki; Chiba, Hiroo

    2005-01-01

    Since cardiac interventional procedures deliver high doses of radiation to the physician, radiation protection for the physician in cardiac catheterization laboratories is very important. One of the most important means of protecting the physician from scatter radiation is to use additional lead shielding devices, such as tableside lead drapes and ceiling-mounted lead acrylic protection. During cardiac interventional procedures (cardiac IVR), however, it is not clear how much lead shielding reduces the physician dose. This study compared the physician dose [effective dose equivalent (EDE) and dose equivalent (DE)] with and without additional shielding during cardiac IVR. Fluoroscopy scatter radiation was measured using a human phantom, with an ionization chamber survey meter, with and without additional shielding. With the additional shielding, fluoroscopy scatter radiation measured with the human phantom was reduced by up to 98%, as compared with that without. The mean EDE (whole body, mean±SD) dose to the operator, determined using a Luxel badge, was 2.55±1.65 and 4.65±1.21 mSv/year with and without the additional shielding, respectively (p=0.086). Similarly, the mean DE (lens of the eye) to the operator was 15.0±9.3 and 25.73±5.28 mSv/year, respectively (p=0.092). In conclusion, although tableside drapes and lead acrylic shields suspended from the ceiling provided extra protection to the physician during cardiac IVR, the reduction in the estimated physician dose (EDE and DE) during cardiac catheterization with additional shielding was lower than we expected. Therefore, there is a need to develop more ergonomically useful protection devices for cardiac IVR. (author)

  7. 76 FR 454 - Hazardous Materials Transportation: Revisions of Special Permits Procedures

    Science.gov (United States)

    2011-01-05

    ... special permits. The HMR generally are performance-oriented regulations that provide the regulated... forbidden for transportation by aircraft except under a special permit (see Columns 9A and 9B in the table...

  8. 7 CFR 1753.68 - Purchasing special equipment.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Purchasing special equipment. 1753.68 Section 1753.68... AGRICULTURE TELECOMMUNICATIONS SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Purchase and Installation of Special Equipment § 1753.68 Purchasing special equipment. (a) General. (1) Equipment purchases are...

  9. SU-E-J-59: Feasibility of Markerless Tumor Tracking by Sequential Dual-Energy Fluoroscopy On a Clinical Tumor Tracking System

    Energy Technology Data Exchange (ETDEWEB)

    Dhont, J; Poels, K; Verellen, D; Tournel, K; Gevaert, T; Steenbeke, F; Burghelea, M; De Ridder, M [Department of Radiotherapy, Universitair Ziekenhuis Brussel, Brussels (Belgium)

    2015-06-15

    Purpose: To evaluate the feasibility of markerless tumor tracking through the implementation of a novel dual-energy imaging approach into the clinical dynamic tracking (DT) workflow of the Vero SBRT system. Methods: Two sequential 20 s (11 Hz) fluoroscopy sequences were acquired at the start of one fraction for 7 patients treated for primary and metastatic lung cancer with DT on the Vero system. Sequences were acquired using 2 on-board kV imaging systems located at ±45° from the MV beam axis, at respectively 60 kVp (3.2 mAs) and 120 kVp (2.0 mAs). Offline, a normalized cross-correlation algorithm was applied to match the high (HE) and low energy (LE) images. Per breathing phase (inhale, exhale, maximum inhale and maximum exhale), the 5 best-matching HE and LE couples were extracted for DE subtraction. A contrast analysis according to gross tumor volume was conducted based on contrast-to-noise ratio (CNR). Improved tumor visibility was quantified using an improvement ratio. Results: Using the implanted fiducial as a benchmark, HE-LE sequence matching was effective for 13 out of 14 imaging angles. Overlying bony anatomy was removed on all DE images. With the exception of two imaging angles, the DE images showed no significantly improved tumor visibility compared to HE images, with an improvement ratio averaged over all patients of 1.46 ± 1.64. Qualitatively, it was observed that for those imaging angles that showed no significantly improved CNR, the tumor tissue could not be reliably visualized on neither HE nor DE images due to a total or partial overlap with other soft tissue. Conclusion: Dual-energy subtraction imaging by sequential orthogonal fluoroscopy was shown feasible by implementing an additional LE fluoroscopy sequence. However, for most imaging angles, DE images did not provide improved tumor visibility over single-energy images. Optimizing imaging angles is likely to improve tumor visibility and the efficacy of dual-energy imaging. This work was in

  10. Medical staff radiation exposure in electrophysiology procedures: First results during biventricular ICD implantation

    International Nuclear Information System (INIS)

    Rossi, Pier Luca; Bianchini, David; Corazza, Ivan; Compagnone, Gaetano; Ferrari, Paolo; Gualdrini, Gianfranco; Zannoli, Romano

    2011-01-01

    Cardiac resynchronization therapy (CRT) requires a very long fluoroscopy time due to the need to monitor the placement of the device and electrodes inside the patient’s body at every step of the procedure. Aim of this study was to analyse staff X-ray exposure during the intervention, measuring H p (10) values with electronic dosimeters worn by medical staff. The scattered X-ray field was characterized using a spectrometric CdTe (cadmium-telluride) detector to define the radiation field impinging on the operator and thereby identify the correct dosimeter position for accurate measurement (i.e., above or under the shielding apron). In particular, knowledge of the X-ray spectrum yields information on photon flux and the energy distribution of the X-rays. Dosimetric data were then recorded in a series of 20 consecutive patients, obtaining a first set of H p (10) data that can be used to estimate the risk for the electrophysiologist performing this procedure.

  11. Factors influencing changes in levels of radiation doses received by patients during gastroduodenal series procedures in the Hospital Dr. Max Peralta de Cartago

    International Nuclear Information System (INIS)

    Guzman Campos, Jeremy; Vargas Navarro, Jonnathan

    2009-01-01

    A measurement was made of the number of radiation doses emitted by fluoroscopy equipment used in Hospital Dr. Max Peralta, specifically at the Centro de Deteccion de Cancer Gastrico. The analysis has included the factors could be influencing on increase of the total dose to the patient, by means of indicators that directly affect the unnecessary increase in dose, such as: the procedure, sequences of images, indicators of dosage levels, varying conditions of actual studies, variations dose levels and production process factors. [es

  12. Towards the definition of Institutional diagnostic reference levels in paediatric interventional cardiology procedures in Greece.

    Science.gov (United States)

    Kottou, S; Kollaros, N; Plemmenos, C; Mastorakou, I; Apostolopoulou, S C; Tsapaki, V

    2018-02-01

    This study aimed to evaluate paediatric radiation doses in a dedicated cardiology hospital, with the objective of characterising patterns in dose variation. The ultimate purpose was to define Local (Institutional) Diagnostic Reference Levels (LDRLs) for different types of paediatric cardiac interventional procedures (IC), according to patient age. From a total of 710 cases performed during three consecutive years, by operators with more than 15 years of experience, the age was noted in only 477 IC procedures. The median values obtained for Fluoroscopy Time (FT), Number of Frames (N) and Kerma Area Product (P KA ) by age range were 5.8 min, 1322 and 2.0 Gy.cm 2 for definition of LDRLs presents challenges mainly due to the multiple clinical and technical factors affecting the outcome. On the other hand the lack of paediatric IC DRLs makes the identification of good practices more difficult. A consensus is needed on IC procedures nomenclature and grouping in order to allow a common assessment and comparison of doses. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  13. Pediatric patient doses in interventional cardiology procedures

    International Nuclear Information System (INIS)

    Medeiros, R.B.; Murata, C.H.; Moreira, A.C.

    2014-01-01

    The radiation doses from interventional procedures is relevant when treating children because of their greater radiosensitivity compared with adults. The purposes of this paper were to estimate the dose received by 18 pediatric patients who underwent cardiac interventional procedures and to correlate the maximum entrance surface air kerma (Ke,max), estimated with radiochromic films, with the cumulative air kerma values displayed at the end of procedures. This study was performed in children up to 6 years. The study was performed in two hospitals, one located in Recife and the other one in São Paulo. The x-ray imaging systems used were Phillips Allura 12 model with image intensifier system and a Phillips Allura FD10 flat panel system. To estimate the Ke,max on the patient’s skin radiochromic films(Gafchromic XR-RV2) were used. These values were estimated from the maximum optical density measured on film using a calibration curve. The results showed cumulative air kerma values ranging from 78.3- 500.0mGy, with a mean value of 242,3 mGy. The resulting Ke,max values ranged from 20.0-461.8 mGy, with a mean value of 208,8 mGy. The Ke,max values were correlated with the displayed cumulative air kerma values. The correlation factor R² was 0.78, meaning that the value displayed in the equipment’s console can be useful for monitoring the skin absorbed dose throughout the procedure. The routine fluoroscopy time records is not able by itself alert the physician about the risk of dose exceeding the threshold of adverse reactions, which can vary from an early erythema to serious harmful skin damage. (author)

  14. Ulnar artery: The Ulysses ultimate resort for coronary procedures

    Directory of Open Access Journals (Sweden)

    George Hahalis, MD, PhD

    2016-07-01

    Full Text Available Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA. Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.

  15. A new model with an anatomically accurate human renal collecting system for training in fluoroscopy-guided percutaneous nephrolithotomy access.

    Science.gov (United States)

    Turney, Benjamin W

    2014-03-01

    Obtaining renal access is one of the most important and complex steps in learning percutaneous nephrolithotomy (PCNL). Ideally, this skill should be practiced outside the operating room. There is a need for anatomically accurate and cheap models for simulated training. The objective was to develop a cost-effective, anatomically accurate, nonbiologic training model for simulated PCNL access under fluoroscopic guidance. Collecting systems from routine computed tomography urograms were extracted and reformatted using specialized software. These images were printed in a water-soluble plastic on a three-dimensional (3D) printer to create biomodels. These models were embedded in silicone and then the models were dissolved in water to leave a hollow collecting system within a silicone model. These PCNL models were filled with contrast medium and sealed. A layer of dense foam acted as a spacer to replicate the tissues between skin and kidney. 3D printed models of human collecting systems are a useful adjunct in planning PCNL access. The PCNL access training model is relatively low cost and reproduces the anatomy of the renal collecting system faithfully. A range of models reflecting the variety and complexity of human collecting systems can be reproduced. The fluoroscopic triangulation process needed to target the calix of choice can be practiced successfully in this model. This silicone PCNL training model accurately replicates the anatomic architecture and orientation of the human renal collecting system. It provides a safe, clean, and effective model for training in accurate fluoroscopy-guided PCNL access.

  16. Leach test of six 192-iridium pellets based on the IAEA 'special form' test procedures

    International Nuclear Information System (INIS)

    Gordon, G.; Gerdingh, R.

    1981-07-01

    The designation 'special form' may be applied to indispersible solid radioactive material if the material meets the requirements of the tests described in the International Atomic Energy Agency Regulations for the Safe Transport of Radioactive Type Materials. This report presents the procedures and results of a leach test performed as specified in the regulations on 6 'as received' active 192-iridium pellets. Mechanical tests were not carried out prior to or following the leach test. The activity of each of the first 6 water baths was found to be between 2.3 and 12.6 μCi, (8.5 x 10 4 and 4.7 x 10 5 Bq) and of the second 6, between 1.3 to 6.0 μCi, (4.8 x 10 4 to 2.2 x 10 5 Bq) thus exceeding the allowable limit

  17. Augmented reality fluoroscopy simulation of the guide-wire insertion in DHS surgery: A proof of concept study.

    Science.gov (United States)

    van Duren, B H; Sugand, K; Wescott, R; Carrington, R; Hart, A

    2018-05-01

    Hip fractures contribute to a significant clinical burden globally with over 1.6 million cases per annum and up to 30% mortality rate within the first year. Insertion of a dynamic hip screw (DHS) is a frequently performed procedure to treat extracapsular neck of femur fractures. Poorly performed DHS fixation of extracapsular neck of femur fractures can result in poor mobilisation, chronic pain, and increased cut-out rate requiring revision surgery. A realistic, affordable, and portable fluoroscopic simulation system can improve performance metrics in trainees, including the tip-apex distance (the only clinically validated outcome), and improve outcomes. We developed a digital fluoroscopic imaging simulator using orthogonal cameras to track coloured markers attached to the guide-wire which created a virtual overlay on fluoroscopic images of the hip. To test the accuracy with which the augmented reality system could track a guide-wire, a standard workshop femur was used to calibrate the system with a positional marker fixed to indicate the apex; this allowed for comparison between guide-wire tip-apex distance (TAD) calculated by the system to be compared to that physically measured. Tests were undertaken to determine: (1) how well the apex could be targeted; (2) the accuracy of the calculated TAD. (3) The number of iterations through the algorithm giving the optimal accuracy-time relationship. The calculated TAD was found to have an average root mean square error of 4.2 mm. The accuracy of the algorithm was shown to increase with the number of iterations up to 20 beyond which the error asymptotically converged to an error of 2 mm. This work demonstrates a novel augmented reality simulation of guide-wire insertion in DHS surgery. To our knowledge this has not been previously achieved. In contrast to virtual reality, augmented reality is able to simulate fluoroscopy while allowing the trainee to interact with real instrumentation and performing the procedure on

  18. 75 FR 43898 - Hazardous Materials Transportation: Revisions of Special Permits Procedures

    Science.gov (United States)

    2010-07-27

    .... The HMR generally are performance-oriented regulations that provide the regulated community with a... aircraft except under a special permit (see Columns 9A and 9B in the table in 49 CFR 172.101), an applicant... forbidden for transportation by aircraft except under a special permit (see Columns 9A and 9B in the table...

  19. 78 FR 24305 - Actions on Special Permit Applications

    Science.gov (United States)

    2013-04-24

    ... special permit Lincoln, NE. to authorize an alternative fire protection system. 11624-M Clean Harbors 49... Special Permit Applications AGENCY: Pipeline and Hazardous Materials Safety Administration (PHMSA), DOT. ACTION: Notice of actions on Special Permit Applications. SUMMARY: In accordance with the procedures...

  20. Fluoroscopy without the grid: a method of reducing the radiation dose

    International Nuclear Information System (INIS)

    Drury, P.; Robinson, A.

    1980-01-01

    The anti-scatter grid has been removed from the fluoroscopic set during the course of over 80 contrast examinations performed routinely during the ordinary workload of a busy paediatric radiology department. This manoeuvre approximatley halves the radiation dose to the patient during both fluoroscopy and radiography. Experience suggests that the degree of loss of contrast consequent on the abandonment of the grid is diagnostically acceptable during many examinations performed on children (of all ages), when balanced against the lower radiation dose received. In addition, an assessment has been made of the contrast improvement factor of the grids in two fluoroscopic sets in common use, using tissue-equivalent phantoms of various thicknesses. Although the contrast was significantly improved by the use of the grid, to a degree dependent on various factors, the relevance of this improvement in clinical radiology depends on exactly what information is being sought. It is recommended that radiologists should use the grid with discretion when performing fluoroscopic examinations on children and that the apparatus for such examinations should have the capability for easy removal and reintroduction of the grid. (author)

  1. Brazing of special metallic materials and material combinations using a special material

    International Nuclear Information System (INIS)

    Lison, R.

    1981-01-01

    The special materials include metals of groups IVa, Va and VIa of the periodic tables and their alloys. Their particular properties have won them applications in many highly specialized industries. For these materials to be used, mastery of thermal joining methods appropriate to their characteristics is necessary. High-temperature brazing is one such method for joining special materials. This paper presents variants of this technique suitable for each individual special material. Compatibility tests between various brazing metals and various special materials have been carried out by simulating the temperature/time cycle involved in brazing procedures. Special materials are relatively expensive, and their special properties are not required at every point in a structure: elsewhere they can be replaced by a different special material or by other metals or alloys. This means that joints must be made between two special materials or between a special material and a conventional material. When certain conditions are fulfilled, such joins can be made by high-temperature brazing. This paper also shows the extent to which the geometry of the join determines the choice of process. Example of applications are also given. (orig.)

  2. Heel Effect: Dose Mapping And Profiling For Mobile C-Arm Fluoroscopy Unit Toshiba SXT-1000A

    International Nuclear Information System (INIS)

    Husaini Salleh; Mohd Khalid Matori; Muhammad Jamal Md Isa; Mohd Ramli Arshad; Shahrul Azlan Azizan; Mohd Firdaus Abdul Rahman; Md Khairusalih Md Zin

    2014-01-01

    Heel Effect is the well known phenomena in x-ray production. It contributes the effect to image formation and as well as scattered radiation. But there is paucity in the study related to heel effect. This study is for mapping and profiling the dose on the surface of water phantom by using mobile C-arm unit Toshiba SXT-1000A. Based on the result the dose profile is increasing up to about 57 % from anode to cathode bound of the irradiated area. This result and information can be used as a guide to manipulate these phenomena for better image quality and radiation safety for this specific and dedicated fluoroscopy unit. (author)

  3. 32 CFR 145.6 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Procedures. 145.6 Section 145.6 National Defense... THE OFFICE OF SPECIAL COUNSEL OF THE MERIT SYSTEMS PROTECTION BOARD § 145.6 Procedures. (a... corrective or disciplinary action considered appropriate because of facts disclosed by such an investigation...

  4. Comparison of patient doses in interventional radiology procedures performed in two large hospitals in Greece

    International Nuclear Information System (INIS)

    Papageorgiou, E.; Tsapaki, V.; Tsalafoutas, I. A.; Maurikou, E.; Kottou, S.; Orfanos, A.; Karidas, G.; Fidanis, T.; Zafiriadou, E.; Neofotistou, V.

    2007-01-01

    Purpose of the study was to determine patient doses in the most common interventional radiology (IR) procedures performed in two large Greek hospitals. A total of 164 patients who underwent 4 types of IR procedures were studied. Fluoroscopy time, total exposure time, number of frames, number of runs, radiation field size, and cumulative dose-area product (DAP) were recorded. The median DAP values for carotid arteriography and lower limb arteriography were 66 and 123 Gy cm 2 for hospital 'A' and 21 and 49 Gy cm 2 for hospital 'B'. For the cerebral arteriographies performed in hospital 'A', the median DAP was 116 Gy cm 2 while for the hepatic embolizations performed in hospital 'B', it was 104 Gy cm 2 . The DAP values observed in hospital 'A' for carotid arteriography and lower limb arteriography were almost three times than those of hospital 'B'. From the data analysis, it is evident that dose optimization in hospital 'A' should be pursued through revision of the techniques used. (authors)

  5. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)-Results of the FERARI study.

    Science.gov (United States)

    Becher, Tobias; Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula; Mashayekhi, Kambis; Borggrefe, Martin; Akin, Ibrahim

    2016-12-01

    Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose-area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8min, p=0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p=0.826), procedural duration (46.0 vs. 45.0min, p=0.363) and contrast agent use (185.5 vs. 199.5ml, p=0.742) were also similar in radial and femoral PCI. There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Significant Improvement of Puncture Accuracy and Fluoroscopy Reduction in Percutaneous Transforaminal Endoscopic Discectomy With Novel Lumbar Location System: Preliminary Report of Prospective Hello Study.

    Science.gov (United States)

    Fan, Guoxin; Guan, Xiaofei; Zhang, Hailong; Wu, Xinbo; Gu, Xin; Gu, Guangfei; Fan, Yunshan; He, Shisheng

    2015-12-01

    Prospective nonrandomized control study.The study aimed to investigate the implication of the HE's Lumbar LOcation (HELLO) system in improving the puncture accuracy and reducing fluoroscopy in percutaneous transforaminal endoscopic discectomy (PTED).Percutaneous transforaminal endoscopic discectomy is one of the most popular minimally invasive spine surgeries that heavily depend on repeated fluoroscopy. Increased fluoroscopy will induce higher radiation exposure to surgeons and patients. Accurate puncture in PTED can be achieved by accurate preoperative location and definite trajectory.The HELLO system mainly consists of self-made surface locator and puncture-assisted device. The surface locator was used to identify the exact puncture target and the puncture-assisted device was used to optimize the puncture trajectory. Patients who had single L4/5 or L5/S1 lumbar intervertebral disc herniation and underwent PTED were included the study. Patients receiving the HELLO system were assigned in Group A, and those taking conventional method were assigned in Group B. Study primary endpoint was puncture times and fluoroscopic times, and the secondary endpoint was location time and operation time.A total of 62 patients who received PTED were included in this study. The average age was 45.35 ± 8.70 years in Group A and 46.61 ± 7.84 years in Group B (P = 0.552). There were no significant differences in gender, body mass index, conservative time, and surgical segment between the 2 groups (P > 0.05). The puncture times were 1.19 ± 0.48 in Group A and 6.03 ± 1.87 in Group B (P HELLO system is accurate preoperative location and definite trajectory. This preliminary report indicated that the HELLO system significantly improves the puncture accuracy of PTED and reduces the fluoroscopic times, preoperative location time, as well as operation time. (ChiCTR-ICR-15006730).

