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1.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32994178

RESUMO

BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method. METHODS: Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher's exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]). RESULTS: We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1-2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25-27.0) for the blind method (P = .001). CONCLUSIONS: Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.


Assuntos
Intubação Gastrointestinal/métodos , Imãs , Piloro , Adolescente , Adulto , Criança , Pré-Escolar , Estado Terminal , Campos Eletromagnéticos , Nutrição Enteral/métodos , Feminino , Humanos , Análise de Intenção de Tratamento , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Piloro/diagnóstico por imagem , Exposição à Radiação/prevenção & controle , Radiografia Abdominal/estatística & dados numéricos , Estatísticas não Paramétricas , Fatores de Tempo , Adulto Jovem
2.
Br J Radiol ; 93(1115): 20200245, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32970457

RESUMO

Not surprisingly, our knowledge of the impact of radiation on the brain has evolved considerably. Decades of work have struggled with identifying the critical cellular targets in the brain, the latency of functional change and understanding how irradiation alters the balance between excitatory and inhibitory circuits. Radiation-induced cell kill following clinical fractionation paradigms pointed to both stromal and parenchymal targets but also defined an exquisite sensitivity of neurogenic populations of newly born cells in the brain. It became more and more apparent too, that acute (days) events transpiring after exposure were poorly prognostic of the late (months-years) waves of radiation injury believed to underlie neurocognitive deficits. Much of these gaps in knowledge persisted as NASA became interested in how exposure to much different radiation types, doses and dose rates that characterize the space radiation environment might impair central nervous system functionality, with possibly negative implications for deep space travel. Now emerging evidence from researchers engaged in clinical, translational and environmental radiation sciences have begun to fill these gaps and have uncovered some surprising similarities in the response of the brain to seemingly disparate exposure scenarios. This article highlights many of the commonalities between the vastly different irradiation paradigms that distinguish clinical treatments from occupational exposures in deep space.


Assuntos
Neoplasias Encefálicas/radioterapia , Encéfalo/efeitos da radiação , Exposição à Radiação/efeitos adversos , Lesões por Radiação/complicações , Voo Espacial , Neoplasias Encefálicas/terapia , Transtornos Cognitivos/etiologia , Humanos , Íons , Transferência Linear de Energia , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle
3.
Radiol Med ; 125(11): 1024-1039, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32930945

RESUMO

Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose reduction over the last decade was obtained, with the beginning of the sub-mSv era in CTCA. The main technical basis to obtain a radiation dose reduction in CTCA is the use of a low tube voltage, the adoption of a prospective electrocardiogram-triggering spiral protocol and the application of the tube current modulation with the iterative reconstruction technique. Nevertheless, CTCA examinations are characterized by a wide range of radiation doses between different radiology departments. Moreover, the dose exposure in CTCA is extremely important because the benefit-risk calculus in comparison with other modalities also depends on it. Finally, because anatomical evaluation not adequately predicts the hemodynamic relevance of coronary stenosis, a low radiation dose in routine CTCA would allow the greatest use of the myocardial CT perfusion, fractional flow reserve-CT, dual-energy CT and artificial intelligence, to shift focus from morphological assessment to a comprehensive morphological and functional evaluation of the stenosis. Therefore, the aim of this work is to summarize the correct use of the technical basis in order that CTCA becomes an established examination for assessment of the coronary artery disease with low radiation dose.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doses de Radiação , Exposição à Radiação/prevenção & controle , Fatores Etários , Algoritmos , Inteligência Artificial , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada/instrumentação , Circulação Coronária , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo
4.
Medicine (Baltimore) ; 99(34): e21831, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846829

