Patient Radiation Exposure Research Articles

Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: preoperative planning, patient satisfaction, and improved resident skills

BackgroundProximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study’s objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients.Materials and methodsTwenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated.ResultsIntraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention.ConclusionsFewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims.Level of evidenceLevel I, prospective randomized case–control study.

Radioactive seed localization is a safe and effective tool for breast cancer surgery: an evaluation of over 25,000 cases.

Radioactive seed localization (RSL) provides a precise and efficient method for removing non-palpable breast lesions. It has proven to be a valuable addition to breast surgery, improving perioperative logistics and patient satisfaction. This retrospective review examines the lessons learned from a high-volume cancer center's RSL program after 10 years of practice and over 25 000 cases. We provide an updated model for assessing the patient's radiation dose from RSL seed implantation and demonstrate the safety of RSL to staff members. Additionally, we emphasize the importance of various aspects of presurgical evaluation, surgical techniques, post-surgical management, and regulatory compliance for a successful RSL program. Notably, the program has reduced radiation exposure for patients and medical staff.

Incidence of acute and delayed rectal toxicities following hydrogel spacer insertion in men receiving dose-escalated radiotherapy for prostate cancer

Objectives: The objective of this study was to evaluate the effectiveness of a hydrogel spacer in reducing acute and delayed rectal toxicities. Materials and Methods: Patients undergoing definitive radiotherapy between January 2015 and March 2018 were retrospectively identified from our institutional cancer registry. Planning data were collected on dose-volume histograms (DVH) for V65, V70 and V75 Gy. All patients underwent definitive volumetric modulated arc therapy (VMAT) of 78 Gy over 39 fractions in a single centre. Toxicity reporting and definitions were in accordance with Common Terminology Criteria for Adverse Events (CTCAE) guidelines. Results: A total of 162 patients received radiotherapy during the study period (spacer n = 80; no spacer n = 82). Baseline characteristics between groups were comparable. Acute rectal toxicity was documented in 19 men (24%) with spacer versus 36 men (44%) without spacer devices ( p = 0.007). Over a median post-treatment follow-up period of 17 months (range = 3–38 months), there was a significant reduction in delayed toxicity in men with spacers compared to men without (17 men 21% vs. 31 men 39%, p = 0.021). Conclusion: Hydrogel spacer devices reduce rectal radiation exposure in prostate cancer patients undergoing radiotherapy. This translates into a clinical benefit in terms of acute and delayed rectal toxicities. Level of evidence: cohort study

Examination of Modern Strategies of Instructing Patients for Radiation Protection in the Nuclear Medicine Department

Background: In every nuclear medicine center, there are places where people are exposed to more radiation than in other areas. To reduce the radiation exposure of employees and patients referring to these centers, it is necessary to observe special precautions to reduce the amount of dose received by different people, especially in the case of women of reproductive age. This study aimed to educate patients and companions to reduce the harmful effects of ionizing radiation. Methods: In this study, a questionnaire was used as the measurement tool. It contained demographic information and questions related to the evaluation of the quality of education, the level of awareness of patients and their companions, and also their level of satisfaction with the educational facilities of the center. The sample size included 193 patients who had been referred to the Gamma Scan department of Farshchian hospital. The data collected were analyzed using SPSS 19 software. For validity and reliability, the obtained information was analyzed with the help of mean, frequency, and percentage for qualitative variables. Results: The results of this study showed no significant correlation between knowledge level and gender (P=0.178). However, there was a direct relationship between the two variables of knowledge and level of education which is statistically significant (P=0.001). Conclusion: Measurements and statistical studies showed that in the nuclear medicine department of Farshchian Heart Hospital in Hamedan, the level of awareness of patients regarding radiation protection is weak and needs to be improved.

Cochlear measurement in computed tomography and magnetic resonance imaging data sets by the Otoplan measurement tool: a retrospective comparative study.

