Fluoroscopy-guided Procedures Research Articles

Assessing the impact of 3D imaging assistance on efficiency and safety in atrial fibrillation cryoablation

Abstract Introduction Pulmonary vein (PV) isolation is a cornerstone therapy for symptomatic atrial fibrillation (AF). Current 3D-navigation technologies used with radiofrequency (RF) ablation allow drastic reduction of X-ray exposure and better anatomical characterization improving acute and long-term procedural results. Cryoballoon ablation (CA) procedures typically rely on conventional fluoroscopy, resulting in significant X-ray exposure. Although contemporary fluoroscopy technologies allow for potential 3D imaging integration, their specific utility in improving procedural guidance during CA remains undefined. Method Using semi-automatic segmentation obtained from pre-procedural cardiac computed tomography, 3D segmentations of the left atrium, including PV, spine and primary bronchi walls were fused on the real-time fluoroscopy acquisitions in three standard positions (AP, LAO, RAO), acquired at the beginning of the procedure (Figure1). We compared procedural characteristics of CA performed with 3D-fusion imaging to conventional fluoroscopy-guided procedures. Results Thirty-six patients (aged 60±13 yo, 85% male) with paroxysmal AF treated with CA were included in the study: 18 in the control group (conventional fluoroscopy) and 18 in the 3D-assisted group. Acute PV isolation was achieved in all patients. The 3D-assisted CA was associated with significantly shorter procedure duration (mean 97.8±15.5 vs 82.1±16.1 min, p=0.0048); left-sided dwelling time (mean 77±15.2 vs 65.1±14.4 min, p=0.0351); and lower X-ray energy delivered to the patient (Dose Area product) with mean 661±373.1 vs 378.1±316.8 cGy*cm2 (p=0.013). Interestingly, we found that 72.2% of 3D guided procedures were done in less than 90min, while 77.8% of conventional cases required more than 90min to be completed (Figure 2D). Conclusion 3D-fusion imaging integration is feasible and allows for an exact PV anatomy depiction on fluoroscopy. Our data illustrates that it might significantly improve CA efficiency (shorter procedure duration) and safety (lower X-ray exposure and left-sided dwelling time). Our approach could also impact long-term results since it might reduce the likeability of missing intermediate PVs. Further research is needed to evaluate the incremental value of 3D imaging in long term efficacy.Figure 1Figure 2

Transesophageal echocardiography-guided versus fluoroscopy-guided patent foramen ovale closure: A single center registry.

Percutaneous closure of patent foramen ovale (PFO) is conventionally performed under continuous transesophageal echocardiographic (TEE) guidance. We aimed to evaluate whether a simplified procedural approach, including pure fluoroscopy-guidance and final TEE control, as well as an aimed 'next-day-discharge' is comparable with the conventional TEE-guided procedure in terms of periprocedural and intermediate-term outcomes. All patients who underwent a PFO closure at our center between 2010 and 2022 were retrospectively included. Prior to June 2019 cases were performed with continuous TEE guidance (TEE-guided group). Since June 2019, only pure fluoroscopy-guided PFO closures have been performed with TEE insertion and control just prior to device release (fluoroscopy-guided group). We analyzed procedural aspects, as well as long term clinical and echocardiographic outcomes. In total 291 patients were included in the analysis: 197 in the TEE-guided group and 94 in the fluoroscopy-guided group. Fluoroscopy-guided procedures were markedly shorter (48±20 min vs. 25±9 min; p<.01). There was no difference in procedural complications, including death, major bleeding, device dislodgement, stroke or clinically relevant peripheral embolization between the two groups (.5% vs. 0%; p=.99). Hospital stay was also shorter with the simplified approach (2.5±1.6 vs. 3.5±1.2 days; p< .01), allowing 85% same-day discharges during the last 12 months of observation period. At 6±3 months echocardiographic follow-up a residual leakage was described in 8% of the TEE-guided cases and 2% of the fluoroscopy-guided cases (p= .08). While a complete TEE-free PFO closure might have potential procedural risks, our approach of pure fluoroscopy-guided with a brisk final TEE check seems to be advantageous in terms of procedural aspects with no sign of any acute or intermediate-term hazard and it could offer an equitable compromise between the two worlds: a complete TEE procedure and a procedure without any TEE.

Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study

IntroductionUreteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. Material and methodsPatients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. ResultsA total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%, p=.127) or postoperative complication rate (35.0% vs 31.5%, p=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR 0.991; 95% IC 0.407–2.411; p=.983), when adjusted for procedure type, stone size and stone number. ConclusionURS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.

Cardiac magnetic resonance-guided cardiac ablation: a case series of an early experience.

Radiofrequency (RF) catheter ablation has become a widely used therapeutic approach. However, long-term results in terms of arrhythmia recurrence are still suboptimal. Cardiac magnetic resonance (CMR) could offer a valuable tool to overcome this limitation, with the possibility of targeting the arrhythmic substrate and evaluating the location, depth, and possible gaps of RF lesions. Moreover, real-time CMR-guided procedures offer a radiation-free approach with an evaluation of anatomical structures, substrates, RF lesions, and possible complications during a single procedure. The first steps in the field have been made with cavotricuspid isthmus ablation, showing similar procedural duration and success rate to standard fluoroscopy-guided procedures, while allowing visualization of anatomic structures and RF lesions. These promising results open the path for further studies in the context of more complex arrhythmias, like atrial fibrillation and ventricular tachycardias. Of note, setting up an interventional CMR (iCMR) centre requires safety and technical standards, mostly related to the need for CMR-compatible equipment and medical staff's educational training. For the cardiac imagers, it is fundamental to provide correct CMR sequences for catheter tracking and guide RF delivery. At the same time, the electrophysiologist needs a rapid interpretation of CMR images during the procedures. The aim of this paper is first to review the logistic and technical aspects of setting up an iCMR suite. Then, we will describe the experience in iCMR-guided flutter ablations of two European centres, Policlinico Casilino in Rome, Italy, and Haga Teaching Hospital in The Hague, the Netherlands.

Eficacia y seguridad de la ureteroscopia y la cirugía retrógrada intrarrenal sin fluoroscopia para el tratamiento de la urolitiasis: estudio comparativo

IntroductionUreteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. Material and methodsPatients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. ResultsA total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%; P=.127) or postoperative complication rate (35.0% vs 31.5%; P=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR: 0.991; 95%IC: 0.407-2.411; P=.983), when adjusted for procedure type, stone size and stone number. ConclusionURS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.

MP35-20 COMPARING TREATMENT OUTCOMES FOR FLUOROSCOPIC AND ‘FLUOROSCOPY-FREE’ ENDOUROLOGICAL PROCEDURES: A SYSTEMATIC REVIEW ON BEHALF OF THE EAU UROLITHIASIS GUIDELINES PANEL