RESUMO

Adoption of interventional endoscopic procedures is increasing with increasing prevalence of diseases. However, medical radiation exposure is concerning; therefore, radiation protection for medical staff is important. However, there is limited information on the usefulness of an additional lead shielding device during interventional endoscopic procedures. Therefore, we aimed to determine whether an additional lead shielding device protects medical staff from radiation.An X-ray unit (CUREVISTA; Hitachi Medical Systems, Tokyo, Japan) with an over-couch X-ray system was used. Fluoroscopy-associated scattered radiation was measured using a water phantom placed at the locations of the endoscopist, assistant, nurse, and clinical engineer. For each location, measurements were performed at the gonad and thyroid gland/eye levels. Comparisons were performed between with and without the additional lead shielding device and with and without a gap in the shielding device. Additionally, a clinical study was performed with 27 endoscopic retrograde cholangiopancreatography procedures.The scattered radiation dose was lower with than without additional lead shielding at all medical staff locations and decreased by 84.7%, 82.8%, 78.2%, and 83.7%, respectively, at the gonad level and by 89.2%, 86.4%, 91.2%, and 87.0%, respectively, at the thyroid gland/eye level. Additionally, the scattered radiation dose was lower without than with a gap in the shielding device at all locations.An additional lead shielding device could protect medical staff from radiation during interventional endoscopic procedures. However, gaps in protective equipment reduce effectiveness and should be eliminated.


Assuntos
Exposição Ocupacional/prevenção & controle , Exposição à Radiação/prevenção & controle , Proteção Radiológica/instrumentação , Radiografia Intervencionista/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Fluoroscopia/efeitos adversos , Gônadas/efeitos da radiação , Humanos , Traumatismos Ocupacionais/prevenção & controle , Imagens de Fantasmas/estatística & dados numéricos , Equipamentos de Proteção/normas , Doses de Radiação , Lesões por Radiação/prevenção & controle , Proteção Radiológica/métodos , Glândula Tireoide/efeitos da radiação
5.
J Vasc Interv Radiol ; 31(10): 1578-1586, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32861570

RESUMO

PURPOSE: To demonstrate that temporary organ displacement (TOD) by drainage catheter placement and hydrodissection is feasible and reproducible for simulation (SIM) and stereotactic body radiation treatment (SBRT). MATERIALS AND METHODS: Between February 2010 and December 2018, 31 consecutive patients (20 men and 11 women; median age, 59 years; range 20-80 years) received both SIM and SBRT with TOD. The minimum required displacement was 10 mm between the gross tumor volume (GTV) and the organ at risk (OAR). Complete displacement was defined as the ability to displace the OAR from the GTV a minimum of 10 mm across the entire boundary. SIM was performed with hydrodissection on the same day. On the day of SBRT, displacement was reproduced by hydrodissection. Displacement was measured on computed tomography images of TOD, SIM, and SBRT. The drain was removed after SBRT. RESULTS: TOD (hydrodissection) was significantly associated with successful displacement of the OAR from a GTV greater than 10 mm (median, 20 mm vs 4.1 mm, P < .001) and maintained displacement at SIM and SBRT (SIM: 29.4 mm vs 4.1 mm, P < .001; SBRT: 32.4 mm vs 4.1 mm, P < .001). The OAR-GTV boundary showed a median reduction of 35 mm (95% confidence interval, 27.5-37.5 mm) after TOD. TOD achieved complete displacement in 22 of 31 (71%) patients, and 25 of 31 (81%) patients were able to undergo single-fraction ablative SBRT. No patients developed procedure-related complications within 30 days. SIM and SBRT were successful without OAR toxicities within a median of 33 months (range, 3-92 months). CONCLUSIONS: TOD with placement of drain and hydrodissection is technically feasible and safe and maintains displacement for SIM and SBRT.


Assuntos
Cateteres de Demora , Drenagem/instrumentação , Órgãos em Risco , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Radiocirurgia , Neoplasias Retroperitoneais/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Neoplasias Retroperitoneais/diagnóstico por imagem , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Br J Radiol ; 93(1115): 20200562, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32822545

RESUMO

Whole-body MRI (WB-MRI) has evolved since its first introduction in the 1970s as an imaging technique to detect and survey disease across multiple sites and organ systems in the body. The development of diffusion-weighted MRI (DWI) has added a new dimension to the implementation of WB-MRI on modern scanners, offering excellent lesion-to-background contrast, while achieving acceptable spatial resolution to detect focal lesions 5 to 10 mm in size. MRI hardware and software advances have reduced acquisition times, with studies taking 40-50 min to complete.The rising awareness of medical radiation exposure coupled with the advantages of MRI has resulted in increased utilization of WB-MRI in oncology, paediatrics, rheumatological and musculoskeletal conditions and more recently in population screening. There is recognition that WB-MRI can be used to track disease evolution and monitor response heterogeneity in patients with cancer. There are also opportunities to combine WB-MRI with molecular imaging on PET-MRI systems to harness the strengths of hybrid imaging. The advent of artificial intelligence and machine learning will shorten image acquisition times and image analyses, making the technique more competitive against other imaging technologies.