  7. Reduction of radiation exposure while maintaining high-quality fluoroscopic images during interventional cardiology using novel x-ray tube technology with extra beam filtering.

    Science.gov (United States)

    den Boer, A; de Feyter, P J; Hummel, W A; Keane, D; Roelandt, J R

    1994-06-01

    Radiographic technology plays an integral role in interventional cardiology. The number of interventions continues to increase, and the associated radiation exposure to patients and personnel is of major concern. This study was undertaken to determine whether a newly developed x-ray tube deploying grid-switched pulsed fluoroscopy and extra beam filtering can achieve a reduction in radiation exposure while maintaining fluoroscopic images of high quality. Three fluoroscopic techniques were compared: continuous fluoroscopy, pulsed fluoroscopy, and a newly developed high-output pulsed fluoroscopy with extra filtering. To ascertain differences in the quality of images and to determine differences in patient entrance and investigator radiation exposure, the radiated volume curve was measured to determine the required high voltage levels (kVpeak) for different object sizes for each fluoroscopic mode. The fluoroscopic data of 124 patient procedures were combined. The data were analyzed for radiographic projections, image intensifier field size, and x-ray tube kilovoltage levels (kVpeak). On the basis of this analysis, a reference procedure was constructed. The reference procedure was tested on a phantom or dummy patient by all three fluoroscopic modes. The phantom was so designed that the kilovoltage requirements for each projection were comparable to those needed for the average patient. Radiation exposure of the operator and patient was measured during each mode. The patient entrance dose was measured in air, and the operator dose was measured by 18 dosimeters on a dummy operator. Pulsed compared with continuous fluoroscopy could be performed with improved image quality at lower kilovoltages. The patient entrance dose was reduced by 21% and the operator dose by 54%. High-output pulsed fluoroscopy with extra beam filtering compared with continuous fluoroscopy improved the image quality, lowered the kilovoltage requirements, and reduced the patient entrance dose by 55% and

  8. Intraoperative intermittent blocking of the common iliac arteries in cases of placenta percreta without the use of fluoroscopy; Intraoperative intermittierende Blockung der Arteriae iliacae communes bei Placenta percreta unter Vermeidung von Roentgenstrahlung

    Energy Technology Data Exchange (ETDEWEB)

    Heinze, S. [Frankfurt Univ. (Germany). Inst. of Forensic Medicine; Klinikum Oldenburg (Germany). Inst. of Diagnostic and Interventional Radiology; Filsinger, B. [St. Marienkrankenhaus, Ludwigshafen (Germany). Maternity Clinic; Kastenholz, G.; Schroeder, R.J. [St. Marienkrankenhaus, Ludwigshafen (Germany). Dept. of Radiology

    2016-12-15

    The number of patients with placenta accreta, percreta and increta is increasing. The morbidity and mortality are higher mostly due to hemorrhage. Therefore, new methods to reduce the risk of severe bleeding are necessary. Three patients were treated in collaboration by obstetricians, urologists, anesthesiologists, and radiologists. An MRI of the pelvis was performed and the diameters and lengths of the iliac arteries were measured to avoid fluoroscopy during the preoperative placement of catheter balloons into the iliac arteries. During the operational procedure the balloons were inflated and deflated depending on the operative site and the occurrence of bleeding. In comparison to the literature, severe bleeding was clearly reduced. No complications of the intervention were observed. The presented method to reduce severe bleeding might represent significant progress in the management of abnormal placenta implantation. Nevertheless, further controlled studies are needed in order to establish evidence-based recommendations.

  9. Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations

    Energy Technology Data Exchange (ETDEWEB)

    Creeden, Sean G.; Rao, Anil G.; Eklund, Meryle J.; Hill, Jeanne G.; Thacker, Paul G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2017-03-15

    Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold. (orig.)

  10. Environmental Measurements Laboratory (EML) procedures manual

    International Nuclear Information System (INIS)

    Chieco, N.A.; Bogen, D.C.; Knutson, E.O.

    1990-11-01

    Volume 1 of this manual documents the procedures and existing technology that are currently used by the Environmental Measurements Laboratory. A section devoted to quality assurance has been included. These procedures have been updated and revised and new procedures have been added. They include: sampling; radiation measurements; analytical chemistry; radionuclide data; special facilities; and specifications. 228 refs., 62 figs., 37 tabs. (FL)

  11. 21 CFR 1309.03 - Information; special instructions.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Information; special instructions. 1309.03 Section... MANUFACTURERS, DISTRIBUTORS, IMPORTERS AND EXPORTERS OF LIST I CHEMICALS General Information § 1309.03 Information; special instructions. Information regarding procedures under these rules and instructions...

  12. 21 CFR 1301.03 - Information; special instructions.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Information; special instructions. 1301.03 Section... MANUFACTURERS, DISTRIBUTORS, AND DISPENSERS OF CONTROLLED SUBSTANCES General Information § 1301.03 Information; special instructions. Information regarding procedures under these rules and instructions supplementing...

  13. Ulnar artery: The Ulysses ultimate resort for coronary procedures.

    Science.gov (United States)

    Hahalis, George; Deftereos, Spyridon; Bertrand, Olivier F

    2016-08-20

    Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates. Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

  14. Surface ECG and Fluoroscopy are Not Predictive of Right Ventricular Septal Lead Position Compared to Cardiac CT.

    Science.gov (United States)

    Rowe, Matthew K; Moore, Peter; Pratap, Jit; Coucher, John; Gould, Paul A; Kaye, Gerald C

    2017-05-01

    Controversy exists regarding the optimal lead position for chronic right ventricular (RV) pacing. Placing a lead at the RV septum relies upon fluoroscopy assisted by a surface 12-lead electrocardiogram (ECG). We compared the postimplant lead position determined by ECG-gated multidetector contrast-enhanced computed tomography (MDCT) with the position derived from the surface 12-lead ECG. Eighteen patients with permanent RV leads were prospectively enrolled. Leads were placed in the RV septum (RVS) in 10 and the RV apex (RVA) in eight using fluoroscopy with anteroposterior and left anterior oblique 30° views. All patients underwent MDCT imaging and paced ECG analysis. ECG criteria were: QRS duration; QRS axis; positive or negative net QRS amplitude in leads I, aVL, V1, and V6; presence of notching in the inferior leads; and transition point in precordial leads at or after V4. Of the 10 leads implanted in the RVS, computed tomography (CT) imaging revealed seven to be at the anterior RV wall, two at the anteroseptal junction, and one in the true septum. For the eight RVA leads, four were anterior, two septal, and two anteroseptal. All leads implanted in the RVS met at least one ECG criteria (median 3, range 1-6). However, no criteria were specific for septal position as judged by MDCT. Mean QRS duration was 160 ± 24 ms in the RVS group compared with 168 ± 14 ms for RVA pacing (P = 0.38). We conclude that the surface ECG is not sufficiently accurate to determine RV septal lead tip position compared to cardiac CT. © 2017 Wiley Periodicals, Inc.

  15. Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Garnon, Julien, E-mail: juliengarnon@gmail.com; Koch, Guillaume, E-mail: Guillaume.koch@gmail.com [University Hospital of Strasbourg, Department of Interventional Radiology (France); Ramamurthy, Nitin, E-mail: Nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Caudrelier, Jean, E-mail: caudjean@yahoo.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France); Rao, Pramod, E-mail: pramodrao@me.com [University of Strasbourg, ICube (France); Tsoumakidou, Georgia, E-mail: Georgia.tsoumakidou@chru-strasbourg.fr; Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Gangi, Afshin, E-mail: Afshin.gangi@chru-strasbourg.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France)

    2016-09-15

    ObjectiveTo review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures.Materials and MethodsBetween May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57–75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment.ResultsFour pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1–4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2–3 months; one case could not be followed due to early post-procedural oncologic mortality.ConclusionPercutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.

  16. Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases

    International Nuclear Information System (INIS)

    Garnon, Julien; Koch, Guillaume; Ramamurthy, Nitin; Caudrelier, Jean; Rao, Pramod; Tsoumakidou, Georgia; Cazzato, Roberto Luigi; Gangi, Afshin

    2016-01-01

    ObjectiveTo review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures.Materials and MethodsBetween May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57–75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment.ResultsFour pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1–4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2–3 months; one case could not be followed due to early post-procedural oncologic mortality.ConclusionPercutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.

  17. Removal of a Wire Brush Bristle from the Hypopharynx Using Suspension, Microscope, and Fluoroscopy

    Directory of Open Access Journals (Sweden)

    Matthew R. Naunheim

    2015-01-01

    Full Text Available Wire brush bristles are an increasingly recognized hazard that can present as a foreign body in the aerodigestive tract. Due to their small size and tendency to become embedded in surrounding tissue, these small metallic bristles present a unique operative challenge to otolaryngologists. Here we present a case of a 40-year-old woman who underwent endoscopic extraction of a wire bristle from the posterior pharyngeal wall using suspension, microscopy, and C-arm fluoroscopy. We believe this is the first published case of an endoscopic removal of a buried foreign body in the hypopharynx using these methods of localization concurrently. By leveraging multiple techniques for visualization, surgeons can avoid open exploration while ensuring complete removal of the object. Additionally, this case highlights the importance of regulatory oversight and consumer awareness of the hazards of grill brushes.

  18. 48 CFR 17.504 - Ordering procedures.

    Science.gov (United States)

    2010-10-01

    ... METHODS AND CONTRACT TYPES SPECIAL CONTRACTING METHODS Interagency Acquisitions Under the Economy Act 17.504 Ordering procedures. (a) Before placing an Economy Act order for supplies or services with another...; see also 6.302 for procedures to follow where using other than full and open competition.) The...

  19. Identifying the Learning Curve for Uterine Artery Embolisation in an Interventional Radiological Training Unit

    Energy Technology Data Exchange (ETDEWEB)

    Das, Raj, E-mail: rajdas@nhs.net, E-mail: raj.das@stgeorges.nhs.uk; Lucatelli, Pierleone, E-mail: pierleone.lucatelli@gmail.com; Wang, Haofan, E-mail: wwhhff123@gmail.com; Belli, Anna-Maria, E-mail: anna.belli@stgeorges.nhs.uk [St George’s Hospital, Department of Radiology (United Kingdom)

    2015-08-15

    AimA clear understanding of operator experience is important in improving technical success whilst minimising patient risk undergoing endovascular procedures, and there is the need to ensure that trainees have the appropriate skills as primary operators. The aim of the study is to retrospectively analyse uterine artery embolisation (UAE) procedures performed by interventional radiology (IR) trainees at an IR training unit analysing fluoroscopy times and radiation dose as surrogate markers of technical skill.MethodsTen IR fellows were primary operator in 200 UAE procedures over a 5-year period. We compared fluoroscopy times, radiation dose and complications, after having them categorised according to three groups: Group 1, initial five, Group 2, >5 procedures and Group 3, penultimate five UAE procedures. We documented factors that may affect screening time (number of vials employed and use of microcatheters).ResultsMean fluoroscopy time was 18.4 (±8.1), 17.3 (±9.0), 16.3 (±8.4) min in Groups 1, 2 and 3, respectively. There was no statistically significant difference between these groups (p > 0.05) with respect to fluoroscopy time or radiation dose. Analysis after correction for confounding factors showed no statistical significance (p > 0.05). All procedures were technically successful, and total complication rate was 4 %.ConclusionUAE was chosen as a highly standardised procedure followed by IR practitioners. Although there is a non-significant trend for shorter screening times with experience, technical success and safety were not compromised with appropriate Consultant supervision, which illustrates a safe construct for IR training. This is important and reassuring information for patients undergoing a procedure in a training unit.

  20. Early Childhood Special Education. Dental and Oral Hygiene Procedures for Young Children with Special Needs.

    Science.gov (United States)

    Sluder, R. S.; Luder, Linda C.

    1995-01-01

    Notes that children with special needs often require specific considerations with regard to dental care. Discusses some of the physical disabilities and how they interfere with dental hygiene, and how child caregivers can modify daily routines and assist disabled children with areas of hygiene the children may find difficult. (HTH)

  1. On the decennium of penal order procedure in Serbia

    Directory of Open Access Journals (Sweden)

    Brkić Snežana

    2011-01-01

    Full Text Available In this paper, the author defines the notion and explains the penal order procedure and its general characteristics. It is one of the special simplified criminal proceedings, which has got special basis and special structure. This procedural form is ultimately aimed at the rationalization of the criminal procedure. It is achieved by avoiding the main hearing in the trial proceeding. The author presents the evolution of the penal order in Serbia from 2001 to 2011. He points to some legal innovations in this field during that decennium. He compares old and new legal provisions about penal order and finds some differences. There is a constant tendency to expanding the area of criminal offences which can be judged in this procedural form. New legal provisions are, in general, better than previous. However, the practice has shown that application of penal order is too small. The previous practice does not live up to expectations of theory and legislator.

  2. The Special Court for Sierra Leone

    DEFF Research Database (Denmark)

    Damgaard, Ciara Therése

    2004-01-01

    The focus of this article is the Special Court for Sierra Leone and the extent to which it can be said that the Special Court has already challenged, or will, in the future, challenge the tradition of impunity for gender-based crimes. In this regard, an analysis is undertaken of the Special Court......'s Statute, Rules of Procedure and Evidence and practice to date, in order to determine its treatment of gender-based crimes and whether it can be said that the Special Court for Sierra Leone challenges the tradition of impunity for gender-based crimes. Udgivelsesdato: december 2004...

  3. Noise aliasing in interline-video-based fluoroscopy systems

    International Nuclear Information System (INIS)

    Lai, H.; Cunningham, I.A.

    2002-01-01

    Video-based imaging systems for continuous (nonpulsed) x-ray fluoroscopy use a variety of video formats. Conventional video-camera systems may operate in either interlaced or progressive-scan modes, and CCD systems may operate in interline- or frame-transfer modes. A theoretical model of the image noise power spectrum corresponding to these formats is described. It is shown that with respect to frame-transfer or progressive-readout modes, interline or interlaced cameras operating in a frame-integration mode will result in a spectral shift of 25% of the total image noise power from low spatial frequencies to high. In a field-integration mode, noise power is doubled with most of the increase occurring at high spatial frequencies. The differences are due primarily to the effect of noise aliasing. In interline or interlaced formats, alternate lines are obtained with each video field resulting in a vertical sampling frequency for noise that is one half of the physical sampling frequency. The extent of noise aliasing is modified by differences in the statistical correlations between video fields in the different modes. The theoretical model is validated with experiments using an x-ray image intensifier and CCD-camera system. It is shown that different video modes affect the shape of the noise-power spectrum and therefore the detective quantum efficiency. While the effect on observer performance is not addressed, it is concluded that in order to minimize image noise at the critical mid-to-high spatial frequencies for a specified x-ray exposure, fluoroscopic systems should use only frame-transfer (CCD camera) or progressive-scan (conventional video) formats

  4. The synthesis of radioactive polymeric microspheres for SPECT imaging during embolization procedures

    International Nuclear Information System (INIS)

    Carvalheira, Luciana; Pinto, José C.C.S.; Souza, Marcio N. de

    2017-01-01

    Vascular embolization is an important clinical procedure, frequently used to reduce the size of a tumor, to facilitate the removal of a tumor during surgery or to define a treatment of tumor malformation. In addition, imaging is an important component for the evaluation and care of patients undergoing vascular embolization. Nowadays, during the embolization procedure, the radiologist uses the Angiography or Fluoroscopy (X-Ray images) technique to estimate devascularization, since only pathological examinations are able to show the exact location of the blockade and microspheres. SPECT imaging is widely used in Brazil and provides images of superior quality to the mentioned techniques. Therefore, radioactive polymeric microspheres can be used as radioembolization agents for SPECT imaging. This technique can improve the resolution of images and, consequently, the embolization procedure efficacy of uterine fibroids for example, by allowing the track of particles distribution in the veins and tumor, the homogeneity of this distribution and the end of the embolization procedure. In this work, we evaluate the copolymerization of 4-vinylphenol and vinyl acetate as a synthesis route for a new radioembolization agent. GPC analysis results showed that this comonomer presence improved the molar mass distribution. In addition, bulk polymerization tests and kinetic studies showed that the selected comonomer retards the reaction time, but does not decrease the conversion percentage. Indeed, this result points out the necessity of a comonomer chemical modification to improve yield results. (author)

  5. The synthesis of radioactive polymeric microspheres for SPECT imaging during embolization procedures

    Energy Technology Data Exchange (ETDEWEB)

    Carvalheira, Luciana; Pinto, José C.C.S.; Souza, Marcio N. de, E-mail: luciana@ien.gov.br, E-mail: nele@eq.ufrj.br [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Coordenacao de Pos-Graduacao e Pesquisa de Engenharia (PEQ/COPPE/UFRJ), Rio de Janeiro, RJ (Brazil)

    2017-07-01

    Vascular embolization is an important clinical procedure, frequently used to reduce the size of a tumor, to facilitate the removal of a tumor during surgery or to define a treatment of tumor malformation. In addition, imaging is an important component for the evaluation and care of patients undergoing vascular embolization. Nowadays, during the embolization procedure, the radiologist uses the Angiography or Fluoroscopy (X-Ray images) technique to estimate devascularization, since only pathological examinations are able to show the exact location of the blockade and microspheres. SPECT imaging is widely used in Brazil and provides images of superior quality to the mentioned techniques. Therefore, radioactive polymeric microspheres can be used as radioembolization agents for SPECT imaging. This technique can improve the resolution of images and, consequently, the embolization procedure efficacy of uterine fibroids for example, by allowing the track of particles distribution in the veins and tumor, the homogeneity of this distribution and the end of the embolization procedure. In this work, we evaluate the copolymerization of 4-vinylphenol and vinyl acetate as a synthesis route for a new radioembolization agent. GPC analysis results showed that this comonomer presence improved the molar mass distribution. In addition, bulk polymerization tests and kinetic studies showed that the selected comonomer retards the reaction time, but does not decrease the conversion percentage. Indeed, this result points out the necessity of a comonomer chemical modification to improve yield results. (author)

  6. Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

    International Nuclear Information System (INIS)

    Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik; Chai, Jae Won; Ahn, Joong Mo

    2015-01-01

    To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases

  7. Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Chai, Jae Won [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); Ahn, Joong Mo [Dept. of Radiology, University of Pittsburgh Medical Center, Pittsburgh (United States)

    2015-09-15

    To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases.

