Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization

Vogl, Thomas J.; Alizadeh, Leona S.; Maeder, R; Naguib, N; Herrmann, Eva; Bickford, Matthew W.; Burck, Iris; Albrecht, Moritz H.

doi:10.1097/rli.0000000000000519

Cited by 10 publications

(3 citation statements)

References 36 publications

(39 reference statements)

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“…Our study augments the results of a clinical study by Vogl et al on 106 patients receiving transarterial chemoembolisation using ARTIS pheno® (Siemens Healthineers, Forchheim Germany), which reported superior IQ in fluoroscopy at a lower radiation dose as compared to the predecessor using DEC, as higher copper filtration was applied [ 19 ]. However, their study compared the IQ and dose between two systems under non-identical conditions and focused on the imaging of iodine and iron, which limits the potential of skin radiation dose savings as the material-specific advantages of tantalum were not investigated.…”

Section: Discussionsupporting

confidence: 73%

Tantalum-specific contrast-to-noise ratio or conventional detector dose-driven exposure control in angiography: radiation dose and image quality evaluation in a porcine model

et al. 2022

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Background The aim of this animal study was to compare the fluoroscopic image quality (IQ) and radiation dose between a tantalum (Ta)-specific contrast-to-noise ratio-driven exposure control (Ta-CEC) and a detector dose-driven exposure control (DEC) in abdominal angiography. Methods Nine angiography scenarios were created in seven anaesthetised pigs using Ta-based embolisation material during percutaneous liver and kidney intervention. Fluoroscopic images were acquired using three DEC protocols with different dose levels and Ta-CEC protocols with different IQ levels, sampled in small steps. Polymethyl-methacrylate and aluminium plates were used to simulate attenuation of three water equivalent thicknesses (WET). Three blinded readers evaluated the IQ of DEC and dose equivalent Ta images and selected the Ta-IQ equivalent image corresponding to the DEC image. Results Interobserver agreement for the IQ assessment was 0.43 for DEC, 0.56 for Ta-CEC and for the assessment of incident air kerma at the interventional reference point (Ka,r) for the Ta-IQ equivalent image 0.73. The average IQ of the dose equivalent Ta images was superior compared to the DEC images (p < 0.001) and also for every WET (26, 31, or 36 cm) and dose level (p ≤ 0.022). The average Ka,r for the Ta-IQ equivalent images was 59 ± 16% (mean ± standard deviation) lower compared to the DEC images (p < 0.001). Conclusions Compared to DEC, Ta-CEC significantly improved the fluoroscopic depiction of Ta, while maintaining the Ka,r. Alternatively, the Ka,r can be significantly reduced by using Ta-CEC instead of DEC, while maintaining equivalent IQ.

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Section: Discussionsupporting

confidence: 73%

Tantalum-specific contrast-to-noise ratio or conventional detector dose-driven exposure control in angiography: radiation dose and image quality evaluation in a porcine model

et al. 2022

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“…Minimally invasive endovascular interventions play an increasing role in the treatment of a wide range of pathologies [1][2][3][4]. These procedures, however, deliver high radiation doses both to the patients and the medical staff, which in turn raises serious concerns regarding the harmful effects of ionizing radiation.…”

Section: Introductionmentioning

confidence: 99%

Radiation Exposure Reduction by Digital Variance Angiography in Lower Limb Angiography: A Randomized Controlled Trial

Sótonyi

Berczeli

Gyánó

et al. 2023

JCDD

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Background: digital variance angiography (DVA) provides higher image quality than digital subtraction angiography (DSA). This study investigates whether the quality reserve of DVA allows for radiation dose reduction during lower limb angiography (LLA), and compares the performance of two DVA algorithms. Methods: this prospective block-randomized controlled study enrolled 114 peripheral arterial disease patients undergoing LLA into normal dose (ND, 1.2 µGy/frame, n = 57) or low-dose (LD, 0.36 µGy/frame, n = 57) groups. DSA images were generated in both groups, DVA1 and DVA2 images were generated in the LD group. Total and DSA-related radiation dose area product (DAP) were analyzed. Image quality was assessed on a 5-grade Likert scale by six readers. Results: the total and DSA-related DAP were reduced by 38% and 61% in the LD group. The overall visual evaluation scores (median (IQR)) of LD-DSA (3.50 (1.17)) were significantly lower than the ND-DSA scores (3.83 (1.00), p < 0.001). There was no difference between ND-DSA and LD-DVA1 (3.83 (1.17)), but the LD-DVA2 scores were significantly higher (4.00 (0.83), p < 0.01). The difference between LD-DVA2 and LD-DVA1 was also significant (p < 0.001). Conclusions: DVA significantly reduced the total and DSA-related radiation dose in LLA, without affecting the image quality. LD-DVA2 images outperformed LD-DVA1, therefore DVA2 might be especially beneficial in lower limb interventions.

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“…Due to everyday exposure, catheter lab and hybrid operating room staff are also exposed to both stochastic and deterministic injuries, which might lead to the development of oncological disorders 3 and cataract 4 , respectively. The demand for minimally invasive procedures is gradually increasing as the procedures are evolving and evidence-based international guidelines are broadening the indication field for the vascular, oncological and other interventional procedures, such as prostatic artery embolization 5 or transarterial chemoembolization 6 . Therefore, the demand for radiation protection measures 7 , 8 is increasing in the medical device research and development area 9 .…”

Section: Introductionmentioning

confidence: 99%

Digital variance angiography allows about 70% decrease of DSA-related radiation exposure in lower limb X-ray angiography

Gyánó

Berczeli

Csobay-Novák

et al. 2021

Sci Rep

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Our aim was to investigate whether the previously observed higher contrast-to-noise ratio (CNR) and better image quality of Digital Variance Angiography (DVA) - compared to Digital Subtraction Angiography (DSA) - can be used to reduce radiation exposure in lower limb X-ray angiography. This prospective study enrolled 30 peripheral artery disease patients (mean ± SD age 70 ± 8 years) undergoing diagnostic angiography. In all patients, both normal (1.2 µGy/frame; 100%) and low-dose (0.36 µGy/frame; 30%) protocols were used for the acquisition of images in three anatomical regions (abdominal, femoral, crural). The CNR of DSA and DVA images were calculated, and the visual quality was evaluated by seven specialists using a 5-grade Likert scale. For investigating non-inferiority, the difference of low-dose DVA and normal dose DSA scores (DVA30-DSA100) was analyzed. DVA produced two- to three-fold CNR and significantly higher visual score than DSA. DVA30 proved to be superior to DSA100 in the crural region (difference 0.25 ± 0.07, p < 0.001), and there was no significant difference in the femoral (− 0.08 ± 0.06, p = 0.435) and abdominal (− 0.10 ± 0.09, p = 0.350) regions. Our data show that DVA allows about 70% reduction of DSA-related radiation exposure in lower limb X-ray angiography, providing a potential new radiation protection tool for the patients and the medical staff.

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Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization

Cited by 10 publications

References 36 publications

Tantalum-specific contrast-to-noise ratio or conventional detector dose-driven exposure control in angiography: radiation dose and image quality evaluation in a porcine model

Tantalum-specific contrast-to-noise ratio or conventional detector dose-driven exposure control in angiography: radiation dose and image quality evaluation in a porcine model

Radiation Exposure Reduction by Digital Variance Angiography in Lower Limb Angiography: A Randomized Controlled Trial

Digital variance angiography allows about 70% decrease of DSA-related radiation exposure in lower limb X-ray angiography

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