Assuntos
Predisposição Genética para Doença , Imagem por Ressonância Magnética/métodos , Neoplasias/diagnóstico por imagem , Imagem Corporal Total/métodos , Imagem de Difusão por Ressonância Magnética/tendências , Feminino , História do Século XXI , Humanos , Achados Incidentais , Imagem por Ressonância Magnética/tendências , Masculino , Imagem Multimodal/métodos , Neoplasias/genética , Tomografia por Emissão de Pósitrons/métodos , Exposição à Radiação/prevenção & controle , Fatores de Tempo
7.
Medicine (Baltimore) ; 99(31): e21424, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756146

RESUMO

BACKGROUND: Spine interventionists frequently employ fluoroscopy to guide injection procedures. The increase in fluoroscopically guided procedures in recent years has led to a growing concern about radiation exposure. A new method of covering the C-arm tube with a lead apron has been suggested to reduce radiation exposure. This study aimed to compare the radiation exposure when performing lumbar transforaminal epidural steroid injections (TFESIs) using this new method to a control group. METHODS: A total of 200 patients who underwent lumbar TFESIs by a single physician were recruited. Patients were divided into 2 groups, the new method group (group A) and the control group (group C), and the amount of radiation exposure was compared. The dosimetry badge locations were marked as outside of apron, inside of apron, outside of thyroid collar, inside of thyroid collar, ring, and glasses. RESULTS: The cumulative dose equivalents of all the measurement sites were reduced in group A compared with group C, and the most reduced site was inside the thyroid collar. CONCLUSIONS: Covering the C-arm tube with a lead apron can be effective in reducing the cumulative radiation exposure when performing fluoroscopically guided TFESIs.


Assuntos
Fluoroscopia/efeitos adversos , Injeções Epidurais , Exposição Ocupacional/prevenção & controle , Médicos , Roupa de Proteção , Exposição à Radiação/prevenção & controle , Corticosteroides/administração & dosagem , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/efeitos adversos
8.
Eur J Vasc Endovasc Surg ; 60(3): 374-385, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32682690

RESUMO

OBJECTIVE: Occupational exposure is a growing concern among the endovascular specialist community. Several types of imaging equipment are available, such as mobile C arms or hybrid rooms, and some have been shown to deliver higher levels of radiation. A literature review was conducted to identify studies reporting dose data during standard (EVAR) and complex abdominal aortic endovascular repair (fenestrated/branched EVAR [F/BEVAR]). METHODS: A search of the MEDLINE and the Cochrane databases was performed by two independent investigators using the medical subject heading terms "aortic aneurysms", "radiation", and "humans" over a search period of 10 years. Studies with full text available in English and reporting radiation data independently from the imaging equipment type were included. Experimental studies were excluded. RESULTS: The lowest dose-area product levels during EVAR and F/BEVAR were identified in hybrid rooms, while the highest were with fixed systems. When adherence to the as low as reasonably achievable principles was stipulated by the authors, dose reports tended to be among the lowest. Several studies, especially of F/BEVAR, report concerning levels of radiation for both patients and staff. CONCLUSION: Modern imaging equipment type, team involvement with radiation management, and the support of recent imaging technologies such as fusion help to reduce the dose delivered during standard and complex EVAR. Investment in modern imaging technology should be considered in every centre providing endovascular management of aortic aneurysms.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares , Exposição Ocupacional , Saúde do Trabalhador , Salas Cirúrgicas , Doses de Radiação , Exposição à Radiação , Radiografia Intervencionista , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Humanos , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Proteção Radiológica , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Espalhamento de Radiação
9.
Rev Cardiovasc Med ; 21(2): 303-307, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32706218

