Removal of the Antiscatter Grid During Routine Biliary Interventional Procedures Performed in a Flat-Panel Interventional Suite: Preliminary Data on Image Quality and Patient Radiation Exposure

Abstract

Our preliminary data show that removal of the grid during routine biliary procedures is feasible and results in a significant decrease of patient radiation exposure. This seems of particular relevance because most of these patients require frequent reintervention. Larger studies with more procedures are warranted to confirm these data.

Direct Effective Dose Calculations in Pediatric Fluoroscopy-Guided Abdominal Interventions with Rando-Alderson Phantoms – Optimization of Preset Parameter Settings

“…Pediatric patients requiring abdominal interventions, e.g. pediatric liver transplant recipients presenting with portal vein or biliary disease usually require repeated interventions leading to an accumulated risk[15, 16]. The life expectancy of patients with pediatric liver transplant is reduced compared to the normal population[17], however other pediatric interventional procedures such as embolization of extracranial vascular malformations involve children with a normal life expectancy.…”

“…The grid is usually not necessary for children<15kg, as the amount of scatter radiation is limited. Cortis et al have demonstrated that removal of the antiscatter grid during routine biliary interventions in a pediatric patient population significantly reduced patient radiation exposure with acceptable image quality[15]. Image quality of the acquired phantom scans did not reveal a substantial loss in image quality, as subjectively assessed b three independent readers.…”

Percutaneous Biliary Interventions in Pediatric Patients

“…Second, given the predominantly benign nature of their diseases, patients theoretically have a normal life expectancy after liver transplantation; so, the development of stochastic radiation damage must be taken into account. 32,33 In the last several decades, several campaigns have brought awareness to this issue with the best known as the ALARA (As Low As Reasonably Achievable) principle. In 2009, a "step lightly, image gently" campaign was launched by the Alliance for Radiation Safety in Pediatric Imaging 11,12,[33][34][35] to further educate and raise awareness about the use of radiographic examinations in the pediatric population.…”

“…Second, given the predominantly benign nature of their diseases, patients theoretically have a normal life expectancy after liver transplantation; so, the development of stochastic radiation damage must be taken into account. 32 33…”

Technical evaluation of a prototype ratio 29:1 grid for adult patient cardiovascular angiography imaging conditions

“…However, this perspective is not exclusive and may depend on pediatric patient size (Onnasch et al 2004, Gislason et al 2010, Ubeda et al 2013, Chamberlain et al 2019. Others have also investigated the use of non-grid or air gap techniques to mitigate scatter for adult patient fluoroscopic and angiographic imaging (Gray and Swee 1982, Partridge et al 2006, Cortis et al 2014, Smith et al 2016, Roy et al 2017. Simply removing the grid results in reduced patient radiation dose due to the combination of automatic dose rate control circuit and lack of x-ray beam attenuation by the grid.…”