  8. Development of an Estimating Procedure for the Annual PLAN Process - with Special Emphasis on the Estimating Group

    International Nuclear Information System (INIS)

    Lichtenberg, Steen

    2003-01-01

    matters, and finally (3) correct and transparent statistical calculations of the result. The resulting proposals for a new procedure include a model structure for the analysis team and its procedures, the initial identification and handling of the sources of uncertainty, a choice of scenarios and alternatives to be examined, followed by some quantification phases, during which the data on timing, costs, etc. are evaluated and followed by a calculation. The result consists of information about the necessary size of the fee rates for various degrees of safety or probability, as well as the primary sources of the remaining uncertainty involved. A workable procedure is always achieved through a balance between complying strictly with the relevant natural laws and being sufficiently simple and intelligible, with a minimum of 'black boxes'. The relevance of the desired balance is discussed and verification is attempted. Special attention is given to a discussion on the application of the Bayesian statistical theory, the paradigm of which is still new to some professionals and decision-makers. The procedure has been tested in several steps. So far, the procedure has lived up to or exceeded expectations. Some primary conclusions are summarised in the final chapter. More tests will be required. The results of this testing are to be published separately

  9. Long-term follow-up of two interventional procedures for achalasia

    International Nuclear Information System (INIS)

    Cheng Yingsheng; Li Minghua; Shang Kezhong

    2005-01-01

    Objective: To observed the long-term follow-up of the two types of interventional procedure for achalasia. Methods: The study cohort was comprised of 140 patients of achalasia including 70 patients treated under fluoroscopy with pneumatic dilation (group A) and 70 with temporary partially covered metal stent dilation (group B). Results: One hundred and forty dilations were performed on the 70 patients of group A with complications of chest pain (n=35), reflux (n=18), and bleeding (n=8); 38 patients of relapsing dysphagia during a 12-month follow-up, and 50 patients out of 60 of recurrent dysphagia during a 36-month follow-up. Seventy partially covered expandable metal stents were temporarily placed in the 70 patients of group B and withdrawn after 3-7 days via gastroscopy with complications of chest pain (n=28), reflux (n=15), and bleeding (n=9); 7 patients out of 70 exhibited dysphagia relapse during a 12-month followup, and 9 out of 58 patients exhibited dysphagia relapse during a 36-month follow-up. All the stents were inserted and withdrawn successfully. The follow-up in groups A-B lasted for 12-96 months. Conclusion: Temporary partially covered metal stent dilation is one of the best methods of interventional procedure for achalasia in long-term follow-up. (authors)

  10. Radiation exposure from fluoroscopy during fixation of hip fracture and fracture of ankle: Effect of surgical experience

    Directory of Open Access Journals (Sweden)

    Botchu Rajesh

    2008-01-01

    Full Text Available Background: Over the years, there has been a tremendous increase in the use of fluoroscopy in orthopaedics. The risk of contracting cancer is significantly higher for an orthopedic surgeon. Hip and spine surgeries account for 99% of the total radiation dose. The amount of radiation to patients and operating surgeon depends on the position of the patient and the type of protection used during the surgery. A retrospective study to assess the influence of the radiation exposure of the operating surgeon during fluoroscopically assisted fixation of fractures of neck of femur (dynamic hip screw and ankle (Weber B was performed at a district general hospital in the United Kingdom. Materials and Methods: Sixty patients with undisplaced intertrochanteric fracture were included in the hip group, and 60 patients with isolated fracture of lateral malleolus without communition were included in the ankle group. The hip and ankle groups were further divided into subgroups of 20 patients each depending on the operative experience of the operating surgeon. All patients had fluoroscopically assisted fixation of fracture by the same approach and technique. The radiation dose and screening time of each group were recorded and analyzed. Results: The radiation dose and screening time during fluoroscopically assisted fixation of fracture neck of femur were significantly high with surgeons and trainees with less than 3 years of surgical experience in comparison with surgeons with more than 10 years of experience. The radiation dose and screening time during fluoroscopically assisted fixation of Weber B fracture of ankle were relatively independent of operating surgeon′s surgical experience. Conclusion: The experience of operating surgeon is one of the important factors affecting screening time and radiation dose during fluoroscopically assisted fixation of fracture neck of femur. The use of snapshot pulsed fluoroscopy and involvement of senior surgeons could

  11. Sphincter-saving procedure for radiation-injuried rectum. A report of four cases with special reference to pull-through procedure

    Energy Technology Data Exchange (ETDEWEB)

    Moriya, Y.; Koyama, Y.; Hojo, K. (National Cancer Center, Tokyo (Japan))

    1982-09-01

    Up to this time the sigmoid colostomy has been widely accepted and conventional treatment for radiation-injured rectum, but patients without residual malignancy strongly desire to live without colostomy. We have tried to remove the involved rectal segments by sphincter-saving procedures. Four patients underwent these procedures, pull-through procedure in three and low anterior resection in one. Among sphincter-saving procedures, pull-through procedure was most adequate. Provided the following five conditions are fulfilled, pull-through procedure should be considered for severe radiation-injured rectum. (1) No recurrence of initial malignancy in the pelvis. (2) More than 2 cm intact rectal segment above dentate line may be preserved. (3) No radiation-injured segment in upper sigmoid. (4) No severe radiation damage in small intestine. (5) Patients under 70 year-old, with normal tonus of anal sphincter.

  12. Thermoluminescent dosimetry in fluoroscopy of pediatric patients; Dosimetria termoluminiscente en fluoroscopia de pacientes pediatricos

    Energy Technology Data Exchange (ETDEWEB)

    Garcia V, E.; Azorin N, J. [Universidad Autonoma Metropolitana, Unidad Iztapalapa, Departamento de Fisica, San Rafael Atlixco 186, Col. Vicentina, 09340 Ciudad de Mexico (Mexico); Hidalgo T, S.; Dies S, P., E-mail: azorin@xanum.uam.mx [Hospital Infantil de Mexico Federico Gomez, Dr. Marquez 162, Col. Doctores, 06720 Ciudad de Mexico (Mexico)

    2016-10-15

    The use of thermoluminescent dosimeters in the area of medical physics and especially in radiology is of paramount importance to guarantee the quality of a particular study, which for this reason the need to verify by means of measurements of peripheral dose in studies of esophagogastroduodenal series by fluoroscopy using TLD of LiF:Mg, Ti. For this the necessary measurements were carried out directly in patients of the Children s Hospital of Mexico Federico Gomez. Previously characterized the dosimeters were used the graphs of the linear equation to obtain the absorbed dose of each dosimeter and was found that the values of the absorbed dose in each patient changes for various reasons like the anatomy, thickness of the tissues, age and exposure time during the study and was verify that none of the studies performed on patients exceeded dose levels that could affect healthy organs. (Author)

  13. Foreign Body Retrieval

    Medline Plus

    Full Text Available ... recording an image on photographic film or a special detector. Many foreign bodies, like coins and batteries, ... or white on x-ray. Fluoroscopy is a special x-ray technique that makes it possible to ...

  14. Evaluation of patients skin dose undergoing interventional cardiology procedure using radiochromic films

    International Nuclear Information System (INIS)

    Silva, Mauro W. Oliveira da; Canevaro, Lucia V.; Rodrigues, Barbara B. Dias

    2011-01-01

    In interventional cardiology (IC), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures are the most frequent ones. Since the 1990s, the number of IC procedures has increased rapidly. It is also known that these procedures are associated with high radiation doses due to long fluoroscopy time (FT) and large number of cine-frames (CF) acquired to document the procedure. Mapping skin doses in IC is useful to find the probability of skin injuries, to detect areas of overlapping field, and to get a permanent record of the most exposed areas of skin. The purpose of this study was to estimate the maximum skin dose (MSD) in patients undergoing CA and PTCA, and to compare these values with the reference levels proposed in the literature. Patients' dose measurements were carried out on a sample of 38 patients at the hemodynamic department, in four local hospitals in Rio de Janeiro, Brazil, using Gafchromic XR-RV2 films. In PTCA procedures, the median and third quartile values of MSD were estimated at 2.5 and 5.3 Gy, respectively. For the CA procedures, the median and third quartile values of MSD were estimated at 0.5 and 0.7 Gy, respectively. In this paper, we used the Pearson's correlation coefficient (r), and we found a fairly strong correlation between FT and MSD (r=0.8334, p<0.0001), for CA procedures. The 1 Gy threshold for deterministic effects was exceeded in nine patients. The use of Gafchromic XR-RV2 films was shown to be an effective method to measure MSD and the dose distribution map. The method is effective to identify the distribution of radiation fields, thus allowing the follow-up of the patient to investigate the appearance of skin injuries. (author)

  15. Electrical modeling of X-Ray tubes used in fluoroscopy systems with the objective of minimizing radiation transmitted to patients; Modelagem eletrica dos tubos de raios-X utilizados em sistemas de fluoroscopia com o objetivo de minimizar a radiacao transmitida ao paciente

    Energy Technology Data Exchange (ETDEWEB)

    Duarte, Raghunatha Faria; Oliveira, Bruno Andrade de; Souza, Euzebio de, E-mail: raghunathafaria@gmail.com, E-mail: brunodoliver90@hotmail.com, E-mail: euzebio.souza@prof.unibh.br [Centro Universitario de Belo Horizonte (UniBH), Belo Horizonte, MG (Brazil)

    2017-09-01

    The purpose of this article was to demonstrate the processes and parameters that are necessary for the operation of all X-rays in the use in fluoroscopy technique, the constructive part of the High Voltage Generator and the X-ray tube and how the X-ray release occurs to the patient during the examination, the condition of how the current and potential difference generates the X-rays incident to the patient during the procedure and what unnecessary exposure to such rays may be detrimental in amounts that do not add an image to the examination. In this way, a proposal was made for the electric modeling of an X-ray tube, in which it addressed an alternative to minimize the radiation that passes through the patient without generating useful images. (author)

  16. Estimating Effective Dose from Phantom Dose Measurements in Atrial Fibrillation Ablation Procedures and Comparison of MOSFET and TLD Detectors in a Small Animal Dosimetry Setting

    Science.gov (United States)

    Anderson-Evans, Colin David

    Two different studies will be presented in this work. The first involves the calculation of effective dose from a phantom study which simulates an atrial fibrillation (AF) ablation procedure. The second involves the validation of metal-oxide semiconducting field effect transistors (MOSFET) for small animal dosimetry applications as well as improved characterization of the animal irradiators on Duke University's campus. Atrial Fibrillation is an ever increasing health risk in the United States. The most common type of cardiac arrhythmia, AF is associated with increased mortality and ischemic cerebrovascular events. Managing AF can include, among other treatments, an interventional procedure called catheter ablation. The procedure involves the use of biplane fluoroscopy during which a patient can be exposed to radiation for as much as two hours or more. The deleterious effects of radiation become a concern when dealing with long fluoroscopy times, and because the AF ablation procedure is elective, it makes relating the risks of radiation ever more essential. This study hopes to quantify the risk through the derivation of dose conversion coefficients (DCCs) from the dose-area product (DAP) with the intent that DCCs can be used to provide estimates of effective dose (ED) for typical AF ablation procedures. A bi-plane fluoroscopic and angiographic system was used for the simulated AF ablation procedures. For acquisition of organ dose measurements, 20 diagnostic MOSFET detectors were placed at selected organs in a male anthropomorphic phantom, and these detectors were attached to 4 bias supplies to obtain organ dose readings. The DAP was recorded from the system console and independently validated with an ionization chamber and radiochromic film. Bi-plane fluoroscopy was performed on the phantom for 10 minutes to acquire the dose rate for each organ, and the average clinical procedure time was multiplied by each organ dose rate to obtain individual organ doses. The

  17. Editor's choice--Use of disposable radiation-absorbing surgical drapes results in significant dose reduction during EVAR procedures.

    Science.gov (United States)

    Kloeze, C; Klompenhouwer, E G; Brands, P J M; van Sambeek, M R H M; Cuypers, P W M; Teijink, J A W

    2014-03-01

    Because of the increasing number of interventional endovascular procedures with fluoroscopy and the corresponding high annual dose for interventionalists, additional dose-protecting measures are desirable. The purpose of this study was to evaluate the effect of disposable radiation-absorbing surgical drapes in reducing scatter radiation exposure for interventionalists and supporting staff during an endovascular aneurysm repair (EVAR) procedure. This was a randomized control trial in which 36 EVAR procedures were randomized between execution with and without disposable radiation-absorbing surgical drapes (Radpad: Worldwide Innovations & Technologies, Inc., Kansas City, US, type 5511A). Dosimetric measurements were performed on the interventionalist (hand and chest) and theatre nurse (chest) with and without the use of the drapes to obtain the dose reduction and effect on the annual dose caused by the drapes. Use of disposable radiation-absorbing surgical drapes resulted in dose reductions of 49%, 55%, and 48%, respectively, measured on the hand and chest of the interventionalist and the chest of the theatre nurse. The use of disposable radiation-absorbing surgical drapes significantly reduces scatter radiation exposure for both the interventionalist and the supporting staff during EVAR procedures. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  18. Exposure to rays and radiation hazards in connection with diagnostic X-ray procedures in children

    International Nuclear Information System (INIS)

    Protzer, K.

    1988-01-01

    In this study, figures and data about radiation exposures for diagnostic purposes are surveyed that were collected in connection with X-ray procedures in children. The data were sorted according to body regions and techniques required for their examination so as to permit separate analyses of procedures in the urogenital tract (intravenous urogramme, micturition cystourethrography), thorax (angiocardiogramme, thoractic aortogramme, examinations using cardiac catheters), gastrointestinal system (fluoroscopy and contrast-enhanced irrigoscopy), pelvis (survey radiography), skull (computed tomography) as well as in miscellaneous group of further origins. The second part of the report discusses the uncertainties surrounding the assessment of radiation hazards and indicated radiation doses. A formula is represented for the calculation of life-time reductions that can be applied to any type of cancer and embraces a number of factors like life expectancy at age X, the patient's age at the time of radiotherapy, the five-year-survival rate for the condition under investigation and the diseased organ. At the end of the study, some methods are pointed out that may be helpful in limiting radiation exposure. (KST) [de

  19. 28 CFR 44.304 - Special Counsel acting on own initiative.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Special Counsel acting on own initiative...-RELATED EMPLOYMENT PRACTICES Enforcement Procedures § 44.304 Special Counsel acting on own initiative. (a) The Special Counsel may, on his or her own initiative, conduct investigations respecting unfair...

  20. Correlation of patient maximum skin doses in cardiac procedures with various dose indicators

    International Nuclear Information System (INIS)

    Domienik, J.; Papierz, S.; Jankowski, J.; Peruga, J.Z.; Werduch, A.; Religa, W.

    2008-01-01

    In most countries of European Union, legislation requires the determination of the total skin dose received by patients during interventional procedures in order to prevent deterministic damages. Various dose indicators like dose-area product (DAP), cumulative dose (CD) and entrance dose at the patient plane (EFD) are used for patient dosimetry purposes in clinical practice. This study aimed at relating those dose indicators with doses ascribed to the most irradiated areas of the patient skin usually expressed in terms of local maximal skin dose (MSD). The study was performed in two different facilities for two most common cardiac procedures coronary angiography (CA) and percutaneous coronary interventions (PCI). For CA procedures, the registered values of fluoroscopy time, total DAP and MSD were in the range (0.7-27.3) min, (16-317) Gy cm 2 and (43-1507) mGy, respectively, and for interventions, accordingly (2.1-43.6) min, (17-425) Gy cm 2 , (71-1555) mGy. Moreover, for CA procedures, CD and EFD were in the ranges (295-4689) mGy and (121-1768) mGy and for PCI (267-6524) mGy and (68-2279) mGy, respectively. No general and satisfactory correlation was found for safe estimation of MSD. However, results show that the best dose indicator which might serve for rough, preliminary estimation is DAP value. In the study, the appropriate trigger levels were proposed for both facilities. (authors)

  1. Three-dimensional C-arm CT-guided transjugular intrahepatic portosystemic shunt placement: Feasibility, technical success and procedural time

    Energy Technology Data Exchange (ETDEWEB)

    Ketelsen, Dominik; Groezinger, Gerd; Maurer, Michael; Grosse, Ulrich; Horger, Marius; Nikolaou, Konstantin; Syha, Roland [University of Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Lauer, Ulrich M. [University of Tuebingen, Internal Medicine I, Department of Gastroenterology, Hepatology and Infectious disease, Tuebingen (Germany)

    2016-12-15

    Establishment of transjugular intrahepatic portosystemic shunts (TIPS) constitutes a standard procedure in patients suffering from portal hypertension. The most difficult step in TIPS placement is blind puncture of the portal vein. This study aimed to evaluate three-dimensional mapping of portal vein branches and targeted puncture of the portal vein. Twelve consecutive patients suffering from refractory ascites by liver cirrhosis were included in this retrospective study to evaluate feasibility, technical success and procedural time of C-arm CT-targeted puncture of the portal vein. As a control, 22 patients receiving TIPS placement with fluoroscopy-guided blind puncture were included to compare procedural time. Technical success could be obtained in 100 % of the study group (targeted puncture) and in 95.5 % of the control group (blind puncture). Appropriate, three-dimensional C-arm CT-guided mapping of the portal vein branches could be achieved in all patients. The median number of punctures in the C-arm CT-guided study group was 2 ± 1.3 punctures. Procedural time was significantly lower in the study group (14.8 ± 8.2 min) compared to the control group (32.6 ± 22.7 min) (p = 0.02). C-arm CT-guided portal vein mapping is technically feasible and a promising tool for TIPS placement resulting in a significant reduction of procedural time. (orig.)

  2. Investigation of the influence of the working procedure on patient dose in angiography of the lower limbs

    International Nuclear Information System (INIS)

    Struelens, L.; Vanhavere, F.; Bosmans, H.

    2002-01-01

    This document presents dose measurements on patients in the field of interventional angiography. We have restricted this study to a common IR procedure, namely diagnostic angiography of the lower limbs. In this examination, radiographs are made over 6 adjoining standard regions from abdomen to feet. The RX tube is moved from one region to another under fluoroscopic guidance. To visualise the arteries, contrast media is injected through a catheter that has been inserted in the abdominal artery. The positioning of the catheter is also controlled by fluoroscopy. Only typical procedures (without medical complications) in male and female patients were considered in this study. Within the scope of the optimisation of patient doses, we looked for the influence of both the working procedure and the exposure parameters on patient dose. Examinations as performed by different operators and in different hospitals were included in the study. The effective dose E is calculated with the use of calculated derived conversion factors, which link practical dose measurements under well-defined conditions with estimates of the effective dose. Measurements in 4 different hospitals, 2 university hospitals and 2 peripheral hospitals are compared

  3. Measurements of surgeons' exposure to ionizing radiation dose: comparison of conventional and mini C-arm fluoroscopy.

    Science.gov (United States)

    Sung, K H; Min, E; Chung, C Y; Jo, B C; Park, M S; Lee, K

    2016-03-01

    This study was performed to measure the equivalent scattered radiation dose delivered to susceptible organs while simulating orthopaedic surgery using conventional and mini C-arm fluoroscopy. In addition, shielding effects on the thyroid, thymus, and gonad, and the direct exposure delivered to the patient's hands were also compared. A conventional and mini C-arms were installed in an operating room, and a hand and an operator phantom were used to simulate a patient's hand and a surgeon. Photoluminescence dosimeters were used to measure the equivalent dose by scattered radiation arriving at the thyroid, thymus, and gonad on a whole-body phantom in the position of the surgeon. Equivalent scattered radiation doses were measured in four groups: (1) unshielded conventional C-arm group; (2) unshielded mini C-arm group; (3) lead-shielded conventional C-arm group; and (4) lead-shielded mini C-arm group. Equivalent scattered radiation doses to the unshielded group were significantly lower in the mini C-arm group than those in the conventional C-arm group for all organs. The gonad in the lead-shielded conventional C-arm group showed the highest equivalent dose among operator-susceptible organs, and radiation dose was reduced by approximately 96% compared with that in the unshielded group. Scattered radiation was not detected in any susceptible organ in the lead-shielded mini C-arm group. The direct radiation dose to the hand phantom measured from the mini C-arm was significantly lower than that measured from the conventional C-arm. The results show that the equivalent scattered radiation dose to the surgeon's susceptible organs and the direct radiation dose to a patient's hand can be decreased significantly by using a mini C-arm rather than a conventional C-arm. However, protective lead garments, such as a thyroid shield and apron, should be applied to minimize radiation exposure to susceptible organs, even during use of mini C-arm fluoroscopy. © The Author(s) 2015.

  4. 10 CFR 11.13 - Special requirements for transportation.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Special requirements for transportation. 11.13 Section 11.13 Energy NUCLEAR REGULATORY COMMISSION CRITERIA AND PROCEDURES FOR DETERMINING ELIGIBILITY FOR... Authorization § 11.13 Special requirements for transportation. (a) All individuals who, after 365 days following...

  5. WE-A-12A-01: Medical Physics 1.0 to 2.0, Session 2: Radiography, Mammography and Fluoroscopy

    International Nuclear Information System (INIS)

    Gingold, E; Karellas, A; Strauss, K

    2014-01-01

    . Fluoroscopy 2.0: Physics support of fluoroscopy should be operationally as opposed to compliance focused. Testing protocols must address new hardware, acquisition methods, and image processing. Future available tools are discussed. Proper configuration of acquisition parameters (focal spot size, voltage and added filter, tube current, pulse width, pulse rate, scatter removal) as a function of patient size from the neonate to bariatric patient is key to providing diagnostic image quality at properly managed radiation doses. Learning Objectives: Appreciate the limitations of the currently available tools and techniques in clinical medical physics in radiography, mammography, and fluoroscopy, and ways to improve upon current deficiencies. Appreciate the changing environment of imaging practice and the need for the medical physicist to be an expert consultant and educator in a capacity that extends beyond the annual survey of equipment. Understand the status of the rapidly changing environment in breast imaging from planar imaging to tomosynthesis and possibly to breast CT. Identify appropriate configuration of acquisition parameters as a function of patient size to manage radiation dose and ensure diagnostic image quality

  6. WE-A-12A-01: Medical Physics 1.0 to 2.0, Session 2: Radiography, Mammography and Fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Gingold, E [Thomas Jefferson University, Philadelphia, PA (United States); Karellas, A [University of Massachusetts Medical School, Worcester, MA (United States); Strauss, K [Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States)

    2014-06-15

    . Fluoroscopy 2.0: Physics support of fluoroscopy should be operationally as opposed to compliance focused. Testing protocols must address new hardware, acquisition methods, and image processing. Future available tools are discussed. Proper configuration of acquisition parameters (focal spot size, voltage and added filter, tube current, pulse width, pulse rate, scatter removal) as a function of patient size from the neonate to bariatric patient is key to providing diagnostic image quality at properly managed radiation doses. Learning Objectives: Appreciate the limitations of the currently available tools and techniques in clinical medical physics in radiography, mammography, and fluoroscopy, and ways to improve upon current deficiencies. Appreciate the changing environment of imaging practice and the need for the medical physicist to be an expert consultant and educator in a capacity that extends beyond the annual survey of equipment. Understand the status of the rapidly changing environment in breast imaging from planar imaging to tomosynthesis and possibly to breast CT. Identify appropriate configuration of acquisition parameters as a function of patient size to manage radiation dose and ensure diagnostic image quality.