RESUMO

A 36-year-old woman with 12-week gestation visited the emergency department, complaining of palpitations. Her electrocardiography (ECG) demonstrated ventricular pre-excitation combined with atrial fibrillation. The polarity of the delta waves in leads V5, V6, I, and aVL were positive and negative in leads V1, III, and aVF, suggesting that the accessory pathway (AP) was located on the right posterior free wall. She did not want to take any medicine to prevent the tachycardia. Moreover, the shortest pre-excited RR interval during the atrial fibrillation was 200 ms, so we decided to ablate the AP without fluoroscopy. An electrophysiology study was performed with guidance of a 3-dimension (3D) navigation system and intracardiac echocardiography (ICE). We ablated the right free wall AP without fluoroscopy. A follow-up ECG no longer exhibited any delta waves. Even in the early period of pregnancy, catheter ablation might be performed safely using ICE and a 3D navigation system without fluoroscopy. Therefore, it could more often be considered as a therapeutic option in pregnant women without concern for radiation exposure.


Assuntos
Ablação por Cateter , Complicações Cardiovasculares na Gravidez/cirurgia , Exposição à Radiação/prevenção & controle , Síndrome de Wolff-Parkinson-White/cirurgia , Potenciais de Ação , Adulto , Ecocardiografia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Frequência Cardíaca , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado do Tratamento , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologia
10.
Br J Radiol ; 93(1112): 20200018, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32543896

RESUMO

OBJECTIVES: Radiation from cardiac angiography procedures is harmful to patients and the staff performing them. This study sought to investigate operator radiation dose for a range of procedures and different operators in order to investigate trends and optimise dose. METHODS: Real-time dosemeters (RTDs) were worn by operators for angiography procedures for 3 years. Dose-area product (DAP) and RTD were collected. RTD was normalised to DAP (RTD/DAP) to compare radiation dose and radiation protection measures. Comparisons were made across procedure categories and individual operators. RESULTS: In 7626 procedures, median and 75th percentile levels were established for operator dose for 8 procedure categories. There was a significant difference in all operator dose measures and DAP across procedure categories (p<0.001). DAP, RTD, and RTD/DAP were significantly different across 22 individual operators (p<0.001). CONCLUSION: DAP was significantly different across procedure categories and a higher RTD was seen with higher DAP. RTD/DAP can demonstrate radiation protection effectiveness and identified differences between procedures and individual operators with this measure. Procedures and individuals were identified where further optimisation of radiation protection measures may be beneficial. A reference level for operator dose can be created and audited against on a regular basis. ADVANCES IN KNOWLEDGE: This study demonstrates that operator dose can be easily and routinely measured on a case by case basis to investigate dose trends for different procedures. Normalising the operator dose to DAP demonstrates radiation protection effectiveness for the individual operator which can then be optimised as part of an ongoing audit program.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Angiografia Coronária/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Exposição à Radiação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Dosímetros de Radiação , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Proteção Radiológica/métodos , Radiografia Intervencionista/métodos , Estudos Retrospectivos
11.
Ann Vasc Surg ; 68: 305-309, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32479875

RESUMO

BACKGROUND: Female gender is considered a risk factor for worse perioperative outcomes after fenestrated endovascular aneurysm repair (FEVAR). We hypothesized that women would have more unfavorable anatomy, increasing case complexity and leading to higher radiation doses. Our aim was to evaluate the effect of gender on radiation dose during FEVARs. METHODS: This single-center retrospective study was performed from 1/2015 to 2/2018. For patient data, linear model and stepwise variable selection algorithm were used. All dose measurements were log transformed before analysis. Significance level for parameter estimates and corresponding 95% confidence intervals were all transformed back using an exponential function. P-value of <0.05 was considered statistically significant. All analyses were performed in SAS 9.4 (SAS Institute Inc., Cary, NC). RESULTS: A total of 169 FEVARs (45 women) were performed on a Philips Allura Xper FD 20 fluoroscopy system equipped with clarity technology. There was no difference in body mass index (BMI) or operative time between genders, P = 0.9. The median reference air kerma for women was significantly lower than that for men (1,672 mGy vs. 2,496 mGy), P < 0.001. Women had on average a 28% total dose reduction after controlling for BMI, number of vessels fenestrated, operative time, and type of device, P < 0.001. The median fluorography and fluoroscopy doses for women were significantly lower than those for men (973 mGy vs. 1,401 mGy and 659 mGy vs. 1,008 mGy), resulting in a 24% fluorography dose reduction and a 38% fluoroscopy dose reduction for women, P < 0.001. CONCLUSIONS: FEVARs can be performed successfully in women with comparatively lower radiation doses.


