Radiation exposure to operating staff during rotational flat-panel angiography and C-arm cone beam computed tomography (CT) applications

Schulz, Boris; Heidenreich, Ralf; Heidenreich, Monika; Eichler, Katrin; Thalhammer, A.; Naeem, Naguib Nagy Naguib; Vogl, Thomas J.; Zangos, S

doi:10.1016/j.ejrad.2012.01.010

Cited by 29 publications

(15 citation statements)

References 18 publications

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“…Moreover, a comparison of effective patient doses between CBCT and CT guidance has already been provided by Braak et al [8] who reported a 13-42% dose reduction for CBCT guidance compared with CT guidance. However, when compared with CT, CBCT guidance likely results in a higher operator dose [24]. Therefore, appropriate shielding should be used [25].…”

Section: Discussionmentioning

confidence: 99%

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

Busser¹,

Braak²,

Fütterer³

et al. 2013

BJR

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Objective: To determine the accuracy of cone beam CT (CBCT) guidance and CT guidance in reaching small targets in relation to needle path complexity in a phantom. Methods: CBCT guidance combines three-dimensional CBCT imaging with fluoroscopy overlay and needle planning software to provide real-time needle guidance. The accuracy of needle positioning, quantified as deviation from a target, was assessed for inplane, angulated and double angulated needle paths. Four interventional radiologists reached four targets along the three paths using CBCT and CT guidance. Accuracies were compared between CBCT and CT for each needle path and between the three approaches within both modalities. The effect of user experience in CBCT guidance was also assessed. Results: Accuracies for CBCT were significantly better than CT for the double angulated needle path (2.2 vs 6.7 mm, p,0.001) for all radiologists. CBCT guidance showed no significant differences between the three approaches. For CT, deviations increased with increasing needle path complexity from 3.3 mm for the inplane placements to 4.4 mm (p50.007) and 6.7 mm (p,0.001) for the angulated and double angulated CT-guided needle placements, respectively. For double angulated needle paths, experienced CBCT users showed consistently higher accuracies than trained users [1.8 mm (range 1.2-2.2) vs 3.3 mm (range 2.1-7.2) deviation from target, respectively; p50.003]. Conclusion: In terms of accuracy, CBCT is the preferred modality, irrespective of the level of user experience, for more difficult guidance procedures requiring double angulated needle paths as in oncological interventions. Advances in knowledge: Accuracy of CBCT guidance has not been discussed before. CBCT guidance allows accurate needle placement irrespective of needle path complexity. For angulated and double-angulated needle paths, CBCT is more accurate than CT guidance.Needle guidance for puncture or other minimally invasive procedures is increasing in standard interventional radiology practice. In local therapy procedures, such as percutaneous ablations, accurate placement of one or more needles is important in order to provide effective treatment [1]. This is especially the case in treatment or biopsy procedures of small lesions, in which the tip of the needle needs to be placed within a range of millimetres of the target point. Therefore, image guidance plays a significant role in accurate percutaneous needle placement [2].Currently, most needle placement procedures are performed using CT guidance, fluoroscopy or ultrasound [3]. CT images provide good visualisation of the target and surrounding tissues. For needle guidance, however, CT has limitations mainly because it does not allow real-time feedback on needle progression. For semi-real-time imaging within the CT scanner, CT-fluoroscopy can be used at the expense of a higher radiation dose to the patient and operator [4]. Acquiring CT fluoroscopy images to check needle position takes approximately 1 s, time in which the needle cannot be progressed.Fluorosc...

