Fusion Imaging Reduces Radiation and Contrast Medium Exposure During Endovascular Revascularization of Iliac Steno-Occlusive Disease

Stahlberg, Erik; Sieren, M; Anton, Susanne; Jacob, F.; Planert, M.; Barkhausen, Jörg; Goltz, Jan Peter

doi:10.1007/s00270-019-02250-5

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…Concerns that were mentioned are mainly radiation exposure and workload issues. In line with those concerns, radiation protection during interventions is constantly being improved and innovative software solutions can significantly reduce the radiation dose by up to 35 % 17 18 . Furthermore, our survey shows that overall overtime hours in interventional radiology were not higher than in diagnostic radiology.…”

Section: Discussionmentioning

confidence: 99%

Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology – A Nationwide Survey

Sieren

Katoh

Mahnken

et al. 2022

Rofo

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Introduction With the increasing need for minimally invasive procedures based on lower complication rates, higher patient acceptance, and technical developments, there is a growing focus on the sound interventional training of young radiologists. This survey aimed to analyze the current situation in interventional radiology (IR) training in Germany to detect shortcomings and identify areas for improvement. Materials and Methods From November 1–30, 2020, an online questionnaire was distributed to representative radiological associations and societies with the request to forward it to radiology residents and radiologists < 40 years. The 44 questions covered six distinct areas from personal working conditions to the characterization of the IR department, training conditions, role of women in IR, and attendance at congresses/external training. Results A total of 330 participants completed the questionnaire. 77 % of participants expressed a high interest in IR, and 47 % could even imagine subspecializing in interventional radiology. Most institutions provided the necessary learning conditions and infrastructure. The rate of overall satisfaction with IR training conditions was 45 % (vs. a dissatisfaction rate of 39 %). However, females showed a lower satisfaction rate with their training environment than male participants (28 % vs. 51 %; P = 0.06). Positive correlations with work satisfaction were found for the presence and duration of the IR rotation, the number of partly independently/mentored performed interventions, and structured feedback. Moreover, the need for a structured training curriculum was expressed by 67 % of participants. Conclusion Radiological residents and young radiologists expressed a high interest in interventional radiology, and they rate the infrastructure of German hospitals regarding IR as sufficient. However, they expressed the need for consistent IR rotations and better-structured resident and postgraduate education (curricula & interviews). Key Points: Interest in interventional radiology among radiological residents and young radiologists in Germany is high, but satisfaction with interventional radiology training leaves room for improvement. The most frequently mentioned aspects that can improve IR training were Citation Format

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Section: Discussionmentioning

confidence: 99%

Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology – A Nationwide Survey

Sieren

Katoh

Mahnken

et al. 2022

Rofo

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“…Carbon dioxide (CO 2 ) being a negative contrast is an alternative, when contraindications for ICM such as allergic reactions, renal problems and thyrotoxicosis exist [ 4 – 6 ]. An important goal of present-day research is the reduction in ICM usage and X-ray dose, to minimize ICM complications as well as the radiation exposure for patients and staff involved [ 7 – 10 ]. Lowering the radiation or ICM dose normally results in reduced image quality.…”

Section: Introductionmentioning

confidence: 99%

Digital Variance Angiography in Lower-Limb Angiography with Metal Implants

Bastian

König

Viniol

et al. 2020

Cardiovasc Intervent Radiol

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Purpose The presence of metal implants may reduce angiographic image quality due to automated beam adjustments. Digital variance angiography (DVA) is reported to be superior to digital subtraction angiography (DSA) with increased contrast-to-noise ratio (CNR) and better image quality. The aim of the study was to evaluate whether DVA could counterbalance the image quality impairment of lower-limb angiographies with metal implants. Materials and Methods From November 2019 to January 2020, 85 raw lower-limb iodine contrast angiograms of 12 patients with metal implants were processed retrospectively with DVA analyses. For objective comparison, CNR of DSA and DVA images was calculated and the ratio CNRDVA/CNRDSA was determined. Visual image quality was evaluated in a paired comparison and by a five-grade Likert scale by three experienced radiologists. Results The CNR was calculated and compared in 1252 regions of interest in 37 image pairs containing metal implants. The median ratio of CNRDVA/CNRDSA was 1.84 with an interquartile range of 1.35–2.32. Paired comparison resulted in 84.5% in favour of DVA with an interrater agreement of 83.2% (Fleiss κ 0.454, p < 0.001). The overall image quality scores for DSA and DVA were 3.64 ± 0.08 and 4.43 ± 0.06, respectively (p < 0.001, Wilcoxon signed-rank test) with consistently higher individual ratings for DVA. Conclusion Our small-sample pilot study shows that DVA provides significantly improved image quality in lower-limb angiography with metal implants, compared to DSA imaging. The improved CNR suggest that this approach could reduce radiation exposure for lower-limb angiography with metal implants. Level of Evidence Level 4, case studies