Assuntos
Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Doses de Radiação , Exposição à Radiação , Radiografia Intervencionista , Aneurisma Aórtico/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Duração da Cirurgia , Desenho de Prótese , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
12.
J Surg Res ; 255: 111-117, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543375

RESUMO

BACKGROUND: Traumatic brain injury is the leading cause of morbidity and mortality for children in the United States. The aim of this study was to develop and implement a guideline to reduce radiation exposure in the pediatric head injury patient by identifying the patient population where repeat imaging is necessary and to establish rapid brain protocol magnetic resonance imaging as the first-line modality. METHODS: A retrospective chart review of trauma patients between 0 and 14 y of age admitted at a pediatric level 2 trauma center was performed between January 2013 and June 2019. The guideline established the appropriateness of repeat scans for patients with Glasgow Coma Scale >13 with clinical neurological deterioration or patients with Glasgow Coma Scale ≤13 and intracranial hemorrhagic lesion on initial head computed tomography (CT). RESULTS: Our trauma registry included 592 patients during the study period, 415 before implementation and 161 after implementation. A total of 132 patients met inclusion criteria, 116 pre-guideline and 16 post-guideline. The number of patients receiving repeat head CTs significantly decreased from 34.5% to 6.3% (P < 0.02). There was also a significant decrease in the mean number of head CT/patient pre-guideline 1.63 (range 1-7) compared with post-guideline 1.06 (range 1-2) (P < 0.02). CONCLUSIONS: CT head imaging is invaluable in the initial trauma evaluation of pediatric patients. However, it can be overused, and the radiation may lead to long-term deleterious effects. Establishing a head imaging guideline which limits use with clinical criteria can be effective in reducing radiation exposure without missing injuries.


Assuntos
Traumatismos Cranianos Fechados/diagnóstico , Hemorragia Intracraniana Traumática/diagnóstico , Guias de Prática Clínica como Assunto , Exposição à Radiação/prevenção & controle , Tomografia Computadorizada por Raios X/normas , Adolescente , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Protocolos Clínicos/normas , Feminino , Escala de Coma de Glasgow , Traumatismos Cranianos Fechados/complicações , Humanos , Lactente , Recém-Nascido , Hemorragia Intracraniana Traumática/etiologia , Imagem por Ressonância Magnética , Masculino , Seleção de Pacientes , Projetos Piloto , Exposição à Radiação/efeitos adversos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/efeitos adversos , Centros de Traumatologia/normas , Procedimentos Desnecessários/normas
13.
Urologe A ; 59(10): 1231-1236, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32377765

RESUMO

BACKGROUND AND OBJECTIVES: Eye lens radiation exposure during fluoroscopy-guided interventional procedures may result in occupational radiation-induced cataracts. We evaluated the eye lens radiation doses and the protective effect of X­ray protective visors during ureteroscopic procedures. MATERIALS AND METHODS: Eye lens doses were measured in front of and behind X­ray protective visors using eye lens dosemeters during ureteroscopic procedures done by 4 different endourologic surgeons within a 12-week period. Background radiation dose, simultaneously measured with transport dosemeters, was subtracted. Measured eye lens doses below the detection limit of the eye lens dosemeters were adjusted to the detection limit of 0.028 mSv. Correlating the eye lens doses (ELD) to the dose-area-product (DAP) an ELD/DAP ratio was calculated. Applying this ELD/DAP ratio the potential reduction of the eye lens radiation dose was retrospectively calculated for all ureteroscopic procedures done within one year. RESULTS: Within the 12-week period 76 ureteroscopies were done by the 4 endourologic surgeons. The accumulated eye lens radiation dose was 0.796 mSv in front of the X­ray protective visors, and 0.338 mSv behind the X­ray protective visors. Thus, the eye lens radiation exposure was reduced to at least 42% by using X­ray protective visors. Considering the 215 documented ureteroscopies in our clinic in the year before starting the study, occupational radiation exposure to the eye lens would have been reduced by X­ray protective visors from 4.090 to 1.737 mSv. CONCLUSION: X­ray protective visors can effectively reduce the radiation exposure to the eye lens during fluoroscopy-guided endourologic procedures and should be used especially by high-volume endourologic surgeons.