You have accessJournal of UrologyCME1 Apr 2023MP35-20 COMPARING TREATMENT OUTCOMES FOR FLUOROSCOPIC AND ‘FLUOROSCOPY-FREE’ ENDOUROLOGICAL PROCEDURES: A SYSTEMATIC REVIEW ON BEHALF OF THE EAU UROLITHIASIS GUIDELINES PANEL Niall Davis, Lazaros Tzelves, Robert Geraghty, Riccardo Lombardo, Cathy Yuan, Ales Petrik, Andreas Neisius, Giovanni Gambaro, Helene Jung, Robert Shepherd, Thomas Tailly, Bhaskar Somani, and Andreas Skolarikos Niall DavisNiall Davis More articles by this author , Lazaros TzelvesLazaros Tzelves More articles by this author , Robert GeraghtyRobert Geraghty More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Cathy YuanCathy Yuan More articles by this author , Ales PetrikAles Petrik More articles by this author , Andreas NeisiusAndreas Neisius More articles by this author , Giovanni GambaroGiovanni Gambaro More articles by this author , Helene JungHelene Jung More articles by this author , Robert ShepherdRobert Shepherd More articles by this author , Thomas TaillyThomas Tailly More articles by this author , Bhaskar SomaniBhaskar Somani More articles by this author , and Andreas SkolarikosAndreas Skolarikos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endourological procedures frequently necessitate fluoroscopic guidance, which results in harmful radiation exposure to patients and staff. Recently, several reports underlined the possibility to bypass the use of fluoroscopy. The aim of this systematic review and meta-analysis is to compare benefits and risks of fluoroscopic vs fluoroscopy-free procedures. METHODS: A systematic review of literature in MEDLINE/Pubmed, Embase and Cochrane controlled trials database and ClinicalTrial.gov was performed between 1970-2022. Primary outcomes assessed were complications and stone-free rate (SFR), while eligible studies reported data on ureteroscopy and percutaneous nephrolithotripsy (PCNL). RESULTS: 24 eligible studies (12 randomized and 12 observational) out of 834 initially screened abstracts were eligible for analysis, accounting for 4882 patients. Pooled analysis of all procedures revealed no significant differences for SFR, operative time, length of stay, minor (Clavien I-II) or major complications (Clavien III-V) between groups. Similar results were noted when subanalyses for ureteroscopy and PCNL were performed. When only randomized studies were analyzed, results were similar except that minor and major complications favored fluoroscopy-free group (RR 0.68 and 0.59 respectively). CONCLUSIONS: Pooled analysis revealed that the SFR and complication rates when fluoroscopy-free procedures are used, are similar with fluoroscopy-guided procedures. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e477 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niall Davis More articles by this author Lazaros Tzelves More articles by this author Robert Geraghty More articles by this author Riccardo Lombardo More articles by this author Cathy Yuan More articles by this author Ales Petrik More articles by this author Andreas Neisius More articles by this author Giovanni Gambaro More articles by this author Helene Jung More articles by this author Robert Shepherd More articles by this author Thomas Tailly More articles by this author Bhaskar Somani More articles by this author Andreas Skolarikos More articles by this author Expand All Advertisement PDF downloadLoading ...

Influence of radiation dose reduction gloves on exposure parameters, entrance dose rates and eye doses of interventionalists during mobile C-arm fluoroscopic procedures: A phantom study

IntroductionDuring fluoroscopic examinations, radiation dose reduction gloves (RRGs) protect the hands of the interventionalist against ionising scattered radiation from the patient. Some fluoroscopic procedures may require the hands of the interventionalist in the path of the primary X-ray beam. This study investigates the influence of RRGs in the field of view (FOV) on exposure parameters, entrance dose rates and eye doses of interventionalists during mobile C-arm fluoroscopic procedures. MethodPolymethylmethacrylate (PMMA) slabs were stacked on each other to simulate patient thicknesses. The abdomen protocol of the unit was selected for the study. The entrance dose rates to the surface of the PMMA slabs and the scattered radiation were measured for an undercouch configuration with and without RRGs in the FOV. The exposure parameters were noted. The scattered radiation for an overcouch configuration was measured. ResultsThe entrance dose rate increases as the FOV decreases for a fixed thickness of PMMA. The presence of RRGs in the FOV increases the exposure parameters, entrance dose rates and the scattered radiation to the eyes of the interventionalist. For the first level of RRG coverage, percentage increases in entrance dose rates and eye doses for the 23 cm FOV for all thicknesses of PMMA slabs ranged from 1.0% to 17.0% and 20.0%–30.0%, respectively; for the second level of RRG coverage, the entrance dose rates ranged from 17.0% to 45.0% and the eye doses from 50.0% to 60.0%. Percentage increases depend on the FOV, the patient's thickness, and the size and orientation of the RRGs in the FOV. Scattered radiation to the eyes of the interventionalist increases with an overcouch configuration compared to an undercouch configuration. ConclusionSterile RRGs protects the hands of the interventionalist against scattered radiation. But in the FOV, they increase the scattered radiation to the personnel and the patient entrance dose rate. Implications for practiceFor best practice in C-arm fluoroscopy-guided procedures, appropriate FOV and C-arm orientation should be selected, whilst RRGs should not be in the path of the primary beam unless necessary.