  7. Merrill's Atlas of radiographic positions and radiologic procedures. Volumes 1-3. Sixth edition

    International Nuclear Information System (INIS)

    Ballinger, P.W.

    1985-01-01

    Merrill's Atlas describes and explains the routine and specialized radiologic procedures for all body systems. This edition thoroughly reorganized, updated and expanded. Volumes one and two describe all routine and flouroscopic procedures; and volume three describes more specialized areas in the profession

  8. Thyroid Radiation Dose to Patients from Diagnostic Radiology Procedures over Eight Decades: 1930-2010.

    Science.gov (United States)

    Chang, Lienard A; Miller, Donald L; Lee, Choonsik; Melo, Dunstana R; Villoing, Daphnée; Drozdovitch, Vladimir; Thierry-Chef, Isabelle; Winters, Sarah J; Labrake, Michael; Myers, Charles F; Lim, Hyeyeun; Kitahara, Cari M; Linet, Martha S; Simon, Steven L

    2017-12-01

    This study summarizes and compares estimates of radiation absorbed dose to the thyroid gland for typical patients who underwent diagnostic radiology examinations in the years from 1930 to 2010. The authors estimated the thyroid dose for common examinations, including radiography, mammography, dental radiography, fluoroscopy, nuclear medicine, and computed tomography (CT). For the most part, a clear downward trend in thyroid dose over time for each procedure was observed. Historically, the highest thyroid doses came from the nuclear medicine thyroid scans in the 1960s (630 mGy), full-mouth series dental radiography (390 mGy) in the early years of the use of x rays in dentistry (1930s), and the barium swallow (esophagram) fluoroscopic exam also in the 1930s (140 mGy). Thyroid uptake nuclear medicine examinations and pancreatic scans also gave relatively high doses to the thyroid (64 mGy and 21 mGy, respectively, in the 1960s). In the 21st century, the highest thyroid doses still result from nuclear medicine thyroid scans (130 mGy), but high thyroid doses are also associated with chest/abdomen/pelvis CT scans (18 and 19 mGy for males and females, respectively). Thyroid doses from CT scans did not exhibit the same downward trend as observed for other examinations. The largest thyroid doses from conventional radiography came from cervical spine and skull examinations. Thyroid doses from mammography (which began in the 1960s) were generally a fraction of 1 mGy. The highest average doses to the thyroid from mammography were about 0.42 mGy, with modestly larger doses associated with imaging of breasts with large compressed thicknesses. Thyroid doses from dental radiographic procedures have decreased markedly throughout the decades, from an average of 390 mGy for a full-mouth series in the 1930s to an average of 0.31 mGy today. Upper GI series fluoroscopy examinations resulted in up to two orders of magnitude lower thyroid doses than the barium swallow. There are

  9. Occupational doses in pediatric barium meal procedures

    International Nuclear Information System (INIS)

    Filipov, D.; Schelin, H.R.; Denyak, V.; Legnani, A.; Ledesma, J.A.; Paschuk, S.A.; Sauzen, J.; Yagui, A.; Hoff, G.; Khoury, H.J.

    2015-01-01

    Ionizing radiation has become an indispensable tool when it comes to diagnosis and therapy. However, its use should happen in a rational manner, taking into account the risks to which the staff is being exposed. Barium meal (BM), or upper gastrointestinal (GI) studies, using fluoroscopy, are widely used for gastroesophageal reflux disease diagnostic in children and professionals are required to stay inside the examination room to position and immobilize pediatric patients during the procedure. Therefore, it is very important that proffessionals strictly follow the technical standards of radiation protection. According to the ICRP and the NCRP recommendations, the annual limit equivalent doses for eyes, thyroid and hands are, espectively, 20 mSv, 150 mSv and 500 mSv. Based on those data, the aim of the current study is to estimate the annual equivalent dose for eyes, thyroid and hands of professionals who perform BM procedures in children. This was done using properly package LiF:Mg,Cu,P thermoluminescent dosimeters in 37 procedures; 2 pairs were positioned near each staff´s eye, 2 pairs on each professional´s neck (on and under the lead protector) and 2 pairs on both staff´s hands. The range of the estimative annual equivalent doses, for eyes, thyroid and hands, are, respectively: 14 – 36 mSv, 7 – 22 mSv and 14 – 58 mSv. Only the closest staff to the patient exceeded the annual equivalent doses in the eyes (around 80% higher than the limit set by ICRP). However, the results from this study, for hands and thyroid, compared to similar studies, show higher values. Therefore, the optimization implementation is necessary, so that the radiation levels can be reduced. (authors)

  10. Visualization of femorotibial contact in total knee arthroplasty using X-ray fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Takaharu E-mail: yamazaki@image.med.osaka-u.ac.jp; Watanabe, Tetsu; Nakajima, Yoshikazu; Sugamoto, Kazuomi; Tomita, Tetsuya; Maeda, Daisuke; Sahara, Wataru; Yoshikawa, Hideki; Tamura, Shinichi

    2005-01-01

    The purpose of this study was to build a visualization technique of the femorotibial contact in fixed-bearing total knee arthroplasty (TKA) using X-ray fluoroscopy, and to apply this technique to a TKA patient during dynamic motion. In vivo kinametcis of the metallic knee implant was determined using a 2D/3D registration technique, which uses computer assisted design (CAD) model of the implant to estimate the 3D pose of radiopaque metallic femoral and tibial components from a single-plane fluoroscopic image. In fixed-bearing TKA, a 3D pose of radiolucent tibial polyethylene insert can be determined from the estimated pose of the tibial component. To visualize femorotibial contact, the proximity between surfaces of femoral component and tibial insert was calculated, and mapped onto the insert surface model. For the clinical application, dynamic states of contact on the tibial insert were observed including axial rotation and unilateral loading during knee flexion, and post-cam contact of posterior stabilized TKA. The present technique provided us new information and enabled us to better understand the relationship between in vivo knee kinematics and articular shape of the implant.

  11. Lung cancer mortality between 1950 and 1987 after exposure to fractionated moderate-dose-rate ionizing radiation in the Canadian fluoroscopy cohort study and a comparison with lung cancer mortality in the atomic bomb survivors study

    International Nuclear Information System (INIS)

    Howe, G.R.

    1995-01-01

    Current lung cancer risk estimates after exposure to low-linear energy transfer radiation such as X rays are based on studies of people exposed to such radiation at high dose rates, for example the atomic bomb survivors. Radiobiology and animal experiments suggest that risks from exposure at low to moderate dose rates, for example medical diagnostic procedures, may be overestimated by such risk models, but data for humans to examine this issue are limited. In this paper we report on lung cancer mortality between 1950 and 1987 in a cohort of 64,172 Canadian tuberculosis patients, of whom 39% were exposed to highly fractionated multiple chest fluoroscopies leading to a mean lung radiation dose of 1.02 Sv received at moderate dose rates. These data have been used to estimate the excess relative risk per sievert of lung cancer mortality, and this is compared directly to estimates derived from 75,991 atomic bomb survivors. Based on 1,178 lung cancer deaths in the fluoroscopy study, there was no evidence of any positive association between risk and dose, with the relative risk at 1 Sv being 1.00 (95% confidence interval 0.94, 1.07), which contrasts with that based on the atomic bomb survivors, 1.60 (1.27, 1.99). The difference in effect between the two studies almost certainly did not arise by chance (P = 0.0001). This study provides strong support from data for humans for a substantial fractionation/dose-rate effect for low-linear energy transfer radiation and lung cancer risk. This implies that lung cancer risk from exposures to such radiation at present-day dose rates is likely to be lower than would be predicted by current radiation risk models based on studies of high-dose-rate exposures. 25 refs., 8 tabs

  12. Gonad doses for male patients from stomach examination and oral cholegraphy using the X-ray image intensifying technique and television fluoroscopy

    International Nuclear Information System (INIS)

    Steinbach, W.; Richter, K.; Koenig, W.; Menzel, B.; Reisinger, W.; Uhlich, F.

    1979-01-01

    The gonad dose was measured for male patients undergoing stomach examinations and oral cholegraphy by means of a diagnostic twelve pulse generator (TuR D 1500) and an X-ray apparatus 'Diagnost 100' (Philips-Mueller). In a small group of patients the gonad dose was ascertained per exposure to a 70 mm single spot film, to a 24 cm x 30 cm full size radiograph, and per minute of exposure to image intensifier fluoroscopy. The total gonad dose in both the diagnostic techniques was determined seperately in larger groups of patients. In stomach examination large size radiography led to a gonad dose 20 times higher than that obtained with the spot film technique, while exposure from cholegraphy was 10 times higher. The gonad dose per exposure of a single spot film was about 0.5 mrad. In examinations of the stomach the gonad dose from one minute fluroscopy was 18 times higher than the doses determined for a single spot film, and in cholegraphy it was 10 times higher. Supposing mean values of the number of radiographs and of the fluoroscopy time according to the conditions applied, the gonad dose in stomach examination from the film-screen technique is about twice that from the television image-intensifying technique. By comparison, oral cholegraphy exclusively performed by large-size radiography yielded about the same gonad dose as the spot film television technique. Total dose values determined separately confirmed these evaluations. (author)

  13. Clinical background and its relation to results of percutaneous needle biopsy of suspected bone metastasis under guidance with CT fluoroscopy

    International Nuclear Information System (INIS)

    Aoki, Jun; Koyama, Yoshinori; Morita, Hideo; Takahashi, Ayako; Nakajima, Takahito; Yagi, Akiko; Arai, Kiyokazu; Shinozaki, Tetsuya; Watanabe, Hideomi

    2005-01-01

    The purpose of this study was to investigate the clinical background of needle biopsy of suspected bone metastasis under guidance with CT fluoroscopy. During a 3-year period (from April 2000 to March 2003), 103 needle biopsies on 101 lesions of 90 patients were performed for pathological evaluation of suspected bone metastasis. The clinical course of these patients prior to biopsy and its relation to the biopsy results were retrospectively reviewed. Sixty-two patients (69% of total cases) were referred for biopsy from orthopedic surgeons, and 51 of these patients consulted orthopedic surgeons on the initial presentation. Malignancy was pathologically proved in 47 (76%) of the 62 orthopedic patients, and in 19 (68%) of the 28 patients referred from other clinicians. Thirteen (21%) of the orthopedic patients had a history of malignancy, while 22 (78%) of the non-orthopedic patients were cancer patients. Metastasis was pathologically proved in 23 (66%) of the 35 patients with a history of malignancy, while malignancy was pathologically proved in 43 (78%) of the 55 patients without known malignancy. Diagnostic accuracy of the needle bone biopsy was 96%, and its complication rate was 0.7%. In the era of CT fluoroscopy, needle biopsy for suspected bone metastasis was most frequently requested for the patients who consulted orthopedic surgeons for the occurrence of local bone pain as the initial symptom of unknown malignancy. Frequency of malignancy proved by the biopsy in those patients was as high as that in the cancer patients referred from other clinicians. (author)

  14. Fluoroscopy-guided reduction and fibular nail fixation to manage unstable ankle fractures in patients with diabetes: a retrospective cohort study.

    Science.gov (United States)

    Ashman, B D; Kong, C; Wing, K J; Penner, M J; Bugler, K E; White, T O; Younger, A S E

    2016-09-01

    Patients with diabetes are at increased risk of wound complications after open reduction and internal fixation of unstable ankle fractures. A fibular nail avoids large surgical incisions and allows anatomical reduction of the mortise. We retrospectively reviewed the results of fluoroscopy-guided reduction and percutaneous fibular nail fixation for unstable Weber type B or C fractures in 24 adult patients with type 1 or type 2 diabetes. The re-operation rate for wound dehiscence or other indications such as amputation, mortality and functional outcomes was determined. Two patients developed lateral side wound infection, one of whom underwent wound debridement. Three other patients required re-operation for removal of symptomatic hardware. No patient required a below-knee amputation. Six patients died during the study period for unrelated reasons. At a median follow-up of 12 months (7 to 38) the mean Short Form-36 Mental Component Score and Physical Component Score were 53.2 (95% confidence intervals (CI) 48.1 to 58.4) and 39.3 (95% CI 32.1 to 46.4), respectively. The mean Visual Analogue Score for pain was 3.1 (95% 1.4 to 4.9). The mean Ankle Osteoarthritis Scale total score was 32.9 (95% CI 16.0 to 49.7). Fluoroscopy-guided reduction and fibular nail fixation of unstable ankle fractures in patients with diabetes was associated with a low incidence of wound and overall complications, while providing effective surgical fixation. Cite this article: Bone Joint J 2016;98-B:1197-1201. ©2016 The British Editorial Society of Bone & Joint Surgery.

  15. 34 CFR 668.149 - Special provisions for the approval of assessment procedures for special populations for whom no...

    Science.gov (United States)

    2010-07-01

    ... procedure or instrument measures both basic verbal and quantitative skills at the secondary school level. (2... recommended by the test developer, provided that the test administrator— (i) Uses those procedures or... verbal and quantitative skills at the secondary school level; and (4) The passing scores and the methods...

  16. Pros and Cons of 3D Image Fusion in Endovascular Aortic Repair: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Goudeketting, Seline R; Heinen, Stefan G H; Ünlü, Çağdaş; van den Heuvel, Daniel A F; de Vries, Jean-Paul P M; van Strijen, Marco J; Sailer, Anna M

    2017-08-01

    To systematically review and meta-analyze the added value of 3-dimensional (3D) image fusion technology in endovascular aortic repair for its potential to reduce contrast media volume, radiation dose, procedure time, and fluoroscopy time. Electronic databases were systematically searched for studies published between January 2010 and March 2016 that included a control group describing 3D fusion imaging in endovascular aortic procedures. Two independent reviewers assessed the methodological quality of the included studies and extracted data on iodinated contrast volume, radiation dose, procedure time, and fluoroscopy time. The contrast use for standard and complex endovascular aortic repairs (fenestrated, branched, and chimney) were pooled using a random-effects model; outcomes are reported as the mean difference with 95% confidence intervals (CIs). Seven studies, 5 retrospective and 2 prospective, involving 921 patients were selected for analysis. The methodological quality of the studies was moderate (median 17, range 15-18). The use of fusion imaging led to an estimated mean reduction in iodinated contrast of 40.1 mL (95% CI 16.4 to 63.7, p=0.002) for standard procedures and a mean 70.7 mL (95% CI 44.8 to 96.6, p<0.001) for complex repairs. Secondary outcome measures were not pooled because of potential bias in nonrandomized data, but radiation doses, procedure times, and fluoroscopy times were lower, although not always significantly, in the fusion group in 6 of the 7 studies. Compared with the control group, 3D fusion imaging is associated with a significant reduction in the volume of contrast employed for standard and complex endovascular aortic procedures, which can be particularly important in patients with renal failure. Radiation doses, procedure times, and fluoroscopy times were reduced when 3D fusion was used.

  17. [Costing nuclear medicine diagnostic procedures].

    Science.gov (United States)

    Markou, Pavlos

    2005-01-01

    To the Editor: Referring to a recent special report about the cost analysis of twenty-nine nuclear medicine procedures, I would like to clarify some basic aspects for determining costs of nuclear medicine procedure with various costing methodologies. Activity Based Costing (ABC) method, is a new approach in imaging services costing that can provide the most accurate cost data, but is difficult to perform in nuclear medicine diagnostic procedures. That is because ABC requires determining and analyzing all direct and indirect costs of each procedure, according all its activities. Traditional costing methods, like those for estimating incomes and expenses per procedure or fixed and variable costs per procedure, which are widely used in break-even point analysis and the method of ratio-of-costs-to-charges per procedure may be easily performed in nuclear medicine departments, to evaluate the variability and differences between costs and reimbursement - charges.

  18. 16. Optimal guidance of percutaneous device closure of PDA by transthoracic echocardiography

    Directory of Open Access Journals (Sweden)

    M. Alobaidan

    2016-07-01

    Full Text Available Patent ductus arteriosus (PDA is common congenital cardiac lesion and the most accepted way of management is transcatheter occlusion by device which is usually done under fluoroscopy guidance. Transoesophageal echo cardiography and transaortic imaging were used in adult to guide the procedure which is with certain applications in pediatric age group transthoracic echocardiography (TTE in pediatric population provides excellent images for PDA and may replace the use of fluoroscopy to guide PDA closure at least in special situations. To highlight the feasibility of device closure under guidance of TTE to be applied in sick patients who are not suitable for transfer to cardiac catheter laboratory or those with contraindication to contrast and or radiation application. 18 patients from July 2013 to May 2015 underwent TTE guidance device closure of PDA, 1 patient was excluded after device embolization which necessitate retrieval under fluoroscopy (fluoro.. Conscious sedation was used in 17 patients except 1 who was sick and already ventilated in ICU, there were 11 female and 7 male, antegrade approach was used in 10 patients with partial fluoro and retrograde approach in 8 patients without fluoro. Median age is 7 months, median weight is 8 kg (3.2–11 kg, 2 patients with renal impairment, 2 with Leukemia, median procedure time is 35 min, median fluoro. is 2.2 min, PDA size were small in 13 patients and moderate in 5, immediate closure is achieved in all. The devices were ADOI, ADOS, ADOII, Occlutech, and AVP2. Device embolization in 1 with successful retrieval and second device was used with complete closure percutaneous PDA closure under TTE guidance is feasible, safe and recommended in selected patients with certain situation.

  19. 76 FR 4369 - Special Law Enforcement Commissions

    Science.gov (United States)

    2011-01-25

    ...This notice announces the online publication of the Interim Special Law Enforcement Commission Policy, Rules and Procedures, the Interim Special Law Enforcement Commission Protocols and the Interim Domestic Violence Waiver that will be used by the Office of Justice Services following passage of the Tribal Law and Order Act of 2010. The documents are published on the Indian Affairs Web site.

  20. Raised Anxiety Levels Among Outpatients Preparing to Undergo a Medical Imaging Procedure: Prevalence and Correlates.

    Science.gov (United States)

    Forshaw, Kristy L; Boyes, Allison W; Carey, Mariko L; Hall, Alix E; Symonds, Michael; Brown, Sandy; Sanson-Fisher, Rob W

    2018-04-01

    To examine the percentage of patients with raised state anxiety levels before undergoing a medical imaging procedure; their attribution of procedural-related anxiety or worry; and sociodemographic, health, and procedural characteristics associated with raised state anxiety levels. This prospective cross-sectional study was undertaken in the outpatient medical imaging department at a major public hospital in Australia, with institutional board approval. Adult outpatients undergoing a medical imaging procedure (CT, x-ray, MRI, ultrasound, angiography, or fluoroscopy) completed a preprocedural survey. Anxiety was measured by the short-form state scale of the six-item State-Trait Anxiety Inventory (STAI: Y-6). The number and percentage of participants who reported raised anxiety levels (defined as a STAI: Y-6 score ≥ 33.16) and their attribution of procedural-related anxiety or worry were calculated. Characteristics associated with raised anxiety were examined using multiple logistic regression analysis. Of the 548 (86%) patients who consented to participate, 488 (77%) completed all STAI: Y-6 items. Half of the participants (n = 240; 49%) experienced raised anxiety, and of these, 48% (n = 114) reported feeling most anxious or worried about the possible results. Female gender, imaging modality, medical condition, first time having the procedure, and lower patient-perceived health status were statistically significantly associated with raised anxiety levels. Raised anxiety is common before medical imaging procedures and is mostly attributed to the possible results. Providing increased psychological preparation, particularly to patients with circulatory conditions or neoplasms or those that do not know their medical condition, may help reduce preprocedural anxiety among these subgroups. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. Radiation exposure to staff and patients during two endocrinological procedures

    International Nuclear Information System (INIS)

    Hristova-Popova, J.; Vassileva, J.; Saltirov, I.; Petkova, K.

    2012-01-01

    The purpose of the present work is to obtain information about the exposure to patient and staff during percutaneous nephrolithotripsy and ureteroscopy with intracorporeal lithotripsy and to search for a correlation between these parameters. The collected data for each procedure consist of the total air kerma-area product, P KA , cumulative dose, CD, fluoroscopy time, FT, number of images acquired, as well as clinical patient data. Average, minimum, maximum and median values were calculated for 38 patients. Mean values and median in parentheses were as follows: 355 (383) cGy cm 2 (P KA for PCNL); 433 (286) cGy cm 2 (P KA for URS); 42 (37) mGy (CD for PCNL); 12 (7) mGy (CD for URS); 3.5 (3.0) min (FT for PCNL); 1.4 (1.3) min (FT for URS). The typical operator doses for PCNL and URS were assessed to be 66.1 μSv and 34.3 μSv, respectively, while the maximum doses for the same type of procedures were 152.6 μSv and 124.1 μSv. Good correlation was observed between the staff dose and P KA for both procedures, while the correlation of staff dose with CD and FT was found to be weak. While applying principles of radiation protection and normal load in the clinic, there is no possibility to exceed the new annual dose limit for eye lens of 20 mSv per year averaged over 5 years. The correlation of P KA with FT and CD was also explored and no significant interconnection was observed. (authors)

  2. 15 CFR 295.10 - Special reporting and auditing requirements.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Special reporting and auditing... ADVANCED TECHNOLOGY PROGRAM General § 295.10 Special reporting and auditing requirements. Each award by the Program shall contain procedures regarding technical, business, and financial reporting and auditing...