Using Otoplan software, it is possible to measure the cochlea before cochlear implant surgery. Until now, computed tomography (CT) of the cochlea has been necessary for this purpose. The aim of this study was to find out whether measuring the cochlea with magnetic resonance imaging (MRI) using Otoplan is possible with the same accuracy. The cochlea of 44 patients of the local cochlear implant centre was measured by Otoplan using high-resolution CT-bone and MRI images, and the determined lengths were compared. No significant difference was found between the cochlear lengths measured, regardless of whether the length measurement was based on a CT or an MRI data set. For the determination of cochlear length prior to cochlear implant surgery, MRI images are just as suitable as CT images, therefore CT is not mandatory for length measurement by Otoplan, which could reduce the patient's radiation exposure.

Evaluating Radiation Exposure for Patients During Pelvic X-ray Exams in Dhaka Metropolitan Area, Bangladesh

Objectives: This study aims to comprehensively assess Entrance Skin Dose (ESD) variability across diverse age groups in various diagnostic areas such as RGU, MCU, Fistulogram, Sinogram, and radiography of SI Joint, Coccyx, and Hip Joint in the pelvic region. The investigation delves into elucidating the range and mean ESD values while identifying factors contributing to fluctuations, enabling precise understanding and strategies for managing radiation exposure in pelvic X-ray examinations. Method & Materials: A qualitative research study took place in one of the hospitals in Dhaka City, Bangladesh, with participation from 138 patients. Radiation protocols in Dhaka City used consistent methods for diverse ages during X-ray examinations. Detailed data on Entrance Skin Dose for various exams like pelvic, SI joint, and fistulogram were meticulously collected and analyzed, aiding in understanding demographic-specific radiation variations. Result: The diverse dataset of Entrance Skin Dose (ESD) measurements across varying age groups in pelvic X-ray examinations reveals a range of ESD values, highlighting fluctuations within specific ages. The overall mean ESD averages approximately 1.87, indicating a moderate consistency in radiation exposure across ages. Notably, certain age brackets, such as patients aged 24 and those in their early teens, exhibit higher ESD values, while others, like ages 15 and 72–76, showcase notable variability. These findings underscore the need for tailored imaging protocols and monitoring strategies in clinical practice. Conclusion: In conclusion, this comprehensive examination underscores the intricate relationship between age, diagnostic areas, and the variability of ESD values, highlighting the need for nuanced approaches in healthcare management to ensure optimized patient outcomes while minimizing radiation exposure risks.

The application of extended reality technology-assisted intraoperative navigation in orthopedic surgery.

Extended reality (XR) technology refers to any situation where real-world objects are enhanced with computer technology, including virtual reality, augmented reality, and mixed reality. Augmented reality and mixed reality technologies have been widely applied in orthopedic clinical practice, including in teaching, preoperative planning, intraoperative navigation, and surgical outcome evaluation. The primary goal of this narrative review is to summarize the effectiveness and superiority of XR-technology-assisted intraoperative navigation in the fields of trauma, joint, spine, and bone tumor surgery, as well as to discuss the current shortcomings in intraoperative navigation applications. We reviewed titles of more than 200 studies obtained from PubMed with the following search terms: extended reality, mixed reality, augmented reality, virtual reality, intraoperative navigation, and orthopedic surgery; of those 200 studies, 69 related papers were selected for abstract review. Finally, the full text of 55 studies was analyzed and reviewed. They were classified into four groups-trauma, joint, spine, and bone tumor surgery-according to their content. Most of studies that we reviewed showed that XR-technology-assisted intraoperative navigation can effectively improve the accuracy of implant placement, such as that of screws and prostheses, reduce postoperative complications caused by inaccurate implantation, facilitate the achievement of tumor-free surgical margins, shorten the surgical duration, reduce radiation exposure for patients and surgeons, minimize further damage caused by the need for visual exposure during surgery, and provide richer and more efficient intraoperative communication, thereby facilitating academic exchange, medical assistance, and the implementation of remote healthcare.

Customised weight-based volume contrast media protocol for multiphase abdominal computed tomography.