Occupational radiation dose from gastrointestinal endoscopy procedures with special emphasis on eye lens doses in endoscopic retrograde cholangiopancreatography.

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) procedures may result in remarkable radiation doses to patients and staff. The aim of this prospective study was to determine occupational exposures in gastrointestinal endoscopy procedures, with a special emphasis on eye lens dose in ERCP. Methods Altogether 604 fluoroscopy-guided procedures, of which 560 were ERCPs belonging to four American Society for Gastrointestinal Endoscopy procedural complexity levels, were performed using two fluoroscopy systems. Personal deep-dose equivalent H p (10), shallow-dose equivalent H p (0.07), and eye lens dose equivalent H p (3) of eight interventionists and H p (3) for two nurse dosimeters were measured. Thereafter, conversion coefficients from kerma-area product (KAP) for H p (10), H p (0.07), and H p (3) were determined and dose equivalents per procedure to an operator and assisting staff were estimated. Further, mean conversion factors from H p (10) and H p (0.07) to H p (3) were calculated. Results The median KAP in ERCP was 1.0 Gy·cm 2 , with mobile c-arm yielding higher doses than a floor-mounted device ( P < 0.001). The median H p (3) per ERCP was estimated to be 0.6 µSv (max. 12.5 µSv) and 0.4 µSv (max. 12.2 µSv) for operators and assisting staff, respectively. The median H p (10) and H p (0.07) per procedure ranged from 0.6 to 1.8µSv. ERCP procedural complexity level ( P ≤ 0.002) and interventionist ( P < 0.001) affected dose equivalents. Conclusions Occupational dose limits are unlikely to be exceeded in gastrointestinal endoscopy practice when following radiation-hygienic working methods and focusing on dose optimization. The eye lens dose equivalent H p (3) may be estimated with sufficient agreement from the H p (10) and H p (0.07).

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Quantitative assessments of image intensifier distortion induced by weak (Sub-Gauss) magnetic fields during fluoroscopically-guided procedures.

Fluoroscopically-guided procedures at our hospital have been aborted due to sigmoidal distortion (S-distortion) when an image intensifier (II) system is used in a surgical environment distant from any apparent sources of strong magnetic fields, such as a nearby magnetic resonance imaging (MRI) scanner. Clearly, current clinical practice fails to account for the impact of ambient weak magnetic fields and/or other contributing factors on S-distortion induction. This study attempts to quantitatively assess the threshold level of magnetic field, along with other potential factors, that can induce intolerable S-distortion during image-intensified fluoroscopically-guided procedures. We will also discover the origins of such level of magnetic field in typical surgical facilities and provide our practical mitigation strategies accordingly. Ten surgical facilities and their accessory equipment (e.g., surgical tables) were screened using an AC/DC gaussmeter for the distribution and magnitude of magnetic field (magnetic flux density). A 'hot spot' of magnetic field was identified to further investigate the induction of S-distortion by scanning a titanium rod phantom using a GE OEC 9900 Elite II system placed at increasing distance from the 'hot spot' corresponding to decreasing magnetic field experienced by the II. The measurements were compared to that on a 'cold spot', and a GE flat panel detector (FPD) fluoroscopy was used as the negative control. Rod phantoms made of various magnetic susceptible materials (titanium, steel, aluminium, and copper) were scanned to explore the potential effects of implant material on S-distortion. An upper extremity anthropomorphic phantom was imaged on various surgical tables to mimic clinical sceneries. The GE II model and Siemens ARCADIS Orbic II model were compared to evaluate if S-distortion induction varied among different II models. Two metrics, angle of rotation (θ) and deviation/length ratio, were used to quantify the degree of S-distortion. Three designs of external magnetic shielding were evaluated for mitigating S-distortion. We identified static magnetic fields up to 2500µT and 70µT on the floor and at 1-meter height, respectively, in random locations of surgical facilities. A large variation of magnetic field (64±20µT) was detected on the surface of surgical tables, with background magnetic fields of ∼35µT. Quantitative assessments demonstrated that even weak magnetic fields at sub-Gauss level (<100µT) could induce noticeable distortion artifacts, deemed unacceptable (θ>4°). S-distortion was independent of the implant material being imaged but dependent on the II model - the threshold magnetic fields (4° distortion induction) were as low as 47µT and 94µT for the GE and Siemens II models. Mitigation possibilities of S-distortion include relocating the II to an area with subthreshold magnetic fields and shielding the II utilizing cylindrical mu-metal shields with an extension for alleviating the effect of openings. This work demonstrates that ambient sub-Gauss magnetic fields originating from any possible sources in a surgical environment have to be carefully considered when performing an image-intensified fluoroscopically-guided procedure, because such weak magnetic fields are likely able to induce unacceptable S-distortion artifacts in the acquired X-ray images leading to undesirable surgical outcomes.

