Common Radiological Procedures Research Articles

SU‐GG‐I‐70: Patient Dose Measurements for Establishing Guidance Levels for Medical Exposures in Diagnostic Radiology

Patient dose measurements in diagnostic radiology are conducted for common and specialized radiological procedures. The Objective of this study is to obtain a range of radiation doses received by patients undergoing diagnostic radiology examinations in Lebanon, to investigate the variability of patient doses in relation to x‐ray equipment used to compare the results with international guidance levels and to implement corrective actions to reduce doses.

Neither MRI, CT nor US is superior to diagnose tumors in the salivary glands--an extended case study.

ObjectivesUltrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most common radiological procedures for the diagnosis of tumor-like lesions of the salivary glands. The aim of the present study was to determine whether MRI or CT provide additional information besides that delivered by US.Study design/Methods109 patients with a tumor-like lesion of the salivary glands underwent surgery. MRI and CT were arranged in 73 and in 40 patients respectively, whereas all 109 patients were prospectively diagnosed by US. The results of CT, MRI and US were compared with the histological outcome. Furthermore, the recent rise in the number of CT and MRI studies was investigated.ResultsOn CT and MRI, there was no rise in the percentage of malignant tumors or advanced surgical procedures. In respect of the radiological assessment of the lesion (benign/malignant) and the correct diagnosis, CT, MRI and US were comparable in terms of sensitivity, specificity and accuracy. No significant difference was found in the Chi-square test (p > 0.05).ConclusionThe evaluation of the preoperative results of CT, MRI and US revealed no advantage for CT or MRI; these procedures are only required in specific cases. An update or revision of the current preoperative diagnostic management is deemed necessary.

Trauma surgery and risk of radiation injury to patients

Image intensifiers are widely used in orthopaedic trauma surgery. Since beginning of fluoroscopy use, concerns have been raised regarding the radiation risks to the patients and the theatre staff in these operations. The radiation risks are classified into two types, stochastic and deterministic risks. Effective dose (ED) and skin dose (SD) values were derived from dose area product (DAP) values and used to quantify the stochastic and deterministic risks, respectively. Patients (670) who had dynamic hip screw (DHS) fixation, cannulated hip screw (CHS) fixation, intra-medullary nailing (IMN) of femur and tibia were included in the study. ED values were 0.3, 0.6, 0.9 and 0.01 mSv and stochastic risks were 3 × 10−5, 6 × 10−5, 9 × 10−5 and 1 × 10−6 for DHS, CHS, IMN of femur and IMN of tibia, respectively. Maximum SD values were 36, 65, 100 and 46 mGy which were only 2, 3, 5 and 2% of threshold dose for temporary skin erythema (2 Gy) in DHS, CHS, IMN of femur and IMN of tibia operations. The radiation exposure in these operations was very low compared to common intervention radiology procedures. The study concludes that the risk of radiation injury in lower limb trauma surgery is extremely small. The radiation doses to patients are within maximum permissible dose (MPD) limits recommended by International Commission on Radiological Protection.

A Guide to Antibiotics for the Interventional Radiologist

Antibiotics are among the most common pharmaceutical agents used by the interventional radiologist. This article updates some of the practical aspects of the use of antibiotics in interventional radiological practice and provides some general guidelines with respect to indications for and selection of antibiotics. In particular, the objectives of this article are to review the basic pharmacology of the common antibiotic agents, the interventional radiological procedures in which prophylactic antibiotics are usually administered, the specific antimicrobial agents recommended for prophylaxis before common interventional radiological procedures, the appropriate antibiotics for patients allergic to penicillins, and the indications for antibiotic prophylaxis to prevent bacterial endocarditis.

