Reduce Radiation Exposure Research Articles

A systematic review of deep learning-based denoising for low-dose computed tomography from a perceptual quality perspective.

Low-dose computed tomography (LDCT) scans are essential in reducing radiation exposure but often suffer from significant image noise that can impair diagnostic accuracy. While deep learning approaches have enhanced LDCT denoising capabilities, the predominant reliance on objective metrics like PSNR and SSIM has resulted in over-smoothed images that lack critical detail. This paper explores advanced deep learning methods tailored specifically to improve perceptual quality in LDCT images, focusing on generating diagnostic-quality images preferred in clinical practice. We review and compare current methodologies, including perceptual loss functions and generative adversarial networks, addressing the significant limitations of current benchmarks and the subjective nature of perceptual quality evaluation. Through a systematic analysis, this study underscores the urgent need for developing methods that balance both perceptual and diagnostic quality, proposing new directions for future research in the field.

Median dose area product and fluoroscopy time have stabilized on a low level during the last years: data from the swedish national catheter ablation registry

Abstract Background Despite the utilization of 3D-mapping systems, the use of fluoroscopy is still necessary in most procedures of catheter ablations of arrhythmias, but associated with serious health risks to both patients and operators. However, given the rapid improvement of the 3D-mapping systems, the usage of fluoroscopy has likely decreased during the past 15 years. Purpose The purpose of this study was to explore trends over time in usage of fluoroscopy in catheter ablation for all arrhythmias. Methods The Swedish Catheter Ablation Registry covers virtually all (>97%) catheter ablations performed in Sweden since 2005. Patients >18 years of age undergoing catheter ablation from January 1st 2006 to December 31st 2020 were included. Periprocedural data; median dose area product and fluoroscopy time were analyzed and compared. Periprocedural data were compared between 2006, 2015 and 2020 to find possible trends. Results A total of 61242 procedures were performed during the study period. The breakdown between the different arrhythmias was: 3% ventricular tachycardia (VT), 3% premature ventricular complex (PVC), 5% atrial tachycardia (AT), 7% atrioventricular junction ablation (AVJ), 10% atrioventricular reentry tachycardia (AVRT), 14% cavotricuspid isthmus ablation (CTI), 20% atrioventricular nodal reentry tachycardia (AVNRT) and 39% atrial fibrillation (AF). In 2006, the median fluoroscopy duration for AF, VT and PVC were recorded at 41, 32 and 37 minutes, respectively. Subsequently in 2015 the corresponding times were recorded at 14, 8 and 13 minutes. In 2020 respective procedures had a median fluoroscopy time of 11, 10 and 18 minutes (p< 0.001 for trend for all ablations). In 2006 median dose area product for AF, VT and PVC were 3998 cGycm2, 4300 cGycm2, and 5138 cGycm2, respectively. By 2015 the median dose area product had decreased to 1005 cGycm2, 432 cGycm2 and 1123 cGycm2 respectively. In 2020 the median dose area product had decreased further to 524 cGycm2, 380 cGycm2 and 848 cGycm2 (p<0.001 for trends for all ablations). See figure 1 for all procedures. Conclusion Fluoroscopy time and median dose area product have decreased significantly over a 15-year period and have stabilized on a low level over the last 5 years. Given the associated risks, efforts to further reduce radiation exposure are clearly warranted.Median dose area product

Pediatric contrast-enhanced chest CT on a photon-counting detector CT: radiation dose and image quality compared to energy-integrated detector CT.

