Percutaneous cryoablation of renal masses under CT fluoroscopy: radiation doses to the patient and interventionalist.

PURPOSE: Computed tomographic (CT) fluoroscopy-guided percutaneous cryoablation is an effective therapeutic method used to treat focal renal masses. The purpose of this study is to quantify the radiation dose to the patient and interventional radiologist during percutaneous cryoablation of renal masses using CT fluoroscopic guidance. METHODS: Over a 1-year period, the CT fluoroscopy time during percutaneous cryoablation of renal masses was recorded in 41 patients. The level of complexity of each procedure was designated as simple, intermediate, or complex. Patient organ radiation doses were estimated using an anthropomorphic model. Dose to the interventional radiologist was estimated using ion chamber survey meters. RESULTS: The average CT fluoroscopy time for technically simple cases was 47 s, 126 s for intermediate cases, and 264 s for complex cases. The relative risk of hematologic stomach and liver malignancy in patients undergoing this procedure was 1.003-1.074. The lifetime attributable risk of cancer ranged from 2 to 58, with the highest risk in younger patients for developing leukemia. The estimated radiation dose to the interventionalist without lead shielding was 390 mR (3.9 mGy) per year of cases. CONCLUSIONS: The radiation risk to the patient during CT fluoroscopy-guided percutaneous renal mass cryoablation is, as expected, related to procedure complexity. Quantification of patient organ radiation dose was estimated using an anthropomorphic model. This information, along with the associated relative risk of malignancy, may assist in evaluating risks of the procedure, particularly in younger patients. The radiation dose to the interventionist is low regardless of procedure complexity, but highlights the importance of lead shielding.

Evaluation of the absorbed dose to the breast using radiochromic film in a dedicated CT mammotomography system employing a quasi-monochromatic x-ray beam.

PURPOSE: A dual modality SPECT-CT prototype system dedicated to uncompressed breast imaging (mammotomography) has been developed. The computed tomography subsystem incorporates an ultrathick K-edge filtration technique producing a quasi-monochromatic x-ray cone beam that optimizes the dose efficiency of the system for lesion imaging in an uncompressed breast. Here, the absorbed dose in various geometric phantoms and in an uncompressed and pendant cadaveric breast using a normal tomographic cone beam imaging protocol is characterized using both thermoluminescent dosimeter (TLD) measurements and ionization chamber-calibrated radiochromic film. METHODS: Initially, two geometric phantoms and an anthropomorphic breast phantom are filled in turn with oil and water to simulate the dose to objects that mimic various breast shapes having effective density bounds of 100% fatty and glandular breast compositions, respectively. Ultimately, an excised human cadaver breast is tomographically scanned using the normal tomographic imaging protocol, and the dose to the breast tissue is evaluated and compared to the earlier phantom-based measurements. RESULTS: Measured trends in dose distribution across all breast geometric and anthropomorphic phantom volumes indicate lower doses in the medial breast and more proximal to the chest wall, with consequently higher doses near the lateral peripheries and nipple regions. Measured doses to the oil-filled phantoms are consistently lower across all volume shapes due to the reduced mass energy-absorption coefficient of oil relative to water. The mean measured dose to the breast cadaver, composed of adipose and glandular tissues, was measured to be 4.2 mGy compared to a mean whole-breast dose of 3.8 and 4.5 mGy for the oil- and water-filled anthropomorphic breast phantoms, respectively. CONCLUSIONS: Assuming rotational symmetry due to the tomographic acquisition exposures, these results characterize the 3D dose distributions in an uncompressed human breast tissue volume for this dedicated breast imaging device and illustrate advantages of using the novel ultrathick K-edge filtered beam to minimize the dose to the breast during fully-3D imaging.

Early first-trimester fetal radiation dose estimation in 16-MDCT without and with automated tube current modulation.