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“…While the positive effects of fusion technology on radiation and contrast exposure are well established (Stahlberg et al 2019;Goudeketting et al 2018;Sailer et al 2015;Swerdlow et al 2019;Goudeketting et al 2017), the present study focuses on assessing differences between the different registration techniques and imaging modalities used for fusion imaging in a comprehensive, standardized setting. The maximum acceptable error of registration in FI is debatable.…”

Section: Table 1 Comparison Of Different Registration Techniques and Imaging Modalitiesmentioning

confidence: 99%

“…While the minimally invasive approach carries advantages for the patient, contrast media (CM) poses a health risk to the patient and ionizing radiation for both the patient and the interventionist (Brooks et al 2011;Gleeson and Bulugahapitiya 2004;Kawatani et al 2016;Solomon and Dumouchel 2006). Fusion imaging (FI) is becoming more established as an add-on technique for significantly reducing CM doses and radiation exposure in various endovascular procedures (Stahlberg et al 2019;Goudeketting et al 2018;Sailer et al 2015;Swerdlow et al 2019;Goudeketting et al 2017). Nonetheless, significant inaccuracies in fusion overlays have been reported (Schulz et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Accuracy of registration techniques and vascular imaging modalities in fusion imaging for aortic endovascular interventions: a phantom study

et al. 2021

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Background This study aimed to assess the error of different registration techniques and imaging modalities for fusion imaging of the aorta in a standardized setting using a anthropomorphic body phantom. Materials and methods A phantom with the 3D printed vasculature of a patient suffering from an infrarenal aortic aneurysm was constructed. Pulsatile flow was generated via an external pump. CTA/MRA of the phantom was performed, and a virtual 3D vascular model was computed. Subsequently, fusion imaging was performed employing 3D-3D and 2D-3D registration techniques. Accuracy of the registration was evaluated from 7 right/left anterior oblique c-arm angulations using the agreement of centerlines and landmarks between the phantom vessels and the virtual 3D virtual vascular model. Differences between imaging modalities were assessed in a head-to-head comparison based on centerline deviation. Statistics included the comparison of means ± standard deviations, student’s t-test, Bland-Altman analysis, and intraclass correlation coefficient for intra- and inter-reader analysis. Results 3D-3D registration was superior to 2D-3D registration, with the highest mean centerline deviation being 1.67 ± 0.24 mm compared to 4.47 ± 0.92 mm. The highest absolute deviation was 3.25 mm for 3D-3D and 6.25 mm for 2D-3D registration. Differences for all angulations between registration techniques reached statistical significance. A decrease in registration accuracy was observed for c-arm angulations beyond 30° right anterior oblique/left anterior oblique. All landmarks (100%) were correctly positioned using 3D-3D registration compared to 81% using 2D-3D registration. Differences in accuracy between CT and MRI were acceptably small. Intra- and inter-reader reliability was excellent. Conclusion In the realm of registration techniques, the 3D-3D method proved more accurate than did the 2D-3D method. Based on our data, the use of 2D-3D registration for interventions with high registration quality requirements (e.g., fenestrated aortic repair procedures) cannot be fully recommended. Regarding imaging modalities, CTA and MRA can be used equivalently.

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Fusion Imaging Reduces Radiation and Contrast Medium Exposure During Endovascular Revascularization of Iliac Steno-Occlusive Disease

Cited by 12 publications

References 20 publications

Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology – A Nationwide Survey

Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology – A Nationwide Survey

Digital Variance Angiography in Lower-Limb Angiography with Metal Implants

Accuracy of registration techniques and vascular imaging modalities in fusion imaging for aortic endovascular interventions: a phantom study

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