Patient Radiation Exposure Research Articles

3D-navigation for SI screw fixation – How does it affect radiation exposure for patients and medical personnel?

Background3D-navigation for percutaneous sacroiliac (SI) screw fixation is becoming increasingly common and several studies report great advantages of this technology. However, there is still limited clinical evidence on the efficacy regarding radiation exposure for patient and personnel. MethodsThis is a retrospective, single-center cohort study. All patients who underwent percutaneous sacroiliac screw fixation for an injury of the posterior pelvic ring from 2014 to 2021 were screened. Inclusion criteria were: conclusive radiation dosage reports, signed informed consent, a twelve month follow up and a complete data set. Patients were stratified in two groups (3D-navigation (Group 3D-N) vs. control (Group F)) based on the imaging modality used. Primary outcomes were radiation exposure for patient and personnel. Secondary outcomes were reoperations, complications, and intraoperative precision. ResultsOf 392 patients screened, 174 patients (3D-N: n = 50, F: n = 124) could be included for final analysis. We noted a significant reduction of the dose corresponding to potential radiation exposure for medical personnel (-15.3 mGy, 95 %CI: -2.1 to -28.5, p = 0.0232), but also a significant increase of the dose quantifying radiation exposure for patients (+77.0 mGy, 95 %CI: +53.3 to +100.6, p < 0.0001), when using navigation. In addition, the rate of radiographic malplacement was significantly reduced (F: 11.3% vs. 3D-N: 0 %, p = 0.0113) despite a substantial increase in transsacral screw placement (F: 19.4% vs. 3D-N: 76 %). ConclusionOur data clearly suggests that the use of 3D-navigation for percutaneous SI screw fixation decreases radiation exposure for medical personnel, while increasing radiation exposure for patients. Furthermore, intraoperative precision is improved, even in more challenging operations.

Comparison between the Old and New Philips Imaging System in the Cardiac Catheterization

Background: X-ray systems in the cardiac catheterization laboratory are essential to helping and treating patients best. However, they come at the cost of harming the patients and health workers through unnecessary high exposure to radiation particles. Aim: The study aimed to evaluate and compare the effectiveness and the radiation doses of the recent Philips imaging systems Azurion Hybrid OR and the older Philips systems Allura Xper FD 10 and Allura clarity FD 10 in the cardiac catheterization laboratories. Method: A descriptive, comparative research design was utilized, 480 procedures were assessed retrospectively, and all met predetermined inclusion criteria from January 2014 until May 2023. Dose area product, Air Kerma, and Fluoroscopy time (Fluro time) were compared between the three Philips systems, which are Allura Xper FD10/10 R 7.2 and Allura Clarity FD10 R8.2 (old system) and Hybrid Azurion new Philips system. Result: Allura clarity FD 10 and Azurion Hybrid OR were superior to Allura Xper FD 10 in Dose Area Product and Air Kerma (p&lt;0.5). However, fluro time was statistically non-significant among the systems. Conclusion: The latest X-ray imaging systems significantly manage Dose Area Product and Air Kerma levels during medical procedures. Employing these advanced technologies in a cardiac catheterization lab can yield optimal outcomes while minimizing radiation exposure for patients and healthcare personnel.

Evaluation of the Entrance Surface Doses (ESD) for common diagnostic X-ray examinations

ObjectiveThe purpose of this study was to assess the Entrance Skin Dose (ESD) in patients undergoing multiple types of radiographic examinations across three hospitals in Saudi Arabia. MethodsThe patient ESD was estimated directly using optically stimulated luminesces (OSL) and indirectly using a survey meter and calculations for 100 adult patients undergoing common diagnostic X-ray examinations, including a posterior anterior chest, posterior anterior hand, anterior posterior foot, and anterior posterior knee examinations, in three hospitals in Saudi Arabia. Comparative analysis with national and international reference values was conducted. ResultsOur analyses revealed considerable heterogeneity in X-ray exposure parameters among the hospitals. The mean ESD values for the chest examination were 0.28 ± 0.13 mGy for the direct method and 0.19 ± 0.11 mGy for the indirect method. Hand examination using the direct method resulted in a mean ESD of 0.42 ± 0.15 mGy, while the indirect method yielded 0.23 ± 0.06 mGy. Remarkably, the ESD values in most cases exceeded national and international guidelines, with the knee examination ESD using the direct and indirect methods showing an alarming value of 1.54 ± 0.31 mGy and 1.18 ± 0.21 mGy, respectively. The correlation between direct ESD, indirect ESD showed a strong positive correlation exists between direct ESD and Indirect ESD (r = 0.8, p < 0.001). ConclusionThe study highlights the urgent need for standardized protocols and quality control measures across radiographic facilities in Saudi Arabia. The elevated ESD values signify a critical issue that requires immediate attention to minimize patient radiation exposure while maintaining diagnostic image quality. Quality control tests and adjustments in examination parameters are strongly advised.