Radiation in Gastroenterology.

The benefit of radiation is immense in the field of gastroenterology. Radiation is used daily in different gastrointestinal imaging and diagnostic and therapeutic interventional procedures. Radiotherapy is one of the primary modalities of treatment of gastrointestinal malignancies. There are various modalities of radiotherapy. Radiotherapy can injure malignant cells by directly damaging DNA, RNA, proteins, and lipids and indirectly by forming free radicals. External beam radiation, internal beam radiation and radio-isotope therapy are the major ways of delivering radiation to the malignant tissue. Radiation can also cause inflammation, fibrosis, organ dysfunction, and malignancy. Patients with repeated exposure to radiation for diagnostic imaging and therapeutic procedures are at slightly increased risk of malignancy. Gastrointestinal endoscopists performing fluoroscopy-guided procedures are also at increased risk of malignancy and cataract formation. The radiological protection society recommends certain preventive and protective measures to avoid side effects of radiation. Gastrointestinal complications related to radiation therapy for oncologic processes, and exposure risks for patients and health care providers involved in diagnostic or therapeutic imaging will be discussed in this review.

Fluoroscopic-guided procedures of the lower extremity.

This article reviews the literature and the authors’ experiences regarding the performance of lower extremity fluoroscopically guided procedures from the hip to the toes. An overview of injections and aspirations, their indications, risks, and complications are provided, focusing on anesthetics, corticosteroids, and contrast agents. A variety of approaches to each joint and the associated pearls and pitfalls of each approach will be discussed.

O003 Radiation-related chromosomal aberrations observed in high volume endovascular operators performing X-ray guided surgery

Abstract Introduction The biological effects of chronic, low dose radiation, to which operators performing fluoroscopy-guided procedures are exposed, are unknown. We have previously demonstrated acute DNA damage/repair in lymphocytes from operators performing fluoroscopy-guided endovascular aneurysm repair (EVAR), but these markers normalised after 24 hours and did not inform on the residual accumulated effects of chronic radiation exposure. In the present study cytogenetic techniques were used to examine for chromosomal aberrations in endovascular operators. Methods Peripheral blood lymphocytes were isolated from high volume endovascular operators performing EVAR and age-matched radiation naïve general surgeons as controls. Giemsa staining was used to visualise the full complement of chromosomes and all dicentrics, where 2 centromeres are present in a single chromosome, were identified. The genome was analysed for abnormal exchanges of genetic material between chromosomes using multiplex fluorescence in situ hybridisation (mFISH). Results Lymphocytes from 18 operators (12 exposed, 6 controls) were analysed. A higher frequency of dicentric chromosomes were found in exposed operators compared with controls (0.0011 vs 0.0004, respectively, P=0.002) after examining 54,000 lymphocytes. Twice as many complex chromosome rearrangements were seen in endovascular operators compared with controls (0.48% vs 0.24%). Aneuploidy, the abnormal loss of chromosomes, was more frequent in endovascular operators with a median difference of 0.35 per chromosome (P=0.004). Conclusion We have found a higher frequency of chromosomal aberrations in endovascular operators compared with radiation naïve colleagues. This justifies further individual biological profiling for genomic instability and personalised radiation risk assessment. Take-home message Radiation-related DNA damage occurs in endovascular operators despite current radiation protection measures. Biological dosimetry could be a useful tool, allowing personalised risk assessment.

