Radiological Procedures Research Articles

Optimizing Post-Kasai Management in Biliary Atresia: Balancing Native Liver Survival and Transplant Timing.

Kasai procedure (KPE) is a palliative intervention in infants with biliary atresia (BA) aiming to restore biliary drainage. While the measure of success in BA is the post-Kasai native liver survival (NLS), BA remains the most frequent indication for liver transplantation in children. While a considerable amount of children fail to clear their jaundice following KPE, resulting in early liver failure and transplantation, some children become jaundice-free after "successful" KPE. However, sequelae of chronic liver disease might affect those children, becoming a later risk for NLS. While liver transplantation is inevitable in the majority of children, various salvage procedures have been recently described to maintain NLS. This article provides a comprehensive overview of procedures performed after KPE to prolong NLS in BA patients from early childhood to late adulthood and discusses their indications and limitations. A literature-based search for surgical and radiological interventions performed in BA patients after KPE to prolong NLS (salvage procedures) was performed using PubMed. Data from case reports, retrospective studies, and registries were included. Fifteen studies included 794 patients who underwent post-KPE salvage procedures. The Oxford Centre for Evidence-Based Medicine levels were IIc to IV.Interventions included redo-Kasai's (n = 710) for cessation of bile flow post-KPE, surgical and radiological procedures (n = 14) for bile lakes, and recurrent cholangitis, shunt surgery (n = 49), and transjugular intrahepatic portosystemic shunt (n = 21) for portal hypertension in BA patients. Age at the time of salvage interventions varied considerably, including redo-Kasai's at 27 days of life and percutaneous biliary interventions in a 35-year-old. Salvage procedures can maintain NLS after KPE in BA patients with disease sequelae. However, indications remain scarce and liver transplantation is ultimately unavoidable in the majority of patients. While redo-Kasai numbers are globally decreasing with the advances in liver transplantation, procedures for bile lakes and portal hypertension can be viable options for patients with complications but otherwise stable liver function. Discussion on those procedures should be held by multidisciplinary expert teams, involving pediatric hepatologists, pediatric surgeons, and transplant surgeons to elaborate on the potential of maintaining NLS or proceeding with transplantation.

Point-counterpoint: should sedation be used for image-guided biopsies?

Cross-sectional interventional radiology procedures can be performed using a range of techniques with approaches varying across institutions. One area in which practices for these procedures may differ is in the use of moderate sedation. This perspective discusses the pros and cons of using moderate sedation for deep organ biopsies commonly experienced in radiology departments.

Fetal Radiation Dose in Common Diagnostic Radiology Procedures for Pregnant Patients: Findings from In-Phantom Measurements

The diagnosis of emergent conditions during pregnancy can be delayed due to insufficient knowledge of fetal radiation doses in different imaging modalities. The aim of this article is to investigate the ranges of fetal doses in most common diagnostic and interventional radiology procedures. Procedures were carried out on an anthropomorphic phantom, Tena, representing a pregnant woman in the 18th week of pregnancy with the fetus in breech position. Different clinical scenarios using computer tomography (CT), radiography, fluoroscopy and digital subtraction angiography were selected in three teaching hospitals. Measurements were performed using radiophotoluminescent glass dosimeters placed in dedicated holes in the fetal head and fetal body. Measured fetal doses were below 1 mGy when the fetus was not in the primary beam. The highest fetal doses, up to 47 mGy, were measured after a CT scan for polytrauma and up to 24 mGy after a CT scan of the abdomen and pelvis. Significant variability in fetal doses for the same procedure was found between different hospitals but within the same hospital also. All obtained results are below the threshold for deterministic effects given by the International Commission for Radiation Protection but can be reached with two or more imaging procedures employed. The variability in fetal doses for the same procedures highlights the need for the improved optimization of imaging protocols.

External Validation of SHA2PE Score: A Score to Predict Low-Risk Lower Gastrointestinal Bleeding in the Emergency Department.