Sonolucent Cranial Implants: A Window into the Future of Management of Neurosurgical Patients? A Systematic Review and Cost Analysis

Background and ObjectivesComputerized tomography (CT) is a cornerstone of the identification and management of acute changes in neurosurgery patients. In addition to the monetary expense of CT scans, further costs are incurred due to the time of patient transport and radiation exposure. Ultrasounds (US) offer a safe, inexpensive, and bedside alternative to CT but obstacles remain due to decreased penetrance in the adult skull. Sonolucent Cranial Implants (SCI) offer a window for ultrasounds to view intracranial architectures. MethodsThe authors performed a PRISMA guidelines-based systematic review of the literature. Information was extracted from included articles in regards to illness pathology, ultrasound imaging feasibility, comparison to standard imaging, infections, and revisions. Costs were collected in regards to price of implant and follow-up imaging. Results226 articles resulted of which 5 were included in the study. Ninety non-duplicate patients who received SCIs were analyzed. The pathologies of included patients is as follows: 51 patients were after extracranial-intracranial bypass, 37 after VP shunt placement for hydrocephalus, one after tumor resection, and one after cranioplasty following decompressive hemicraniectomy. All studies noted feasibility of ultrasound and comparability to standard imaging following SCI placement. Follow up imaging with trans-sonolucent cranial implant ultrasound was estimated to save up to $4,000 per patient depending on the procedure. ConclusionInitial studies suggest that ultrasound imaging through SCIs is a safe and efficacious alternative to CT imaging in neurosurgical patients. Cost analysis suggests that SCI and subsequent US can offer a cost savings compared to current treatment.

Internal dose assessment of lymphoma 18F-FDG Positron Emission Tomography (PET) scan

This study aimed to assess the internal radiation exposure of patients who have undergone a Positron Emission Tomography (PET) scan using 18F-FDG radiopharmaceutical. A total of 24 patients (8 men, 16 women, with an average age of 43.88 ± 18.57 years and weight of 57.54 ± 13.04 kg) who had been diagnosed with lymphoma were administered with 300.80 ± 23.09 MBq of 18F-FDG for a PET scan of the whole body. The IDAC-Dose 2.1 program, developed by the International Commission on Radiological Protection (ICRP), was used to measure absorbed and effective doses. The organs selected for absorbed dose analysis were the breast, kidneys, adrenals, liver, and brain, with the brain receiving the highest absorbed dose and the breast receiving the lowest absorbed dose. The effective dose for all patients was 4.85 ± 0.37 mSv, and the ratio of the effective dose to the administered activity was 1.611 × 10−2 mSv/MBq. The safety of the current practice using 18F-FDG PET scan was ascertained, given that the ratio of effective dose to administered activity was lower than 1.9 x 10−2 mSv/MBq.

Comparison of Radiation Exposure for Pregnant Patients Requiring Intervention for Suspected Obstructing Nephrolithiasis