Assuntos
Cristalino , Exposição à Radiação , Doses de Radiação , Exposição à Radiação/análise , Exposição à Radiação/prevenção & controle , Estudos Retrospectivos , Ureteroscopia , Raios X
14.
Surg Today ; 50(10): 1249-1254, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32458233

RESUMO

PURPOSE: To establish whether new indices on plain chest X-ray (CXR) can replace those on computed tomography (CT) for the follow-up of children who have undergone the Nuss procedure. METHODS: The subjects of this retrospective study were 45 children who underwent the Nuss procedure between 2000 and 2016. The Haller index (HI) was measured by preoperative CT. Preoperative and postoperative chest deformities were evaluated by two CXR measurements: the concave rate on the lateral view (CR; the depth of the concavity divided by the anterior-posterior diameter of the rib cage) and the tracheal bifurcation angle (TBA) on the anterior view. Data are expressed as the median with range. RESULTS: The median age and HI of the children, when they underwent the Nuss procedure, was 9.3 (3.8-17.3) years and 4.5 (3.2-10.1), respectively. The preoperative CR was correlated significantly with the HI. The postoperative CR was significantly lower than the preoperative CR [pre: 0.17 (0.08-0.37), post: 0.09 (0.01-0.18), p < 0.05], and the low value was sustained after bar removal. The TBA decreased significantly after the Nuss procedure from 74.2° (55-104) preoperatively to 65.0° (45-92) postoperatively (p < 0.05). CONCLUSIONS: These results suggest that CXR can replace CT for the follow-up of patients after the Nuss procedure, with lower radiation exposure.


Assuntos
Tórax em Funil/diagnóstico por imagem , Exposição à Radiação/prevenção & controle , Radiografia Torácica , Procedimentos Cirúrgicos Torácicos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Tórax em Funil/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/efeitos adversos
16.
Circ Cardiovasc Interv ; 13(5): e008888, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32406263

RESUMO

BACKGROUND: Robotic percutaneous coronary intervention (R-PCI) has been shown to benefit the operator but has not shown any significant benefit to the patient. We sought to compare a large cohort of R-PCI to traditional percutaneous coronary intervention (PCI) procedures performed at a tertiary care center in the same time frame. METHODS: A total of 996 consecutive patients referred for PCI between December 2017 and March 2019 were studied, of which 310 (31.1%) patients were selected to undergo R-PCI and 686 (68.9%) patients underwent traditional PCI. The coprimary study outcome measures were air kerma, dose-area product, fluoroscopy time, volume of contrast, and total procedural time. Caliper propensity-matching technique was used (caliper, 0.05) to match each R-PCI patient to the nearest traditional PCI patient without replacement. RESULTS: Air kerma (mGy; median [interquartile range]; P; 884 [537-1398] versus 1110 [699-1498]; P=0.002) and dose-area product (cGycm2; 4734 [2695-7746] versus 5746 [3751-7833]; P=0.003) were significantly lower in the R-PCI group. There was no difference in fluoroscopy time (minutes; 5.51 [3.53-8.31] versus 5.48 [3.31-9.37]; P=0.936) and contrast volume (mL; 130 [103-170] versus 140 [100-180]; P=0.905). Total procedural time (minutes) was significantly higher in the R-PCI group (27 [21-40] versus 37 [27-50]; P<0.0005). CONCLUSIONS: R-PCI is associated with a significant decrease in radiation exposure to the patient with no increase in fluoroscopy time, as well as contrast utilization, and a minor increase in procedure duration compared with traditional PCI.