Introduction: Lower gastrointestinal bleeding (LGIB) frequently leads to emergency department (ED) visits and hospitalizations, encompassing a spectrum of outcomes from spontaneous resolution to intrahospital mortality. Aim: The purpose of this study was to validate a scoring system designed to identify cases of low-risk LGIB, allowing for safe discharge from the ED. Methods: A retrospective analysis of all gastrointestinal bleeding cases presented at three EDs in 2020 was conducted, focusing specifically on patients with LGIB. The SHA2PE score incorporates factors such as systolic blood pressure, hemoglobin levels, use of antiplatelet or anticoagulant medications, pulse rate, and episodes of bright blood per rectum. Results: Out of 1112 patients presenting with LGIB to the ED, 55 were hospitalized, 20 required blood transfusions, 15 underwent colonoscopies, one underwent interventional radiology procedures, and two patients died. Employing a SHA2PE score with a cutoff value of 1 yielded a specificity of 78.5% (95% CI (confidence interval) [75.8-81.0]), sensitivity of 76.8% (95% CI [63.6-87.0]), positive predictive value (PPV) of 17.0% (95% CI [12.6-22.2]), and negative predictive value (NPV) of 98.3% (95% CI [97.2-99.1]) for predicting the need for hospitalization and intrahospital intervention. When considering return visits to the ED within 7 days with the same presentation, the score demonstrated a specificity of 78.8% (95% CI [76.0-81.3]), sensitivity of 68.6% (95% CI [56.4-79.1]), PPV of 19% (95% CI [14.3-24.4]), and NPV of 97.2% (95% CI [95.8-98.2]). Conclusions: The SHA2PE score demonstrates potential in predicting cases of low-risk LGIB, offering a high NPV for hospitalization, the need for intrahospital intervention, and return visits to the ED. However, these findings should be interpreted cautiously given the low prevalence of interventions and limitations in the study's population and design.

Short-term Postoperative Complications of Lymphatic Malformation Surgical Excision: A 20-Year Institutional Review.

To evaluate outcomes and postoperative complications following surgical resection of lymphatic malformations (LMs) at a single multidisciplinary vascular anomalies center. A single-center retrospective review of all patients ≤21 years old who underwent surgical resection of a lymphatic malformation at a quaternary referral center with a multidisciplinary vascular anomalies team from 2004 to 2024. Data pertaining to postoperative outcomes and treatments was abstracted. A total of 109 surgical procedures were included and examined. The most common 30-day postoperative complications included: seroma (18.3%), superficial surgical site infection (18.3%), and wound dehiscence (12.8%), with lower rates of nerve palsy/injury (5.5%), lymphedema (2.8%), hematomas (3.7%), and abscesses (4.6%). An interventional radiology procedure within 30-days postoperatively was required for management of seroma in 8 patients (7.3%), while 7 (6.4%) patients required reoperation. Among patients who underwent attempted complete resection, recurrence of the LM was documented in 32.0% (16/50). Subjective quality of life improvement was noted in 69.7%. There was no difference in incidence of postoperative complications reported in patients who underwent preoperative sclerotherapy vs those that did not (p=0.980). Seroma and surgical site infection were the most reported short-term postoperative complications followed by wound dehiscence with low rates of other complications in surgical resection of LMs. Few patients required postoperative procedural intervention. Despite a relatively high rate of short-term complications, patients reported high satisfaction and symptom improvement following LM resection, which underscores the important role for surgical management of LMs in select patients. III. Cohort study.

Integrated multiple interventional radiologic procedures for diagnosis and treatment of unresectable breast cancer: a case description.

Integrated multiple interventional radiologic procedures for diagnosis and treatment of unresectable breast cancer: a case description.

The Role of Modern Radiological Procedures in Diagnosing Blunt Liver Injuries Manifested by Upper Gastrointestinal Bleeding.