To identify the differences in radiation exposure per suspected stone episode between percutaneous nephrostomy tube (PCN), stent, and primary ureteroscopy (URS).The incidence of nephrolithiasis in pregnancy is low; however, repercussions for both mother and fetus can be significant. In cases of suspected obstructing nephrolithiasis, intervention may be required, including ureteral stent, PCN, or URS, with the potential for multiple subsequent procedures that often utilize fluoroscopy. Pregnant patients who required an intervention (stent, PCN, or URS) for suspected obstructing nephrolithiasis were retrospectively reviewed. The primary outcome was total fluoroscopy exposure per suspected stone episode. Secondary outcomes included fluoroscopic exposure per procedure and number of procedures required. After excluding patients with renal anomalies and incomplete radiation data, 78 out of 100 patients were included in the analysis. Forty patients (51.3%) underwent initial stent placement, 22 (28.2%) underwent initial PCN placement, and 16 (20.5%) underwent primary URS. Total mean radiation exposure per stone episode was significantly higher in patients who underwent PCN, (286.9mGy vs 3.7mGy (stent) and 0.2mGy (URS), P<.001). In addition, patients who underwent initial PCN placement had significantly more procedures (P<.001) and mean radiation exposure per procedure was higher (P<.001). More than 40% of PCNs experienced dysfunction, and mean duration between PCN exchanges was 16.5days. In pregnant patients with suspected obstructing nephrolithiasis requiring intervention, initial PCN placement was associated with a significantly higher number of procedures, radiation exposure per procedure, and total radiation exposure per suspected stone episode compared to stent and URS.

Computed Tomography-Based Coronary Artery Calcium Score Calculation at a Reduced Tube Voltage Utilizing Iterative Reconstruction and Threshold Modification Techniques: A Feasibility Study.

The coronary artery calcium score (CACS) indicates cardiovascular health. A concern in this regard is the ionizing radiation from computed tomography (CT). Recent studies have tried to introduce low-dose CT techniques to assess CACS. We aimed to investigate the accuracy of iterative reconstruction (IR) and threshold modification while applying low tube voltage in coronary artery calcium imaging. The study population consisted of 107 patients. Each subject underwent an electrocardiogram-gated CT twice, once with a standard voltage of 120 kVp and then a reduced voltage of 80 kVp. The standard filtered back projection (FBP) reconstruction was applied in both voltages. Considering Hounsfield unit (HU) thresholds other than 130 (150, 170, and 190), CACS was calculated using the FBP-reconstructed 80 kVp images. Moreover, the 80 kVp images were reconstructed utilizing IR at different strength levels. CACS was measured in each set of images. The intraclass correlation coefficient (ICC) was used to compare the CACSs. A 64% reduction in the effective dose was observed in the 80 kVp protocol compared to the 120 kVp protocol. Excellent agreement existed between CACS at high-level (strength level = 5) IR in low-kVp images and the standard CACS protocol in scores ≥ 11 (ICC > 0.9 and p < 0.05). Increasing the threshold density to 190 HU in FBP-reconstructed low-kVp images yielded excellent agreement with the standard protocol in scores ≥ 11 (ICC > 0.9 and p < 0.05) and good agreement in score zero (ICC = 0.84 and p = 0.02). The modification of the density threshold and IR provides an accurate calculation of CACS in low-voltage CT with the potential to decrease patient radiation exposure.

OPTIMISASI DOSIS DAN KUALITAS CITRA PADA PEMERIKSAAN PULMONARY ARTERY CATHETER (PAC) DAN PERCUTANEUS CORONARY INTERVENTION (PCI) SEBAGAI UPAYA PROTEKSI RADIASI PASIEN DI CATHLAB RSUP ADAM MALIK MEDAN

The radiation exposure a patient receives during diagnosis and treatment cannot be fully avoided. However, it is crucial to optimize the radiation dose to ensure it is only as much as needed. The purpose of this study is to minimize the patient's radiation exposure during interventions and produce optimal image quality. To accomplish this, dose optimization and image quality were evaluated during PAC and PCI procedures in the Cathlab room at Adam Malik Hospital using Philips Allura Xper FD20. The study was retrospective, using patient dose audits from January 2020 to February 2023, with 250 PACs and 139 PCI mature patients. The median dose value (Q2) was compared to the National diagnostic reference level (NDRL) third quartile (Q3) value to determine optimal patient dose levels. We used a 28 cm PMMA phantom and a 2 cm imaging quality in-house phantom to represent the patient and a solid-state detector to measure surface dose. Medical physicists, radiographers, cardiologists, and nurses worked together in optimization cycles to ensure dose levels were kept to a minimum. Image quality was assessed by calculating the signal difference-to-noise ratio (SDNR), and images were recorded in DICOM format and analyzed using Image J software. Entrance Surface Air Kerma (ESAK) values were recorded to calculate Figure of Merit (FOM) values for each change in physical parameters. The study showed that the distance between the image detector and the object significantly affects the patient's dose. A distance of 14 cm resulted in a higher dose than a distance of 2 cm. The SDNR value varied with the object image distance (OID) factor, and increasing the object's distance to the image detector did not increase the SDNR value. Setting the OID spacing to a minimum is recommended for PAC and PCI procedures to minimize the patient's radiation exposure. The FOM values were affected by both the ESAK and SDNR values. Keywords: Dose Optimization, Image Quality, objek to image distance (OID), Pulmonary Artery Catheter, Percutaneous Coronary Intervention, Cathlab.