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Section: Discussionmentioning

confidence: 99%

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

Busser¹,

Braak²,

Fütterer³

et al. 2013

BJR

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“…On the other hand, the additional use of CBCT decreases the deterministic risk (cumulative dose) when compared with a procedure using fluoroscopy and DSA alone and facilitates the procedure, potentially reducing the procedure time (37). As for all interventional procedures using x-ray exposure, the operators should wear protective devices and leave the examination room when performing 3D scans, and CBCT acquisition should be used judiciously (37,40). …”

Section: Cbct Imaging: How It Workmentioning

confidence: 99%

How I Do It: Cone-Beam CT during Transarterial Chemoembolization for Liver Cancer

Tacher¹,

Radaelli²,

Lin³

et al. 2015

Radiology

149

119

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Cone-beam computed tomography (CBCT) is an imaging technique that provides computed tomographic (CT) images from a rotational scan acquired with a C-arm equipped with a flat panel detector. Utilizing CBCT images during interventional procedures bridges the gap between the world of diagnostic imaging (typically three-dimensional imaging but performed separately from the procedure) and that of interventional radiology (typically two-dimensional imaging). CBCT is capable of providing more information than standard two-dimensional angiography in localizing and/or visualizing liver tumors (“seeing” the tumor) and targeting tumors though precise microcatheter placement in close proximity to the tumors (“reaching” the tumor). It can also be useful in evaluating treatment success at the time of procedure (“assessing” treatment success). CBCT technology is rapidly evolving along with the development of various contrast material injection protocols and multiphasic CBCT techniques. The purpose of this article is to provide a review of the principles of CBCT imaging, including purpose and clinical evidence of the different techniques, and to introduce a decision-making algorithm as a guide for the routine utilization of CBCT during transarterial chemoembolization of liver cancer.

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“…Schulz et al (2012) measured dose to the eye ranging from 28.0 to 79.3 mSv for CBCT hepatic arterial embolisation and biliary tube placement procedures. The primary source of radiation is the x-ray tube, and, ideally, the patient alone .…”

Section: Factors Influencing Dose To Workermentioning

confidence: 99%

“…(177) Non-vascular interventions include procedures such as vertebroplasty (treatment of vertebral fractures, osteoporosis, or metastases), drainage of abscesses or Schulz et al, 2012 fluid collections, image-guided biopsies, percutaneous transhepatic cholangiography drainage (PTCD), and tumour ablation (e.g. liver tumour microwave ablation) .…”

Section: Non-vascular Interventionsmentioning

confidence: 99%

ICRP Publication 129: Radiological Protection in Cone Beam Computed Tomography (CBCT)

Rehani¹,

Gupta²,

Bartling³

et al. 2015

Ann ICRP

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The objective of this publication is to provide guidance on radiological protection in the new technology of cone beam computed tomography (CBCT). Publications 87 and 102 dealt with patient dose management in computed tomography (CT) and multi-detector CT. The new applications of CBCT and the associated radiological protection issues are substantially different from those of conventional CT. The perception that CBCT involves lower doses was only true in initial applications. CBCT is now used widely by specialists who have little or no training in radiological protection. This publication provides recommendations on radiation dose management directed at different stakeholders, and covers principles of radiological protection, training, and quality assurance aspects. Advice on appropriate use of CBCT needs to be made widely available. Advice on optimisation of protection when using CBCT equipment needs to be strengthened, particularly with respect to the use of newer features of the equipment. Manufacturers should standardise radiation dose displays on CBCT equipment to assist users in optimisation of protection and comparisons of performance. Additional challenges to radiological protection are introduced when CBCT-capable equipment is used for both fluoroscopy and tomography during the same procedure. Standardised methods need to be established for tracking and reporting of patient radiation doses from these procedures. The recommendations provided in this publication may evolve in the future as CBCT equipment and applications evolve. As with previous ICRP publications, the Commission hopes that imaging professionals, medical physicists, and manufacturers will use the guidelines and recommendations provided in this publication for implementation of the Commission's principle of optimisation of protection of patients and medical workers, with the objective of keeping exposures as low as reasonably achievable, taking into account economic and societal factors, and consistent with achieving the necessary medical outcomes.

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Radiation exposure to operating staff during rotational flat-panel angiography and C-arm cone beam computed tomography (CT) applications

Cited by 29 publications

References 18 publications

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

How I Do It: Cone-Beam CT during Transarterial Chemoembolization for Liver Cancer

ICRP Publication 129: Radiological Protection in Cone Beam Computed Tomography (CBCT)

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