Objectives: Posttraumatic upper gastrointestinal bleeding (UGIB) is a very rare consequence of blunt liver trauma. It can be quite a diagnostic challenge for clinicians, as it can clinically manifest many weeks after the trauma or be scantily symptomatic. Methods: The following article would like to provide an analysis of clinical cases of 13 patients following blunt liver injuries, the main symptoms of which was bleeding into the gastrointestinal tract through the biliary tree. The article is research of the published literature concentrating on the influence of modern diagnostic methods (scintigraphy, USG and CT) on the diagnosis and long-term survival of patients with haemobilia caused by blunt liver trauma. In each patient, the condition was presented with UGIB symptoms following blunt trauma, before initiation of operative treatment or before death. The cases were divided into 2 groups: prior to and after introduction of modern diagnostic procedures, and then compared together. Results: The study indicates that liver damage can cause symptoms of UGIB, even after minor abdominal trauma and with delayed and uncharacteristic symptoms. Conclusions: Modern diagnostic methods, such as ultrasound, scintigraphy and CT, make it easier to identify these injuries and choose appropriate treatment, reducing the risk of death.

Radiation Perception and Knowledge among Patients at Referral and District Hospitals in Rwanda

Background and objectives: The prevalence of cancer is on the rise, and radiation therapy is an essential part of treatment. However, patients frequently have a limited grasp of radiation therapy, which can result in anxieties and misconceptions. This study's main purpose was to investigate patients' radiation perceptions at both referral and district hospitals in Rwanda by examining patients’ knowledge, attitudes, and concerns related to medical radiation. Materials and Methods: The study employed a quantitative approach where data were collected through structured questionnaires and administered to a diverse sample of patients at referral and district hospitals in Rwanda. The quantitative data collected was analyzed using IBM SPSS software, version 27.0, which was released in 2015. The relationship between the variables was measured using a chi-square test from SPSS. Descriptive statistics were employed, utilizing percentages and frequencies. Results: Findings revealed significant misconceptions among patients, with many lacking awareness of radiation dangers despite undergoing radiological procedures. Factors such as education level influence knowledge levels with higher-educated individuals rating their understanding more positively. Conclusion: Significant exposure differences, knowledge and awareness gaps among selected respondents with varying educational levels regarding medical radiation dangers were found in this study conducted on radiation perceptions among patients in Rwandan hospitals.

Assessment of the importance of teleradiology services in the opinion of electroradiologists in Poland

Teleradiology is a modern service that allows for the transmission of imaging studies between facilities, clinicians, and qualified medical staff. It requires employers to meet many important legal formal criteria to properly deliver services. Teleradiology has significantly improved access to radiological services, including radiological examinations, and to specialists in narrow fields of radiology. The development of teleradiology and telemedicine, despite many benefits, also brings many risks, such as technical errors and improper service delivery. The study aims to assess the importance of teleradiology in the perception of electroradiologists who mediate in the delivery of this service, often overlooked by employers in its organization. The survey was conducted among actively practicing electroradiologists, particularly those working with teleradiology services. Electroradiologists in the study identified the advantages and disadvantages of the service, as well as various aspects related to the organization of teleradiology services. The study also aimed to raise awareness among personnel providing telemedical services. To asses the normality of distribution of the result obtained the following were used Kolmogorov-Smirnov test of normality of distribution, and non-parametric tests were used in their analysis and correlations between the some of the values. The research group (N = 344) consisted of licensed electroradiologists (N = 99, 28.8%), master's degree holders in electroradiology (31.4%, N = 108), and electroradiology technicians (N = 137, 39.8%). Of these, 276 were female (80.2%) and 68 were male (19.8%) aged 23-67 years. Surveyed electroradiologists rated teleradiology services positively. The respondents most frequently pointed out 3 advantages of teleradiology: increased service accessibility, streamlining of radiology department work, and better allocation of human resources. The most commonly mentioned disadvantages of teleradiology among respondents include the possibility of errors in radiological procedures due to the lack of direct involvement of a radiologist in supervising the examination, the absence of a real-time monitoring system for the service, and the lack of standardization of hospital information systems. Med Pr Work Health Saf. 2024;75(6):511-519.