Photon counting detector (PCD) CT benefits from reduced noise compared with conventional energy-integrating detector (EID) CT, which should translate to improved image quality and reduced radiation exposure for pediatric patients undergoing chest CT with IV contrast. To determine the differences in radiation exposure and image quality of PCD CT and EID CT in pediatric chest CT with intravenous (IV) contrast. In this institutional review board-approved retrospective observational study, 20 scan pairs (20 PCD CT; 20 EID CT) for children who underwent chest CT with IV contrast on both a PCD CT (Siemens NAEOTOM Alpha) and an EID CT (Siemens SOMATOM Definition Edge or Force) within 12months were reviewed independently by three pediatric radiologists for three subjective quality features on 5-point Likert scales: overall quality, small structure delineation, and motion artifact. Objective measures of image quality (image noise, signal-to-noise ratio, and contrast-to-noise ratio) were assessed by a single radiologist in several locations in the chest through region of interest measurement of Hounsfield units (HU) and standard deviation. Patient-related and radiation exposure parameters were collected for each scan and summarized with median and interquartile range (IQR). The Wilcoxon rank-sum test was utilized to compare groups. A P < 0.05 indicated statistical significance. Inter-observer agreement of subjective image quality metrics was analyzed using weighted kappa. Age (14.2years vs 13.8years, P= 0.15), height (P= 0.13), weight (P= 0.21), and BMI (P = 0.24) did not significantly differ between groups. There were 10 male and 3 female patients. Compared to EID CT, PCD CT showed lower radiation exposure parameters including volumetric CT dose index, 1.7mGy (IQR 1.1-2.4mGy) vs 3.8mGy (IQR 2.0-4.7mGy) (P< 0.01), and size-specific dose estimate, 2.6mGy (IQR 1.8-3.1mGy) vs 5.0mGy (IQR 3.3-6.2mGy) (P< 0.01). Objective image quality of lung parenchyma was improved on the PCD CT scanner, including image noise 119.5 HU (IQR 95.4-135.7 HU) vs 143.1 HU (IQR 125.4-169.8 HU) (P < 0.01), signal-to-noise ratio (SNR) -6.1 (IQR -8.4 to -4.8) vs -4.9 (IQR -5.6 to -3.8) (P= 0.01), and contrast-to-noise ratio -63.9 (-84.1 to -57.5) vs -60.5 (-76.3 to -52.5) (P = 0.01). Motion artifact was improved on the PCD CT scanner (P< 0.01). No significant differences in overall image quality or small structure delineation were identified (P= 0.06 and P= 0.31). PCD CT pediatric chest CT had significantly reduced radiation exposure, improved image quality, and reduced motion artifact compared with EID CT.

Comparison of angiography-derived index of microcirculatory resistance measurements between low and high frame-rate acquisitions: the prospective ADMIRAL-study

Abstract Background Angiography-derived index of microcirculatory resistance (angio-IMR) is a novel, wire-free, angiography-based method (QFR-IMR®) to assess coronary microvascular dysfunction. If a frame-rate of 15 frames per second (fps) is recommended, there is an interest in decreasing this frame-rate to reduce X-ray exposure. However, the impact of frame-rate reduction on angio-IMR quantification has not been investigated. Purpose To compare angio-IMR at 7.5 fps (angio-IMRlow) to angio-IMR at 15 fps (angio-IMRhigh) in a multicentric study. Methods From October 2023 to February 2024, we conducted a multicentre prospective study including consecutive patients referred for an invasive coronary angiogram with a final diagnosis of ischemia with no obstructive coronaries arteries (INOCA) (positive stress test with normal coronary angiogram) or acute coronary syndrome (ACS). Main exclusion criteria were creatinine clearance&amp;lt;45ml/kg/1.73m2, factors that might substantially impact the coronary angiograms quality (e.g: aortic stenosis, supraventricular tachycardia), and TIMI flow &amp;lt;3. In ACS patients, angio-IMR was measured after revascularisation. The same two acquisitions with different angles (≥25°) were recorded at a rate of 7.5 fps and a rate of 15 fps to measure angio-IMR in the selected vessel (culprit coronary vessel in ACS patients or left anterior descending artery in patients with INOCA). Angio-IMR was measured with dedicated software (QFR-IMR® RE, Medis Medical Imaging). Correlation between angio-IMRlow and angio-IMRhigh was assessed by linear regression and Bland-Altman test. The diagnostic accuracy of angio-IMRlow to predict microcirculatory dysfunction (defined as angio-IMRhigh≥ 25 for INOCA and ≥ 40 for ACS) was also assessed. Statistical significance was awarded by p≤0.05. Results Of 87 consecutive eligible patients, 75 were included in the study, comprising 57 with ACS and 18 with INOCA (mean age 61±12 years, 72% male). Angio-IMRlow (median=35; [IQR:28-48]) was slightly but significantly higher (p=0.04) than angio-IMRhigh (median=34; [IQR:25-45]). Angio-IMRlow and angio-IMRhigh were significantly correlated (r=0.90; p&amp;lt;0.0001) (Figure 1). Using Bland-Altman analysis, mean difference between the two measurements was 2.2 (95% CI 0.1-4.4) with a significant higher value with angio-IMRlow (p=0.04). Moreover, as value of Angio-IMRhigh increases, the difference between angio-IMRlow and angio-IMRhigh becomes more significant (Figure 2). Using angio-IMRhigh to diagnose microcirculatory dysfunction as reference, angio-IMRlow achieved positive and negative predictive values of 83% and 85% respectively with 6 false positives, and 6 false negatives. Conclusion Correlation between angio-IMRhigh and angio-IMRlow is acceptable. Lowering frame acquisition rate reduces radiation exposure without relevantly impact on the diagnostic accuracy of angio-IMR, which can contribute to a widespread use of angio-IMR.Correlation between angioIMRlow and highBland-Altman plot

Comparing Low-to-Zero Fluoroscopic Navigation Systems for AVNRT Catheter Ablation: A Network Meta-Analysis.

