Analysis of Patients' X-ray Exposure in 146 Percutaneous Radiologic Gastrostomies.
Rofo
; 189(9): 820-827, 2017 Sep.
Article
em En
| MEDLINE
| ID: mdl-28609790
ABSTRACT
Purpose Analysis of patient´s X-ray exposure during percutaneous radiologic gastrostomies (PRG) in a larger population. Materials and Methods Data of primary successful PRG-procedures, performed between 2004 and 2015 in 146 patients, were analyzed regarding the exposition to X-ray. Dose-area-product (DAP), dose-length-product (DLP) respectively, and fluoroscopy time (FT) were correlated with the used x-ray systems (Flatpanel Detector (FD) vs. Image Itensifier (BV)) and the necessity for periprocedural placement of a nasogastric tube. Additionally, the effective X-ray dose for PRG placement using fluoroscopy (DL), computed tomography (CT), and cone beam CT (CBCT) was estimated using a conversion factor. Results The median DFP of PRG-placements under fluoroscopy was 163 cGy*cm2 (flat panel detector systems 155 cGy*cm2; X-ray image intensifier 175 cGy*cm2). The median DLZ was 2.2âmin. Intraprocedural placement of a naso- or orogastric probe (nâ=â68) resulted in a significant prolongation of the median DLZ to 2.5âmin versus 2âmin in patients with an already existing probe. In addition, dose values were analyzed in smaller samples of patients in which the PRG was placed under CBCT (nâ=â7, median DFPâ=â2635 cGy*cm2), or using CT (nâ=â4, median DLPâ=â657âmGy*cm). Estimates of the median DFP and DLP showed effective doses of 0.3âmSv for DL-assisted placements (flat panel detector 0.3âmSv, X-ray image converter 0.4âmSv), 7.9âmSv using a CBCT - flat detector, and 9.9âmSv using CT. This corresponds to a factor 26 of DL versus CBCT, or a factor 33 of DL versus CT. Conclusion In order to minimize X-ray exposure during PRG-procedures for patients and staff, fluoroscopically-guided interventions should employ flat detector systems with short transmittance sequences in low dose mode and with slow image frequency. Series recordings can be dispensed with. The intraprocedural placement of a naso- or orogastric probe significantly extends FT, but has little effect on the overall dose of the intervention. Due to the significantly higher X-ray exposure, the use of a CBCT as well as PRG-placements using CT should be limited to clinically absolutely necessary exceptions with strict indication. Key Points · Fluoroscopically-guided PRG placements are interventions with low X-ray exposure.. · X-ray exposure from fluoroscopy is lower using flat panel detector systems as compared to image intensifier systems.. · The concomitant placement of an oro- or nasogastric probe extends the fluoroscopy time.. · Gastric probe placement is worthwhile to prevent the premature use of the significantly radiation-intensive CT.. · The use of the C-arm CT or the CT increases the beam exposure by 26 or 33 times, respectively.. · The PRG placement using C-arm CT and CT should only be performed in exceptional cases.. Citation Format · Petersen TO, Reinhardt M, Fuchs J etâal. Analysis of Patients' X-ray Exposure in 146 Percutaneous Radiologic Gastrostomies. Fortschr Röntgenstr 2017; 189 820â-â827.
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Base de dados:
MEDLINE
Assunto principal:
Fluoroscopia
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Gastrostomia
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Tomografia Computadorizada por Raios X
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Radiografia Intervencionista
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Exposição à Radiação
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Cirurgia Assistida por Computador
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article