  3. Developing, adopting and adapting operating procedures

    International Nuclear Information System (INIS)

    Rabouhams, J.

    1986-01-01

    This lecture specifies all the dispositions which have been taken by EDF Nuclear and Fossil Generation Department - according to the fact that availability and safety largely depend on the quality of the procedures and their easy handling - in order to develop, adopt and adapt the operating procedures. The following points are treated: General organization of procedures for plant operation during normal and abnormal conditions; Personnel and extend of responsibility involved into the development of procedures (research center, training center, specialized services, nuclear station, etc.); Validation of the procedures by means of full-scope simulators; Modifications of the procedures taking into account operation experience in material and human fields; Development of simulation softs in order to perform the procedures in abnormal situations; Evolution of operating technics and future skills. (orig.)

  4. 14 CFR 25.1585 - Operating procedures.

    Science.gov (United States)

    2010-01-01

    ...) Non-normal procedures for malfunction cases and failure conditions involving the use of special... envelopes, determined under § 25.251 must be furnished. The buffet onset envelopes presented may reflect the...

  5. MODERN PECULIARITIES OF THE MEDICAL EXPOSURE LEVELS FORMING OF THE TATARSTAN REPUBLIC POPULATION DURING X-RAY PROCEDURES IMPLEMENTATION

    Directory of Open Access Journals (Sweden)

    S. A. Ryzhkin

    2015-01-01

    Full Text Available The purpose. The purpose of the investigation is an assessment of the peculiarities of forming and registration of the collective doses of patients and the population of the Tatarsatan Republic (RT from medical exposure and the development of measures for optimization of this radiation factor.Materials and methods. The analysis is based on the forms of the Federal statistical observation № 3-DOZ «Data on the exposure doses to patients obtained during medical radiological examination» (form № 3-DOZ and radiation-hygienic passports of RT for the period from 2006 to 2013.The results. Annually in RT there is an increase of the number of performed X-ray procedures, which reached the value of 6279696 (1.64 procedures per resident per year in 2013. During the reporting period (from 2006 to 2013 the structure of the performed X-ray procedures has also changed. It is observed that the percentage of fluorography procedures in the overall structure decreased from 41.3% to 31.3% at the same time the level of absolute value of annually performed fluorography procedures is stable. There is an increase in the absolute number of radiographic procedures performed during the period from 2578754 to 4072810 X-rays per year, that is 1.58 times higher. Absolute and relative values related to X-ray fluoroscopy examinations decreased from 1.1% to 0.7%. In contrast, the absolute number of annually performed X-ray computed tomography examinations (CT has increased over the period by 3.3 times and percentage of CT in overall structure of X-ray procedure is 2.7%. The number of special investigations has increased in 2.1 times, but the relative value remained at average level of 0.4% on general background of the increasing of X-ray activity in the region. This fact influenced the change in the radiation-hygienic indexes of medical radiation exposure of the population of RT. According to №3-DOZ forms and radiation-hygienic passports of the

  6. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    International Nuclear Information System (INIS)

    Paik, Nam Chull

    2016-01-01

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  7. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    Energy Technology Data Exchange (ETDEWEB)

    Paik, Nam Chull, E-mail: pncspine@gmail.com [Arumdaun Wooldul Spine Hospital, Department of Radiology (Korea, Republic of)

    2016-07-15

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  8. Dosimetry in medical specialist in procedures of interventionist radiology; Dosimetria en medico especialista en procedimientos de radiologia intervencionista

    Energy Technology Data Exchange (ETDEWEB)

    Gaona, E. [Universidad Autonoma Metropolitana, Unidad Xochimilco, Calz. del Hueso 1100, Col. Villa Quietud, 04960 Mexico D. F. (Mexico); Vazquez V, J. A.; Rivera M, T. [IPN, Centro de Investigacion en Ciencia Aplicada y Tecnologia Avanzada, Av. Legaria 694, 11500 Mexico D. F. (Mexico); Izeta G, A. C. [Hospital Central Militar, Periferico y Av. Ejercito Nacional s/n, 11200 Mexico D. F. (Mexico); Azorin V, J. C. [Universidad de Guanajuato, Instituto de Fisica, Loma del Bosque 103, 37150 Leon, Guanajuato (Mexico); Arreola, M., E-mail: gaen1310@correo.xoc.uam.mx [Shands Hospital at University of Florida, Department of Radiology, PO Box 100374, Gainesville, FL 32610-0374 (United States)

    2014-08-15

    In this work are presented the experimental results of determining the dose in different body parts, measured by thermoluminescent dosimeters, to medical specialists of implantation procedures of definitive cardiac pacemaker. The medical personnel in ten intervention procedures were controlled according to the procedure type, pathological indication, fluoroscopy time and machine generating estimates of the patient doses. The doses to the extremities of the cardiologist were measured by means of thermoluminescent dosimeters (TLD). The domains of first level in the hand are in the index finger of the left and the right hand. The medium doses of the skin in the eyes, a report of the dose received during each type of intervention procedure in the glandular thyroid and fingers of the cardiologists is made. The results represent the integrated dose to the cardiologist, received during the implantation procedures of definitive cardiac pacemaker in the same patient. By a half time of detection of 70 minutes for patient, the half dose of the skin, received for the right and left hand, ascended to 1,4 mSv, under the glove. In conclusion, the dose average for the dosimeters of the thyroid gland and forehead was varied from 0,41 up to 1,14 mSv for study. The exposure to the X-rays is a topic to consider, more important every time on the development of systematic procedures little invasive, including the angiography, catheter, worker and patient. (Author)

  9. Radiochemical procedures

    International Nuclear Information System (INIS)

    Lyon, W.S.

    1982-01-01

    The modern counting instrumentation has largely obviated the need for separation processes in the radiochemical analysis but problems in low-level radioactivity measurement, environmental-type analyses, and special situations caused in the last years a renaissance of the need for separation techniques. Most of the radiochemical procedures, based on the classic works of the Manhattan Project chemists of the 1940's, were published in the National Nuclear Energy Series (NNES). Improvements such as new solvent extraction and ion exchange separations have been added to these methods throughout the years. Recently the Los Alamos Group have reissued their collected Radiochemical Procedures containing a short summary and review of basic inorganic chemistry - 'Chemistry of the Elements on the Basis of Electronic Configuration'. (A.L.)

  10. 26 CFR 25.6324-1 - Special lien for gift tax.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Special lien for gift tax. 25.6324-1 Section 25... GIFT TAXES GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 Procedure and Administration § 25.6324-1 Special lien for gift tax. For regulations concerning the special lien for the gift tax, see § 301.6324-1...

  11. ICRP PUBLICATION 121: Radiological Protection in Paediatric Diagnostic and Interventional Radiology

    International Nuclear Information System (INIS)

    Khong, P-L.; Ringertz, H.; Donoghue, V.; Frush, D.; Rehani, M.; Appelgate, K.; Sanchez, R.

    2013-01-01

    Paediatric patients have a higher average risk of developing cancer compared with adults receiving the same dose. The longer life expectancy in children allows more time for any harmful effects of radiation to manifest, and developing organs and tissues are more sensitive to the effects of radiation. This publication aims to provide guiding principles of radiological protection for referring clinicians and clinical staff performing diagnostic imaging and interventional procedures for paediatric patients. It begins with a brief description of the basic concepts of radiological protection, followed by the general aspects of radiological protection, including principles of justification and optimisation. Guidelines and suggestions for radiological protection in specific modalities – radiography and fluoroscopy, interventional radiology, and computed tomography – are subsequently covered in depth. The report concludes with a summary and recommendations. The importance of rigorous justification of radiological procedures is emphasised for every procedure involving ionising radiation, and the use of imaging modalities that are non-ionising should always be considered. The basic aim of optimisation of radiological protection is to adjust imaging parameters and institute protective measures such that the required image is obtained with the lowest possible dose of radiation, and that net benefit is maximised to maintain sufficient quality for diagnostic interpretation. Special consideration should be given to the availability of dose reduction measures when purchasing new imaging equipment for paediatric use. One of the unique aspects of paediatric imaging is with regards to the wide range in patient size (and weight), therefore requiring special attention to optimisation and modification of equipment, technique, and imaging parameters. Examples of good radiographic and fluoroscopic technique include attention to patient positioning, field size and adequate collimation

  12. Radiation field distribution within the room for three commonly-used interventional procedures

    International Nuclear Information System (INIS)

    Liu Changcai; Zhang Lin; Min Nan; Lu Feng; Li Quantai; Deng Daping; Chen Yue; Zhu Jianguo

    2014-01-01

    Objective: To detect the radiation field distribution within the room for three commonly-used interventional procedures, in order to provide basic data for the radiation protection and safe operation of staff involved in interventional radiology. Methods: The thermoluminescent dosemeters (TLDs) were placed in different points on the horizontal plane around the interventional table and the vertical plane where the staff often stayed. Based on the selected experimental conditions, the TLDs were grouped to be irradiated. After the experiment, the TLDs were measured in the laboratory to calculate the doses of radiation field. Results: Data obtained at the same position followed basically as cardiovascular intervention > cerebrovascular intervention > liver intervention. Intervention of same type at the same position followed as high-dose group > mid-dose group > low-dose group. These results were consistent with the useful beam doses, and proportional to the fluoroscopy time. A few data with exception were due to measurement error or experimental error. Conclusions: Cerebrovascular and liver interventional procedures resulted in the relatively low radiation doses. The radiation doses at the distance of more than 3 m can be negligible. For cardiovascular interventional procedure, with the decrease of the distance from the X-ray tube, the dose decreased. In the radiation field,the operator, the first assistant and second assistant would exposed to higher dose on the standing points while patients receive lower doses in the head and feet direction. (authors)

  13. Cath lab costs in patients undergoing percutaneous coronary angioplasty - detailed analysis of consecutive procedures.

    Science.gov (United States)

    Dziki, Beata; Miechowicz, Izabela; Iwachów, Piotr; Kuzemczak, Michał; Kałmucki, Piotr; Szyszka, Andrzej; Baszko, Artur; Siminiak, Tomasz

    2017-01-01

    Costs of percutaneous coronary interventions (PCI) have an important impact on health care expenditures. Despite the present stress upon the cost-effectiveness issues in medicine, few comprehensive data exist on costs and resource use in different clinical settings. To assess catheterisation laboratory costs related to use of drugs and single-use devices in patients undergoing PCI due to coronary artery disease. Retrospective analysis of 1500 consecutive PCIs (radial approach, n = 1103; femoral approach, n = 397) performed due to ST segment elevation myocardial infarction (STEMI; n = 345) and non ST-segment elevation myocardial infarction (NSTEMI; n = 426) as well as unstable angina (UA; n = 489) and stable angina (SA; n = 241) was undertaken. Comparative cost analysis was performed and shown in local currency units (PLN). The cath lab costs were higher in STEMI (4295.01 ± 2384.54PLN, p costs were positively correlated with X-ray dose, fluoroscopy, and total procedure times. Patients' age negatively correlated with cath lab costs in STEMI/NSTEMI patients. Cath lab costs were higher in STEMI patients compared to other groups. In STEMI/NSTEMI they were lower in older patients. In all analysed groups costs were related to the level of procedural difficulty. In female patients, the costs of PCI performed via radial approach were higher compared to femoral approach. Despite younger age, male patients underwent more expensive procedures.

  14. Radiation exposure evaluation of the professional working interventionist procedures in a hemodynamics service

    International Nuclear Information System (INIS)

    Da Silva, Leonardo Peres

    2004-01-01

    An evaluation of the dose distribution received by all the workers involved on coronary angioplasty, arteriography, coronary angiography and mitral valvuloplasty procedures has been made in this work. For the measurements, LiF:Mg, Ti TLD(TLD 100) was used, located in seven different points on the worker's body: hands, knees, neck, forehead and thorax, inside and outside lead apron.) The measurements have been done for each hemo dynamical procedure, and the TLD calibrated in personal dose equivalent (H p (d)) operational quantity for 0,07 mm, 3 mm and 10 mm depth. Nurses and auxiliary doctors did not receive expressive dose values, indicating that the adopted radioprotection procedures seem to be appropriate and sufficient for them. However, the same is not true for the doctors direct in charge of the procedure. The results show the importance of the use of thyroid protections in these cases. This work discusses the main factors that cause occupational dose increase. From all interventionist hemo dynamical procedures analyzed, the dose values received by the doctors on coronary angioplasty procedures and coronary angiography were higher than the ones found on arteriography and mitral valvuloplasty. The higher dose values has been found for coronary angiography procedures in X-ray tools, that work with fluoroscopy on continuous mode and have been executed with brachial way, even in the eyes, hands, knees and thyroid, with or without shield. Multiplying these high dose values, measured in one procedure by the mean number of annual procedures made at the studied hospital by each doctor, the individual dose annual limits can be surpassed. Based on these estimations, some optimizations suggestions have been made and one discussion about the need of additional monitoring points is presented. Different algorithms have been used in order to estimate the effective dose, including a new proposal. The obtained results using the actual Radiodiagnostic Brazilian regulation

  15. Increasing Access to Special Collections

    Directory of Open Access Journals (Sweden)

    Ricky Erway

    2012-01-01

    Full Text Available In an environment where we increasingly have access to a collective collection of digitized books, special collections will become increasingly invisible if they are not accessible online. In an era of increasing expectations and decreasing budgets, finding ways to streamline some of our processes is the best way to enable us to do more with less. This report details a number of investigations into how access to special collections can be increased. It includes guidance running the gamut from digitization and rights management to policies and procedures.

  16. Unique migration of a dental needle into the parapharyngeal space: successful removal by an intraoral approach and simulation for tracking visibility in X-ray fluoroscopy.

    Science.gov (United States)

    Okumura, Yuri; Hidaka, Hiroshi; Seiji, Kazumasa; Nomura, Kazuhiro; Takata, Yusuke; Suzuki, Takahiro; Katori, Yukio

    2015-02-01

    The first objective was to describe a novel case of migration of a broken dental needle into the parapharyngeal space. The second was to address the importance of simulation elucidating visualization of such a thin needle under X-ray fluoroscopy. Clinical case records (including computed tomography [CT] and surgical approaches) were reviewed, and a simulation experiment using a head phantom was conducted using the same settings applied intraoperatively. A 36-year-old man was referred after failure to locate a broken 31-G dental needle. Computed tomography revealed migration of the needle into the parapharyngeal space. Intraoperative X-ray fluoroscopy failed to identify the needle, so a steel wire was applied as a reference during X-ray to locate the foreign body. The needle was successfully removed using an intraoral approach with tonsillectomy under surgical microscopy. The simulation showed that the dental needle was able to be identified only after applying an appropriate compensating filter, contrasting with the steel wire. Meticulous preoperative simulation regarding visual identification of dental needle foreign bodies is mandatory. Intraoperative radiography and an intraoral approach with tonsillectomy under surgical microscopy offer benefits for accessing the parapharyngeal space, specifically for cases medial to the great vessels. © The Author(s) 2014.

  17. 19 CFR 12.99 - Procedures for permitted entry.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Procedures for permitted entry. 12.99 Section 12.99 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY SPECIAL CLASSES OF MERCHANDISE Switchblade Knives § 12.99 Procedures for permitted entry...

  18. A patient dose survey or femoral arteriogram diagnostic radiographic examinations using a dose-area product meter

    International Nuclear Information System (INIS)

    Thwaites, J.H.; Rafferty, M.W.; Gray, N.; Black, J.; Stock, B.

    1996-01-01

    We present a method for dealing with a complex radiographic procedure (which involves multiple radiographs and fluoroscopy) in an attempt to provide a simple way of calculating effective dose from which a general risk factor can be determined. A useful index of harm can be obtained by recording the number of radiographs in each region, and the fluoroscopy time, from which the effective dose may be easily calculated. A patient dose survey was carried out using a PTW diamentor for femoral arteriogram procedures in a large teaching hospital. The procedure involves fluoroscopy to the pelvic region to locate a guide wire and catheter, followed by a series of radiographs extending from the pelvic area to the feet to form a collage image of the entire arterial system. Radiographs are taken whilst a bolus of contrast media is injected into the arterial system. The measurements extend a continuing survey of doses for common diagnostic radiographic examinations which have previously included the simple examinations of lumbar spine, abdomen and pelvis. (Author)

  19. Competence and lastingness in specialized clinical laboratories: technical report about requirements concerning quality of users competence and used processes in immunochemical diagnostic procedures using isotopic and non-isotopic tracer technologies

    International Nuclear Information System (INIS)

    Wiegel, B.

    2005-01-01

    From the citizens view this technical report about immunochemical diagnostic procedures using radioactive and nonradioactive tracer technologies describes the requirements in special laboratory diagnostics concerning competency and process control. Governmental or administrational obligations of inspecting both skill and sites to guarantee patients security are pointed out. (orig.)

  20. 正确使用数字减影血管造影机减少介入手术中的辐射吸收剂量%Reducing the absorbed dose of radiation in interventional procedures by using digital subtraction angiography machine correctly

    Institute of Scientific and Technical Information of China (English)

    于曰俊

    2012-01-01

    目的:通过分析介入手术治疗中数字减影血管造影(DSA)参数,探讨减少辐射吸收剂量的途径及防护方法。方法:对随机选取的1200例各类介入手术操作时DSA机器的管电压、管电流和透视时间的资料进行统计分析,研究在介入手术治疗中影响吸收剂量的相关因素。结果:心脏冠状动脉支架术和室上速射频消融术所需透视时间最长,此时的管电流、管电压数值最大,因此应特别注意在行心脏介入手术治疗过程中的吸收剂量,并做好辐射防护。结论:合理应用DSA机器,正确使用缩光器、减少透视时间和每秒脉冲率是减少吸收剂量的有效方法。%Objective: To explore the approach of reducing the absorbed dose of radiation and radiation protection method by analyzing the parameters of digital subtraction angiography (DSA) machine in interventional operations. Methods: The data about the kilovoltage (kV), milliampere (mA) and fluoroscopy time of DSA machines in 1200 cases of various interventional procedures were analyzed to investigate the factors affecting the absorbed dose of radiation in the interventional procedures. Results: The fluoroscopy time was the longest and the values of the kV and mA were the highest in the procedures of percutaneous intracoronary stent implantation and cardiac radiofrequency catheter ablation, so measures for radiation protection should be emphasized in order to reduce the absorbed dose of radiation in cardiac interventional procedure. Conclusion: Rational utilization of DSA machine in shortening fluoroscopy time and decreasing pulse rate per second can reduce the absorbed dose of radiation effectively in interventional operations.

  1. 46 CFR 153.1000 - Special operating requirements for cargoes reactive with water.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Special operating requirements for cargoes reactive with water. 153.1000 Section 153.1000 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... MATERIALS Operations Special Cargo Procedures § 153.1000 Special operating requirements for cargoes reactive...

  2. How to test the special theory of relativity on rotating earth

    International Nuclear Information System (INIS)

    Abolghasem, H.; Khadjehpoor, M.R.; Mansouri, R.

    1988-02-01

    In the framework of a one parameter test theory of special relativity, the difference between Transport- and Einstein synchronization on the rotating earth is calculated. For the special theory of relativity this difference vanishes. Therefore, experiments in which these synchronization procedures are compared, test the special theory of relativity. (author). 8 refs

  3. Trip generation characteristics of special generators

    Science.gov (United States)

    2010-03-01

    Special generators are introduced in the sequential four-step modeling procedure to represent certain types of facilities whose trip generation characteristics are not fully captured by the standard trip generation module. They are also used in the t...

  4. Decreasing radiation doses in digital subtraction angiographies consecutively performed by trainees

    International Nuclear Information System (INIS)

    Xu, G.; Zhao, W.; Zheng, L.; Fan, X.; Yin, Q.; Liu, X.