Low-to-zero fluoroscopic navigation systems lower radiation exposure which improves health outcomes. Conventional x-ray fluoroscopy (CF) has long been the standard to guide to catheter location for cardiac ablation. With advancements in technology, alternative safety navigation systems have been developed. Three primary modalities commonly utilized are three-dimensional electroanatomic mapping (3D-EAM), magnetic navigation system (MNS), and intracardiac echocardiography (ICE), all of which can reduce radiation exposure during the procedure. We aim to compare the efficacy and safety among ICE, EAM, MNS, and CF in ablation of atrioventricular nodal reentrant tachycardia (AVNRT). This is a meta-analysis consisting of observational studies and randomized controlled trials, which evaluated the performance of navigation systems of catheter ablation in AVNRT patients. Primary endpoint was to access the AVNRT recurrence after the procedure during follow-up periods. Secondary endpoints were technical success, fluoroscopic time, fluoroscopic dose area product, radiofrequency ablation time, and adverse events. Random-effect model was applied for pooled estimated effects of included studies. A total of 21 studies (21 CF, 2 ICE, 9 EAM, 11 MNS) including 1716 patients who underwent catheter ablation for AVNRT treatment were analyzed. Of these, 16 were observational studies and 5 were randomized controlled trials. Point estimation of AVNRT recurrence showed ICE exhibited a pooled odds ratio (ORs) of 1.06 (95% confidence interval [CI]: 0.064-17.322), MNS with ORs of 0.51 (95% CI: 0.214-1.219], and EAM with ORs of 0.394 (95% CI: 0.119-1.305) when compared to CF. EAM had significant higher technical success with ORs of 2.781 (95% CI: 1.317-5.872) when compared to CF. Regarding fluoroscopy time, EAM showed the lowest time with mean differences (MD) of -10.348 min (95% CI: -13.385 to -7.3101) and P-score of 0.998. It was followed by MNS with MD of -3.712 min (95% CI: -7.128 to -0.295) and P-score of 0.586, ICE with MD of -1.150 min (95% CI: -6.963 to 4.662) with a P-score of 0.294 compared to CF, which has a P-score of 0.122. There were insignificant adverse events across the procedures. AVNRT ablation navigated by low-to-zero fluoroscopic navigation systems achieves higher efficacy and comparable safety to conventional fluoroscopywhile also reducing risk of radiation exposure time.

First case report of a percutaneous coronary intervention with intracoronary lithotripsy in a heavily calcified and tortuous right coronary artery using the R-One+ robotic system

Abstract Background Advancement in interventional techniques has significantly improved the ability of percutaneous coronary intervention (PCI) to treat complex coronary artery disease. Despite these advancements, coronary artery calcification poses a substantial challenge during PCI, contributing to increased risks of procedural complications, prolonged procedure duration, an increase in radiation exposure dose for both patients and physicians. Recently, robotic PCI has emerged, allowing physicians to remotely control and deliver wires and catheters, leading to a notable reduction of the operator radiation exposure and a decrease in the risk of operator physical injuries such as back pain. Case summary We report the first robotic PCI with the R-One+™ robotic system using intracoronary lithotripsy for lesion preparation of two heavily calcified lesions in a tortuous right coronary artery of a 60-year old male patient followed by double drug-eluting stent implantation. Discussion Robotic PCI with the R-One+™ system can not only manage wires, balloons or stent systems but can also precisely position more bulky catheters such as intracoronary lithotripsy catheters to the target site even in the presence of a tortuous access.