Multiphase computed tomography (CT) using fixed volume contrast media may lead to high radiation exposure and toxicity in patients with low body weight. We evaluated a customised weight-based protocol for multiphase CT in terms of radiation exposure, image quality and cost savings. A total of 224 patients were recruited. An optimised CT protocol was applied using 100 kV and 1 mL/kg of contrast media dosing. The image quality and radiation dose exposure of this CT protocol were compared to those of a standard 120 kV, 80 mL fixed volume protocol. The radiation dose information and CT Hounsfield units were recorded. The signal-to-noise ratio, contrast-to-noise ratio (CNR) and figure of merit (FOM) were used as comparison metrics. The images were assessed for contrast opacification and visual quality by two radiologists. The renal function, contrast media volume and cost were also evaluated. The median effective dose was lowered by 16% in the optimised protocol, while the arterial phase images achieved significantly higher CNR and FOM. The radiologists' evaluation showed more than 97% absolute agreement with no significant differences in image quality. No significant differences were found in the pre- and post-CT estimated glomerular filtration rate. However, contrast media usage was significantly reduced by 1,680 mL, with an overall cost savings of USD 421 in the optimised protocol. The optimised weight-based protocol is cost-efficient and lowers radiation dose while maintaining overall contrast enhancement and image quality.

Influence of exposure protocol, voxel size, and artifact removal algorithm on the trueness of segmentation utilizing an artificial-intelligence-based system.

To evaluate the effects of exposure protocol, voxel sizes, and artifact removal algorithms on the trueness of segmentation in various mandible regions using an artificial intelligence (AI)-based system. Eleven dry human mandibles were scanned using a cone beam computed tomography (CBCT) scanner under differing exposure protocols (standard and ultra-low), voxel sizes (0.15mm, 0.3mm, and 0.45mm), and with or without artifact removal algorithm. The resulting datasets were segmented using an AI-based system, exported as 3D models, and compared to reference files derived from a white-light laboratory scanner. Deviation measurement was performed using a computer-aided design (CAD) program and recorded as root mean square (RMS). The RMS values were used as a representation of the trueness of the AI-segmented 3D models. A 4-way ANOVA was used to assess the impact of voxel size, exposure protocol, artifact removal algorithm, and location on RMS values (α = 0.05). Significant effects were found with voxel size (p < 0.001) and location (p < 0.001), but not with exposure protocol (p = 0.259) or artifact removal algorithm (p = 0.752). Standard exposure groups had significantly lower RMS values than the ultra-low exposure groups in the mandible body with 0.3mm (p = 0.014) or 0.45mm (p < 0.001) voxel sizes, the symphysis with a 0.45mm voxel size (p = 0.011), and the whole mandible with a 0.45mm voxel size (p = 0.001). Exposure protocol did not affect RMS values at teeth and alveolar bone (p = 0.544), mandible angles (p = 0.380), condyles (p = 0.114), and coronoids (p = 0.806) locations. This study informs optimal exposure protocol and voxel size choices in CBCT imaging for true AI-based automatic segmentation with minimal radiation. The artifact removal algorithm did not influence the trueness of AI segmentation. When using an ultra-low exposure protocol to minimize patient radiation exposure in AI segmentations, a voxel size of 0.15mm is recommended, while a voxel size of 0.45mm should be avoided.

Worldwide variations in the knowledge and use of fluoroscopy during percutaneous nephrolithotomy—should we do better? A survey by the European Association of Urology Section for Uro-Technology and the International Alliance of Urolithiasis

ObjectiveThis study aimed to investigate the level of knowledge among urologist of usage of fluoroscopy during percutaneous nephrolithotomy. MethodsWe conducted an anonymous internet-based survey addressed to ESUT/IAU members with particular interest in stone treatment at all levels of expertise. The final version of the questionnaire included 30 questions, evaluated the level of knowledge on X-rays utilization and exposure, and identified correlations between geographic areas, levels of seniority, surgical volumes, and awareness on radiation protection. ResultsIn total, 586 respondents were included. Knowledge of fluoroscopy settings appeared low, particularly among trainees (up to 87.5% were uninformed, p=0.008). Precautions to reduce exposure appeared poorly followed as up to 25.4% of respondents would regularly use continuous fluoroscopy, and up to 20.5% used regularly high-frequency setting and this trend was more obvious among senior specialists (6.2% of trainees use high-frequency settings vs. 21.3% of consultants, p<0.05). Additionally, only 24.9% of respondents would provide X-ray protection to patients too. ConclusionAlthough high and routinary utilization of X-ray, the level of awareness and adhesion to “as low as reasonably achievable” principles among endourologists seems suboptimal in 65.0% of all respondents. Highest volume surgeons, inevitably at higher risk, do not seem to adopt more precautions. More efforts should be addressed to improve these results, reducing the risk related to excessive radiation exposure for both surgical staff and patients in order to minimize health related issues.