    2012-01-01

    Digital subtraction angiography (DSA) performed by trainees may be related to increased radiation exposure. This study was aimed to investigate and quantify this learning effect, with fluoroscopy time and dose-area product (DAP) as parameters. We collected procedure data of the first to the fortieth cerebral DSA consecutively performed by 13 trainees in a training centre. DAP, procedure time, fluoroscopy time, number of cine-frames of the first 20 DSA procedures performed by these trainees were compared with that of the second 20 procedures. There was no significant difference concerning the procedure time between the first and the second 20 procedures (56.3 ±29.5 vs 51.5±20.2 min, p = 0.113). Numbers of cine-frames were very similar between the first and the second 20 procedures (750.7 ±290.3 vs 744.5 ±188.7, p = 0.830). Fluoroscopy time of the first 20 procedures was significantly longer than that of the second 20 procedures (17.8 ±15.4 vs 12.6 ±9.0, p = 0.001). DAP of the first 20 procedures was significantly higher than that of the second 20 procedures (6.4 ±4.9 vs 3.8 ±1.8, p < 0.001). DAP was correlated significantly with the performer's experience (R = -0.288, p < 0.001). There exists a learning effect of radiation exposure during cerebral DSA procedures performed by trainees. The learning effect is significant during the first 20 procedures, and becomes insignificant after 20 procedures. Insufficient catheter skills in novice trainees may be one reason for this effect. (authors)

  5. 47 CFR 80.319 - Radiotelegraph distress call and message transmission procedure.

    Science.gov (United States)

    2010-10-01

    ...) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Safety Watch Requirements and Procedures Distress, Alarm, Urgency and Safety Procedures § 80.319 Radiotelegraph distress call and message...

  6. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)—Results of the FERARI study

    Energy Technology Data Exchange (ETDEWEB)

    Becher, Tobias, E-mail: Tobias.Becher@umm.de [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Mashayekhi, Kambis [Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen (Germany); Borggrefe, Martin; Akin, Ibrahim [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany)

    2016-12-15

    Summary: Background: Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. Methods: The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose–area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Results: Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8 min, p = 0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p = 0.826), procedural duration (46.0 vs. 45.0 min, p = 0.363) and contrast agent use (185.5 vs. 199.5 ml, p = 0.742) were also similar in radial and femoral PCI. Conclusion: There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. - Highlights: • Data comparing radiation exposure in radial versus femoral PCI remain controversial. • 400 enrolled in the FERARI study were prospectively evaluated. • There was no difference regarding radiation exposure in radial versus femoral access. • Furthermore, there was no significant difference regarding contrast agent use.

  7. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)—Results of the FERARI study

    International Nuclear Information System (INIS)

    Becher, Tobias; Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula; Mashayekhi, Kambis; Borggrefe, Martin; Akin, Ibrahim

    2016-01-01

    Summary: Background: Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. Methods: The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose–area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Results: Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8 min, p = 0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p = 0.826), procedural duration (46.0 vs. 45.0 min, p = 0.363) and contrast agent use (185.5 vs. 199.5 ml, p = 0.742) were also similar in radial and femoral PCI. Conclusion: There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. - Highlights: • Data comparing radiation exposure in radial versus femoral PCI remain controversial. • 400 enrolled in the FERARI study were prospectively evaluated. • There was no difference regarding radiation exposure in radial versus femoral access. • Furthermore, there was no significant difference regarding contrast agent use

  8. Radiofrequency ablation of pulmonary metastasis from colorectal cancer - follow up radiological appearances and results

    International Nuclear Information System (INIS)

    Chai, D.; Glenn, D.

    2002-01-01

    Full text: Tumour ablation with radiofrequency (RF) energy is a relatively new procedure for the treatment of focal malignant disease. Several published trials show the benefit of this procedure in the treatment of malignant liver lesions, however, there are few trials on the benefits of treating pulmonary metastases in this way. The first 14 patients having RF ablation of pulmonary metastases from colorectal cancer (CRC) have been followed. 11 had their RF ablation performed at St George Public Hospital under CT fluoroscopy, 3 under fluoroscopy at St George Private Hospital. Complications from the procedure are described, as well as follow up appearances and results. The only significant complications described so far are five pneumothoraces, three requiring treatment with one needing extended hospital admission. Intraprocedural parenchymal haemorrhage, and changes of consolidation in surrounding lung not causing significant clinical symptoms were also found. One case of post procedure pneumonia occurred. Minor haemoptysis also occurred. Successfully ablated lesions show and increase in size in the one week and one month CT scans, but then progressively fall in size. Some show cavitation, which resolves. No significant detrimental impact on quality of life has so far been found, but medium and long-term effects are yet to be studied. RF ablation of pulmonary metastases from CRC, while still at its early stages, shows promise as a possible second line treatment (with other adjuvant therapy) for the management of focal malignant disease in the lung. CT fluoroscopy/fluoroscopy is a viable method for electrode placement and is performed this way at our institution. Copyright (2002) Blackwell Science Pty Ltd

  9. Guide and manual of frequent special radiological procedures pertaining frequent pediatric patient

    International Nuclear Information System (INIS)

    Quesada Rodriguez, Marco V.

    2012-01-01

    A set of instructions and / or recommendations are afforded, developed in a systematic way, whose purpose is to help treating doctors to make decisions about the mode of study appropriate for a specialized clinical circumstance. The instructions are aimed at radiologists, in order to facilitate the selection and realization of special studies in the pediatric patient images, so that in this way, guide of the best and most efficient way to the resolution of the cases before diagnostic doubts that seek to clarify the treating clinician. The studies most frequently requested are exposed, as well as those with their prompt realization will lead to a quick and timely medical care and / or surgical of a specific problem [es

  10. 32 CFR 516.72 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... RELATIONS LITIGATION Cooperation With the Office of Special Counsel § 516.72 Procedures. (a) Witnesses and... government agencies in the normal course of official business. Records constituting attorney work product... funding for travel, per diem and other necessary expenses related to the OSC investigation. These expenses...

  11. Patient Dose Considerations in Interventional Cardiology

    International Nuclear Information System (INIS)

    Ciraj-Bjelac, O.; Rafajlovic, S.; Arandjic, D.; Kosutic, D.

    2011-01-01

    Interventional cardiology procedures are classified as high-dose procedures, owing to increased risk for radiation skin injuries and stochastic effects, such as cancer. European MED Directive 97/43 requires special consideration and dose evaluation for this kind of procedures . Dose received by a patient, in general, depends on the radiological equipment, examination protocol, the way it is implemented, the patient's body weight and nature of disease. Long-term fluoroscopy of certain parts of the body, a significant body mass, high-value dose intensity, continuous rather than pulsed fluoroscopy, small focus-skin distance and repeated procedure on the same patient, are among the factors that can lead to radiation skin injuries. A particular challenge is the fact that the radiation damage of the skin is difficult to detect and connect to the previously conducted cardiologic procedures. The fact that such injuries do not have immediate manifestation is very often reason that many of them remain undetected. The purpose of this work is to assess the level of radiation dose to patients in percutaneous coronary interventions (PCI) and to investigate possibility for setting of a practical trigger value if dose quantities exceed certain levels in terms of dose descriptors available at display of interventional cardiology unit. Two dedicated interventional cardiology units in a large teaching cardiac centre (Clinical Centre of Serbia, Belgrade, Serbia) were included in the survey. Both rooms (D and F) were equipped with X-ray units of the identical model: Siemens Axiom Artis (Siemens, Erlangen, Germany) with the flat panel detector and integrated ionization chamber to measure air kerma-area product (P K A) and air kerma in international reference point (K I RP). Patient doses were assessed in terms of P K A, K I RP and maximum-skin dose (MSD). P K A and K I RP were assessed using a built-in, in situ calibrated dosimeters, while MSD was estimated using radiochromic films

  12. Patient radiation doses in the most common interventional cardiology procedures in croatia: First results

    International Nuclear Information System (INIS)

    Brnic, Z.; Krpan, T.; Faj, D.; Kubelka, D.; Ramac, J. P.; Posedel, D.; Steiner, R.; Vidjak, V.; Brnic, V.; Viskovic, K.; Baraban, V.

    2010-01-01

    Apart from its benefits, the interventional cardiology (IC) is known to generate high radiation doses to patients and medical staff involved. The European Union Medical Exposures Directive 97/43/EURATOM strongly recommend patient dosimetry in interventional radiology, including IC. IC patient radiation doses in four representative IC rooms in Croatia were investigated. Setting reference levels for these procedures have difficulties due to the large difference in procedure complexity. Nevertheless, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high-dose procedures. Local and national diagnostic reference levels (DRLs) were proposed as a guidance. A total of 138 diagnostic (coronary angiography, CA) and 151 therapeutic (PTCA, stenting) procedures were included. Patient irradiation was measured in terms of kerma-area product (KAP), fluoroscopy time (FT) and number of cine-frames (F). KAP was recorded using calibrated KAP-meters. DRLs of KAP, FT and F were calculated as third quartile values rounded up to the integer. Skin doses were assessed on a selected sample of high skin dose procedures, using radiochromic films, and peak skin doses (PSD) were presented. A relative large range of doses in IC was detected. National DRLs were proposed as follows: 32 Gy cm 2 , 6.6 min and 610 frames for CA and 72 Gy cm 2 , 19 min and 1270 frames for PTCA. PSD 2 Gy in 8% of selected patients. Measuring the patient doses in radiological procedures is required by law, but rarely implemented in Croatia. The doses recorded in the study are acceptable when compared with the literature, but optimisation is possible. The preliminary DRL values proposed may be used as a guideline for local departments, and should be a basis for radiation reduction measures and quality assurance programmes in IC in Croatia. (authors)

  13. Pneumomediastinum after odontologic procedure

    International Nuclear Information System (INIS)

    Olivella C, Fabio Alejandro; Bermudez G, Mary; Hidalgo M, Patricia; Sanchez M, Jully Mariana; Solarte R, Ivan; Uriza C, Felipe

    2005-01-01

    The sudden increase in alveolar pressure is a frequent cause of pneumomediastinum, but there are other reasons that could lead to it such as airway or esophagus trauma. The pneumomediastinum, which has been produced after dental procedures, is very rare and product deserves special attention by dentists and medical personnel in order to get its soon recognition and handling

  14. An audit of diagnostic reference levels in interventional cardiology and radiology: Are there differences between academic and non-academic centres?

    International Nuclear Information System (INIS)

    Samara, E. T.; Aroua, A.; De palma, R.; Stauffer, J. C.; Schmidt, S.; Trueb, P. R.; Stuessi, A.; Treier, R.; Bochud, F.; Verdun, F. R.

    2012-01-01

    A wide variation in patient exposure has been observed in interventional radiology and cardiology. The purpose of this study was to investigate the patient dose from fluoroscopy-guided procedures performed in non-academic centres when compared with academic centres. Four procedures (coronary angiography, percutaneous coronary intervention, angiography of the lower limbs and percutaneous transluminal angioplasty of the lower limbs) were evaluated. Data on the dose-area product, fluoroscopy time and number of images for 1000 procedures were obtained from 23 non-academic centres and compared with data from 5 academic centres. No differences were found for cardiology procedures performed in non-academic centres versus academic ones. However, significantly lower doses were delivered to patients for procedures of the lower limbs when they were performed in non-academic centres. This may be due to more complex procedures performed in the academic centres. Comparison between the centres showed a great variation in the patient dose for these lower limb procedures. (authors)

  15. The clinical efficacy observation of fluoroscopy-guided foam sclerotherapy with lauromacrogol for varicose veins of the lower extremities

    International Nuclear Information System (INIS)

    Zhu Yongqiang; Xu Jingxuan; Chen Junying; Wu Yan; Zhang Chuanhong; Li Liang

    2012-01-01

    Objective: To assess the clinical efficacy of foam sclerotherapy with lauromacrogol for varicose veins of the lower extremities. Methods: During the period from February to July 2011, we retrospectively analyzed 20 patients with varicose veins of the lower extremities, who were treated with lauromacrogol foam sclerosing agent injected directly at varicose veins, and in 5 extremities injected at the great saphenous vein (GSV) through a catheter at the same time. Elastic bandages were applied at the site of the injected varicosities after the therapy. The clogging of the varicose veins, the improvement of the clinical symptoms and the adverse reaction were observed. Results: Lauromacrogol foam sclerosing agent was successfully injected under the guidance of fluoroscopy in 20 patients with 28 affected extremities. The average volume of foam sclerosing agent in each affected extremity was 7.8 ml. All patients presented self limiting minor complications, including swelling and pain, which was obviously alleviated by the externally applied Mucopolysaccharide Polysulfate Cream. Two patients presented cough that was relieved after inhaling oxygen. Most of treated varicosities demonstrated pigmentation after the first week, which gradually disappeared after the four-month use of vitamin E capsule. A second foam sclerotherapy was carried out for 3 affected extremities of 3 patients two months after the first therapy. Two cases of leg venous ulcer were healed within a few weeks. All patients could walk immediately with no deep vein thrombosis, pulmonary embolism, anaphylaxis, or transient visual disturbance. Obvious abnormal varicose veins as well as the soreness and fatigue of the lower extremities disappeared in all patients at the 10th-month follow-up. The grading of the disease was significantly improved by the treatment (Z=5.103, P<0.01). Conclusions: The efficacy of lauromacrogol foam sclerosing agent in the treatment of varicose veins of the lower extremities is

  16. Anatomic landmarks of fluoroscopy guided puncture of the pulseless femoral artery

    International Nuclear Information System (INIS)

    Jeon, Min Hee; Han, Gi Seok; Kim, Sung Jin; Park, Kil Sun; Cha, Sang Hoon; Bae, Il Hun; Lee, Seung Young

    2006-01-01

    We wanted to improve puncturing the pulseless femoral artery by evaluating the anatomic landmarks that suggest the course of the femoral artery on fluoroscopy. We analyzed 37 hemipelvis spot images that were centered on the arterial sheath after puncture of the femoral artery. The inguinal angles were measured between the inguinal line connecting the anterior superior iliac spine and the symphysis pubis, and the line of the arterial sheath. Inguinal ligament ratios were measured as the distance from the symphysis pubis to the arterial sheath to the length of the inguinal ligament on the inguinal line. The femoral head ratios were measured as the distance from the medial margin of the femur head to the arterial sheath to the transverse length of the femur head. The mean inguinal angle was 66.5 and the mean inguinal ligament ratio was 0.42 (± 0.03). The mean femoral head ratio was 0.08 (± 0.18). In comparing the men and women, there was no significant difference in the inguinal angle and the femoral head ratio, but the inguinal distance ratio was larger in women (men: 0.41 ± 0.033, women: 0.44 ± 0.031, ρ < 0.05). The femoral artery generally courses just lateral to the medial margin of the femur head (femoral head ratio: 0.08) and the medial 40% of the inguinal ligament (inguinal ligament ratio: 0.42). So, consideration of these relations may be helpful for puncturing the pulseless femoral artery

  17. 48 CFR 17.403 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... CONTRACT TYPES SPECIAL CONTRACTING METHODS Leader Company Contracting 17.403 Procedures. (a) The contracting officer may award a prime contract to a— (1) Leader company, obligating it to subcontract a designated portion of the required end items to a specified follower company and to assist it to produce the...

  18. SOME CONSIDERATIONS REGARDING THE AD-HOC INTERNAL ARBITRATION PROCEDURE IN THE NEW CODE OF CIVIL PROCEDURE

    Directory of Open Access Journals (Sweden)

    Daniela Cristina Creţ

    2013-12-01

    Full Text Available One of the institutions to have undergone essential changes as a result of the 2013 entry into force of the New Code of civil procedure is arbitration. Arbitration is an alternative way of settling conflicts by means of a specialized person or institution, based on the will of the parties or on an international convention. This article will present a few introductory aspects that are essential for a foray into the field, as well as analyze the main aspects of arbitral procedure from the perspective of novelties and changes brought to the provisions of the New Code of civil procedure (hereinafter referred to as N.C.C.P..

  19. Prospective survey on the incidence of chest malignancies after repeated fluoroscopy during artificial pneumothorax therapy for pulmonary tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Kitabatake, T; Kurokawa, S; Yamasaki, M; Sato, T; Kurokawa, H [Niigata Univ. (Japan). School of Medicine

    1975-10-01

    Patients with pulmonary tuberculosis treated in 4 sanatoria in Niigata Prefecture between 1941 and 1961 were followed up by a mail questionnaire. Of 2756 patients, 1193 responded and sent back effective information, letters to 1224 were returned because of uncertain or unknown new address, 326 did not respond, and 13 were excluded because of incomplete answers. Out of the 1193 effective responders, 568 had been treated by artificial pneumothorax (the pneumothorax group), and 552 had not been treated by pneumothorax (the control group). There were 65 deaths in the pneumothorax group, but none of them were from chest malignancies; and 40 deaths in the control group with 4 from chest malignancies. In this survey, there was no evidence of an increased number of chest malignancies (including leukemia) after pneumothorax fluoroscopy.

  20. Fluoroscopy-Guided Removal of Pull-Type Gastrostomy Tubes

    International Nuclear Information System (INIS)

    Ahlers, Christopher M.; Schneider, Jens; Lachmann, Ricarda; Herber, Sascha; Dueber, Christoph; Pitton, Michael B.

    2008-01-01

    These case reports demonstrate a radiologic interventional technique for removal of pull-type gastrostomy tubes. This approach proved to be a safe and efficient procedure in two patients. The procedure may be applicable in situations where endoscopic attempts fail.

  1. Analysis of X-ray radiation doses from different types of intervention for cardiovascular patients

    International Nuclear Information System (INIS)

    Feng Jun; Cheng Jinglin; Guo Jie; Wang Ailing

    2012-01-01

    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·cm 2 , 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. (authors)

  2. Morphology and function of the forelimb in arboreal frogs: specializations for grasping ability?

    Science.gov (United States)

    Manzano, Adriana S; Abdala, Virginia; Herrel, Anthony

    2008-09-01

    Frogs are characterized by a unique morphology associated with their saltatory lifestyle. Although variation in the form and function of the pelvic girdle and associated appendicular system related to specialized locomotor modes such as swimming or burrowing has been documented, the forelimbs have typically been viewed as relatively unspecialized. Yet, previous authors have noted versatility in forelimb function among arboreal frogs associated with feeding. Here we study the morphology and function of the forelimb and hand during locomotion in two species of arboreal frogs (Litoria caerulea and Phyllomedusa bicolor). Our data show a complex arrangement of the distal forelimb and hand musculature with some notable differences between species. Analyses of high-speed video and video fluoroscopy recordings show that forelimbs are used in alternating fashion in a diagonal sequence footfall pattern and that the position of the hand is adjusted when walking on substrates of different diameters. Electromyographic recordings show that the flexors of the hand are active during substrate contact, suggesting the use of gripping to generate a stabilizing torque. Measurements of grasping forces in vivo and during stimulation experiments show that both species, are capable of executing a so-called power grip but also indicates marked differences between species, in the magnitude of forces generated. Stimulation experiments showed an increased control of digit flexion in the more specialized of the two species, allowing it to execute a precision grip paralleled only by that seen in primates.

  3. Feasibility and safety of transfemoral intra-arterial chemotherapy for head and neck cancer using a 3-French catheter system: comparison with a 4-French catheter system.

    Science.gov (United States)

    Watanabe, Shigeru; Yamamoto, Akira; Torigoe, Teruyuki; Kanki, Akihiko; Tamada, Tsutomu; Ito, Katsuyoshi

    2016-02-01

    To assess the technical feasibility of transfemoral intra-arterial chemotherapy for head and neck cancer using a 3-French catheter system (3-Fr). Sixty-two patients with head and neck cancer who underwent transfemoral intra-arterial chemotherapy were included in this study. Thirty-three patients underwent treatment using a 3-Fr (group 3-Fr). Twenty-nine patients underwent treatment using a 4-French catheter system (group 4-Fr). The technical success rate, duration of the procedure with fluoroscopy, and rate of procedure-related complications were compared between group 3-Fr and group 4-Fr. In addition, in group 3-Fr, bleeding at the puncture site after 1.5 h of bed rest was evaluated. The technical success rate was 100% in both groups. The duration of the procedure with fluoroscopy didn't differ between group 3-Fr (mean 28.0 min) and group 4-Fr (mean 30.2 min) (p = 0.524). There was no procedure-related complication in either group. In group 3-Fr, no hemorrhagic complication was observed. A 3-French catheter system can be used to perform transfemoral intra-arterial chemotherapy for head and neck cancer and is technically feasible with approximately the same duration of the procedure with fluoroscopy. Furthermore, this method may shorten the bed rest time without hemorrhagic complication, and may reduce the risk of pulmonary embolism.

  4. Control of Nuclear Materials and Special Equipment (Nuclear Safety Regulations)

    International Nuclear Information System (INIS)

    Cizmek, A.; Prah, M.; Medakovic, S.; Ilijas, B.

