Patient Radiation Dose Management in the Follow-Up of Potential Skin Injuries in Neuroradiology

Vañó, Eliseo; Fernández, J.; Sanchez, Roberto Mariano; Martínez, D.; Ibor, L Lopez; Gil, Alberto; Serna-Candel, Carmen

doi:10.3174/ajnr.a3211

Cited by 41 publications

(26 citation statements)

References 21 publications

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“…However, because of the complexity of the pathologies to be treated, there is a significant number of procedures requiring prolonged X-ray procedures or high-dose acquisitions, which can result in increased radiation exposure to the patients as well as staff members [5,6] , leading to potential deterministic and stochastic adverse effects [7] .…”

Section: Introductionmentioning

confidence: 99%

Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site Experience

Hassan¹,

Amelot²

2017

Intervent Neurol

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Background and Purpose: Per the ALARA principle, reducing the dose delivered to both patients and staff must be a priority for endovascular therapists, who should monitor their own practice. We evaluated patient exposure to radiation during common neurointerventions performed with a recent flat-panel detector angiographic system and compared our results with those of recently published studies. Methods: All consecutive patients who underwent a diagnostic cerebral angiography or intervention on 2 modern flat-panel detector angiographic biplane systems (Innova IGS 630, GE Healthcare, Chalfont St Giles, UK) from February to November 2015 were retrospectively analyzed. Dose-area product (DAP), cumulative air kerma (CAK) per plane, fluoroscopy time (FT), and total number of digital subtraction angiography (DSA) frames were collected, reported as median (interquartile range), and compared with the previously published literature. Results: A total of 755 consecutive cases were assessed in our institution during the study period, including 398 diagnostic cerebral angiographies and 357 interventions. The DAP (Gy × cm 2 ), fontal and lateral CAK (Gy), FT (min), and total number of DSA frames were as follows: 43 (33-60), 0.26 (0.19-0.33), 0.09 (0.07-0.13), 5.6 (4.2-7.5), and 245 (193-314) for diagnostic cerebral angiographies, and 66 (41-110), 0.46 (0.25-0.80), 0.18 (0.10-0.30), 18.3 (9.1-30.2), and 281 (184-427) for interventions. Conclusion: Our diagnostic cerebral angiography group had a lower median and was in the 75th percentile of DAP and FT when compared with the published literature. For interventions, both DAP and number of DSA frames were significantly lower than the values reported in the literature, despite a higher FT. Subgroup analysis by procedure type also revealed a lower or comparable DAP.

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Section: Introductionmentioning

confidence: 99%

Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site Experience

Hassan¹,

Amelot²

2017

Intervent Neurol

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“…gadolinium, which causes renal failure in up to 2% of cases 3 ). Diagnostic angiography carries risk, with a complication rate as high as 1.2% in the Asymptomatic Carotid Atherosclerosis Study 11 , in addition to potential dose-dependent radiation-induced skin injuries 32 .…”

Section: Discussionmentioning

confidence: 99%

Prior Infarcts, Reactivity, and Angiography in Moyamoya Disease (PIRAMD): a scoring system for moyamoya severity based on multimodal hemodynamic imaging

