Survey of Exposure Dose during Percutaneous Coronary Intervention for Chronic Total Occlusion.

During percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), longer fluoroscopic time as compared with PCI for non-CTO lesions may cause skin injury by increased radiation. We have performed a multi-center observational study comparing the exposed dose during the PCI of CTO (CTO group) and during the PCI of non-CTO lesions (non-CTO group). Exposure doses were assessed in 313 patients with CTO and 3,310 patients with non-CTO lesions. Total fluoroscopy time (59.0 ±35.5 vs 26.8 ±18.8 min, p<0.0001) and the total air kerma (2.76±2.11 vs 1.27±0.94 Gy, p<0.0001) were significantly greater in the CTO group than in the non-CTO group. The maximum air kerma of the CTO group was 13.62 Gy. Informed consent about the risk of transient depilation and the transient erythema is required for the case with radiation dose over 3 Gy. The frequency of the patient who received radiation >3 Gy was significantly higher in the CTO group as compared with the non-CTO group (34.1% vs 4.9%). Therefore, informed consent before an operation and postoperative follow-up are indispensable for the performed PCI of CTO. Moreover, comprehensive understanding of the exposure dose during operation and to record the final exposure dose may be extremely important for the radiological technologists.

[Failure analysis of medical linear accelerator with reliability analyses].

We analyzed a number of cases about the Linac troubles in our hospital and have examined the effect of preventive maintenance with Weibull analysis and exponential distribution from April 2001 to March 2012. The total failure by irradiation disabled was 1, 192. (1) Medical linear accelerator (MLC) system was 24.0%, (2) radiation dosimetry system 13.1%, and the (3) cooling-water system was 26.5%. It accounts for 63.6% of the total number of failures. Each parameter value m, which means the shape parameter, and the failure period expectancy of parts µ were (1) 1.21, 1.46/3.9, 3.8 years. 3.7, 3.6 years. (2) 2.84, 1.59/6.6, 4.3 years. 6.7, 5.9 years. (3) 5.12, 4.16/6.1, 8.5 years. 6.1, 8.5 years. Each shape parameter was m>1. It is believed that they are in the worn-out failure period. To prevent failure, MLC performance should be overhauled once every 3 years and a cooling unit should be overhauled once every 7 years. Preventive maintenance is useful in assessing the failure of radiation therapy equipment. In a radiation dosimetry part, you can make a preemptive move before the failure by changing the monitor's dosimeter board with a new part from the repairs stockpiled every 6 months for maintenance.

[Development of image quality assurance support system using image recognition technology in radiography in lacked images of chest and abdomen].

In order to provide a precise radiography for diagnosis, it is required that we avoid radiography with defects by having enough evaluation. Conventionally, evaluation was performed only by observation of a radiological technologist (RT). The evaluation support system was developed for providing a high quality assurance without depending on RT observation only. The evaluation support system, called as the Image Quality Assurance Support System (IQASS), is characterized in that "image recognition technology" for the purpose of diagnostic radiography of chest and abdomen areas. The technique of the system used in this study. Of the 259 samples of posterior-anterior (AP) chest, lateral chest, and upright abdominal x-rays, the sensitivity and specificity was 93.1% and 91.8% in the chest AP, 93.3% and 93.6% in the chest lateral, and 95.0% and 93.8% in the upright abdominal x-rays. In the light of these results, it is suggested that AIQAS could be applied to practical usage for the RT.

[Examination of patient dose reduction in cardiovasucular X-ray systems with a metal filter].

In interventional X-ray for cardiology of flat panel digital detector (FPD), the phenomenon that exposure dose was suddenly increased when a subject thickness was thickened was recognized. At that time, variable metal built-in filters in FPD were all off. Therefore, we examined whether dose reduction was possible without affecting a clinical image using metal filter (filter) which we have been conventionally using for dose reduction. About 45% dose reduction was achieved when we measured an exposure dose at 30 cm of acrylic thickness in the presence of a filter. In addition, we measured signal to noise ratio/contrast to noise ratio/a resolution limit by the visual evaluation, and there was no influence by filter usage. In the clinical examination, visual evaluation of image quality of coronary angiography (40 cases) using a 5-point evaluation scale by a physician was performed. As a result, filter usage did not influence the image quality (p=NS). Therefore, reduction of sudden increase of exposure dose was achieved without influencing an image quality by adding filter to FPD.