Assuntos
Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea , Procedimentos Cirúrgicos Robóticos , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Segurança do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Pontuação de Propensão , Doses de Radiação , Exposição à Radiação/prevenção & controle , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
17.
Circ Cardiovasc Interv ; 13(5): e008172, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32408819

RESUMO

BACKGROUND: The C3PO-QI (Congenital Cardiac Catheterization Project on Outcomes - Quality Improvement), a multicenter registry launched in 2015, instituted quality improvement (QI) initiatives to reduce patient radiation exposure. Through regular collaboration, this initiative would allow for harmony among active participants, maximizing efforts and efficiency at achieving radiation best practices. This study sought to report these efforts with a detailed methodology for which institutions can target initiatives, reducing radiation exposure, and increasing patient safety. METHODS: Data were collected prospectively by 8 C3PO-QI institutions between January 1, 2015 and December 31, 2017. Radiation exposure was measured in dose area product per body weight (dose area product/kg; µGy*m2/kg) and reported by expected radiation exposure categories (REC) and institution for 40 published unique procedure types. Targeted interventions addressing selected strategic domains for radiation reduction were implemented in the pediatric catheterization labs of the C3PO-QI institutions. RESULTS: The study consisted of 15 257 unique cases. Median exposure (dose area product/kg) was decreased by 30% for all procedures. Dose area product/kg was reduced in all 3 REC, with the greatest improvement observed in REC I (REC I, -37%; REC II, -23%; REC III, -27%). Although the baseline radiation exposures and exact percent decrease varied across all C3PO-QI sites, each institution demonstrated improvements in radiation dose over time. These improvements occurred with the implementation of institution-specific QI interventions accelerated by participation in the C3PO-QI multicenter collaborative. CONCLUSIONS: Substantial radiation dose reductions can be achieved using targeted QI methodology and interventions. Participation in a multicenter QI collaborative may accelerate improvement across all centers due to enhanced engagement and shared learning between sites.


Assuntos
Cateterismo Cardíaco , Angiografia Coronária , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica , Adolescente , Adulto , Cateterismo Cardíaco/efeitos adversos , Criança , Pré-Escolar , Angiografia Coronária/efeitos adversos , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde , Humanos , Lactente , Masculino , Segurança do Paciente , Estudos Prospectivos , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
18.
Int J Cardiovasc Imaging ; 36(8): 1417-1425, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32350705

RESUMO

Considering the increased use of interventional cardiologic procedures and concern about irradiation to the eyes, it is necessary to measure eye dose in radiation workers. The assessment of eye dose using collar dose is a routine but inaccurate method. Therefore this study was designed to measure eye dose in the radiation workers of various interventional cardiologic procedures. In this study eye dose was measured for left and right eyes in three groups of radiation workers in angiography ward of Afshar hospital in various procedures using TLD. Measurements were done separately for cardiologists, nurses and radio-technologists in 100 procedures. The nurses functioned as surgical assistants and were usually close to the table. The correlation of staff dose to exposure parameters was also investigated. Eye dose in physicians were higher than other staff in all procedures. Also the left eye dose was considerably higher than right one, especially for physicians. The median equivalent dose per procedure of left eye for physicians, nurses and radio-technologists were 7.4, 3.6, 1.4 µSv (PCI) and 3.2, 3.1, 1.3 µSv (Adhoc) and 3.2, 1.7, 1.1 µSv (CA), respectively. The annual left eye equivalent dose with (without) using lead goggles were 2.4 (15.3), 1.4 (2.2), 1.0 (1.1) mSv for physicians, nurses and radio-technologists, respectively. There were also a positive correlation between eye dose and KAP for procedures without lead goggles. The lead goggles showed lower protection effects for radio-technologists than other staff. Only 30% of physicians received a dose higher than 1/3 of the ICRP annual dose limit, therefor only physician eye dose should be monitored in catheterization labs.