Contrast induced nephropathy in women with infertility undergoing hysterosalpingography

BackgroundContrast-induced nephropathy (CIN) defined as an acute kidney injury following the administration of iodinated contrast medium (CM). Hysterosalpingography (HSG) is a radiologic procedure used to investigate the shape and structure of the uterine cavity and the patency of the fallopian tubes in the evaluation of infertility. To date, there have been no reports evaluating the development of CIN after HSG procedure. Therefore, we investigated whether CIN development occurs in infertile women who underwent HSG and its relationship with clinical and laboratory changes in women who underwent HSG.MethodsThis study was undertaken in 65 women who had infertility evaluation, uterine anomalies and/or tubal blockages. CIN was defined as a 25% relative increase, or a 0.5 mg/dL (44 µmol/L) absolute increase, in serum baseline creatinine (SCr) within 72 h of contrast exposure in the absence of alternative conditions. Hysterosalpingography (HSG) was performed using 5–20 ml of contrast medium. All patients performed routine laboratory tests including assessment of serum creatinine and urea and estimated glomerular filtration rates before and 2–3 day after HSG. Statistical analysis was performed with MedCalc Statistical Software Program v22.023 (Ostend, Belgium) program.ResultsThe mean ages of participants were 29.5 years and mean BMI were 26.2 kg/m2. The rate of CIN was 12.3% and the severe nephropathy was 1.5% in our study population. The baseline SCr level was 0.59 ± 0.06 mg/dL in women with CIN and 0.67 ± 0.11 mg/dL in women without CIN. The baseline SCr level was significantly lower in CIN group that non-CIN group (p = 0.0309). The SCr level significantly higher in CIN group than non-CIN group 48–72 h after HSG (p = 0.0005). In the multivariate logistic regression analysis, the baseline SCr was found an independent risk factor for the prediction of CIN in women who underwent HSG.ConclusionThe HSG procedure is generally a safe method, but the iodine-containing contrast material used in HSG may be associated with temporary adverse effects on kidney function.

Deep sedation in lateral position for preterm infants during cerebral magnetic resonance imaging: a pilot study

IntroductionRespiratory adverse events are common during the sedation of preterm babies, often needing active airway support. During magnetic resonance imaging, this occurrence could extend the acquisition time, with a negative impact on the thermic and metabolic homeostasis. The aim of the study is to verify if lying in a lateral position instead of supine could improve the safe quality of sedation, without worsening the quality of imaging.MethodsThis study was performed as a single-center, prospective study at a university-affiliated tertiary care center. A consultant provided deep sedation with sevoflurane 3–4% delivered by an external mask, in the lateral decubitus position. All patients were evaluated for the incidence of apnea and desaturation, quality of imaging obtained, the timing of imaging acquisition, and thermic and metabolic homeostasis.ResultsWe enrolled 23 consecutive preterm babies born < 37 weeks gestational age, candidates for sedation for elective brain magnetic resonance imaging. All patients completed the radiological procedure in 30 min (SD ± 6.39 min) without complications requiring exam interruption. Only one patient (4%) experienced a transient desaturation, while 2 neonates (9%) showed apnea lasting > 20 s. On average, there was a 1 °C decrease in body temperature and full enteral feeding was resumed within 1.5 h. Neuroradiologists rated the quality of the images obtained as high.ConclusionsLateral lying seems to be a viable option for sedated preterm babies during magnetic resonance imaging with a low risk of intervention for apnea and a reduced impact on thermic and metabolic homeostasis. Quality of imaging would be preserved maintaining correct scheduling of standard care.Trial registrationThe study was registered at www.ClinicalTrials.gov before enrollment (NCT05776238 on December, 21th 2023).

Critical Review of Nursing Involvement in X-Ray Imaging: Enhancing Procedures and Patient Experience

This paper aims to critically discuss the growing responsibilities of nursing professionals relative to radiography and X-ray imaging techniques. Traditionally, nursing staff were more or less passive participants in radiological procedures, if they participated at all—they often simply prepared the patient and occasionally assisted the radiographer if needed. Nurses have become less involved in radiologic settings, but as the functional capacities of nurses continue to be extended, their participation in radiologic settings is increasing. This review aims to evaluate the effect of the implemented nursing mediations in terms of the technical efficiency in the X-ray imaging process, safety, and patient satisfaction. Also, the paper examines the training and education required for nurses to assume these roles successfully, as well as the advantages and limitations of enhancing the involvement of nurses in diagnostic imaging. Applying the results of the literature review and case studies, the review underlines the lack of interdisciplinary cooperation. It states several recommendations for improving patient care in a radiological setting.