The CD4+CD28null and the regulatory CD4+CD25High T-cell phenotypes in patients with ulcerative colitis during active and quiescent disease, and following colectomy.

The CD4+CD25High T-cell phenotype has an essential immunoregulatory role, while the CD4+CD28null T-cell reflects immune pathology. We investigated the profiles of the CD4+CD25High and the CD4+CD28null T-cell phenotypes in patients with ulcerative colitis (UC) during active and quiescent phases as well as following colectomy. Fifty-nine UC patients, 34 active (UCa) and 25 quiescent (UCq) together with 19 healthy controls (HC) were included. Ten of 34 UCa patients underwent colectomy due to unremitting UC (UCo). Immunohistochemical phenotypic of the peripheral blood lymphocytes bearing CD4, CD25 or CD28 was done for analyzes by a multiparameter fluorescence activated cell sorting technique. The expression of the CD4+CD25High phenotype was higher in UCq (P<0.01) or UCo (P<0.01) group vs UCa group. Further, the expression of the CD4+CD28null phenotype in UCa or UCo group was higher than in the HC group (P<0.05). However, the expression of the CD4+CD28null phenotype up to 12 months after colectomy was not significantly different from the levels in the same patients during acute phase. Our impression is that a high CD4+CD25High T-cell reflects alleviation of inflammation, while the expression of the CD4+CD28null T-cell phenotype is an etiologic feature in UC patients, and is maintained after removing the affected colon.

[Study of a new axial projection of shoulder joint without abduction of upper extremity].

A study of a method of taking X-rays of the shoulder joint axis when the upper arm is fixed and cannot be rotated. When the shoulder joint has suffered damage, rotating the arm can be very painful, and obtaining accurate images of the axis is frequently difficult. For this reason, at this hospital, the Stockinette-Velpeau procedure is used on patients who cannot rotate their arms to have X-rays taken. In this procedure, the patient bends backwards at a 40-degree angle, and an X-ray of the shoulder joint axis is taken from directly below the joint. Using this method, even if the upper arm is hanging down, information regarding the direction of the axis can be obtained. However, maintaining this body position is difficult and requires assistance. The patient may also experience pain. For this reason, a new method was sought of X-raying the axis from a body position that is easier on the patient and by which diagnostic information on the axis direction can be obtained from patients who cannot rotate their upper arms. The result of seeking a new method was an X-ray that can be taken diagonally at a 25-degree angle relative to the shoulder joint socket. This X-ray method requires no rotation of the axis and provides the closest view of the axis. This new method suggests a way to X-ray the axis that is easy on patients even when the shoulder joint is damaged.

[Development of a prevention of body movement fixation appliance in leg digital subtraction angiography].

In the peripheral angiography to evaluate blood flow below the knee levels in patients with arteriosclerosis obliterans, a motion artifact occurs as a result of body movements of a patient in normal fixation. This sometimes makes a correct evaluation difficult. Therefore, we developed a fixed appliance which can restrain body movement without affecting image quality and blood flow in digital subtraction angiography of a leg. The appliance is filled with the styrofoam of 1 mm diameter in a sealed bag, after air is aspirated from inside the bag. The appliance is stiffened to fit the shape of the crus. We measured signal to noise ratio / contrast to noise ratio / a resolution limit by visual evaluation to examine the influence of the image before and after usage of this appliance. In addition, the blood velocity of the dorsalis artery in ultrasound was measured to examine the effect on the blood flow. As a result, the fixed appliance did not affect blood flow in peripheral angiography to evaluate the clinical significance, the usual 5-point evaluate scale was used. The scale was significantly improved (p <0.01) after usage of this appliance. The newly developed fixed appliance for digital subtraction angiography of a leg is useful to avoid motion artifacts in clinical settings.

[Improvement of body diffusion image using addition technique].

It is difficult to obtain body diffusion weighted images (BDWI) using MRI that does not support parallel imaging and multi-NEX in clinical usage. Therefore, we evaluated whether a multiple image additions technique on the workstation could improve BDWI image quality and be good for clinical use by considering SNR and image distortion. We added 2 to 5 images on the same slice location with changing FOV, slice thickness, or reconstruction matrix in the phantom studies, and confirmed SNR improvement under all conditions. We also confirmed that this addition technique did not affect image distortion. We found that in 16 of the 18 clinical cases, BDWI with 5 images addition match pathology and T2 weighted images. We believe that this addition technique in available in the clinical practice.