P278 Radiation exposure in patients with inflammatory bowel disease

Abstract Background Radiological imaging plays an important role in diagnosis and follow-up of patients with IBD. Due to the progressive character of the disease, repeated imaging may be necessary. A cumulative effective dose (CED), meaning the total diagnostic radiation received, of 75 mSv is often described as the risk level one needs to try not to exceed. However, data on cumulative exposure are limited in IBD. In this retrospective study, we analysed the cumulative radiation exposure of patients with IBD in a Belgian tertiary referral centre. Methods Electronic health records (EHRs) from all IBD patients followed at the tertiary referral centre between January 1st 1990 and December 31st 2021 were searched for examinations with radiation exposure and received doses in house or in any of 27 collaborating Nexuz hospitals working with the same EHR. Both the annual effective dose (AED) and CED were calculated. A sub-analysis of patients diagnosed after January 1st 2007 was performed, as detailed radiation doses were maintained prospectively from that date onwards. Results In total, 3429 IBD patients were included. The median (IQR) AED was 0.39 (0.01-1.66) mSv/year, and was higher in patients with CD than in patients with UC [0.58 (0.01-1.81) vs. 0.17 (0.01- 1.24) mSv/year, p=0.028]. During the first 20 years after diagnosis, the received CED were found higher in patients with CD than UC (Figure, p&amp;lt;0.01). In 5.5% of patients, a CED ≥75 mSv was reached after a median (IQR) of 24 (13-34) years of follow-up. Sub-analysis of 1633 patients diagnosed after January 1st 2007 showed a median (IQR) AED of 0.44 (0.01- 2.12) mSv/year, again higher in patients with CD than in patients with UC [0.82 (0.02-2.38) mSv/year vs. 0.12 (0.01-1.47) mSv/year respectively, p=0.040]. Here, 3.3% patients reached a CED ≥75 mSv during a median (IQR) of 9 (6-12) years of follow-up. Most common reasons for high radiation exposure were comorbidities like malignancy and postoperative complications. Chart review by an IBD expert showed that the indication for most of these examinations was appropriate and that no alternative examination was available in a timely manner. Conclusion Up to 5.5% of patients with IBD were exposed to a CED of ≥75 mSv. Although most decisions to perform imaging with radiation exposure were appropriate, vigilance for unconsidered and excessive imaging should be maintained.

Reducing hand radiation during renal access for percutaneous nephrolithotomy: a comparison of radiation reduction techniques

Percutaneous nephrolithotomy confers the highest radiation to the urologist’s hands compared to other urologic procedures. This study compares radiation exposure to the surgeon’s hand and patient’s body when utilizing three different techniques for needle insertion during renal access. Simulated percutaneous renal access was performed using a cadaveric patient and separate cadaveric forearm representing the surgeon’s hand. Three different needle-holding techniques were compared: conventional glove (control), a radiation-attenuating glove, and a novel needle holder. Five 300-s fluoroscopy trials were performed per treatment arm. The primary outcome was radiation dose (mSv) to the surgeon’s hand. The secondary outcome was radiation dose to the patient. One-way ANOVA and Tukey’s B post-hoc tests were performed with p < 0.05 considered significant. Compared to the control (3.92 mSv), both the radiation-attenuating glove (2.48 mSv) and the needle holder (1.37 mSv) reduced hand radiation exposure (p < 0.001). The needle holder reduced hand radiation compared to the radiation-attenuating glove (p < 0.001). The radiation-attenuating glove resulted in greater radiation produced by the C-arm compared to the needle holder (83.49 vs 69.22 mGy; p = 0.019). Patient radiation exposure was significantly higher with the radiation-attenuating glove compared to the needle holder (8.43 vs 7.03 mSv; p = 0.027). Though radiation-attenuating gloves decreased hand radiation dose by 37%, this came at the price of a 3% increase in patient exposure. In contrast, the needle holder reduced exposure to both the surgeon’s hand by 65% and the patient by 14%. Thus, a well-designed low-density needle holder could optimize radiation safety for both surgeon and patient.