Automated Injectors versus Manual Administration: A Comparative Analysis of Radiation Exposure Reduction in 18F-FDG Delivery

Abstract Background Despite the presence of safety protocols, the manual manipulation of radiopharmaceuticals continues to pose a significant occupational radiation risk. Health care professionals in nuclear medicine are at risk of radiation exposure, particularly to their hands and eyes. Despite existing protective measures, manual handling of radiopharmaceuticals remains a significant source of occupational radiation. Objective This study evaluates the effectiveness of automated injectors in reducing radiation exposure among health care workers during fluorine-18 fluorodeoxyglucose (18F-FDG) administrations, compared with traditional manual injection methods. Methods We assessed radiation exposure levels associated with manual versus automated 18F-FDG injection techniques using specialized dosimeters. Measurements focused on whole-body, extremity, and eye-lens radiation doses to evaluate the potential benefits of automation in minimizing exposure. Results Findings reveal that automated injectors significantly reduce radiation exposure, with decreases of 97.97 and 98.96% in left- and right-hand extremity doses, respectively, 43.24% in eye-lens dose, and 91.66% in whole-body dose compared with manual methods. Conclusion Automated injection systems offer considerable advantages in reducing health care worker radiation exposure in nuclear medicine. The substantial reduction in staff doses underscores the necessity of transitioning to such technology to promote safer clinical environments. This study highlights the critical role of automation in enhancing occupational safety standards within diagnostic radiology settings.

Coil Embolization for Cerebral Aneurysm Using Low Pulse Rate Fluoroscopy.

Although coil embolization is commonly perceived as a minimally invasive procedure, the associated radiation exposure cannot be disregarded. To date, no specific study has investigated radiation exposure during coil embolization. This study aimed to investigate the potential of lowering the pulse rate to decrease radiation exposure during coil embolization while maintaining patient safety. Radiation data and clinical features of 70 patients who underwent coil embolization between 2015 and 2020 were retrospectively analyzed. Since July 2017, the pulse rate was regulated from 7.5 to 4 frames per second (f/s). Statistical analyses were performed to examine the correlation between pulse rate and radiation exposure. Out of the 70 procedures, 30 were performed at the standard pulse rate (7.5 f/s), and 40 were performed at the lower pulse rate (4 f/s). In the lower-pulse-rate group, the absorbed dose to the patient (AK) was 2580.7 (±217) mGy, whereas in the standard-pulse-rate group, it was 4760 (±411.1). Both the dose-area product (DAP) and AK were substantially reduced in the low pulse rate group (p = 0.000002). There was a significant correlation between DAP and AK and pulse rate (p = 0.004, p = 0.0017, respectively). Moreover, there was no significant correlation between pulse rate and perioperative complications. Our findings suggest that using a lower pulse rate (4 f/s) can effectively reduce radiation exposure during coil embolization for cerebral aneurysms while ensuring patient safety.

Deep-learning-based attenuation map generation in kidney single photon emission computed tomography

BackgroundAccurate attenuation correction (AC) is vital in nuclear medicine, particularly for quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) imaging. This study aimed to establish a CT-free quantification technology in kidney SPECT imaging using deep learning to generate synthetic attenuation maps (μ-maps) from SPECT data, thereby reducing radiation exposure and eliminating the need for CT scans.ResultsA dataset of 1000 Tc-99m DTPA SPECT/CT scans was analyzed for training (n = 800), validation (n = 100), and testing (n = 100) using a modified 3D U-Net for deep learning. The study investigated the use of primary emission and scattering SPECT data, normalization methods, loss function optimization, and up-sampling techniques for optimal μ-map generation. The problem of checkerboard artifacts, unique to μ-map generation from SPECT signals, and the effects of iodine contrast media were evaluated. The addition of scattering SPECT to primary emission SPECT imaging, logarithmic maximum normalization, the combination of absolute difference loss (L1) and three times the absolute gradient difference loss (3 × LGDL), and the nearest-neighbor interpolation significantly enhanced AI performance in μ-map generation (p < 0.00001). Checkerboard artifacts were effectively eliminated using the nearest-neighbor interpolation technique. The developed AI algorithm produced μ-maps neutral to the presence of iodine contrast and showed negligible contrast effects on quantitative SPECT measurement, such as glomerular filtration rate (GFR). The potential reduction in radiation exposure by transitioning to AI-based CT-free SPECT imaging ranges from 45.3 to 78.8%.ConclusionThe study successfully developed and optimized a deep learning algorithm for generating synthetic μ-maps in kidney SPECT images, demonstrating the potential to transition from conventional SPECT/CT to CT-free SPECT imaging for GFR measurement. This advancement represents a significant step towards enhancing patient safety and efficiency in nuclear medicine.

ECHO-MPS, a dual modality strategy of cardiac imaging to identify myocardial ischemia.