Radiation Doses in Interventional Radiology Procedures: The RAD-IR Study Part II: Skin Dose

To determine peak skin dose (PSD), a measure of the likelihood of radiation-induced skin effects, for a variety of common interventional radiology and interventional neuroradiology procedures, and to identify procedures associated with a PSD greater than 2 Gy. An observational study was conducted at seven academic medical centers in the United States. Sites prospectively contributed demographic and radiation dose data for subjects undergoing 21 specific procedures in a fluoroscopic suite equipped with built-in dosimetry capability. Comprehensive physics evaluations and periodic consistency checks were performed on each unit to verify the stability and consistency of the dosimeter. Seven of 12 fluoroscopic suites in the study were equipped with skin dose mapping software. Over a 3-year period, skin dose data were recorded for 800 instances of 21 interventional radiology procedures. Wide variation in PSD was observed for different instances of the same procedure. Some instances of each procedure we studied resulted in a PSD greater than 2 Gy, except for nephrostomy, pulmonary angiography, and inferior vena cava filter placement. Some instances of transjugular intrahepatic portosystemic shunt (TIPS) creation, renal/visceral angioplasty, and angiographic diagnosis and therapy of gastrointestinal hemorrhage produced PSDs greater than 3 Gy. Some instances of hepatic chemoembolization, other tumor embolization, and neuroembolization procedures in the head and spine produced PSDs greater than 5 Gy. In a subset of 709 instances of higher-dose procedures, there was good overall correlation between PSD and cumulative dose (r = 0.86; P <.000001) and between PSD and dose-area-product (r = 0.85, P <.000001), but there was wide variation in these relationships for individual instances. There are substantial variations in PSD among instances of the same procedure and among different procedure types. Most of the procedures observed may produce a PSD sufficient to cause deterministic effects in skin. It is suggested that dose data be recorded routinely for TIPS creation, angioplasty in the abdomen or pelvis, all embolization procedures, and especially for head and spine embolization procedures. Measurement or estimation of PSD is the best method for determining the likelihood of radiation-induced skin effects. Skin dose mapping is preferable to a single-point measurement of PSD.

Safety of conscious sedation in interventional radiology.

To identify rates of adverse events associated with the use of conscious sedation in interventional radiology. In a 5-month period, prospective data were collected on patients undergoing conscious sedation for interventional radiology procedures (n = 594). Adverse events were categorized as respiratory, sedative, or major adverse events. Respiratory adverse events were those that required oral airway placement, ambu bag, or jaw thrust. Sedation adverse events were unresponsiveness, oxygen saturation less than 90%, use of flumazenil/naloxone, or agitation. Major adverse events were hypotension, intubation, CPR, or cardiac arrest. The frequency of adverse events for the five most common radiology procedures were determined. The five most common procedures (total n = 541) were biliary tube placement/exchange (n = 182), tunneled catheter placement (n = 135), diagnostic arteriography (n = 125), vascular interventions (n = 52), and other catheter insertions (n = 46). Rates for respiratory, sedation, and major adverse events were 4.7%, 4.2%, and 2.0%, respectively. The most frequent major adverse event was hypotension (2.0%). Biliary procedures had the highest rate of total adverse events (p < .05) and respiratory adverse events (p < .05). The frequency of adverse events is low with the use of conscious sedation during interventional procedures. The highest rates occurred during biliary interventions.

Radiation doses to paediatric patients undergoing less common radiological procedures involving fluoroscopy.

A semi-automated dosimetry survey has been undertaken to monitor the radiation doses to patients in a paediatric fluoroscopy room. The doses were assessed using large area Diamentor ionization chambers to measure dose x area product, and by means of thermoluminescent dosemeters attached to the patient's skin in various places. Details of patients and examinations were entered into a computer, all information being stored on a data base. Many radiological examinations have been monitored, including renal and jejunal biopsies, nephrostograms, loopograms, tracheograms and fistulograms. Patients included in the study have been divided into three age bands for dose assessment. Radiation doses for different types of examination have been compared, including more common examinations for which data have been previously presented.

Are we taught how to use a radiology department as medical students?

Thirty-six final year medical students and 28 senior house officers answered a questionnaire designed to evaluate their efficacy in requesting common radiological procedures and their knowledge of what the patient experiences during the investigation. Both groups revealed a significant degree of ignorance, though the house officers were better informed than the students. The need for undergraduate teaching in radiology, particularly in the role of diagnostic radiology in clinical management is discussed.