    2008-01-01

    Based on Nuclear Safety Act (OG 173/03) the State Office for Nuclear Safety (SONS) in 2008 adopted beside Ordinance on performing nuclear activities (OG 74/06) and Ordinance on special conditions for individual activities to be performed by expert organizations which perform activities in the area of nuclear safety (OG 74/06) the new Ordinance on the control of nuclear material and special equipment (OG 15/08). Ordinance on the control of nuclear material and special equipment lays down the list of nuclear materials and special equipment as well as of nuclear activities covered by the system of control of production of special equipment and non-nuclear material, the procedure for notifying the intention to and filing the application for a license to carry out nuclear activities, and the format and contents of the forms for doing so. This Ordinance also lays down the manner in which nuclear material records have to be kept, the procedure for notifying the State administration organization (regulatory body) responsible for nuclear safety by the nuclear material user, and the keeping of registers of nuclear activities, nuclear material and special equipment by the State administration organization (regulatory body) responsible for nuclear safety, as well as the form and content of official nuclear safety inspector identification card and badge.(author)

  5. INITIATION AND CONDUCT OF ADMINISTRATIVE PROCEDURE

    Directory of Open Access Journals (Sweden)

    Milan Stipic

    2013-12-01

    Full Text Available General administrative procedure act contains legal norms that are valid for all identical cases. In addition to the general, there are special administrative procedures, customized to the specific administrative areas. Procedure initiation is regulated. Administrative procedure can be initiated at the request of the proponent and ex officio. When the official determines that the conditions for the conduct of administrative procedure are met, before making a decision, all the facts and circumstances relevant to the resolution of administrative matter have to be identified. When there are no legal requirements for the initiation of procedures, the official shall make a decision to reject the application of the party. The procedure is initiated ex officio when stipulated by law or when protection of public interest requires it. When initiating procedure ex officio, the public authority shall take into consideration the petition or other information that indicate the need to protect the public interest. In such cases the applicant is not a party, and the official is obliged to notify the applicant, if initiation of procedures is not accepted ex officio. Based on the notification, the applicant has a right to complain, including the situation when there is no response within the prescribed period of 30 days. Public authority may, therefore it is not obliged to, initiate administrative procedure by public announcement only in a situation where the parties are unknown, while it is obliged to initiate procedure by public announcement when this method of initiating the procedure is prescribed by law. Initiation of procedure with public announcement occurs in rare cases. Due to the application of efficiency and cost-effectiveness principle, two or more administrative procedures can be merged into one procedure by a conclusion. The condition for this is that the rights or obligations of the parties are based on the same legal basis and on the same or

  6. MEDIATION IN THE OFFENCES FROM THE SPECIAL LAWS

    Directory of Open Access Journals (Sweden)

    Gabriel-Cristian Constantinescu

    2016-11-01

    Full Text Available Changesin Romanian penal laws coming into force from 1st February 2014 brought an increasing number of offenses for which it is possible a penal mediation, including the offenses from the special laws (not included in the main Penal Code, for which the withdrawal of the advance complaint or the reconciliation of the parties removes the penal responsibility. These offences from the special laws are reviewed and detailed by the author with the mark of the removal mode of the penal responsibility, achieving a practical table for practitioners. Mediation procedure in the special laws crimes is similar into the general criminal mediation, but the application of the most favourable in time law may require special attention.

  7. Children with Epilepsy in School: Special Service Usage and Assessment Practices

    Science.gov (United States)

    Wodrich, David L.; Kaplan, Allen M.; Deering, William M.

    2006-01-01

    Special services usage and related assessment procedures were investigated for 50 students with epilepsy. Fifty-six percent of students with epilepsy received special education services, with mental retardation designation and self-contained placement common, especially among individuals with epilepsy plus a coexisting neurological diagnosis.…

  8. Intraoperative three-dimensional fluoroscopy after transpedicular positioning of Kirschner-wire versus conventional intraoperative biplanar fluoroscopic control: A retrospective study of 345 patients and 1880 pedicle screws

    Directory of Open Access Journals (Sweden)

    Ghassan Kerry

    2014-01-01

    Full Text Available Study Design: Retrospective study. Objective: The aim was to find out whether intraoperative three-dimensional imaging after transpedicular positioning of Kirschner wire (K-wire in lumbar and thoracic posterior instrumentation procedures is of benefit to the patients and if this technique is accurately enough to make a postoperative screw position control through computer tomography (CT dispensable. Patients and Methods: Lumbar and thoracic posterior instrumentation procedures conducted at our department between 2002 and 2012 were retrospectively reviewed. The patients were divided into two groups: group A, including patients who underwent intraoperative three-dimensional scan after transpedicular positioning of the K-wire and group B, including patients who underwent only intraoperative biplanar fluoroscopy. An early postoperative CT of the instrumented section was done in all cases to assess the screw position. The rate of immediate intraoperative correction of the K-wires in cases of mal-positioning, as well as the rate of postoperative screw revisions, was measured. Results: In general, 345 patients (1880 screws were reviewed and divided into two groups; group A with 225 patients (1218 screws and group B with 120 patients (662 screws. One patient (0.44% (one screw [0.082%] of group A underwent postoperative screw correction while screw revisions were necessary in 14 patients (11.7% (28 screws [4.2%] of group B. Twenty-three patients (10.2% (28 K-wires [2.3%] of group A underwent intraoperative correction due to primary intraoperative detected K-wire mal-position. None of the corrected K-wires resulted in a corresponding neurological deficit. Conclusion: Three-dimensional imaging after transpedicular K-wire positioning leads to solid intraoperative identification of misplaced K-wires prior to screw placement and reduces screw revision rates compared with conventional fluoroscopic control. When no clinical deterioration emerges, a

  9. 28 CFR 13.4 - Procedures: Responsibilities of the Attorney General.

    Science.gov (United States)

    2010-07-01

    ... SPECIAL NUCLEAR MATERIALS REWARDS REGULATIONS § 13.4 Procedures: Responsibilities of the Attorney General... Special Nuclear Materials Rewards Act, the Attorney General shall: (a) Refer such submission for review to... whether that alien and members of his immediate family may receive immigrant visas and be admitted to the...

  10. MR-guided pain therapy: principles and clinical applications; MR-gesteuerte Schmerztherapie: Prinzipien und klinische Applikationen

    Energy Technology Data Exchange (ETDEWEB)

    Fritz, J.; Pereira, P.L. [Diagnostische Radiologie, Eberhard-Karls-Universitaet, Tuebingen (Germany)

    2007-09-15

    X-ray fluoroscopy and computed tomography are frequently used to perform percutaneous interventions in pain therapy. The development of MR-compatible therapy needles now allows these interventions to be performed under MR imaging guidance. MR-guided interventions may be performed using most clinical MR scanners; however, systems with an open configuration are advantageous. Multiplanar pre- and intra-procedural MR imaging provides the interventionalist with essential information, such as evaluation of anatomy and pathology, as well as the planning of the procedure and monitoring of fluid distribution without the use of contrast agents. With the use of non-ionizing radiation, interventional MR imaging is especially suited for the treatment of children and young adults as well as for serial injection therapy. For spinal MR interventions, passive needle visualization is an easily achievable and reliable method. The resulting needle artifact is influenced by several factors such as the alloy of the needle, the strength of the static magnetic field, the sequence type, the spatial orientation of the therapy needle as well as the echo time and may further be optimized during the intervention by alteration of the last three factors. Fast acquisition techniques and image processing allow for continuous, near real-time MR imaging (so-called MR fluoroscopy) and interactive needle navigations, comparable to X-ray fluoroscopy and CT fluoroscopy. The purpose of this review is to illustrate and discuss general concepts of interventional MR imaging. A spectrum of interventional MR imaging procedures in spinal pain therapy is described and illustrated, including procedures such as lumbar facet joint injections, sacroiliac joint injections, lumbar spinal nerve root infiltrations and drug delivery to the lumbar sympathetic chain. (orig.)

  11. Successful Localization and Surgical Removal of Ingested Sewing Needles Under Mini C-Arm Fluoroscopy: A Case Report

    Directory of Open Access Journals (Sweden)

    Cheng-Jen Ma

    2006-09-01

    Full Text Available Foreign body ingestion is common, but ingestion of multiple sewing needles is rare. Most ingested sharp metallic bodies pass through the digestive tract spontaneously and patients can be managed conservatively. Sometimes, however, perforation develops and surgical treatment is necessary. It is hard to localize ingested sewing needles because they tend to scatter widely in the digestive tract and are impalpable manually. We report a psychiatric patient who ingested six sewing needles: one intact needle was found at the larynx, one had penetrated into the stomach, one was in the duodenum, one was in the cecum, one was broken into two pieces, and the final needle was broken into three pieces. All of the broken fragments were in the colon. The needle at the larynx was removed by a laryngoscope. Subsequently, we used mini C-arm fluoroscopy to localize the remaining needles and successfully removed all of them intraoperatively.

  12. Approach of forensic medicine to gossypiboma.

    Science.gov (United States)

    Karakaya, M Arif; Koç, Okay; Ekiz, Feza; Ağaçhan, A Feran

    2015-01-01

    The aim of this study was to assess the risk factors and preventive measures for gossypibomas and their medico-legal implications in forensic medicine in the Turkish legal system. This study involved a retrospective analysis of the records of 39 patients with gossypiboma. Records were available from the Istanbul Forensic Medicine Institution and were surveyed for faulty treatment between 2008 and 2012. Parameters such as distribution of the cases according to specializations, elective and emergency procedures, surgical procedures, radio-opaque sponge and fluoroscopy availability, routine sponge and instrument counting, number of nurses for counting, and control of the operative field by a second surgeon were investigated. All cases were evaluated by the Istanbul Forensic Medicine Institute 3rd Expertise Committee. This committee comprised of specialists from the departments of forensic medicine, orthopedics and traumatology, general surgery, neurology, internal medicine, pediatrics, chest disease, and infectious diseases. All cases were considered as poor medical practice (malpractice) and surgeons were found to be responsible. In 16 of these 39 cases (41%) emergency procedures were performed. No unexpected event was reported in any procedure. In 16 cases (41%), sponge count was performed and was reported to be complete. Operation notes were available in 16 (41%) cases. Control of the operative field was performed by 1 surgeon, and sponge and instrument count was performed by 1 scrub nurse. Radio-opaque sponge and fluoroscopy were available in 9 (23%) centers in these cases. Gossypiboma can be prevented not only with surgeons' care but also with adequate support of medical device and material. However, it is considered as a poor medical practice. Presence of only 1 general surgeon in the expertise committee and ignorance of the working conditions by the surgeons should be questioned.

  13. Environmental protection and procedural law

    International Nuclear Information System (INIS)

    Mutschler, U.

    1978-01-01

    For the power industry which is 'independent of licensing', the Ule/Laubinger statement as well as its discussion on the 52th German legal experts' day are of considerable importance. It is therefore absolutely necessary to critically investigate the statements of this expert's opinion and the considerations on which they are based. This investigation is limited to those licensing procedures which in the terminology of experts, are 'similar to the plan approval procedure'. This applies mainly to the procedures according to paragraph 4 ff of the Federal Act on the Protection Against Nuisances and paragraph 7 of the Atomic Energy Law: Preliminaries publication of documents, inspection of files, public hearing, taking of evidence, persons with special responsibilities, administrative proceedings, actions by associations. The deficiencies in the execution of environmental procedural law is briefly mentioned. The notes in the article refer only to air pollution. (orig./HP) [de

  14. Diagnostic imaging procedure volume in the United States

    International Nuclear Information System (INIS)

    Johnson, J.L.; Abernathy, D.L.

    1983-01-01

    Comprehensive data on 1979 and 1980 diagnostic imaging procedure volume were collected from a stratified random sample of U.S. short-term general-care hospitals and private practices of radiologists, cardiologists, obstetricians/gynecologists, orthopedic surgeons, and neurologists/neurosurgeons. Approximately 181 million imaging procedures (within the study scope) were performed in 1980. Despite the rapidly increasing use of newer imaging methods, plain film radiography (140.3 million procedures) and contrast studies (22.9 million procedures) continue to comprise the vast majority of diagnostic imaging volume. Ultrasound, computed tomography, nuclear medicine, and special procedures make up less than 10% of total diagnostic imaging procedures. Comparison of the data from this study with data from an earlier study indicates that imaging procedure volume in hospitals expanded at an annual growth rate of almost 8% from 1973 to 1980

  15. 40 CFR 600.111-08 - Test procedures.

    Science.gov (United States)

    2010-07-01

    ... § 600.109(b) while sampling the exhaust gas. (viii) Sampling must begin two seconds before beginning the... convenience of the user, the revised text is set forth as follows: § 600.111-08 Test procedures. (f) Special...

  16. Survey on patient doses in cardiology in Latin America. Criteria for high skin doses follow up

    International Nuclear Information System (INIS)

    Duran, Ariel; Duro, Ivanna; Lopez, Leonardo; Ramirez, Alfredo; Herrera, Carlos; Navarro, Joaquin; Rivarola, Carlos; Lopez, Jose A.

    2008-01-01

    Full text: As part of the International Action Plan for Protection of Patients and supporting by the IAEA, a survey on patient doses in fluoroscopy guided procedures in cardiology in Latin America has been conducted since 2006. One of the objectives of the survey was to set criteria for the identification and evaluation of high skin doses in a certain number of patients to recommend a clinical follow up for potential radiation injuries (more than 3 Gy at the skin). The used methodology for the survey was initiated with two dedicated workshops held in Santiago de Chile (2005) and San Jose de Costa Rica (2007) involving relevant cardiologists from 15 different Latin American Countries. Some sessions were also attended by experts from the Regulatory and Health Authorities. Standardized forms to collect demographic and patient dosimetric data were agreed. Considering that most of the involved centres had still not dosimeters installed in the cardiology x-ray systems, it was agreed to collect data on fluoroscopy time and total number of cine frames per procedure. Relevant factors influencing radio sensitivity of the skin were also collected. Data from 10 countries representing a sample of 709 patients were received during the first year. Procedures included were diagnostic (DG) (coronary angiography and electrophysiology studies), therapeutic (TH) (percutaneous transluminal coronary angioplasties, cardiac ablations and valvuloplasties) or including both DG and TH. A total of 26 patients (3.7%) were selected for potential high skin doses. Initial considered criteria for selection were more than 30 minutes of fluoroscopy, more than 3,000 cine frames per procedure or patients with more than 100 kg of weight. Maximum reported values were 72 minutes and 8,100 frames. In addition, 5 of these patients were diabetic, 6 have previous fluoroscopy procedures and 5 were over 95 kg. The percentage of selected cases for clinical follow up derived from potential skin injuries seem

  17. A prospective survey on the incidence of chest malignancies after repeated fluoroscopy during artificial pneumothorax therapy for pulmonary tuberculosis

    International Nuclear Information System (INIS)

    Kitabatake, Takashi; Kurokawa, Shigeki; Yamasaki, Michio; Sato, Toshiro; Kurokawa, Hisae

    1975-01-01

    Patients with pulmonary tuberculosis treated in 4 sanatoria in Niigata Prefecture between 1941 and 1961 were followed up by a mail questionnaire. Of 2756 patients, 1193 responded and sent back effective information, letters to 1224 were returned because of uncertain or unknown new address, 326 did not respond, and 13 were excluded because of incomplete answers. Out of the 1193 effective responders, 568 had been treated by artificial pneumothorax (the pneumothorax group), and 552 had not been treated by pneumothorax (the control group). There were 65 deaths in the pneumothorax group, but none of them were from chest malignancies; and 40 deaths in the control group with 4 from chest malignancies. In this survey, there was no evidence of an increased number of chest malignancies (including leukemia) after pneumothorax fluoroscopy. (auth.)

  18. Review on patients radiation dose and frequency of procedures during medical exposure in Sudan

    International Nuclear Information System (INIS)

    Abu Baker, Samah Mohamed Nasr

    2015-09-01

    The aim of this study was to estimate patient dose, the annual frequency and the number of staff and devices in the medical applications of ionizing radiation in Sudan. Survey was conducted on diagnostic radiology, nuclear medicine and radiotherapy. With respect to diagnostic radiology, only patient radiation dose was estimated. The data for diagnostic radiology was obtained from 24 peer reviewed scientific published literatures during the years ( 2006 - 2015). The collected publications included about 64 Sudanese hospitals covering different types of diagnostic exams. A values of the effective dose for pediatrics and adult patients were within the ranges of similar worldwide values published by UNSCEAR report in 2008 with exceptional to fluoroscopy hysterosalpingography for adult patients. For nuclear medicine procedures, questionnaires were distributed to five hospitals representing the whole existing NM department in Sudan at the time of of study. The estimated total annual frequency of diagnostic procedures was 0.2 per 1000 population. The estimated total annual collective and annual per caput effective dose from all NM procedures were 16.268 man Sv and 0.5 μSv, respectively. Comparing the annual per caput effective dose with UNSCEAR value our results was less than the worldwide value and greater than the value for heath care level 111-1 v countries. Questionnaires were also distributed to collect data on radiotherapy procedures performed in the two existing radioisotopes Sudanese hospitals. The prescribed dose and the number of fractions were comparable between the two hospitals. The minimum prescribed dose was 20 Gy with 5 fractions for nasopharynx (NPH) palliative and the maximum prescribed dose was 64 Gy with 32 fractions for prostate.(Author)

  19. Authentic Assessment of Special Learners: Problem or Promise?

    Science.gov (United States)

    Choate, Joyce S.; Evans, Susan S.

    1992-01-01

    This article outlines differences between traditional assessment and authentic assessment procedures, discusses problems with each type of assessment in relation to special learners, and offers certain cautions that must be observed when implementing authentic assessment. (JDD)

  20. Special Education Program Evaluation: A Planning Guide. An Overview. CASE Commissioned Series.

    Science.gov (United States)

    McLaughlin, John A.

    This resource guide is intended to help in planning special education program evaluations. It focuses on: basic evaluation concepts, identification of special education decision makers and their information needs, specific evaluation questions, procedures for gathering relevant information, and evaluation of the evaluation process itself.…

  1. 77 FR 15555 - Freedom of Information Act and Privacy Act Procedures

    Science.gov (United States)

    2012-03-16

    ... Freedom of Information Act and Privacy Act Procedures AGENCY: Special Inspector General for Afghanistan... Freedom of Information Act (FOIA) and the Privacy Act of 1974. These procedures will facilitate public..., Freedom of information, Privacy. Authority and Issuance For the reasons set forth above, SIGAR establishes...

  2. Three-dimensional Image Fusion Guidance for Transjugular Intrahepatic Portosystemic Shunt Placement.

    Science.gov (United States)

    Tacher, Vania; Petit, Arthur; Derbel, Haytham; Novelli, Luigi; Vitellius, Manuel; Ridouani, Fourat; Luciani, Alain; Rahmouni, Alain; Duvoux, Christophe; Salloum, Chady; Chiaradia, Mélanie; Kobeiter, Hicham

    2017-11-01

    To assess the safety, feasibility and effectiveness of image fusion guidance with pre-procedural portal phase computed tomography with intraprocedural fluoroscopy for transjugular intrahepatic portosystemic shunt (TIPS) placement. All consecutive cirrhotic patients presenting at our interventional unit for TIPS creation from January 2015 to January 2016 were prospectively enrolled. Procedures were performed under general anesthesia in an interventional suite equipped with flat panel detector, cone-beam computed tomography (CBCT) and image fusion technique. All TIPSs were placed under image fusion guidance. After hepatic vein catheterization, an unenhanced CBCT acquisition was performed and co-registered with the pre-procedural portal phase CT images. A virtual path between hepatic vein and portal branch was made using the virtual needle path trajectory software. Subsequently, the 3D virtual path was overlaid on 2D fluoroscopy for guidance during portal branch cannulation. Safety, feasibility, effectiveness and per-procedural data were evaluated. Sixteen patients (12 males; median age 56 years) were included. Procedures were technically feasible in 15 of the 16 patients (94%). One procedure was aborted due to hepatic vein catheterization failure related to severe liver distortion. No periprocedural complications occurred within 48 h of the procedure. The median dose-area product was 91 Gy cm 2 , fluoroscopy time 15 min, procedure time 40 min and contrast media consumption 65 mL. Clinical benefit of the TIPS placement was observed in nine patients (56%). This study suggests that 3D image fusion guidance for TIPS is feasible, safe and effective. By identifying virtual needle path, CBCT enables real-time multiplanar guidance and may facilitate TIPS placement.

  3. Procedure for marking, encryption, labelling and optical coding

    OpenAIRE

    Barranco, Ángel; Rodríguez-González, Agustín; Sánchez Valencia, Juan Ramón; Aparicio, Francisco J.; Blaszczyk-Lezak, Iwona Krystina; Holgado Bolaños, Miguel; Casquel del Campo, Rafael; Ocaña, J. L.; Molpeceres, C.; García-Ballesteros Ramírez, Juan José; Morales Furió, Miguel

    2009-01-01

    [EN] It permits marking or recording motifs (301) on surfaces whereon there has been deposited previously a fluorescent polymer layer (300) through a procedure of plasma polymerisation (100) of molecules of a colourant. The procedure combines the special characteristics of the polymer layers making them suitable for being capable of recording diverse motifs (301) thereon, and the possibility of recording by laser (10 1) or other techniques. Among such characteristics s...

  4. A patient dose survey for femoral arteriogram diagnostic radiographic examinations using a dose-area product meter

    International Nuclear Information System (INIS)

    Thwaites, J.H.; Rafferty, M.W.; Gray, N.; Black, J.; Stock, B.