Signal-difference-to-noise comparison of temporal subtraction, kV-switching dual-energy and photon-counting dual-energy x-ray angiography.

Dual-energy (DE) x-ray angiography with photon-counting detectors (PCDs) may enable single-exposure DE imaging of coronaryvasculature. To compare the iodine signal-difference-to-noise ratio (SDNR) of single-exposure DE angiography with digital subtraction angiography (DSA) and kV-switching DE angiography for matched patient x-rayexposure. In a phantom study, we determined the technique parameters that maximized the iodine SDNR per root entrance air kerma for DSA, kV-switching DE angiography and single-exposure DE angiography. We measured SDNR from images of a phantom consisting of an iodine step-wedge immersed in a water tank of either 20 or 30cm in thickness. We also imaged a phantom with simulated vessels embedded in background clutter and measured vessel SDNR. For this second phantom, we also applied anti-correlated noise reduction (ACNR) and calculated the resulting iodine SDNR. All images were acquired using a cadmium telluride PCD with two energy bins and analog charge summing for charge sharing suppression. The energy-discrimination capabilities were only used for the single-exposure DE approach. Optimized techniques were compared in terms of SDNR per root air kerma for two levels of x-rayscatter. For the same patient x-ray exposure, the SDNR of single-exposure DE imaging without ACNR was 75% to 85% of that of kV-switching DE imaging (also without ACNR) and DSA, the latter two of which had nearly equal SDNR. The single-exposure DE approach required ∼50% of the tube load of the kV-switching approach to achieve the same SDNR. For matched patient air kermas, the single exposure approach required only ∼25% of the tube load of the kV-switching approach. ACNR increased SDNR by 2.4 and 3.0 for kV-switching and single-exposure DE imaging,respectively. Photon-counting, single-exposure DE angiography can suppress soft tissues and provide iodine SDNR levels comparable to DSA and kV-switching DE angiography for matched patient radiation exposures. When ACNR is used to reduce DE image noise, the SDNR of single-exposure DE imaging and kV-switching DE imaging exceed that of DSA by more than a factor of two. Compared to kV-switching DE imaging, single-exposure DE imaging requires substantially lower tube loading to achieve the sameSDNR.

Comparison of Ultra-High-Resolution and Normal-Resolution CT-Angiography for Intracranial Aneurysm Detection in Patients with Subarachnoid Hemorrhage

Ruptured intracranial aneurysms (IAs) are the leading cause for atraumatic subarachnoid hemorrhage. In case of aneurysm rupture, patients may face life-threatening complications and require aneurysm occlusion. Detection of the aneurysm in computed tomography (CT) imaging is therefore essential for patient outcome. This study provides an evaluation of the diagnostic accuracy of Ultra-High-Resolution Computed Tomography Angiography (UHR-CTA) and Normal-Resolution Computed Tomography Angiography (NR-CTA) concerning IA detection and characterization. Consecutive patients with atraumatic subarachnoid hemorrhage who received Digital Subtraction Angiography (DSA) and either UHR-CTA or NR-CTA were retrospectively included. Three readers evaluated CT-Angiography regarding image quality, diagnostic confidence and presence of IAs. Sensitivity and specificity were calculated on patient-level and segment-level with reference standard DSA-imaging. CTA patient radiation exposure (effective dose) was compared. One hundred and eight patients were identified (mean age = 57.8 ± 14.1 years, 65 women). UHR-CTA revealed significantly higher image quality and diagnostic confidence (P < 0.001) for all readers and significantly lower effective dose (P < 0.001). Readers correctly classified ≥55/56 patients on UHR-CTA and ≥44/52 patients on NR-CTA. We noted significantly higher patient-level sensitivity for UHR-CTA compared to NR-CTA for all three readers (reader 1: 41/41 [100%] vs. 28/34 [82%], reader 2: 41/41 [100%] vs. 30/34 [88%], reader 3: 41/41 [100%] vs. 30/34 [88%], P ≤ 0.04). Segment-level analysis also revealed significantly higher sensitivity for UHR-CTA compared to NR-CTA for all three readers (reader 1: 47/49 [96%] vs. 34/45 [76%], reader 2: 47/49 [96%] vs. 37/45 [82%], reader 3: 48/49 [98%] vs. 37/45 [82%], P ≤ 0.04). Specificity was comparable for both techniques. We found Ultra-High-Resolution CT-Angiography to provide higher sensitivity than Normal-Resolution CT-Angiography for the detection of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage while improving image quality and reducing patient radiation exposure.