Radiation Protection of the Eye Lens in Fluoroscopy-guided Interventional Procedures.

The medical staff involved in fluoroscopy-guided procedures are at potential risks of radiation-induced cataract. Therefore, proper monitoring of the lens doses is critical, and radiation protection should be provided to the maximum extent that is reasonably achievable. The collar dosimeter is necessary to avoid underestimation of the lens dose, and the third dosimeter behind the protective eyewear would be helpful for those who are likely to exceed the dose limit. The reduction of the patient doses will correspondingly reduce the staff doses. Proper placement of the ceiling-mounted shields and minimization of the face-to-glass gap are the keys to effective shielding. The optimization of procedures and devices that help maintain a distance from the irradiated area and to prevent the looking-up posture will substantially reduce the lens dose.

Radiation Exposure and Protection in Computed Tomography Fluoroscopy.

Computed tomography (CT) fluoroscopy-guided procedures, such as those used for percutaneous biopsy, drainage, and radiofrequency ablation, are highly safe and quite often very successful due to the precision offered by the real-time, high-resolution tomographic images. Even so, international guidelines raised concerns regarding operator exposure to high doses of radiation during these procedures. In light of these concerns, operators conducting CT fluoroscopy-guided procedures not only need to be cognizant of the exposure risk but also exhibit sufficient knowledge of radiation protection. This paper reviews the current literature on experimental and clinical studies of radiation exposure doses to operators during CT fluoroscopy-guided procedures. In addition to the literature review, this paper also introduces different approaches that can be implemented to ensure appropriate radiation protection.

Abstract No. 315 Computed tomography vs fluoroscopic guided posterior iliac crest bone marrow aspirate and biopsies

Bone marrow aspirations and biopsies (BMAB) are performed for diagnosis and evaluation of many diseases. The most common location is the posterior iliac crest (PIC). This can be done with palpation or imaging guidance; computed tomography (CT) or fluoroscopy. There is limited data comparing CT versus fluoroscopic-guided procedures. The purpose of this study is to evaluate if CT or fluoroscopy significantly differ in efficiency, effectiveness, radiation exposure, or safety.

Echocardiography-Guided Percutaneous Patent Ductus Arteriosus Closure: 1-Year Single Center Experience in Indonesia.

IntroductionSince the first successful percutaneous closure under transesophageal echocardiographic (TEE) guidance, many centers explored transcatheter procedures without fluoroscopy. This single-center study is aimed to show the feasibility and safety of percutaneous patent ductus arteriosus (PDA) closure under echocardiography-only guidance during our 1-year experience.MethodsPatients with PDA were recruited for percutaneous PDA closure guided by either fluoroscopy or echocardiography-only in National Cardiovascular Center Harapan Kita (ClinicalTrials.gov Identifier: NCT05321849, clinicaltrials.gov/ct2/show/NCT05321849). Patients were evaluated clinically and radiologically using transthoracic echocardiography (TTE) at 6, 24, and 48 h after the procedure. The primary endpoint was the procedural success. Secondary endpoints were the procedural time and the rate of adverse events.ResultsA total of 60 patients underwent transcatheter PDA closure, 30 patients with fluoroscopy and 30 patients with echocardiography guidance. All patients had successful PDA closure. There were only residual shunts, which were disappeared after follow-up in both groups, but one patient with a fluoroscopy-guided procedure had moderate tricuspid regurgitation with suspected thrombus in the tricuspid valve. The procedural time was not significantly different between the fluoroscopy and echocardiography groups.