Patient Radiation Exposure during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy (with Video).

Fluoroscopy must be used cautiously during endoscopic retrograde cholangiopancreatography (ERCP). Radiation exposure data in patients with surgically altered anatomy undergoing enteroscopy-assisted ERCP (EA-ERCP) are scarce. 34 consecutive EA-ERCP procedures were compared with 68 conventional ERCP (C-ERCP) procedures. Patient and procedure characteristics and radiation data were collected. Surgical reconstructions were gastrojejunostomy, Roux-en-Y hepaticojejunostomy, Roux-en-Y total gastrectomy, Roux-en-Y gastric bypass and Whipple's duodenopancreatectomy. Procedures were restricted to biliary indications. Mean fluoroscopy time was comparable in both groups (370 ± 30 s EA-ERCP vs. 393 ± 40 s C-ERCP, p = 0.7074), whereas total mean radiation dose was lower in EA-ERCP (83 ± 6 mGy) compared to C-ERCP (110 ± 11 mGy, p = 0.0491) and dose area product (DAP) was higher in EA-ERCP (2216 ± 173 µGy*m2) compared to C-ERCP (1600 ± 117 µGy*m2, p = 0.0038), as was total procedure time (77 ± 5 min vs. 39 ± 3 min, p < 0.0001). Enteroscope insertion to reach the bile duct during EA-ERCP took 28 ± 4 min, ranging from 4 to 90 min. These results indicate that C-ERCP procedures are generally more complex, needing magnified fluoroscopy, whereas EA-ERCP procedures take more time for enteroscope insertion under wide field fluoroscopic guidance (increased DAP) with less complex ERCP manipulation (lower total radiation dose). Radiation exposure during EA-ERCP in surgically altered anatomy is different as compared to C-ERCP. EA-ERCP takes longer with a higher DAP because of the enteroscope insertion, but with lower total radiation dose because these ERCP procedures are usually less complex.

Impact of Electronic Collimation on Reducing Unnecessary Patient Dose in Digital Radiography.

In radiology, optimizing radiation protection is crucial, and field collimation plays a critical role in minimizing patient dose. As technology has evolved, electronic collimation has become the preferred method due to its effectiveness in digital imaging systems, replacing traditional film-screen systems. The current study aimed to investigate the prevalence of cropping in digital radiography and its potential impact on patient radiation dose because of improper collimation practices. This retrospective analysis was conducted on digital X-ray machine images. Quality control tests were performed to ensure equipment accuracy, and image cropping was then measured by analyzing archived images. Finally, the cropped image fraction and associated unnecessary radiation doses were calculated. Quality control tests confirmed that all imaging equipment was functioned within acceptable alignment and angle tolerances. The analysis of 911 images revealed a high prevalence of cropping (82%), with significant variation across different projections. Lateral knee images exhibited the highest cropping rate (96.2%), while abdominal images had the lowest (36.1%). Electronic image cropping can lead radiologic technologists to inaccurately define the primary radiation field, affecting image quality and potentially increasing patient radiation exposure. Based on the obtained results, proper collimation can reduce the average Dose Area Product (DAP) by 29.01%. This approach not only enhances patient safety but also minimizes unnecessary radiation exposure and potentially reduces healthcare costs.

Discrete Wavelet Transformation for the Sensitive Detection of Ultrashort Radiation Pulse with Radiation-induced Acoustics.

Radiation-induced acoustics (RIA) shows promise in advancing radiological imaging and radiotherapy dosimetry methods. However, RIA signals often require extensive averaging to achieve reasonable signal-to-noise ratios, which increases patient radiation exposure and limits real-time applications. Therefore, this paper proposes a discrete wavelet transform (DWT) based filtering approach to denoise the RIA signals and avoid extensive averaging. The algorithm was benchmarked against low-pass filters and tested on various types of RIA sources, including low-energy X-rays, high-energy X-rays, and protons. The proposed method significantly reduced the required averages (1000 times less averaging for low-energy X-ray RIA, 32 times less averaging for high-energy X-ray RIA, and 4 times less averaging for proton RIA) and demonstrated robustness in filtering signals from different sources of radiation. The coif5 wavelet in conjunction with the sqtwolog threshold selection algorithm yielded the best results. The proposed DWT filtering method enables high-quality, automated, and robust filtering of RIA signals, with a performance similar to low-pass filtering, aiding in the clinical translation of radiation-based acoustic imaging for radiology and radiation oncology.