Is It Appropriate to Completely Eliminate Contact Shielding during CT Examination? A Discourse Based on Experimental Findings.

Through the integration of experimental data and literature, this study examines whether complete elimination of contact shielding during CT examination is warranted, with a particular focus on potential impacts to children's thyroid and pregnant women, as well as limitations associated with contact shielding. Methods: The thermoluminescent dosimeter (TLD) tablets were inserted into the phantom's five organs and tissues. Select fixed exposure, automatic exposure control (AEC), and use contact shielding combined into four experimental modes, with scanning of the phantom's four parts. Obtain the absorbed dose measurements within or outside the FOV. Statistical analysis was conducted using SPSS software. Results: (1) The AEC significantly reduces dose within and outside the FOV, with a dose reduction of 40%-60%. (2) The application of contact shielding outside the FOV significantly reduced the dose adjoin the FOV. (3) Both the use of AEC mode and contact shielding can effectively minimize the dose, with a reduction of 50-80%. (4) The shielding within the FOV may introduce image artifacts or interfere with AEC, the implementation of contact shielding outside FOV provides little reduction in radiation exposure risk through previous literature. (5) Contact shielding exhibits certain drawbacks in all aspects. Conclusion: The utilization of AEC mode in clinical CT should be widely adopted to minimize patient radiation exposure. In general, contact shielding both inside and outside the FOV should be avoided during exposure. However for children under 12 years old with thyroid gland examination, contact shielding could maximally reduce external radiation and may be appropriate. Pregnant women require careful evaluation when considering the use of contact shielding. Contact shielding should not be entirely abandoned.

Characterization of radiation risk associated with computed tomography for the Russian patients using disability-adjusted life years measure

adiation risks assessment in medical exposure of patients is one of the mandatory steps in justifying the medical radiological examinations. The main objectives of such assessment are the need for benefit-harm analysis, when prescribing a study, and informing patients or their legal representatives about the radiation risk associated with the recommended examination. The traditional approach to radiation risk assessment is the use of measures based on lifetime morbidity and/or mortality due to radiation exposure in risk characterization. However, the development of the methodology of population health assessment and the need to harmonize the methodology of radiation risk assessment with risks from exposure to factors of other nature imply the use of more informative generalized health indicators in the assessment of exposure to harmful environmental factors. The aim of actual work was to apply the developed methodology of radiation detriment assessment to characterize the risk by calculating DALY (number of years of healthy full life lost due to exposure to ionizing radiation) values for different sex and age groups of Russian patients undergoing computed tomography. To achieve this goal, the previously developed method of estimating the number of years of healthy life lost due to exposure to ionizing radiation was used. Calculations were performed with the use of a specially developed computer program based on the models of the International Commission on Radiological Protection using medical and demographic data of Russian population. The article presents the results of DALY calculation for six types of computed tomographic examinations. The use of DALY to characterize risk instead of the most widely used value of radiation detriment (or lifetime risk of death, relating the harm from the reduction in the quality of life in the case of non-fatal oncological disease) is an attempt to harmonize the methodology of radiation risk assessment with the methodologies of other kind of health risks. One of the directions of calculation results usage is the development of sexand age-dependent risk coefficients associated with medical exposure of patients. The analysis of the obtained results showed that the age distribution of risks agrees well with the data presented in the methodological recommendations MR 2.6.1.0215-20 “Assessment of radiation risk to patients in radiology examinations”. It is also shown that the DALY indicator can serve as a basis for comparative assessment of obtainable and avoidable risks in the field of medical radiation exposure of patients.

