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Title: SU-D-209-03: Radiation Dose Reduction Using Real-Time Image Processing in Interventional Radiology

Abstract

Purpose: To characterize changes in radiation dose after introducing a new real-time image processing technology in interventional radiology systems. Methods: Interventional radiology (IR) procedures are increasingly complex, at times requiring substantial time and radiation dose. The risk of inducing tissue reactions as well as long-term stochastic effects such as radiation-induced cancer is not trivial. To reduce this risk, IR systems are increasingly equipped with dose reduction technologies.Recently, ClarityIQ (Philips Healthcare) technology was installed in our existing neuroradiology IR (NIR) and vascular IR (VIR) suites respectively. ClarityIQ includes real-time image processing that reduces noise/artifacts, enhances images, and sharpens edges while also reducing radiation dose rates. We reviewed 412 NIR (175 pre- and 237 post-ClarityIQ) procedures and 329 VIR (156 preand 173 post-ClarityIQ) procedures performed at our institution pre- and post-ClarityIQ implementation. NIR procedures were primarily classified as interventional or diagnostic. VIR procedures included drain port, drain placement, tube change, mesenteric, and implanted venous procedures. Air Kerma (AK in units of mGy) was documented for all the cases using a commercial radiation exposure management system. Results: When considering all NIR procedures, median AK decreased from 1194 mGy to 561 mGy. When considering all VIR procedures, median AK decreased from 49 to 14more » mGy. Both NIR and VIR exhibited a decrease in AK exceeding 50% after ClarityIQ implementation, a statistically significant (p<0.05) difference. Of the 5 most common VIR procedures, all median AK values decreased, but significance (p<0.05) was only reached in venous access (N=53), angio mesenteric (N=41), and drain placement procedures (N=31). Conclusion: ClarityIQ can reduce dose significantly for both NIR and VIR procedures. Image quality was not assessed in conjunction with the dose reduction.« less

Authors:
; ; ;  [1]
  1. University Washington, Seattle, WA (United States)
Publication Date:
OSTI Identifier:
22624408
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; ANIMAL TISSUES; BIOMEDICAL RADIOGRAPHY; DOSE RATES; HARBORS; HAZARDS; IMAGE PROCESSING; IMAGES; KERMA; NEOPLASMS; RADIATION DOSES; REVIEWS; STOCHASTIC PROCESSES