Unsupervised Domain Adaptation for Low-Dose CT Reconstruction via Bayesian Uncertainty Alignment.

Low-dose computed tomography (LDCT) image reconstruction techniques can reduce patient radiation exposure while maintaining acceptable imaging quality. Deep learning (DL) is widely used in this problem, but the performance of testing data (also known as target domain) is often degraded in clinical scenarios due to the variations that were not encountered in training data (also known as source domain). Unsupervised domain adaptation (UDA) of LDCT reconstruction has been proposed to solve this problem through distribution alignment. However, existing UDA methods fail to explore the usage of uncertainty quantification, which is crucial for reliable intelligent medical systems in clinical scenarios with unexpected variations. Moreover, existing direct alignment for different patients would lead to content mismatch issues. To address these issues, we propose to leverage a probabilistic reconstruction framework to conduct a joint discrepancy minimization between source and target domains in both the latent and image spaces. In the latent space, we devise a Bayesian uncertainty alignment to reduce the epistemic gap between the two domains. This approach reduces the uncertainty level of target domain data, making it more likely to render well-reconstructed results on target domains. In the image space, we propose a sharpness-aware distribution alignment (SDA) to achieve a match of second-order information, which can ensure that the reconstructed images from the target domain have similar sharpness to normal-dose CT (NDCT) images from the source domain. Experimental results on two simulated datasets and one clinical low-dose imaging dataset show that our proposed method outperforms other methods in quantitative and visualized performance.

Parasagittal Interlaminar and Transforaminal Epidural Steroid Injections for Radicular Low Back Pain; Which is More Comfortable?

This study aimed to compare parasagittal interlaminar (PS) and transforaminal (TF) epidural steroid injections for unilateral L5 and S1 radicular lower back pain in terms of patient comfort, efficacy, safety, contrast enhancement, and radiation exposure. This was a prospective randomized single-blind study. A total of 59 participants were included in this study. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were obtained. A comfort questionnaire was administered to all participants. The total fluoroscopy time and contrast distribution levels were recorded. Pre- and post-treatment VAS scores were similar between the groups. The ODI scores increased in favor of the PS group at week 2 (P < 0.041); however, there was no difference between the two groups at other times. The VAS and ODI scores improved significantly with treatment in both the groups (P < 0.001). Total fluoroscopy time was shorter in the PS group (P < 0.001). PS application was more comfortable (P < 0.001). While no complications were observed in the PS group, three complications occurred in the TF group. Anterior epidural contrast spread to three or more levels was observed in 57% of the participants in the PS group, whereas no spread to more than two levels was observed in the TF group. The PS epidural approach is superior to the TF approach in terms of a low incidence of side effects, less radiation exposure, better patient comfort, higher epidural contrast spread, and single-level needle access.

Estimation of the Added Cancer Risk Derived From EVAR and CTA Follow-Up.

The aim of this study was to assess the risk of radiation-induced cancer development in patients that have undergone an infrarenal EVAR, stratifying the relative contributions of the procedure and the preoperative and postoperative CTAs. The organ-specific absorbed radiation doses from CTA and the EVAR procedure were estimated from the radiation exposures of 95 and 45 male patients, respectively. Lifetime attributable risk (LAR) cancer predictions were calculated for 14 different organs. Life expectancy was assumed from a previous cohort of patients undergoing infra-renal EVAR. The calculated total excess cancer risk was 0.0046, ie, 1 out of 220 patients will develop a neoplasm after being exposed to the ionizing radiation from the preoperative CTA, the EVAR and annual CTA examinations for 15 years. The procedure and the preoperative CTA contributed with 38% of the total excess risk, while the rest was derived from the follow-up. If the entire CTA based follow-up would have been eliminated, an excess risk of 0.0018 (1/560) would remain. 1 out of 219 patients who have undergone EVAR of an infra-renal AAA have a lifetime risk of developing cancer secondary to the radiation exposures related to the procedure and the CTAs used preoperatively and during follow-up. This risk derives mostly from the yearly postoperative CTAs, underlining the potential benefits of reducing or replacing their use. A simulation-based estimation reinforced the potential deleterious effects of the radiation exposure for patients undergoing Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysms (AAA) and subsequently followed by yearly Computer Tomography Angiographies (CTAs). The risk could be as high as 1 out 219 patients developing a neoplasm after 15 years. The largest exposure derives from the follow-up CTAs and efforts to minimize their use as well as the intraoperative radiation are greatly needed. The simulation-based estimations done in this study reinforce potential deleterious effects of the radiation exposure for patients undergoing EVAR of AAA. Efforts should be done to minimize the intraoperative radiation and the number of CTAs used during follow-up.