Biomarkers of lung cancer for screening and in never-smokers-a narrative review.

Lung cancer is the leading cause of cancer-related mortality worldwide, partially attributed to late-stage diagnoses. In order to mitigate this, lung cancer screening (LCS) of high-risk patients is performed using low dose computed tomography (CT) scans, however this method is burdened by high false-positive rates and radiation exposure for patients. Further, screening programs focus on individuals with heavy smoking histories, and as such, never-smokers who may otherwise be at risk of lung cancer are often overlooked. To resolve these limitations, biomarkers have been posited as potential supplements or replacements to low-dose CT, and as such, a large body of research in this area has been produced. However, comparatively little information exists on their clinical efficacy and how this compares to current LCS strategies. Here we conduct a search and narrative review of current literature surrounding biomarkers of lung cancer to supplement LCS, and biomarkers of lung cancer in never-smokers (LCINS). Many potential biomarkers of lung cancer have been identified with varying levels of sensitivity, specificity, clinical efficacy, and supporting evidence. Of the markers identified, multi-target panels of circulating microRNAs, lipids, and metabolites are likely the most clinically efficacious markers to aid current screening programs, as these provide the highest sensitivity and specificity for lung cancer detection. However, circulating lipid and metabolite levels are known to vary in numerous systemic pathologies, highlighting the need for further validation in large cohort randomised studies. Lung cancer biomarkers is a fast-expanding area of research and numerous biomarkers with potential clinical applications have been identified. However, in all cases the level of evidence supporting clinical efficacy is not yet at a level at which it can be translated to clinical practice. The priority now should be to validate existing candidate markers in appropriate clinical contexts and work to integrating these into clinical practice.

Simultaneous percutaneous microwave ablation and biopsy for highly suspected malignant pulmonary nodules: a retrospective cohort study.

The conventional diagnosis and treatment for highly suspected malignant pulmonary nodules (PNs) can avoid unnecessary treatment to some extent. However, the relatively separate puncture processes may not only increase puncture-related complications, but also increase the patient's radiation exposure and hospitalization costs. The purpose of this study was to retrospectively analyze the effectiveness of simultaneous percutaneous microwave ablation (MWA) and percutaneous biopsy (PB) for PNs. From August 2015 to August 2022, 65 consecutive patients [48 solid nodules, 6 ground glass opacities (GGOs), 11 mixed nodules] with suspected single malignant PN underwent MWA and PB combination treatments at the First Affiliated Hospital of Zhengzhou University. The total of 30 patients in Group A underwent synchronous PB and MWA (strategy: low-power MWA-PB-high-power MWA), whereas 35 patients in Group B underwent asynchronous PB and MWA. The technical success, complete ablation (CA), complications, total procedure time (TPT), patient exposure dose (PED), hospitalization time, and costs were compared. An independent samples t-, χ2, or Fisher's exact tests were used. The technical success (100% vs. 100%) and CA (100% vs. 97.1%) rates were not significantly different between Groups A and B. The complications of intrapulmonary hemorrhage (16.7% vs. 41.4%, P=0.02) and hemoptysis (0% vs. 8.6%, P=0.04) were significantly different between Groups A and B. TPT (41.6±7.9 vs. 57.3±8.8 min, P<0.001), PED (12.9±1.4 vs. 19.4±2.3 mSv, P<0.001), hospitalization stay (4.7±1.3 vs. 9.1±2.1 days, P<0.001) and costs (3,768.8±652.9 vs. 4,508.0±514.1 USD, P<0.001) also showed significant differences between Groups A and B. Synchronous PB and MWA for PNs is a safe and effective strategy that can decrease bleeding, PED, the hospitalization stay, and costs.

Transradial Access for Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: Comparison with Transfemoral Access.