Rapid Response to the Acute Iodinated Contrast Shortage During the COVID-19 Pandemic: Single-Institution Experience.

Modern health care depends upon the use of radiologic imaging for diagnostic and therapeutic purposes. Iodinated contrast media (ICM) is used in radiology primarily for CT and fluoroscopy-guided procedures. Outside radiology, other services that use ICM include cardiology, vascular surgery, neurology, urology, and gastroenterology. Quaternary care academic medical centers with level I trauma services, comprehensive stroke centers, and ST-segment elevation myocardial infarction services all rely heavily upon a steady supply of ICM to treat patients.

Gonad irradiation from fluoroscopy during upper limb orthopaedic procedures in a UK District General Hospital.

To perform a dose assessment of radiation received to the surgeon's gonads when performing upper limb fluoroscopy-guided procedures when the C-arm may be positioned in between the surgeon's legs. A calibrated MDH-Radcal 2025 electrometer was used to read the radiation dose for a single exposure and a 5-s screening radiograph with the C-arm firing up and down. These were performed with and without a lead gown positioned over the ionisation chamber where it would ordinarily lie over gonads during surgery. With the tube firing down and lead apron in place the single exposure (SE) recorded<0.01 uSv and screening exposure (SC) recorded 0.01 uSv. With the tube firing up, with lead the SE recorded 0.09 uSv and the SC 0.54 uSv. In the same situation without lead, the recordings were 0.13 uSv SE and 0. 65 uSv SC. With the X-ray tube firing up, there is a measurable radiation dose to the area where the surgeons' gonads lie. The standard lead apron does not provide shielding of the gonads for a surgeon sitting down performing the operation with the tube firing up since the principal source of the radiation is below the edge of the apron and thus scatters up into the unprotected groin. Fluoroscopy with conventional C-arm in upper limb procedures can cause scatter irradiation to gonads. The X-ray beam should always be fired from top to bottom otherwise large doses can be emitted and the lead gown is less protective.

Radiation exposure among anesthetist, orthopedic surgeon, and scrub nurse in orthopedic operation theater complex

Background and Aims: Orthopedic operation theater staff is exposed to primary and scattered radiation during various fluoroscopy-assisted operative procedures during their routine working hours. This exposure is associated with significant health hazard. This prospective study is designed primarily to determine the level of radiation exposure among them and to compare it with the current safety guidelines and secondarily to measure the cumulative scattered radiation exposure inside operation theater complex. Subjects and Methods: Total 15 thermoluminescent dosimeters (TLDs) were used during the study. Seven TLDs were used per team and per procedure at designated position. Participating staff were instructed to use personal protective equipment and to wear the TLDs at all times during their study period. TLDs were analyzed at the end of 6 months. Results: The mean value of radiation exposure of anesthesia machine, orthopedic surgeon, anesthetist with TLD above lead apron, anesthetist with TLD below lead apron, and scrub nurse was 0.05, 1.85, 0.1, 0, and 0.625 mSv units, respectively. The highest individual values for orthopedic surgeon, anesthetist with TLD above the lead apron, and scrub nurse were 2.75, 0.1, and 0.7 mSv units, respectively. All these readings were within permissible limit. Conclusions: If standard safety precautions were followed, cumulative ionizing radiation exposure to participating staff as well as scattered radiation exposure within operation theater complex is minimal and within permissible limit. Routine personal dosimetric monitoring is desirable in staff working with fluoroscopy-guided procedure along with the use of personal protective equipment. Periodic training on radiation risk and protection should be conducted for them to heighten the awareness.