We aimed to evaluate an approach with resting echocardiography (TTE) and stress myocardial perfusion scintigraphy (MPS) compared to standard MPS in patients with stable angina and normal left ventricle (LV). We hypothesized that normal LV on TTE may allow for the elimination of rest MPS without compromising accuracy and offering an efficient diagnostic pathway with reduced radiation exposure. In a prospective, non-randomized study TTE was performed prior to MPS in patients (pts) referred for assessment of coronary artery disease (CAD). In pts with normal LV assessment was performed using the hybrid and the standard approach. TTE and MPS were interpreted by two TTE readers (ER1-2) and two MPS readers (NR1-2). ECHO-MPS was compared with standard MPS for diagnostic accuracy. 103 patients, mean age 61 ± 12 year, (63M, 40W) were recruited. Standard MPS were normal in 75 patients and abnormal in 28 patients, with the hybrid approach 79 studies were reported as normal and 24 studies as abnormal. Kappa values were 0.580, (p < 0.001) for large, 0.394, (p < 0.001) for medium, and 0.298 (p = 0.002) for small defects. With standard MPS as a reference, sensitivity for detection of perfusion defects by ECHO-MPS was 75% (95% CI 0.67-0.83) [NR2] and 78% (95% CI 0.70-0.86)[NR1]. Specificity was 95% (95% CI 0.90-0.99) [NR2] and 95% (CI 95%CI 0.90-0.99) [NR1]. ECHO-MPS protocol provides similar diagnostic accuracy as standard stress-rest MPS. In patients with normal systolic LV function in TTE, performing only stress MPS provides similar information as standard rest and stress MPS.

A Comparative Study on the Consistency of Ultrasound and X-Ray in Assessing Risser Sign.

Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature, sagittal plane imbalance, and vertebral rotation. In China, AIS affects over 3 million individuals, with 300,000 new cases annually. AIS impacts physical and psychological well-being, necessitating tailored treatment plans based on growth risk factors. This study evaluates the consistency of ultrasound and X-ray assessments of the Risser sign in AIS patients and explores correlations between iliac crest distance and pelvic rotation degree. This prospective study enrolled 80 patients diagnosed with AIS from June to September 2023 at Changzhou Sports Hospital. Eligible participants were aged 10-18 with a Cobb angle >10°. Ultrasonographic examinations were conducted by 3 experienced physicians using the VINNO V10 portable ultrasound system. The primary outcome was the Risser stage determined by X-ray and ultrasound, with secondary outcomes including thoracic and thoracic-lumbar segment rotation angles. Statistical analyses included kappa statistics, correlation analyses, and multiple regression. Among the 77 valid cases, 154 iliac wings were evaluated, with a high concordance rate of 77% between ultrasound and X-ray assessments. kappa values for left and right iliac crests were 0.723 and 0.808, respectively. Grouping Risser grades (0-1, 2-3, and 4-5) into 3 categories yielded kappa values of 0.93, 0.96, and 0.93, indicating high consistency. Significant correlations were found between iliac crest distances and rotation angles (left iliac crest distance and left thoracic rotation angle, r = 0.56, P < .001; right iliac crest distance and right thoracic-lumbar rotation angle, r = 0.69, P < .001; right iliac crest distance and right thoracic rotation angle, r = 0.39, P < .01). Ultrasound is a reliable, radiation-free alternative to X-ray for assessing the Risser sign in AIS patients. Despite observed inconsistencies in intermediate Risser grades, ultrasound's ability to reduce radiation exposure and provide consistent results makes it a valuable tool in clinical practice. Further research is needed to optimize ultrasound techniques and explore its potential for early detection and intervention in scoliosis management.

An intuitive guidewire control mechanism for robotic intervention.

Teleoperated Interventional Robotic systems (TIRs) are developed to reduce radiation exposure and physical stress of the physicians and enhance device manipulation accuracy and stability. Nevertheless, TIRs are not widely adopted, partly due to the lack of intuitive control interfaces. Current TIR interfaces like joysticks, keyboards, and touchscreens differ significantly from traditional manual techniques, resulting in a shallow, longer learning curve. To this end, this research introduces a novel control mechanism for intuitive operation and seamless adoption of TIRs. An off-the-shelf medical torque device augmented with a micro-electromagnetic tracker was proposed as the control interface to preserve the tactile sensation and muscle memory integral to interventionalists' proficiency. The control inputs to drive the TIR were extracted via real-time motion mapping of the interface. To verify the efficacy of the proposed control mechanism to accurately operate the TIR, evaluation experiments using industrial grade encoders were conducted. A mean tracking error of 0.32 ± 0.12mm in linear and 0.54 ± 0.07° in angular direction were achieved. The time lag in tracking was found to be 125ms on average using pade approximation. Ergonomically, the developed control interface is 3.5mm diametrically larger, and 4.5g. heavier compared to traditional torque devices. With uncanny resemblance to traditional torque devices while maintaining results comparable to state-of-the-art commercially available TIRs, this research successfully provides an intuitive control interface for potential wider clinical adoption of robot-assisted interventions.