OBJECTIVE: The objective of our study was to correlate the estimated fetal absorbed radiation dose derived by directly measured uterine doses in the early first trimester and the volume CT dose index (CTDI(vol)) for 16-MDCT of the maternal chest, abdomen, and pelvis. MATERIALS AND METHODS: Estimated absorbed fetal dose was measured using a metal oxide semiconductor field effect transistor (MOSFET) dosimeter that was placed in the uterus of an adult female anthropomorphic phantom. The phantom was scanned on a 16-MDCT scanner using three protocols. The scanning parameters for protocol A (trauma) were detector configuration, 16 x 0.625 mm; pitch, 1.75:1; rotation time, 0.5 second; 140 kVp; and 340 mA. The scanning parameters for protocol B (CT angiography) were detector configuration, 16 x 1.25 mm; pitch, 1.38:1; rotation time, 0.6 second; 140 kVp; and 300 mA. The scanning parameters for protocol C, which is the automated tube current modulation (ATCM) protocol previously used in the literature, were detector configuration, 16 x 1.25 mm; pitch, 0.938:1; rotation time, 0.5 second; 140 kVp; and 380 mA. The protocols were also modified for the ATCM mode; the CTDI(vol) was documented from the scanner's console. Correlation between these data was tested with a goodness-of-fit model. RESULTS: Absorbed fetal radiation dose in the early first trimester correlated with the CTDI(vol) via a linear regression equation. For a constant tube current and peak voltage of 140 kVp, fetal dose (mGy) = 1.665 x CTDI(vol) (mGy) - 7.059. For the ATCM mode and a constant kVp of 140, fetal dose (mGy) = 2.151 x CTDI(vol) (mGy) - 2.200. The goodness of fit (R(2)) for the equations is 0.99 and 0.91, respectively. CONCLUSION: In both the manual and ATCM modes, absorbed fetal radiation dose can be estimated from the CTDI(vol) obtained at the time of scanning independent of pitch and tube current-time product (mAs).

Effect of patient size on radiation dose for abdominal MDCT with automatic tube current modulation: phantom study.

OBJECTIVE: The purpose of this study was to evaluate in a phantom study the effect of patient size on radiation dose for abdominal MDCT with automatic tube current modulation. MATERIALS AND METHODS: One or two 4-cm-thick circumferential layers of fat-equivalent material were added to the abdomen of an anthropomorphic phantom to simulate patients of three sizes: small (cross-sectional dimensions, 18 x 22 cm), average size (26 x 30 cm), and oversize (34 x 38 cm). Imaging was performed with a 64-MDCT scanner with combined z-axis and xy-axis tube current modulation according to two protocols: protocol A had a noise index of 12.5 H, and protocol B, 15.0 H. Radiation doses to three abdominal organs and the skin were assessed. Image noise also was measured. RESULTS: Despite increasing patient size, the image noise measured was similar for protocol A (range, 11.7-12.2 H) and protocol B (range, 13.9-14.8 H) (p > 0.05). With the two protocols, in comparison with the dose of the small patient, the abdominal organ doses of the average-sized patient and the oversized patient increased 161.5-190.6%and 426.9-528.1%, respectively (p < 0.001). The skin dose increased as much as 268.6% for the average-sized patient and 816.3% for the oversized patient compared with the small patient (p < 0.001). CONCLUSION: Oversized patients undergoing abdominal MDCT with tube current modulation receive significantly higher doses than do small patients. The noise index needs to be adjusted to the body habitus to ensure dose efficiency.

Radiation dose to the female breast from 16-MDCT body protocols.

OBJECTIVE: The objective of our study was to determine the radiation dose to the female breast from current 16-MDCT body examinations. MATERIALS AND METHODS: Metal oxide semiconductor field effect transistor (MOSFET) detectors were placed in four quadrants of the breast of a female-configured anthropomorphic phantom to determine radiation dose to the breast. Imaging was performed on a 16-MDCT scanner (LightSpeed, GE Healthcare) using current clinical protocols designed to assess pulmonary embolus (PE) (140 kVp, 380 mA, 0.8-sec rotation, 16 x 1.25 mm collimation), appendicitis (140 kVp, 340 mA, 0.5-sec rotation, 16 x 0.625 mm collimation), and renal calculus (140 kVp, 160 mA, 0.5-sec rotation, 16 x 0.625 mm collimation). RESULTS: Radiation dose to the breast ranged from 4 to 6 cGy for the PE protocol and up to 1-2 cGy in the inferior aspect of the right breast and lateral aspect of the left breast for the appendicitis protocol. The renal calculus protocol yielded less than 150 microGy absorbed breast dose. CONCLUSION: Current clinical chest and abdomen protocols result in vairable radiation doses to the breast. The magnitude of exposure may have implications for imaging strategies.