Robust solutions via optimisation and predictive process monitoring for the scheduling of the interventional radiology procedures

AbstractInterventional radiology (IR) is an increasingly used medical specialty relying on the possibilities offered by medical imaging guidance technologies to perform minimally invasive procedures (both diagnostic and therapeutic) through very small incisions or body orifices. Although the operative context is quite similar to that of the classical operating room (OR) literature, to the best of our knowledge management problems arising in the IR operative context never appeared in the healthcare management literature. This is even more true for studies that combine the OR approach with automatic extraction of information from real hospital health record data as in the present study. Two specific features characterise our case study with respect to the traditional OR literature: due to the Italian legislation, the anaesthetist (usually in a very limited number) must be present for the entire duration of the procedure (), and the IR does not have its own ward but receives inpatients from different wards (). The aim of this paper is to introduce a novel approach to determine a robust solution for our case study problem addressing both features and . Our approach is based on the interplay between optimisation and predictive process monitoring (PPM) models. The obtained results show that the proposed approach produces schedules that achieve higher usage rate, lower overtime and more patients operated on than the original schedule. We also show that the integration of PPM models within the optimisation workflow improves the quality of the output schedule with respect to the standard one‐shot optimisation.

Association of anaesthesia-directed sedation with unplanned discharge to a nursing home following non-ambulatory interventional radiology and endoscopic procedures: a retrospective cohort study.

Interventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non-anaesthetists should provide procedural sedation. We studied adult patients who previously lived independently and underwent a non-ambulatory interventional radiology or gastroenterology procedure under anaesthetist-directed or non-anaesthetist-directed sedation at a large healthcare network. The primary outcomes were postprocedural adverse discharge to a nursing home and postprocedural duration of hospital stay. Among 22,868 patients included, 15,168 (66.3%) and 7700 (33.7%) underwent anaesthetist-directed sedation and non-anaesthetist-directed sedation, respectively. Of all patients receiving anaesthetist-directed sedation, 9.2% experienced adverse discharge to a nursing home compared with 21.3% undergoing non-anaesthetist-directed sedation. Anaesthetist-directed sedation was associated with reduced risk of adverse discharge to a nursing home (adjusted relative risk 0.54, 95%CI 0.45-0.63, p < 0.001, adjusted risk difference -4.6%, 95%CI -5.8 to -3.4, p < 0.001) and a shorter postprocedural duration of hospital stay (median (IQR [range]) 2 (1-6 [0-315]) days vs. 5 (2-12 [0-268]) days; adjusted model estimate 0.84, 95%CI 0.79-0.89, p < 0.001). The lower risk of adverse discharge to a nursing home and shorter duration of hospital stay in patients undergoing anaesthetist-directed sedation was reproduced in an instrumental variable analysis (adjusted risk difference -4.3%, 95%CI -8.4 to -0.1, p = 0.043; and -1.41 days, 95%CI -1.43 to -1.41 days, p < 0.001, respectively). Among patients undergoing anaesthetist-directed sedation the mean (SD) proportion of missing blood pressure measurements was lower (0.7 (4.9) % vs. 8.0 (14.6) %, p < 0.001), which mediated the effect of anaesthetist-directed sedation on adverse discharge. Among patients undergoing a non-ambulatory interventional radiology procedure or a gastrointestinal endoscopy, anaesthetist-directed sedation is associated with a reduced risk of adverse discharge to a nursing home and a shorter duration of hospital stay.

Antibacterial and antifungal drug concentrations in intra-abdominal abscesses: a prospective clinical study.