Acceptance and feasibility of an augmented reality-based navigation system with optical tracking for percutaneous procedures in interventional radiology - a simulation-based phantom study.

Augmented reality (AR) projects additional information into the user's field of view during interventions. The aim was to evaluate the acceptance and clinical feasibility of an AR system and to compare users with different levels of experience. A system was examined that projects a CT-generated 3D model of a phantom into the field of view using a HoloLens 2, whereby the tracked needle is displayed and navigated live. A projected ultrasound image is used for live control of the needle positioning. This should minimize radiation exposure and improve orientation.The acceptance and usability of the AR navigation system was evaluated by 10 physicians and medical students with different levels of experience by performing punctures with the system in a phantom. The required time was then compared and a questionnaire was completed to assess clinical acceptance and feasibility. For statistical analysis, frequencies for qualitative characteristics, location and dispersion measures for quantitative characteristics and Spearman rank correlations for correlations were calculated.9 out of 10 subjects hit all 5 target regions in the first attempt, taking an average of 29:39 minutes for all punctures. There was a significant correlation between previous experience in interventional radiology, years in the profession, and the time required. Overall, the time varied from an average of 43:00 min. for medical students to 15:00 min. for chief physicians. All test subjects showed high acceptance of the system and rated especially the potential clinical feasibility, the simplification of the puncture, and the image quality positively. However, the majority require further training for sufficient safety in use.The system offers distinct advantages for navigation and orientation, facilitates percutaneous interventions during training and enables professionally experienced physicians to achieve short intervention times. In addition, the system improves ergonomics during the procedure by making important information always directly available in the field of view and has the potential to reduce the radiation exposure of staff in particular by combining AR and sonography and thus shortening CT-fluoroscopy times. · AR navigation offers advantages for orientation during percutaneous radiological interventions.. · The subjects would like to use the AR system in everyday clinical practice on patients.. · AR improves ergonomics by making important information directly available in the field of view.. · The combination of AR and sonography can significantly reduce radiation exposure for staff.. · Rohmer K, Becker M, Georgiades M et al. Acceptance and feasibility of an augmented reality-based navigation system with optical tracking for percutaneous procedures in interventional radiology - a simulation-based phantom study. Fortschr Röntgenstr 2024; DOI 10.1055/a-2416-1080.

Characteristics of exposure to radioactive iodine during a nuclear incident.

During a nuclear accident, numerous products of nuclear fission are released, including isotopes of radioactive iodine. Among them is iodine-131, with a half-life of 8.02 days, which emits β radiation. For decades, it has been effectively and safely used in medicine. However, in the event of a nuclear accident, uncontrolled exposure can have harmful biological effects. The main sources of internal contamination with iodine-131 are contaminated air, food and water. The most exposed organ is the thyroid gland, where radioactive iodine accumulates via the Na+/I- symporter (NIS). NIS does not distinguish between radioactive iodine isotopes and the stable isotope iodine-127, which is essential for the synthesis of thyroid hormones. Exposure to radioactive iodine during a nuclear accident is primarily associated with papillary thyroid cancer, whose incidence begins to increase a few years after exposure. Children and adolescents are at the highest risk, and the risk is particularly significant for individuals living in iodine-deficient areas. Ensuring an adequate iodine supply is therefore crucial for lowering the risk of the harmful effects of exposure to radioactive iodine at the population level. Protecting the thyroid with potassium iodide tablets significantly reduces radiation exposure, as stable iodine prevents the entry of radioactive iodine into the thyroid. Such protection is effective only within a narrow time window - a few hours before and after the exposure and is recommended only for those under 40 years of age, as the risks of excessive iodine intake outweigh the potential benefits in older individuals.