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review.

This systematic review summarizes existing evidence and outlines the benefits of artificial intelligence-assisted spine surgery. The popularity of artificial intelligence has grown significantly, demonstrating its benefits in computer-assisted surgery and advancements in spinal treatment. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a set of reporting guidelines specifically designed for systematic reviews and meta-analyses. The search strategy used Medical Subject Headings (MeSH) terms, including "MeSH (Artificial intelligence)," "Spine" AND "Spinal" filters, in the last 10 years, and English- from January 1, 2013, to October 31, 2023. In total, 442 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 220 that matched the criteria, of which 11 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. In total, 11 studies met the eligibility criteria. Analysis of these studies revealed the types of artificial intelligence-assisted spine surgery. No evidence suggests the superiority of assisted spine surgery with or without artificial intelligence in terms of outcomes. In terms of feasibility, accuracy, safety, and facilitating lower patient radiation exposure compared with standard fluoroscopic guidance, artificial intelligence-assisted spine surgery produced satisfactory and superior outcomes. The incorporation of artificial intelligence with augmented and virtual reality appears promising, with the potential to enhance surgeon proficiency and overall surgical safety.

Towards safer imaging: A comparative study of deep learning-based denoising and iterative reconstruction in intraindividual low-dose CT scans using an in-vivo large animal model

PurposeComputed tomography (CT) scans are a significant source of medically induced radiation exposure. Novel deep learning-based denoising (DLD) algorithms have been shown to enable diagnostic image quality at lower radiation doses than iterative reconstruction (IR) methods. However, most comparative studies employ low-dose simulations due to ethical constraints. We used real intraindividual animal scans to investigate the dose-reduction capabilities of a DLD algorithm in comparison to IR. Materials and methodsFourteen veterinarian-sedated alive pigs underwent 2 CT scans on the same 3rd generation dual-source scanner with two months between each scan. Four additional scans ensued each time, with mAs reduced to 50 %, 25 %, 10 %, and 5 %. All scans were reconstructed ADMIRE levels 2 (IR2) and a novel DLD algorithm, resulting in 280 datasets. Objective image quality (CT numbers stability, noise, and contrast-to-noise ratio) was measured via consistent regions of interest. Three radiologists independently rated all possible dataset combinations per time point for subjective image quality (−1 = inferior, 0 = equal, 1 = superior). The points were averaged for a semiquantitative score, and inter-rater agreement was measured using Spearman's correlation coefficient and adequately corrected mixed-effects modeling analyzed objective and subjective image quality. ResultsNeither dose-reduction nor reconstruction method negatively impacted CT number stability (p > 0.999). In objective image quality assessment, the lowest radiation dose achievable by DLD when comparing noise (p = 0.544) and CNR (p = 0.115) to 100 % IR2 was 25 %. Overall, inter-rater agreement of the subjective image quality ratings was strong (r ≥ 0.69, mean 0.93 ± 0.05, 95 % CI 0.92–0.94; each p < 0.001), and subjective assessments corroborated that DLD at 25 % radiation dose was comparable to 100 % IR2 in image quality, sharpness, and contrast (p ≥ 0.281). ConclusionsThe DLD algorithm can achieve image quality comparable to the standard IR method but with a significant dose reduction of up to 75%. This suggests a promising avenue for lowering patient radiation exposure without sacrificing diagnostic quality.