Secondary peritonitis with intra-abdominal abscesses (IAA) is difficult to treat because of the supposed low rate of penetration of antimicrobial drugs at the site of infection. However, clinical data about the actual bioavailability of antimicrobial drugs in IAA are scarce. This prospective observational study aimed at assessing the drug penetration in IAA of the antibiotics (piperacillin-tazobactam, carbapenems) and antifungals (fluconazole, echinocandins) that are usually recommended for the treatment of intra-abdominal infections. Patients with IAA who underwent a radiological or surgical drainage procedure were included. Antimicrobial drug concentrations were measured in IAA (CIAA) and in a simultaneous plasma sample (Cplasma) to assess the CIAA/Cplasma ratio. The pharmacodynamic target was defined as a CIAA equal or superior to the clinical breakpoints of susceptibility of the most relevant intra-abdominal pathogens. Clinical outcomes were assessed at hospital discharge. A total of 54 antimicrobial drug measurements were performed in 39 IAA samples originating from 36 patients. Despite important inter-individual variability, piperacillin-tazobactam exhibited the highest CIAA/Cplasma ratios (median 2). The rates of target achievement were 75%-80% for piperacillin-tazobactam and meropenem but 0% for imipenem and ertapenem. These results tended to correlate with clinical outcomes (96% success rate versus 73%, respectively, P = 0.07). Among antifungals, fluconazole exhibited higher CIAA/Cplasma ratios and rates of target achievement compared to echinocandins. However, no differences in clinical outcomes were observed. These results provide unique information about antimicrobial drug penetration in IAA in real clinical conditions and suggest that piperacillin-tazobactam and meropenem may have better efficacy compared to imipenem or ertapenem.

Communication with patients on radiological procedures

In recent years, radiological procedures in medical practice have been increased dramatically. The average radiation exposure from medical procedures and nuclear medicine was estimated to be 3.0 mSv year−1 in the United States, and 2.1 mSv year−1 in South Korea. Radiotherapy and radioisotope therapy are also increasing with the rising incidence of various cancers. Most of patients and physicians understand the concept of risk-benefit assessment and accept the benefit of such procedures that exceed the risk from radiation exposure. However, some patients and their caregivers have overconcern about the radiation exposure. On the other hand, a few do not pay any attention to the radiation protection. Thus, appropriate communication between the physicians, patients and their caregivers are required for optimal patient care and radiation protection. The communication should be based on scientifically appropriate risk assessment. Currently, dosimetry schemes for radiological procedures are well established, and there are considerable epidemiological data about the radiation effect on human health. A physician should be aware of the radiation dose and its effect, when performing a radiological procedure. Also, the purpose and need for radiological diagnosis or treatment should be discussed between the physician and the patient. Reliable quantitative assessment of risk and benefit is the beginning of the communication. In communication with those who have overconcern about radiation exposure, some principles need to be noted to improve emotional perception of the risk, such as high understanding, self-decision, and self-control. For better understanding of the radiation hazard, its amount needs to be understood in comparison with those of other well-known risk factors, such as traffic accident, surgical anaesthesia, and bike riding. Exaggerated or even false information from media or film should be avoided. It is also necessary to give sufficient information on the disease status and other available diagnostic and therapeutic options, except radiological procedures. When the decision for a certain radiological procedure is made by patient, the emotional perception would be improved. Additionally, it is also good to provide guidance for self-controlling radiation dose, if available. In case of radioisotope treatment, there are several preparation methods and guidance for patients to reduce radiation exposure of themselves and their caregiver. In summary, physicians' communication with patients on radiation risk should be based on scientific data, sufficient information, and sharing of decision and control with patients.

Assessment of the Knowledge of Healthcare Professionals Regarding Radiological Examination in Lactating Mothers: A Cross-Sectional Survey Study in the Kingdom of Bahrain.

Objectives Breastfeeding is critical for a mother's health, as well as the development and survival of her infant. Healthcare personnel are a reliable source of information for breastfeeding mothers during and after radiological procedures, assuming their understanding is appropriate. As a result, this study analyzed healthcare professionals' knowledge of breastfeeding and radiological tests on lactating mothers. Methods A cross-sectional survey was implemented using a validated questionnaire containing 25 items about breastfeeding habits and radiation imaging including male and female healthcare staff in primary and tertiary hospitals in Bahrain. The survey comprised 384 responders who were doctors, nurses, radiology technicians, and other allied health professionals. Results In general, 284 (74%) participants scored outstanding knowledge on questions about the health benefits of breastfeeding for both mothers and newborns. However, there was a clear lack of awareness concerning the use of imaging modalities and contrasts on lactating mothers, with only 117 (30.5%) participants scoring an "Excellent" knowledge score. Factors associated with basic knowledge included breastfeeding practice, source of knowledge, and years of experience. The availability of CT/MRI/nuclear scans was one factor related to radiological imaging knowledge. Participants' age, academic background, and profession had strong correlations with fundamental and radiological knowledge. Conclusion Overall, health professionals' awareness and understanding of breastfeeding was average; there is a lack of knowledge of radiological imaging on lactating mothers, which may lead to the discontinuation of breastfeeding following radiological examination. Our study advises incorporating the impacts of exposure to radiological imaging into breastfeeding education programs to increase healthcare providers' knowledge and thereby encourage breastfeeding practice.