Comparison between the intraoperative CT O-arm and C-arm related to radiation dose and accuracy in scoliosis surgery: A review study

Pedicle screw placement is a vital scoliosis therapy operation that aims to address spinal abnormalities while avoiding consequences including neurological damage caused by misplaced screws. Accurate imaging is required for precise screw insertion, with intraoperative CT (O-arm) and fluoroscopy (C-arm) being the principal modalities used. This review assesses various modalities based on their radiation dosages and accuracy. It comprises research published between 2012 and 2020 that evaluates both effective dose and accuracy for pediatric and adult patients. According to the review, the O-arm outperforms the C-arm in terms of accuracy, resulting in shorter procedure times for both pediatric and adult patients. The O-arm's sophisticated 3-D imaging capacity enhances screw insertion accuracy, reducing the likelihood of problems and the need for additional procedures. Furthermore, using pediatric low-dose protocols and techniques like the Detachable Pedicle Marker and Probe (DPMPs) with pulsed fluoroscopy can reduce radiation exposure while still ensuring precise screw placement. The review suggests that the O-arm has considerable advantages over the C-arm, such as improved image quality and lower radiation risk. This leads to enhanced patient safety and procedural outcomes. Overall, the O-arm's capacity to produce high-quality 3-D pictures makes it an invaluable tool in pedicle screw insertion, resulting in more accurate surgical outcomes and reducing the risk of problems associated with spinal deformity repairs.

More is less: image enhancement technology reduces radiation exposure during anterior lumber interbody fusion

BACKGROUND CONTEXTFluoroscopy and radiation exposure occur during anterior lumbar interbody fusion (ALIF). Image enhancement technology is available that can potentially reduce radiation exposure. PURPOSEThe purpose of this study is to evaluate radiation exposure and fluoroscopy times comparing standard fluoroscopy (FL) with a low dose image enhancement platform (LD). STUDY DESIGNRetrospective review of prospectively maintained database. PATIENT SAMPLEConsecutive patients undergoing ALIF with either standard fluoroscopy or low dose image enhancement technology. OUTCOME MEASURESRadiation dispersion and fluoroscopy times in ALIF patients with standard fluoroscopy and low dose image enhancement technology. METHODSA retrospective review of a prospective database on consecutive patients who have undergone ALIF, stratified into 2 groups: subjects with standard fluoroscopy (FL), and low dose fluoroscopy with image enhancement technology (LD). RESULTSA total of 487 ALIF patients were included (FL: 372 vs. LD: 115). LD patients were significantly older (66 vs. 60 years), with more deformity cases (28% vs. 12%), and less degenerative cases (71% vs. 87%), all p<.05; no differences in sex, BMI, or the number of levels operated on between groups. Fluoroscopy time (sec) was significantly higher in LD (51.4 vs. 45.5), with a statistically significant reduction in radiation (mGy) compared to FL (23.3 vs. 48.2), both p<.05. Furthermore, the results showed that radiation dispersion is increasingly reduced as fluoroscopy time increases in LD compared to FL (12%, 56%, and 65% reduction in radiation dispersion for fluoroscopy time <30 sec, between 30 to 60 sec, and >60 sec, respectively). CONCLUSIONSThe use of low dose fluoroscopy with image enhancement technology significantly reduces the cumulative dose of radiation during ALIF compared to standard dose fluoroscopy. Also, radiation dispersion increasingly decreases as fluoroscopy time increases using low dose image enhancement technology. Low dose image enhancement technology improves the safety profile of ALIF for patients and operating room staff.

Comparing Virtual Reality and Traditional Training in Radiation Safety Practices Over Three Years Among Cardiologists and Scrub Nurses

PurposeThis study evaluated the effectiveness of virtual reality (VR) training versus traditional methods in enhancing radiation safety practices among cardiologists and scrub nurses. Developed by Virtual Medical Coaching, VR training simulates radiation safety scenarios in cardiac catheterization laboratories (Cath Labs). MethodsA three-year crossover study was conducted with 150 healthcare professionals (in this study, healthcare professionals are defined as cardiologists and scrub nurses who work in Cath Labs) at five urban hospitals. These professionals are key personnel in fluoroscopy-guided interventional procedures, where radiation safety is a critical concern.Participants, stratified by profession, were randomly assigned to initially receive either VR (virtual medical coaching) or traditional training, followed by a year-long washout period before switching training modalities. Primary outcomes measured changes in radiation exposure via dosimeters, whereas secondary outcomes assessed knowledge retention. ResultsVR training significantly reduced radiation exposure, resulting in a 30% greater decrease in radiation dose than traditional methods do. Cardiologists in Group A (VR training) experienced a mean reduction of 3.37 (p < 0.001), whereas scrub nurses experienced a mean reduction of 2.89 (p < 0.001). In contrast, participants in Group B (traditional training) exhibited a smaller reduction of 1.75 for cardiologists (p < 0.001) and 1.49 for scrub nurses (p < 0.001). The participants transitioning from traditional to VR training demonstrated enhanced retention and application of safety protocols, as reflected by improved knowledge and observed structured clinical examinations (OSCE) scores. The integration of VR into training notably improved procedural knowledge and skills without the risk of radiation exposure, making VR an effective tool for radiation safety education. ConclusionThis study highlights the superiority of VR training in reducing radiation exposure and enhancing practical skills among medical professionals. Virtual medical coaching’s specialized VR modules effectively simulate real-world scenarios, making them valuable components in radiation safety training. The findings advocate the integration of VR into medical education curricula to improve safety standards and training efficacy.