To compare safety, efficacy, radiation exposure and patients comfort in patients of transradial access (TRA) in patients undergoing TARE compared with transfemoral access (TFA) including patient radiation exposure and patient comfort. A total of 222 patients undergoing technetium-99m macro-aggregated albumin and TARE were retrospectively reviewed from 2017 to 2022. We analyzed procedure-related pain, quality of life, recovery time, procedure time, fluoroscopy time (FT), air kerma product and air kerma (AK) to compare the two access for intervention for HCC. A total of 222 [(TFA (n = 147) and TRA (n = 75)] patients who underwent TARE for hepatocellular carcinoma (HCC) were included. No significant difference was found regarding FT and DAP in comparison of TRA and TFA. (p = 0.385, p = 0.842). While the mean AK was 892.7mGy in TFA patients, it was 545.2mGy in TRA patients and there was statistically significant difference (p = 0.017). Patients who underwent TRA had significantly shorter hospital stays, and recovery times compared to those who underwent TFA (p = 0.001, p = 0.001). In terms of both mental health and physical function, TRA versus TFA has been observed to produce more favorable outcomes (p = 0.044, p = 0.032). TRA access for TARE procedures significantly enhances patient comfort and satisfaction. The total radiation dose exposed to the patients who underwent TRA access was found to be significantly lower than the patients who underwent TFA access.

Utility of routine postoperative chest radiography in patients undergoing clavicle fixation: a retrospective chart review.

Although uncommon, pneumothorax is a potentially serious complication following open reduction and internal fixation (ORIF) of clavicle fractures. In many centres it is routine practice to obtain postoperative chest radiographs following ORIF of clavicle fractures to assess for iatrogenic pneumothorax. Given the need to contain health care costs, the low sensitivity for detecting small pneumothorax and a desire to decrease patient radiation exposure, the practice of ordering chest radiographs following ORIF of clavicle fractures may be unnecessary. All patients undergoing ORIF of clavicle fractures with plate and screw fixation at Kingston Health Sciences Centre between April 2009 and June 2020 were identified from the Discharge Abstract Database (inpatient) and National Ambulatory Care Reporting System (outpatient) using relevant Canadian Classification of Health Intervention procedure codes. Charts were manually reviewed to confirm diagnosis and procedure, and patients with preoperative pneumothorax were excluded. The frequency of postoperative chest radiograph and pneumothorax detection were calculated. Among the 292 patients who underwent ORIF of clavicle fractures during the study period, 17 were excluded for having a pneumothorax on preoperative chest radiograph. Of the remaining 275 patients, 101 (36.7%) had postoperative chest radiographs, of whom none were found to have postoperative iatrogenic pneumothorax. Since 2009, the rate of routine postoperative chest radiography following ORIF of clavicle fractures is 36.7% at our centre. During this time period, none of the 101 patients who had postoperative chest radiographs had a postoperative iatrogenic pneumothorax. To our knowledge, this is the largest series of patients available, and our findings confirm those of several smaller studies. Owing to the low rate of postoperative iatrogenic pneumothorax, we conclude that postoperative chest radiography is unnecessary following ORIF of clavicle fractures.

Advancing dentistry: fractal assessment of bone health in pediatric patients with celiac disease using dental images.

To assess the effects of a gluten-free diet on bone structure in children with celiac disease using fractal analysis on panoramic radiographs. A total of 49 patients with celiac disease aged 6-13 years, separated into 2 groups as previously and newly diagnosed, and a control group of 32 healthy individuals were evaluated. In previously and newly diagnosed patients with celiac disease, body mass index (BMI) Z-scores were calculated, calcium, alkaline phosphatase, vitamin D3, and parathormone levels were measured and bone mineral density (BMD) Z-scores obtained from dual energy X-ray absorptiometry. In all patients, the fractal dimensions (FD) of the right and left temporomandibular condyles were evaluated with the fractal analysis method on panoramic radiographs. The mean values of serum biomarker levels and the BMI and BMD Z-scores for both celiac groups were within the normal reference range. No statistically significant difference was determined between right and left condyle FD values in the 3 groups examined. In terms of both right and left condyle FD values, there was a statistically significant difference between groups. The highest FD values were determined in the previously diagnosed group. Differences in FD values were observed among patients with celiac disease following the gluten-free diet. Utilizing fractal analysis on panoramic radiographs can prove valuable for dentists in evaluating BMD due to its cost-effectiveness, easy accessibility, and reduced radiation exposure for patients, enabling them to provide comprehensive oral health care and potential early interventions for patients with celiac disease.