Ladner¹,

Donahue²,

Arteaga³

et al. 2017

JNS

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Objective: Quantification of vasculopathy severity and its impact on parenchymal hemodynamics is a necessary prerequisite for informing management decisions and evaluating intervention response in patients with moyamoya disease (MMD). The authors performed digital subtraction angiography and noninvasive structural and hemodynamic MRI, and they outline a new classification system for patients with moyamoya that they have named Prior Infarcts, Reactivity, and Angi- ography in Moyamoya Disease (PIRAMD). Methods: Healthy control volunteers (n = 11; age 46 +/− 12 years [mean +/− SD]) and patients (n = 25; 42 +/− 13.5 years) with angiographically confirmed moyamoya provided informed consent and underwent structural (T1-weighted, T2- weighted, FLAIR, MR angiography) and hemodynamic (T2*- and cerebral blood flow–weighted) 3-T MRI. Cerebrovascular reactivity (CVR) in the internal carotid artery territory was assessed using susceptibility-weighted MRI during a hy- percapnic stimulus. Only hemispheres without prior revascularization were assessed. Each hemisphere was considered symptomatic if localizing signs were present on neurological examination and/or there was a history of transient ischemic attack with symptoms referable to that hemisphere. The PIRAMD factor weighting versus symptomatology was optimized using binary logistic regression and receiver operating characteristic curve analysis with bootstrapping. The PIRAMD finding was scored from 0 to 10. For each hemisphere, 1 point was assigned for prior infarct, 3 points for reduced CVR, 3 points for a modified Suzuki Score ≥ Grade II, and 3 points for flow impairment in ≥ 2 of 7 predefined vascular territories. Hemispheres were divided into 3 severity grades based on total PIRAMD score, as follows: Grade 1, 0–5 points; Grade 2, 6–9 points; and Grade 3, 10 points. Results: In 28 of 46 (60.9%) hemispheres the findings met clinical symptomatic criteria. With decreased CVR, the odds ratio of having a symptomatic hemisphere was 13 (95% CI 1.1–22.6, p = 0.002). The area under the curve for individual PIRAMD factors was 0.67–0.72, and for the PIRAMD grade it was 0.845. There were 0/8 (0%), 10/18 (55.6%), and 18/20 (90%) symptomatic PIRAMD Grade 1, 2, and 3 hemispheres, respectively. Conclusions: A scoring system for total impairment is proposed that uses noninvasive MRI parameters. This scoring system correlates with symptomatology and may provide a measure of hemodynamic severity in moyamoya, which could be used for guiding management decisions and evaluating intervention response.

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“…

F (x) = \frac{k_{b} T}{p} true[\frac{1}{4} {(1 - \frac{x}{L_{c}})}^{- 2} - \frac{1}{4} + \frac{x}{L_{c}} true]

The WLC equation predicts the entropic restoring force ( F ) generated upon extension ( x ) of a protein in terms of its contour length ( L C ) and persistence length ( p ) which characterizes the orientational correlation of segments in the chain. This analytical approximation is used to fit the WLC model to experimental force-extension curves (75, 76); to include stiffness of the chain, a modified WLC chain with “elastic modulus” parameter can be used (77). Using AFM and optical tweezers several groups have determined the persistence length of single unfolded polypeptide chains to range between 0.3 and 1.0 nm (4, 43, 75, 78-83).…”

Section: Basic Principles Of Single-molecule Force Spectroscopy Mementioning

confidence: 99%

Tracking unfolding and refolding reactions of single proteins using atomic force microscopy methods

Bujalowski

Oberhauser

2013

Methods

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During the last two decades single-molecule manipulation techniques such as atomic force microscopy (AFM) has risen to prominence through their unique capacity to provide fundamental information on the structure and function of biomolecules. Here we describe the use of single-molecule AFM to track protein unfolding and refolding pathways, enzymatic catalysis and the effects of osmolytes and chaperones on protein stability and folding. We will outline the principles of operation for two different AFM pulling techniques: length clamp and force-clamp discuss prominent applications. We provide protocols for the construction of polyproteins which are amenable for AFM experiments, the preparation of different coverslips, choice and calibration of AFM cantilevers. We also discuss the selection criteria for AFM recordings, the calibration of AFM cantilevers, protein sample preparations and analysis of the obtained data.

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Patient Radiation Dose Management in the Follow-Up of Potential Skin Injuries in Neuroradiology

Cited by 41 publications

References 21 publications

Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site Experience

Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site Experience

Prior Infarcts, Reactivity, and Angiography in Moyamoya Disease (PIRAMD): a scoring system for moyamoya severity based on multimodal hemodynamic imaging

Tracking unfolding and refolding reactions of single proteins using atomic force microscopy methods

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