Clinical usability and efficacy of a robotic bone fracture reduction system: A pilot animal study

Challenges in minimally invasive surgeries, such as intramedullary nailing for long bone fractures, include radiation overexposure for patients and surgeons, potential malreduction, and physical burden on surgeons in maintaining the reduction status. A robotic bone fracture reduction system was developed in this study to address these problems. The system consists of a hexapod with six degrees of freedom, with a fracture reduction device and a master device. This study aimed to evaluate the novel system in a preclinical setting. The length of the six axes in the system can be adjusted to precisely control the length, angle, and rotation so that no additional traction is required. Fluoroscopic images can be remotely examined to reduce the risk of radiation exposure for surgeons. In this study, alignment accuracy and radiation exposure were measured using 32 bovine bone fracture models, and these surgical outcomes were compared to those of conventional manual surgery to verify the clinical usability and effectiveness of the system. The alignment accuracy was assessed by analyzing length, angulation, and rotation. The four surgeons participating in this study were divided into two groups (expert and novice) according to their clinical experience. All parameters in robotic surgery significantly decreased by approximately 4 mm and 8° on average (p≤0.05) compared to conventional surgery. The mean radiation exposure in robot-assisted surgery was 0.11 mSv, showing a significant decrease compared to conventional surgery (p<0.05). Reduction accuracy was higher in robotic surgery performed by the novice group than in conventional surgery performed by the expert group; however, standard deviation values were inversed. In conclusion, the bone fracture reduction robot system increased the alignment accuracy through precise control while reducing radiation exposure in surgeons, as the surgery was performed remotely. The use of this system is predicted to improve the accuracy and reproducibility of the surgery and the safety of medical staff.11Abbreviations: CT, computed tomography; FRD, fracture reduction device; FRMD, fracture reduction master device; SD, standard deviation

TCT-745 Real-World Reductions in Lead-Free Radiation Exposure With the Rampart System During Endovascular Procedures

TCT-745 Real-World Reductions in Lead-Free Radiation Exposure With the Rampart System During Endovascular Procedures

A Multidisciplinary Assessment of Standard Low Dose Versus Ultra-Low Dose Chest CT Scans For Pectus Excavatum Imaging

AimEvaluation of ultra-low dose chest CT imaging for the assessment of pectus excavatum severity as determined by pediatric radiologists and pediatric surgeons using Haller (HI) and Correction indices (CI). MethodsA single institution, prospective evaluation of patients being evaluated for pectus excavatum were scanned with a standard low-dose chest CT protocol (CARE) followed by a consecutive ultra-low dose CT scan (ULTRA). 3 surgeons and 4 radiologists were instructed to determine HI and CI in each series. The Intraclass Correlation Coefficient (ICC) was used to calculate the agreement level between CARE and ULTRA. Bland-Altman (BA) and scatter plots were also performed to determine bias of each approach. Results32 patients had CARE and ULTRA consecutively. The ICC for HI demonstrated good reliability with a value of 0.89 and excellent reliability for CI with a value of 0.91. The reliability for HI was greater in the surgeon group (0.89) compared to the radiologist group (0.88). The reliability for CI was greater in the radiologist group (0.92) compared to the surgeon group (0.90). The Bland Altman plots for the HI and CI demonstrate no consistent bias for CARE or ULTRA approach when evaluating HI and CI. ConclusionUltra-low dose CT scan imaging compared to standard low-dose CT appears to be a reliable alternative for evaluating PE severity as assessed by HI and CI. This work supports the evaluation and potential development of a standardized CT imaging protocol capable of reducing radiation exposure without sacrificing imaging for PE patients. Level of evidence2