Impact of low dose settings on radiation exposure during pediatric fluoroscopic guided interventions

Wildgruber, Moritz; Köhler, Michael; Brill, Richard; Goessmann, Holger; Uller, Wibke; Müller-Wille, René; Wohlgemuth, Walter A.

doi:10.1016/j.ejrad.2018.01.011

Cited by 7 publications

(15 citation statements)

References 21 publications

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“…In the use of a wide-ranging scan field, perfusion dynamics of the entire affected limb can be evaluated. As perfusion imaging requires repetitive scanning over a certain time period, the radiation burden has to be critically weighted against the potential benefits [ 13 , 81 , 82 ]. In case of further specific situations, such as if the AVM involves bone, CT may be of particular interest in the assessment of the surrounding tissues [ 64 ].…”

Section: Subtype-specific Imaging Findingsmentioning

confidence: 99%

Imaging of peripheral vascular malformations — current concepts and future perspectives

et al. 2021

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Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.

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Section: Subtype-specific Imaging Findingsmentioning

confidence: 99%

Imaging of peripheral vascular malformations — current concepts and future perspectives

et al. 2021

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“…Perfusion 4D CT imaging is not recommended as a standard imaging tool, especially in slow-flow vascular anomalies. Perfusion analysis of arterial feeding vessels and venous drainage of complex AVMs requires repetitive imaging with increased radiation exposure, which has to be taken into consideration [28]. In highly complex and extensive fast-flow AVMs, 4D CT imaging should be reserved for intervention planning, when arterial inflow vessels to the nidus of the AVM and venous outflow have to be identified for transarterial, transvenous and percutaneous access to the lesion during one embolization procedure [29].…”

Section: Computed Tomographymentioning

confidence: 99%

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Sadick

Overhoff

Baeßler

et al. 2019

Fortschr Röntgenstr

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Background Peripheral vascular anomalies represent a rare disease with an underlying congenital mesenchymal and angiogenetic disorder. Vascular anomalies are subdivided into vascular tumors and vascular malformations. Both entities include characteristic features and flow dynamics. Symptoms can occur in infancy and adulthood. Vascular anomalies may be accompanied by characteristic clinical findings which facilitate disease classification. The role of periinterventional imaging is to confirm the clinically suspected diagnosis, taking into account the extent and location of the vascular anomaly for the purpose of treatment planning. Method In accordance with the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies are mainly categorized as slow-flow and fast-flow lesions. Based on the diagnosis and flow dynamics of the vascular anomaly, the recommended periinterventional imaging is described, ranging from ultrasonography and plain radiography to dedicated ultrafast CT and MRI protocols, percutaneous phlebography and transcatheter angiography. Each vascular anomaly requires dedicated imaging. Differentiation between slow-flow and fast-flow vascular anomalies facilitates selection of the appropriate imaging modality or a combination of diagnostic tools. Results Slow-flow congenital vascular anomalies mainly include venous and lymphatic or combined malformations. Ultrasound and MRI and especially MR-venography are essential for periinterventional imaging. Arteriovenous malformations are fast-flow vascular anomalies. They should be imaged with dedicated MR protocols, especially when extensive. CT with 4D perfusion imaging as well as time-resolved 3D MR-A allow multiplanar perfusion-based assessment of the multiple arterial inflow and venous drainage vessels of arterio-venous malformations. These imaging tools should be subject to intervention planning, as they can reduce procedure time significantly. Fast-flow vascular tumors like hemangiomas should be worked up with ultrasound, including color-coded duplex sonography, MRI and transcatheter angiography in case of a therapeutic approach. In combined malformation syndromes, radiological imaging has to be adapted according to the dominant underlying vessels and their flow dynamics. Conclusion Guide to evaluation of flow dynamics in peripheral vascular anomalies, involving vascular malformations and vascular tumors with the intention to facilitate selection of periinterventional imaging modalities and diagnostic and therapeutic approach to vascular anomalies. Key Points: Citation Format

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“…Of course, the image quality required for the procedure should be better than that of angiography, but according to a previous study using a low-dose fluoroscopic protocol for peripheral AVM, the image quality was satisfactory and the dose decreased by more than 80%. 16 As for the neurovascular procedure, further research will be needed on a low-dose protocol with a good balance of image quality and dose.…”

Section: Discussionmentioning

confidence: 99%

“…Although the low-dose fluoroscopic protocol in diagnostic cerebral angiography did not result in a great clinical significance, it may be meaningful if applied to complex neurovascular procedures such as embolization of brain arteriovenous malformations (AVM) or dural arteriovenous fistulas, which are associated with a high proportion of performing fluoroscopy. Of course, the image quality required for the procedure should be better than that of angiography, but according to a previous study using a low-dose fluoroscopic protocol for peripheral AVM, the image quality was satisfactory and the dose decreased by more than 80% [ 16 ]. As for the neurovascular procedure, further research will be needed on a low-dose protocol with a good balance of image quality and dose.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Fluoroscopy Protocol for Diagnostic Cerebral Angiography

Song

Han

Kim³

et al. 2020

Neurointervention

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Purpose: We applied a low-dose fluoroscopic protocol in routine diagnostic cerebral angiography and evaluated the feasibility of the protocol.Materials and Methods: We retrospectively reviewed a total of 60 patients who underwent diagnostic cerebral angiography for various neurovascular diseases from September to November 2019. Routine protocols were used for patients in the first phase and low-dose protocols in the second phase. We compared radiation dose, fluoroscopy time, and complications between groups.Results: Age, diseases, and operators were not significantly different between the two groups. The mean fluoroscopy dose significantly decreased by 52% in the low-dose group (3.09 vs. 6.38 Gy·cm<sup>2</sup> ); however, the total dose was not significantly different between the two groups (34.07 vs. 33.70 Gy·cm<sup>2</sup> ). The total fluoroscopic time was slightly longer in the low-dose group, but the difference was not statistically significant (12.2. vs. 12.5 minutes). In all patients, angiography was successfully performed without complications.Conclusion: The low-dose fluoroscopy protocol is feasible to apply for diagnostic cerebral angiography in that this protocol could significantly reduce the fluoroscopic dose.

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Impact of low dose settings on radiation exposure during pediatric fluoroscopic guided interventions

Cited by 7 publications

References 21 publications

Imaging of peripheral vascular malformations — current concepts and future perspectives

Imaging of peripheral vascular malformations — current concepts and future perspectives

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Low-Dose Fluoroscopy Protocol for Diagnostic Cerebral Angiography

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