    1996-01-01

    A patient dose survey was carried out for femoral arteriogram procedures at the Sir Charles Gairdner Hospital. The procedure involves fluoroscopy to the pelvic region to locate a guide wire and catheter, followed by a series of radiographs extending from the pelvic area to the feet to form a collage image of the entire arterial system. Radiographs are taken whilst a bolus of contrast media is injected into the arterial system. A dose-area product meter was used to determine the dose-area product delivered to patients. Radiographic and patient details were logged with dose-area product for each part of each procedure. Mean energy imparted, mean effective dose and effective dose equivalent are calculated for the examinations. Calculated effective doses are shown to produce results consistent with those of other authors. We present a method for dealing with a complex radiographic procedure including multiple radiographs and fluoroscopy in an attempt to provide a simple way of calculating effective dose from which a general risk factor can be determined. The effective dose varies considerably from examination to examination due to the large range in the number of radiographs taken in any one procedure. A useful index can be obtained by logging the number of radiographs in each region, and fluoroscopy time, from which the effective dose may be easily calculated. These measurements extend a continuing survey of doses for common diagnostic radiographic examinations which previously included the simple examinations: lumbar spine, abdoment and pelvis. (author)

  5. Procedure entry in the register of yachts

    Directory of Open Access Journals (Sweden)

    Zorana Kostović

    2011-01-01

    Full Text Available The procedure of ship registration is regulated in the Maritime Code of Croatia (2004. This procedure, in comparison with the recently suspended Maritime Code of Croatia (1994, includes substantial changes, especially in the domain of yacht registration. New Maritime Code has founded special yacht-register for yachts and yachts under construction. A yacht which is registered as a Croatian yacht is entitled to the benefits conffered by the Maritime Code of Croatia (right to fly a Croatian flag, etc.. There are two modes proscribed under the provisions of Maritime Code of Croatia (2004 for yacht-registration: 1 mandatory and 2 facultative. Yachts whose owners are Croatian citizens with residence i Republic Croatia or companies which are registered in the Republic of Croatia are obligated to register under the provisions of Maritime Code of Croatia (2004. On the other hand, yacht whose owners are not Croatian citizens or whose owners are Croatian citizens but without the residence in the Republic of Croatia, can be registered in the Republic of Croatia, depending on the will of the owner. Yachts under construction can be registered in special registers for such kind of vessels if they are built in Croatian shipyards (owners can be either Croatian citizens or foreigners. Jurisdiction in this matter belongs to port authorities and all procedure is carried out in accordance with the rules of administrative procedure.

  6. Clinical accuracy of three-dimensional fluoroscopy (IsoC-3D)-assisted upper thoracic pedicle screw insertion

    International Nuclear Information System (INIS)

    Sugimoto, Yoshihisa; Ito, Yasuo; Shimokawa, Tetsuya; Shiozaki, Yasuyuki; Mazaki, Tetsuro; Tomioka, Masao; Tanaka, Masato

    2010-01-01

    Correct screw placement is especially difficult in the upper thoracic vertebrae. At the cervicothoracic junction (C7-T2), problems can arise because of the narrowness of the pedicle and the difficulty of using a lateral image intensifier there. Other upper thoracic vertebrae (T3-6) pose a problem for screw insertion also because of the narrower pedicle. We inserted 154 pedicle screws into 78 vertebrae (C7 to T6) in 38 patients. Screws were placed using intraoperative data acquisition by an isocentric C-arm fluoroscope (Siremobile Iso-C3D) and computer navigation. Out of 90 pedicle screws inserted into 45 vertebrae between C7 and T2, 87 of the 90 (96.7%) screws were classified as grade 1 (no perforation). Of 64 pedicle screws inserted into 33 vertebrae between T3 and T6, 61 of 64 (95.3%) screws were classified as grade 1. In this study, we reduced pedicle screw misplacement at the level of the C7 and upper thoracic (T1-6) vertebrae using the three-dimensional fluoroscopy navigation system. (author)

  7. Doses in pediatric urinary studies guided by fluoroscopy: methodology oriented to the education

    International Nuclear Information System (INIS)

    Cotelo, E.; Castillo, C.; Padilla, M.; Rabin, C.

    2006-01-01

    The challenge of the Radiological Protection (RP) it is to implement Programs of Quality Guarantee without limiting them to the quality control. Radiologists and technicians should to familiarize with the dosimetry of patient, and the specialists in RP need to have clinical practice. The children (more radiosensitive that the adults) they present difficulties own to establish clinical approaches of quality due to their variations anthropomorphic (wide age range) and to specific illnesses. Also, those studies guided by fluoroscopy are of difficult standardization by the numerous ones pathologies (with anatomic-physiologic variations). It was determined the Kerma Area Product (P K,A ) in 25 subjected patients to cystourethrographies carried out by the same radiologist doctor. Its were registered anthropometric data, technical parameters, irradiated area, number radiographs, P K,A , pathologies. The complications (collaboration, delays in urinating), the radiological protocols and the learning curve of the radiologist were analyzed. When knowing the 'in situ' dose, the radiologist could relate it with those variables that determine it, optimizing immediately it practice. The hope wide range of obtained P K,A (0.17 - 1.85) Gy.cm 2 deepened the analysis. The measurement of P K,A (non mandatory in all Latin America) it constitutes an incomparable educational tool in RP, should be used, at least, in reference hospitals. (Author)

  8. 14 CFR 93.345 - VFR outbound procedures for fringe airports.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false VFR outbound procedures for fringe airports... Metropolitan Area Special Flight Rules Area § 93.345 VFR outbound procedures for fringe airports. (a) A pilot may depart from a fringe airport as defined in § 93.335 without filing a flight plan or communicating...

  9. Procedural learning and dyslexia.

    Science.gov (United States)

    Nicolson, R I; Fawcett, A J; Brookes, R L; Needle, J

    2010-08-01

    Three major 'neural systems', specialized for different types of information processing, are the sensory, declarative, and procedural systems. It has been proposed (Trends Neurosci., 30(4), 135-141) that dyslexia may be attributable to impaired function in the procedural system together with intact declarative function. We provide a brief overview of the increasing evidence relating to the hypothesis, noting that the framework involves two main claims: first that 'neural systems' provides a productive level of description avoiding the underspecificity of cognitive descriptions and the overspecificity of brain structural accounts; and second that a distinctive feature of procedural learning is its extended time course, covering from minutes to months. In this article, we focus on the second claim. Three studies-speeded single word reading, long-term response learning, and overnight skill consolidation-are reviewed which together provide clear evidence of difficulties in procedural learning for individuals with dyslexia, even when the tasks are outside the literacy domain. The educational implications of the results are then discussed, and in particular the potential difficulties that impaired overnight procedural consolidation would entail. It is proposed that response to intervention could be better predicted if diagnostic tests on the different forms of learning were first undertaken. 2010 John Wiley & Sons, Ltd.

  10. SU-G-JeP3-01: A Method to Quantify Lung SBRT Target Localization Accuracy Based On Digitally Reconstructed Fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Lafata, K; Ren, L; Cai, J; Yin, F [Duke University Medical Center, Durham, NC (United States)

    2016-06-15

    Purpose: To develop a methodology based on digitally-reconstructed-fluoroscopy (DRF) to quantitatively assess target localization accuracy of lung SBRT, and to evaluate using both a dynamic digital phantom and a patient dataset. Methods: For each treatment field, a 10-phase DRF is generated based on the planning 4DCT. Each frame is pre-processed with a morphological top-hat filter, and corresponding beam apertures are projected to each detector plane. A template-matching algorithm based on cross-correlation is used to detect the tumor location in each frame. Tumor motion relative beam aperture is extracted in the superior-inferior direction based on each frame’s impulse response to the template, and the mean tumor position (MTP) is calculated as the average tumor displacement. The DRF template coordinates are then transferred to the corresponding MV-cine dataset, which is retrospectively filtered as above. The treatment MTP is calculated within each field’s projection space, relative to the DRF-defined template. The field’s localization error is defined as the difference between the DRF-derived-MTP (planning) and the MV-cine-derived-MTP (delivery). A dynamic digital phantom was used to assess the algorithm’s ability to detect intra-fractional changes in patient alignment, by simulating different spatial variations in the MV-cine and calculating the corresponding change in MTP. Inter-and-intra-fractional variation, IGRT accuracy, and filtering effects were investigated on a patient dataset. Results: Phantom results demonstrated a high accuracy in detecting both translational and rotational variation. The lowest localization error of the patient dataset was achieved at each fraction’s first field (mean=0.38mm), with Fx3 demonstrating a particularly strong correlation between intra-fractional motion-caused localization error and treatment progress. Filtering significantly improved tracking visibility in both the DRF and MV-cine images. Conclusion: We have

  11. CONSIDERATIONS REGARDING THE ON-GOING CONTRACTS AFTER THE INSOLVENCY PROCEDURE HAS BEEN INSTITUTED

    Directory of Open Access Journals (Sweden)

    Dan-Alexandru SITARU

    2015-07-01

    Full Text Available The main purpose of the article is to highlight new aspects regarding contracts that a legal person had perfected before the insolvency procedure is opened. Once the syndic judge rules in favour of opening the procedure the judicial administrator, named in that case, has a special power, a right to opt, to either permit the contract to run its course or to denounce it thus ending its effects. Sometimes, due to the special nature of some contracts, the right of option is conditioned and certain procedures must be enforced. Also, due to an obvious possibility that the respective contract might create an unbalance to the debtors’ accounts and other sectors, the judicial administrator must take special consideration and can also modify the articles of the contract, rendering new significance or substituting the content of the provisions. Nonetheless, a combination of these possibilities may be preferable to the judicial administrator, partially changing the contracts or keeping in effect only what is in the debtors favour.

  12. Radiologic protection in pediatric radiology: ICRP recommendations

    International Nuclear Information System (INIS)

    Sanchez, Ramon; Khong, Pek-Lan; Ringertz, Hans

    2013-01-01

    ICRP has provided an updated overview of radiation protection principles in pediatric radiology. The authors recommend that staff, radiologists, medical physicists and vendors involved in pediatric radiology read this document. For conventional radiography, the report gives advice on patient positioning, immobilization, shielding and appropriate exposure conditions. It describes extensively the use of pulsed fluoroscopy, the importance of limiting fluoroscopy time, and how shielding and geometry must be used to avoid unnecessary radiation to the patient and operator. Furthermore, the use of fluoroscopy in interventional procedures with emphasis on dose reduction to patients and staff is discussed in light of the increasing frequency, complexity and length ofthe procedures. CT is the main reason that medical imaging in several developed countries is the highest annual per capita effective radiation dose from man-made sources. The ICRP report gives extensive descriptions of how CT protocols can be optimized to minimize radiation exposure in pediatric patients. The importance of balancing image quality with acceptable noise in pediatric imaging and the controversies regarding the use of protective shielding in CT are also discussed.

  13. The Consumer Protection Act 68 of 2008 and procedural fairness in

    African Journals Online (AJOL)

    MJM Venter

    fair. In a South African context, procedural fairness and substantive fairness are therefore of equal importance. 5. The Consumer Protection Act and procedural fairness. In the discussion below, the special ..... actually read the terms, but standardisation in presentation may make it slightly easier for a consumer to understand ...

  14. Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study.

    Science.gov (United States)

    Matityahu, Amir; Kahler, David; Krettek, Christian; Stöckle, Ulrich; Grutzner, Paul Alfred; Messmer, Peter; Ljungqvist, Jan; Gebhard, Florian

    2014-12-01

    To evaluate the accuracy of computer-assisted sacral screw fixation compared with conventional techniques in the dysmorphic versus normal sacrum. Review of a previous study database. Database of a multinational study with 9 participating trauma centers. The reviewed group included 130 patients, 72 from the navigated group and 58 from the conventional group. Of these, 109 were in the nondysmorphic group and 21 in the dysmorphic group. Placement of sacroiliac (SI) screws was performed using standard fluoroscopy for the conventional group and BrainLAB navigation software with either 2-dimensional or 3-dimensional (3D) navigation for the navigated group. Accuracy of SI screw placement by 2-dimensional and 3D navigation versus conventional fluoroscopy in dysmorphic and nondysmorphic patients, as evaluated by 6 observers using postoperative computerized tomography imaging at least 1 year after initial surgery. Intraobserver agreement was also evaluated. There were 11.9% (13/109) of patients with misplaced screws in the nondysmorphic group and 28.6% (6/21) of patients with misplaced screws in the dysmorphic group, none of which were in the 3D navigation group. Raw agreement between the 6 observers regarding misplaced screws was 32%. However, the percent overall agreement was 69.0% (kappa = 0.38, P dysmorphic proximal sacral segment. We recommend the use of 3D navigation, where available, for insertion of SI screws in patients with normal and dysmorphic proximal sacral segments. Therapeutic level I.

  15. Yttrium-90 Resin Microsphere Radioembolization Using an Antireflux Catheter: An Alternative to Traditional Coil Embolization for Nontarget Protection

    International Nuclear Information System (INIS)

    Morshedi, Maud M.; Bauman, Michael; Rose, Steven C.; Kikolski, Steven G.

    2015-01-01

    PurposeSerious complications can result from nontarget embolization during yttrium-90 (Y-90) transarterial radioembolization. Hepatoenteric artery coil embolization has been traditionally performed to prevent nontarget radioembolization. The U.S. Food and Drug Administration–approved Surefire Infusion System (SIS) catheter, designed to prevent reflux, is an alternative to coils. The hypothesis that quantifiable SIS procedural parameters are comparable to coil embolization was tested.MethodsFourteen patients aged 36–79 years with colorectal, neuroendocrine, hepatocellular, and other predominantly bilobar hepatic tumors who underwent resin microsphere Y-90 radioembolization using only the SIS catheter (n = 7) versus only detachable coils (n = 7) for nontarget protection were reviewed retrospectively. Procedure time, fluoroscopy time, contrast dose, radiation dose, and cost were evaluated.ResultsMultivariate analysis identified significant cohort differences in the procedural parameters evaluated (F(10, 3) = 10.39, p = 0.04). Between-group comparisons of the pretreatment planning procedure in the SIS catheter group compared to the coil embolization group demonstrated a significant reduction in procedure time (102.6 vs. 192.1 min, respectively, p = 0.0004), fluoroscopy time (14.3 vs. 49.7 min, respectively, p = 0.0016), and contrast material dose (mean dose of 174.3 vs. 265.0 mL, respectively, p = 0.0098). Procedural parameters were not significantly different between the two groups during subsequent dose delivery procedures. Overall cost of combined first-time radioembolization procedures was significantly less in the SIS group ($4252) compared to retrievable coil embolization ($11,123; p = 0.001).ConclusionThe SIS catheter results in a reduction in procedure time, fluoroscopy time, and contrast material dose and may be an attractive cost-effective alternative to detachable coil embolization for prevention of nontarget radioembolization

  16. Yttrium-90 Resin Microsphere Radioembolization Using an Antireflux Catheter: An Alternative to Traditional Coil Embolization for Nontarget Protection

    Energy Technology Data Exchange (ETDEWEB)

    Morshedi, Maud M., E-mail: maud.morshedi@my.rfums.org; Bauman, Michael, E-mail: mbauman@ucsd.edu; Rose, Steven C., E-mail: scrose@ucsd.edu; Kikolski, Steven G., E-mail: skikolski@gmail.com [University of California San Diego Health Sciences, Radiology Department, University of California San Diego Medical Center (United States)

    2015-04-15

    PurposeSerious complications can result from nontarget embolization during yttrium-90 (Y-90) transarterial radioembolization. Hepatoenteric artery coil embolization has been traditionally performed to prevent nontarget radioembolization. The U.S. Food and Drug Administration–approved Surefire Infusion System (SIS) catheter, designed to prevent reflux, is an alternative to coils. The hypothesis that quantifiable SIS procedural parameters are comparable to coil embolization was tested.MethodsFourteen patients aged 36–79 years with colorectal, neuroendocrine, hepatocellular, and other predominantly bilobar hepatic tumors who underwent resin microsphere Y-90 radioembolization using only the SIS catheter (n = 7) versus only detachable coils (n = 7) for nontarget protection were reviewed retrospectively. Procedure time, fluoroscopy time, contrast dose, radiation dose, and cost were evaluated.ResultsMultivariate analysis identified significant cohort differences in the procedural parameters evaluated (F(10, 3) = 10.39, p = 0.04). Between-group comparisons of the pretreatment planning procedure in the SIS catheter group compared to the coil embolization group demonstrated a significant reduction in procedure time (102.6 vs. 192.1 min, respectively, p = 0.0004), fluoroscopy time (14.3 vs. 49.7 min, respectively, p = 0.0016), and contrast material dose (mean dose of 174.3 vs. 265.0 mL, respectively, p = 0.0098). Procedural parameters were not significantly different between the two groups during subsequent dose delivery procedures. Overall cost of combined first-time radioembolization procedures was significantly less in the SIS group ($4252) compared to retrievable coil embolization ($11,123; p = 0.001).ConclusionThe SIS catheter results in a reduction in procedure time, fluoroscopy time, and contrast material dose and may be an attractive cost-effective alternative to detachable coil embolization for prevention of nontarget radioembolization.

  17. 46 CFR 153.30 - Special area endorsement.

    Science.gov (United States)

    2010-10-01

    ... endorsement. The Coast Guard endorses the Certificate of Inspection of a United States ship allowing it to operate in special areas if the ship owner— (a) Requests the endorsement following the procedures in § 153... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SHIPS CARRYING...

  18. Hysterosalpingography

    Medline Plus

    Full Text Available ... through the body, recording an image on photographic film or a special detector. Fluoroscopy uses a continuous ... recently, x-ray images were maintained on large film sheets (much like a large photographic negative). Today, ...

  19. Radiation exposure during ureteroscopy

    International Nuclear Information System (INIS)

    Bagley, D.H.; Cubler-Goodman, A.

    1990-01-01

    Use of fluoroscopy during ureteroscopy increases the risk of radiation exposure to the urologist and patient. Radiation entrance dosages were measured at skin level in 37 patients, and at the neck, trunk and finger of the urologist, and neck and trunk of the circulating nurse. Radiation exposure time was measured in 79 patients, and was related to the purpose of the procedure and the type of ureteroscope used, whether rigid or flexible. Exposure could be minimized by decreasing the fluoroscopy time. A portable C-arm fluoroscopy unit with electronic imaging and last image hold mode should be used to minimize exposure time. Lead aprons and thyroid shields should be used by the urologist and other personnel in the endoscopy room

  20. Effectiveness of the implementation of a simple radiation reduction protocol in the catheterization laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Jurado-Román, Alfonso, E-mail: alfonsojuradoroman@gmail.com [Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real (Spain); Sánchez-Pérez, Ignacio; Lozano Ruíz-Poveda, Fernando; López-Lluva, María T.; Pinilla-Echeverri, Natalia; Moreno Arciniegas, Andrea [Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario de Ciudad Real (Spain); Agudo-Quilez, Pilar [Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid (Spain); Gil Agudo, Antonio [Servicio de Radiofísica y Protección Radiológica, Hospital General Universitario de Ciudad Real (Spain)

    2016-07-15

    Background and purpose: A reduction in radiation doses at the catheterization laboratory, maintaining the quality of procedures is essential. Our objective was to analyze the results of a simple radiation reduction protocol at a high-volume interventional cardiology unit. Methods: We analyzed 1160 consecutive procedures: 580 performed before the implementation of the protocol and 580 after it. The protocol consisted in: the reduction of the number of ventriculographies and aortographies, the optimization of the collimation and the geometry of the X ray tube-patient-receptor, the use of low dose-rate fluoroscopy and the reduction of the number of cine sequences using the software “last fluoroscopy hold”. Results: There were no significant differences in clinical baseline features or in the procedural characteristics with the exception of a higher percentage of radial approach (30.7% vs 69.6%; p < 0.001) and of percutaneous coronary interventions of chronic total occlusions after the implementation of the protocol (2.1% vs 6.7%; p = 0,001). Angiographic success was similar during both periods (98.3% vs 99.2%; p = 0.2). There were no significant differences between both periods regarding the overall duration of the procedures (26.9 vs 29.6 min; p = 0.14), or the fluoroscopy time (13.3 vs 13.2 min; p = 0.8). We observed a reduction in the percentage of procedures with ventriculography (80.9% vs 7.1%; p < 0.0001) or aortography (15.4% vs 4.4%; p < 0.0001), the cine runs (21.8 vs 6.9; p < 0.0001) and the dose–area product (165 vs 71 Gyxcm{sup 2}; p < 0.0001). Conclusions: With the implementation of a simple radiation reduction protocol, a 57% reduction of dose–area product was observed without a reduction in the quality or the complexity of procedures. - Highlights: • This simple protocol can achieve a reduction in dose–area product of 57%. • It does not interfere with the quality or complexity of the procedures. • Full advantage of “Last Fluoroscopy