Comparative analysis for variation of skeletal and dental parameters in bilateral cleft palate in central India population – A Nemoceph study

Introduction: An area of dentistry called orthodontics focuses on repositioning crooked teeth and regulating facial development. Orthodontists and oral surgeons use cephalometric analysis as a planning tool for their patient care. Conventional film-based radiography equipment has been replaced with direct digital devices, which have advantages such as reduced patient radiation exposure, immediate radiographic image generation, the removal of the need for darkrooms, and simple image sharing. The second-most typical craniofacial abnormality that results in birth abnormalities is cleft lip and palate. Such patients frequently do not receive cephalometric testing because of their hypoplastic growth and limited development. Research is needed to help plan a standard treatment regimen, perform orthognathic operations, and use a low-radiation analysis technique. Objectives: To evaluate skeletal and dental parameters for cleft lip and palate using Down analysis, Steiner's analysis, and Tweed's analysis using Nemoceph. Methods: Around 50 cases from cleft lip and palate and non-cleft lip and palate will be selected from the orthodontics department of Sharad Pawar Dental College and Hospital. Steiner's, Down's, and Tweed's analyses will be evaluated using Nemoceph. Further analysis will be conducted using the observational data from the readings. There will be millimetre-based measurements made. Comparative analysis will be done with one-way ANOVA and post hoc statistics and regression analysis will be done for association of demographic variables. Expected outcomes: This study will use the nasion as a stable landmark to evaluate point A in cleft lip and palate patients, making it easier to perform normal cephalometric analysis. This will enable the evaluation of the probable position of point A for performing cephalometric analysis in orthodontics.

Free-Hand MIS TLIF without 3D Navigation-How to Achieve Low Radiation Exposure for Both Surgeon and Patient.

Transforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) is used. While computer-assisted navigation (CAN) reduce the surgeon's radiation exposure, the patient's exposure is higher. When we investigated 2D-fluoroscopically guided and 3D-navigated MIS TLIF in a randomized controlled trial, we detected low radiation doses for both the surgeon and the patient in the 2D-fluoroscopy group. Therefore, we extended the dataset, and herein, we report the radiation-sparing surgical technique of 2D-fluoroscopy-guided MIS TLIF. Monosegmental and bisegmental MIS TLIF was performed on 24 patients in adherence to advanced radiation protection principles and a radiation-sparing surgical protocol. Dedicated dosemeters recorded patient and surgeon radiation exposure. For safety assessment, pedicle screw accuracy was graded according to the Gertzbein-Robbins classification. In total, 99 of 102 (97.1%) pedicle screws were correctly positioned (Gertzbein grade A/B). No breach caused neurological symptoms or necessitated revision surgery. The effective radiation dose to the surgeon was 41 ± 12 µSv per segment. Fluoroscopy time was 64 ± 34 s and 75 ± 43 radiographic images per segment were performed. Patient radiation doses at the neck, chest, and umbilical area were 65 ± 40, 123 ± 116, and 823 ± 862 µSv per segment, respectively. Using a dedicated radiation-sparing free-hand technique, 2D-fluoroscopy-guided MIS TLIF is successfully achievable with low radiation exposure to both the surgeon and the patient. With this technique, the maximum annual radiation exposure to the surgeon will not be exceeded, even with workday use.

Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department

AbstractObjectiveCervical spine imaging decision‐making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergency department–trauma team dynamics may affect implementation of such a tool.MethodsWe interviewed (pediatric and general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons and ED nurses at 21 hospitals to ascertain how team dynamics affect the pediatric cervical spine imaging decision‐making process. Data were coded following a framework‐driven deductive coding process and thematic analysis was used.ResultsForty‐eight physicians, advanced practice providers, and nurses from 21 hospitals (inclusive of three US regions, trauma levels I–III, and serving towns/cities of various population sizes) were interviewed. Overall, emergency physicians and trauma surgeons indicate being generally responsible for pediatric cervical spine imaging decisions. Conflict often occurs between these specialties due to differential weighting of concerns for missing an injury versus avoiding radiation exposure. Participants described a lack of trust and unclear roles regarding ownership for the final imaging decision. Nurses commonly described low psychological safety that prohibits them from participating in the decision‐making process.ConclusionsImplementation of a standardized risk assessment tool for cervical spine trauma imaging decisions must consider perspectives of both emergency medicine and trauma. Policies to define appropriate use of standardized tools within this team environment should be developed.