Exposure of volunteers in medical research – justified and optimised?

Volunteers participating in medical research must be adequately protected. A volunteer can be a person undergoing treatment for an illness (a patient) or a healthy person. The radiological imaging and therapy procedures used could be routine or project-specific with different purposes. This contribution aims to explore the features and conditions of this planned exposure situation and to address some challenges. The result of a national study is presented. The main aspects covered in this presentation are justification, optimisation of radiation protection and the use of dose constraints. The guidelines in ICRP Publication 62 were reflected upon.

Long-Term Reoperation Rates Following Pancreatoduodenectomy for Pancreatic Adenocarcinoma.

Short-term outcomes after pancreatoduodenectomy (PD) are well-studied, but long-term reoperation rates and their indications remain poorly characterized. A single-center retrospective chart review was performed on patients who underwent PD for pancreatic adenocarcinoma between 1/2011 and 12/2021. Reoperations occurring >90days after PD were dichotomized to being related or unrelated to the index PD or pancreatic adenocarcinoma. The Kaplan-Meier analysis estimated the incidence of long-term reoperation at 1 and 5years postoperatively. Six-hundred twenty-eight patients were included. The 5-year incidence of any additional operation >90days after PD was 30.0% (95% CI 23.2-36.2%), and the 5-year incidence of any long-term related reoperation was 21.2% (95% CI 15.0-26.8%). The most common indications for reoperations by 5-year incidence were cancer recurrence (12.8%, 95% CI 7.6-17.7%), incisional hernia (6.2%, 95% CI 2.6-9.7%), small bowel obstruction (1.3%, 95% CI 0.2-2.4%), and leak, fistula, or infection (1.0%, 95% CI 0.1-2.0%). Of the examined risk factors, only 90-day reoperation was found to be predictive of long-term related reoperations (P = 0.02). Additionally, the 5-year incidence of endoscopic or interventional radiology procedures was 20.2% (95% CI 14.5-25.4%). However, 40.9% (95% CI 33.6-47.3%) of patients required additional surgery or procedures of any kind between 90 days and 5years after PD. Within 5years of PD, one in three patients required additional surgery, and one in five had operations for related indications. Related reoperative indications included recurrence, hernia, PD-specific complications, and small bowel obstruction. However, the rates of each of these reoperations were relatively low.

Estimating occupational exposure in interventional radiology through Air Kerma Area Product - calculation of Effective Dose conversion factors

During interventional radiology procedures, interventionists are positioned close to the patient and directly exposed to ionizing radiation. This study presents a methodology to estimate the effective dose of interventionists through Air Kerma Area Product (PKA) in three interventional procedure modalities: coronary, cerebral, and peripheral. Optically stimulated luminescence dosimeters were used in several body regions (thyroid, eye lens, abdomen, feet, and hands) to assess equivalent doses and to convert external to internal doses – leading to effective doses related to each modality. These effective doses were then correlated to the total PKA given by the equipment. Thus, an effective dose estimate factor was calculated to represent the conversion between equipment parameters and the effective dose obtained from dosimeters, resulting in a novel methodology. The agreement between the methods was in the range of ± 0.13 μSv for angiographies and -8.3 to 5.3 μSv for angioplasties. These findings underscore the reliability of PKA as a predictor of effective dose, facilitating a rapid and precise assessment of occupational exposure in IR. This novel approach has the potential to enhance radiation safety protocols and optimize protection strategies for IR professionals, ensuring more accurate monitoring and control of radiation exposure in clinical settings.