Assuntos
Cardiologistas , Dispositivos de Proteção dos Olhos , Olho/efeitos da radiação , Chumbo , Recursos Humanos de Enfermagem no Hospital , Auxiliares de Cirurgia , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Radiografia Intervencionista , Radiologistas , Estudos Transversais , Humanos , Descrição de Cargo , Saúde do Trabalhador , Fatores de Proteção , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Dosimetria Termoluminescente
19.
Int J Cardiovasc Imaging ; 36(9): 1791-1799, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32419092

RESUMO

The aim of this study was to investigate the image quality and radiation dose of different scanning protocols in dual-source CT cardiothoracic angiography for children with tetralogy of Fallot (TOF). Seventy-five consecutive children with known or suspected TOF were enrolled to undergo prospective ECG-triggering sequential dual-source CT (DSCT) cardiothoracic angiography. According to the scanning protocols, these patients were randomly divided into 3 groups: fixed delay time (FDT, n = 25, group A), automatic bolus-tracking (ABT, n = 25, group B) and manual bolus-tracking (MBT, n = 25, group C). Subjective and objective image quality were evaluated. The radiation doses were recorded. The image quality scores of group C were significantly higher than those of group A and B. The absolute value of difference (D-value) on CT attenuation between left (CTLV) and right ventricle (CTRV) in group C was significantly lower than that in group A and B. The total effective dose of groups A, B and C were 0.39 ± 0.06 mSv, 0.40 ± 0.07 mSv and 0.40 ± 0.08 mSv, respectively. There was no significant difference among 3 groups (P = 0.722). Scanning protocol has significantly impacts on the image quality of cardiovascular structures for TOF patients. Compared with the conventional scanning protocols FDT and ABT, the MBT technique provides high image quality and achieves more homogenous attenuation among different patients with TOF.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Doses de Radiação , Exposição à Radiação/prevenção & controle , Tetralogia de Fallot/diagnóstico por imagem , Técnicas de Imagem de Sincronização Cardíaca , Angiografia por Tomografia Computadorizada/efeitos adversos , Meios de Contraste/administração & dosagem , Angiografia Coronária/efeitos adversos , Vasos Coronários/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Lactente , Masculino , Tomografia Computadorizada Multidetectores/efeitos adversos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Exposição à Radiação/efeitos adversos , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Tetralogia de Fallot/fisiopatologia
20.
Int J Cardiovasc Imaging ; 36(9): 1599-1607, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32447632

RESUMO

To evaluate predictors of zero-X ray procedures for supraventricular arrhythmias (SVT) using minimally fluoroscopic approach (MFA). Patients referred for RF catheter ablation of SVT were admitted for a MFA with an electro-anatomical navigation system or a conventional fluoroscopic approach (ConvA). Exclusion criterion was the need to perform a transseptal puncture. 206 patients (98 men, age 53 ± 19 years) underwent an EP study, 93 (45%) with an MFA and 113 (55%) with a ConvA. Fifty-five had no inducible arrhythmias (EPS). Fifty-four had AV nodal reentrant tachycardia (AVNRT), 49 patients had typical atrial flutter (AFL), 37 had AV reciprocating tachycardia (AVRT/WPW), 11 had focal atrial tachycardia (AT), and underwent a RF ablation. X-ray was not used at all in 51/93 (58%) procedures (zero X ray). MFA was associated with a significant reduction in total fluoroscopy time (5.5 ± 10 vs 13 ± 18 min, P = 0.01) and operator radiation dose (0.8 ± 2.5 vs 3 ± 8.2 mSV, P < 0.05). The greatest absolute dose reduction was observed in AVNRT (0.1 ± 0.3 vs 5.1 ± 10 mSV, P = 0.01, 98% relative dose reduction) and in AFL (1.3 ± 3.6 vs 11 ± 16 mSV, P = 0.003, 88% relative dose reduction) groups. Both AVNRT or AFL resulted the only statistically significant predictors of zero x ray at multivariate analysis (OR 4.5, 95% CI 1.5-13 and OR 5, 95% CI 1.7-15, P < 0.001, respectively). Success and complication rate was comparable between groups (P = NS). Using MFA for SVT ablation, radiological exposure is significantly reduced. Type of arrhythmia is the strongest predictor of zero X ray procedure.


Assuntos
Flutter Atrial/cirurgia , Ablação por Cateter , Exposição Ocupacional/prevenção & controle , Doses de Radiação , Exposição à Radiação/prevenção & controle , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/cirurgia , Potenciais de Ação , Adulto , Idoso , Flutter Atrial/diagnóstico por imagem , Flutter Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Fluoroscopia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Segurança do Paciente , Exposição à Radiação/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico por imagem , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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