Comparison of Radiation Exposure Associated With Intraoperative Cone-Beam Computed Tomography and Follow-up Multidetector Computed Tomography Angiography for Evaluating Endovascular Aneurysm Repairs

Steuwe, Andrea; Geisbüsch, Philipp; Schulz, Christof Johannes; Böckler, Dittmar; Kauczor, Hans‐Ulrich; Stiller, Wolfram

doi:10.1177/1526602816649588

Cited by 15 publications

(10 citation statements)

References 31 publications

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“…The results of this study align most closely with those of Stuewe et al, indicating that, when using clinical modes of acquisition, radiation doses from FPCT are 100–200% higher than those from MDCT. Kwok et al found that radiation doses during abdominal imaging using fixed techniques were about 50% higher in FPCT compared to MDCT .…”

Section: Discussionsupporting

confidence: 90%

“…Previous investigators have used different methods in attempts to answer these questions. Steuwe et al compared FPCT to MDCT for endovascular aneurysm repair (EVAR) and found effective doses ( E ) of 4.9 mSv for FPCT compared to 2.6 mSv for MDCT for single phase imaging with matched imaged length and both scans under automatic exposure control (AEC) . Bai et al measured E of 7.04 mSv for the FPCT compared to 8.42 mSv for MDCT using fixed technique at 120 kV, and reported lower contrast‐to‐noise ratio (CNR) and higher noise for FPCT compared to MDCT .…”

Section: Introductionmentioning

confidence: 99%

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Comparison of radiation dose and image quality between flat panel computed tomography and multidetector computed tomography in a hybrid CT‐angiography suite

Jones

Odisio

2020

J Applied Clin Med Phys

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The purpose of this study was to compare, using the same radiation dose and image quality metrics, flat panel computed tomography (FPCT) to multidetector CT (MDCT) in interventional radiology. A single robotic angiography system with FPCT was compared to a single MDCT system, both installed in a hybrid CT‐angiography laboratory and both operating under automatic exposure control. Radiation dose was measured on the central axis (Dc) of a CT dosimetry phantom 30 cm in diameter and 60 cm in length using default protocols for FPCT and MDCT with the imaged length in MDCT matched to the field of view of FPCT. The noise power spectrum (NPS), modulation transfer function (MTF), and z‐axis resolution were measured using the same phantom. Iodine contrast to noise ratio (CNR) was also measured. Radiation dose (Dc) was 41%–69% lower in MDCT compared to FPCT when default protocols and automatic exposure control were used. While spatial resolution could generally be matched with appropriate choice of kernel in MDCT, MTF dropped more quickly at higher spatial frequency for MDCT than FPCT. Image noise was 49%–120% higher for MDCT compared to FPCT for comparable in‐plane spatial resolution. Z‐axis resolution was slightly better for MDCT than FPCT, while iodine CNR depended on protocol selection. Radiation dose was much lower for MDCT compared to FPCT, but image noise was much higher. Matching image noise in MDCT to FPCT would result in similar radiation doses. Iodine contrast depended on dose modulation settings for MDCT.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Comparison of radiation dose and image quality between flat panel computed tomography and multidetector computed tomography in a hybrid CT‐angiography suite

Jones

Odisio

2020

J Applied Clin Med Phys

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“…Several studies have investigated the impact of CBCT after F-BEVAR. [1][2][3]9,15 They have reported that endoleaks and kinking were detected intraoperatively with a better sensitivity than with 2D completion angiograms, possibly leading to immediate correction and reduction of early reintervention rate. According to Tenorio et al, 9 up to 1 of 5 patients could have positive findings leading to a prompt revision after CBCT, especially after F-BEVAR.…”

Section: Discussionmentioning

confidence: 99%

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

et al. 2021

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Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

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“…Moreover, such intraoperative radiation reduction may also have an impact on the OR staff who are subjected to scatter radiation during the procedure and who have been shown to have more malignancies than staff members not performing fluoroscopically-guided procedures. 2 However, even if a CBCT is associated with significant radiation exposure, 10 it does not necessarily affect the staff because they can be outside the room during exposure. On the contrary, the acquisition of the 2 projections in fluoroscopy requires the proximity of the surgeon to the machine in order to adjust the table position.…”

Section: Discussionmentioning

confidence: 99%

Validation of a New Method for 2D Fusion Imaging Registration in a System Prepared Only for 3D

et al. 2020

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Purpose: To validate a new 2D-3D registration method of fusion imaging during aortic repair in a system prepared only for 3D-3D registration and to compare radiation doses and accuracy. Materials and Methods: The study involved 189 patients, including 94 patients (median age 70 years; 85 men) who underwent abdominal endovascular aneurysm repair (EVAR) with 2D-3D fusion on an Artis zee imaging system and 95 EVAR patients (median age 70 years; 81 men) from a prior study who had 3D-3D registration done using cone beam computed tomography (CBCT). For the 2D-3D registration, an offline CBCT of the empty operating table was imported into the intraoperative dataset and superimposed on the preoperative computed tomography angiogram (CTA). Then 2 intraoperative single-frame 2D images of the skeleton were aligned with the patient’s skeleton on the preoperative CTA to complete the registration process. A digital subtraction angiogram was done to correct any misalignment of the aortic CTA volume. Values are given as the median [interquartile range (IQR) Q1, Q3]. Results: The 2D-3D registration had an accuracy of 4.0 mm (IQR 3.0, 5.0) after bone matching compared with the final correction with DSA (78% within 5 mm). By applying the 2D-3D protocol the radiation exposure (dose area product) from the registration of the fusion image was significantly reduced compared with the 3D-3D registration [1.12 Gy∙cm2 (IQR 0.41, 2.14) vs 43.4 Gy∙cm2 (IQR 37.1, 49.0), respectively; p<0.001). Conclusion: The new 2D-3D registration protocol based on 2 single-frame images avoids an intraoperative CBCT and can be used for fusion imaging registration in a system originally designed for 3D-3D only. This 2D-3D registration protocol is accurate and leads to a significant reduction in radiation exposure.

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Comparison of Radiation Exposure Associated With Intraoperative Cone-Beam Computed Tomography and Follow-up Multidetector Computed Tomography Angiography for Evaluating Endovascular Aneurysm Repairs

Cited by 15 publications

References 31 publications

Comparison of radiation dose and image quality between flat panel computed tomography and multidetector computed tomography in a hybrid CT‐angiography suite

Comparison of radiation dose and image quality between flat panel computed tomography and multidetector computed tomography in a hybrid CT‐angiography suite

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

Validation of a New Method for 2D Fusion Imaging Registration in a System Prepared Only for 3D

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