Citation Formats

Kanal, K, Moirano, J, Zamora, D, and Stewart, B. SU-D-209-03: Radiation Dose Reduction Using Real-Time Image Processing in Interventional Radiology. United States: N. p., 2016. Web. doi:10.1118/1.4955664.
Kanal, K, Moirano, J, Zamora, D, & Stewart, B. SU-D-209-03: Radiation Dose Reduction Using Real-Time Image Processing in Interventional Radiology. United States. doi:10.1118/1.4955664.
Kanal, K, Moirano, J, Zamora, D, and Stewart, B. 2016. "SU-D-209-03: Radiation Dose Reduction Using Real-Time Image Processing in Interventional Radiology". United States. doi:10.1118/1.4955664.
@article{osti_22624408,
title = {SU-D-209-03: Radiation Dose Reduction Using Real-Time Image Processing in Interventional Radiology},
author = {Kanal, K and Moirano, J and Zamora, D and Stewart, B},
abstractNote = {Purpose: To characterize changes in radiation dose after introducing a new real-time image processing technology in interventional radiology systems. Methods: Interventional radiology (IR) procedures are increasingly complex, at times requiring substantial time and radiation dose. The risk of inducing tissue reactions as well as long-term stochastic effects such as radiation-induced cancer is not trivial. To reduce this risk, IR systems are increasingly equipped with dose reduction technologies.Recently, ClarityIQ (Philips Healthcare) technology was installed in our existing neuroradiology IR (NIR) and vascular IR (VIR) suites respectively. ClarityIQ includes real-time image processing that reduces noise/artifacts, enhances images, and sharpens edges while also reducing radiation dose rates. We reviewed 412 NIR (175 pre- and 237 post-ClarityIQ) procedures and 329 VIR (156 preand 173 post-ClarityIQ) procedures performed at our institution pre- and post-ClarityIQ implementation. NIR procedures were primarily classified as interventional or diagnostic. VIR procedures included drain port, drain placement, tube change, mesenteric, and implanted venous procedures. Air Kerma (AK in units of mGy) was documented for all the cases using a commercial radiation exposure management system. Results: When considering all NIR procedures, median AK decreased from 1194 mGy to 561 mGy. When considering all VIR procedures, median AK decreased from 49 to 14 mGy. Both NIR and VIR exhibited a decrease in AK exceeding 50% after ClarityIQ implementation, a statistically significant (p<0.05) difference. Of the 5 most common VIR procedures, all median AK values decreased, but significance (p<0.05) was only reached in venous access (N=53), angio mesenteric (N=41), and drain placement procedures (N=31). Conclusion: ClarityIQ can reduce dose significantly for both NIR and VIR procedures. Image quality was not assessed in conjunction with the dose reduction.},
doi = {10.1118/1.4955664},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To quantify the patient radiation dose reduction achieved during transarterial chemoembolization (TACE) procedures performed in a body interventional radiology suite equipped with the Philips Allura Clarity imaging acquisition and processing platform, compared to TACE procedures performed in the same suite equipped with the Philips Allura Xper platform. Methods: Total fluoroscopy time, cumulative dose area product, and cumulative air kerma were recorded for the first 25 TACE procedures performed to treat hepatocellular carcinoma (HCC) in a Philips body interventional radiology suite equipped with Philips Allura Clarity. The same data were collected for the prior 85 TACE procedures performed to treatmore » HCC in the same suite equipped with Philips Allura Xper. Mean values from these cohorts were compared using two-tailed t tests. Results: Following installation of the Philips Allura Clarity platform, a 42.8% reduction in mean cumulative dose area product (3033.2 versus 1733.6 mGycm∧2, p < 0.0001) and a 31.2% reduction in mean cumulative air kerma (1445.4 versus 994.2 mGy, p < 0.001) was achieved compared to similar procedures performed in the same suite equipped with the Philips Allura Xper platform. Mean total fluoroscopy time was not significantly different between the two cohorts (1679.3 versus 1791.3 seconds, p = 0.41). Conclusion: This study demonstrates a significant patient radiation dose reduction during TACE procedures performed to treat HCC after a body interventional radiology suite was converted to the Philips Allura Clarity platform from the Philips Allura Xper platform. Future work will focus on evaluation of patient dose reduction in a larger cohort of patients across a broader range of procedures and in specific populations, including obese patients and pediatric patients, and comparison of image quality between the two platforms. Funding for this study was provided by Philips Healthcare, with 5% salary support provided to authors K. Pallav Kolli and Robert G. Gould for time devoted to the study. Data acquisition and analysis was performed by the authors independent of the funding source.« less
  • Purpose: To investigate the effects of image receptor technology and dose reduction software on radiation dose estimates for most frequently performed fluoroscopically-guided interventional (FGI) procedures at a tertiary health care center. Methods: IRB approval was obtained for retrospective analysis of FGI procedures performed in the interventional radiology suites between January-2011 and December-2015. This included procedures performed using image-intensifier (II) based systems which were subsequently replaced, flat-panel-detector (FPD) based systems which were later upgraded with ClarityIQ dose reduction software (Philips Healthcare) and relatively new FPD system already equipped with ClarityIQ. Post procedure, technologists entered system-reported cumulative air kerma (CAK) and kerma-areamore » product (KAP; only KAP for II based systems) in RIS; these values were analyzed. Data pre-processing included correcting typographical errors and cross-verifying CAK and KAP. The most frequent high and low dose FGI procedures were identified and corresponding CAK and KAP values were compared. Results: Out of 27,251 procedures within this time period, most frequent high and low dose procedures were chemo/immuno-embolization (n=1967) and abscess drainage (n=1821). Mean KAP for embolization and abscess drainage procedures were 260,657, 310,304 and 94,908 mGycm{sup 2}, and 14,497, 15,040 and 6307 mGycm{sup 2} using II-, FPD- and FPD with ClarityIQ- based systems, respectively. Statistically significant differences were observed in KAP values for embolization procedures with respect to different systems but for abscess drainage procedures significant differences were only noted between systems with FPD and FPD with ClarityIQ (p<0.05). Mean CAK reduced significantly from 823 to 308 mGy and from 43 to 21 mGy for embolization and abscess drainage procedures, respectively, in transitioning to FPD systems with ClarityIQ (p<0.05). Conclusion: While transitioning from II- to FPD- based systems was not associated with dose reduction for the most frequently performed FGI procedures, substantial dose reduction was noted with relatively newer systems and dose reduction software.« less
  • No abstract prepared.
  • Purpose: There are no effective real-time direct skin dosimeters for interventional radiology. Such a scintillation dosimeter would be available if there was a suitable red emission phosphor in the medical x-ray range, since the silicon photodiode is a highly efficient device for red light. However, it is unknown whether there is a suitable red emission phosphor. The purpose of this study is to find a suitable red emission phosphor that can be used in x-ray dosimeters. Methods: Five kinds of phosphors which emit red light when irradiated with electron beams or ultraviolet rays in practical devices were chosen. For themore » brightness measurement, phosphor was put into transparent plastic cells or coated onto plastic sheets. The phosphors were irradiated with medical range x-rays [60–120 kV(peak), maximum dose rate of 160 mGy min{sup −1}], and the emission was measured by a luminance meter. Several characteristics, such as brightness, dose rate dependence, tube voltage dependence, and brightness stability, were investigated. Results: The luminescence of Y V O{sub 4}:Eu, (Y,Gd,Eu) BO{sub 3}, and Y{sub 2}O{sub 3}:Eu significantly deteriorated by 5%–10% when irradiated with continuous 2 Gy x-rays. The 0.5MgF{sub 2}⋅3.5MgO⋅GeO{sub 2}:Mn phosphor did not emit enough. Only the Y{sub 2}O{sub 2}S:Eu,Sm phosphor had hardly any brightness deterioration, and it had a linear relationship so that the x-ray dose rate could be determined from the brightness with sufficient accuracy. For the tube voltage dependence of the Y{sub 2}O{sub 2}S:Eu,Sm phosphor, the brightness per unit dose rate with 120 kV(peak) x-rays was 30% higher than that with 60 kV(peak) x-rays. Conclusions: Five kinds of phosphors were chosen as an x-ray scintillator for a real-time direct skin dosimeter. The Y V O{sub 4}:Eu, (Y,Gd,Eu)BO{sub 3}, and Y{sub 2}O{sub 3}:Eu phosphors had brightness deterioration caused by the x-rays. Only the Y{sub 2}O{sub 2}S:Eu,Sm phosphor had hardly any brightness deterioration, and it is a candidate for an x-ray scintillator for such a skin dosimeter.« less
  • A fast, accurate and stable optimization algorithm is very important for inverse planning of intensity-modulated radiation therapy (IMRT), and for implementing dose-adaptive radiotherapy in the future. Conventional numerical search algorithms with positive beam weight constraints generally require numerous iterations and may produce suboptimal dose results due to trapping in local minima regions of the objective function landscape. A direct solution of the inverse problem using conventional quadratic objective functions without positive beam constraints is more efficient but it will result in unrealistic negative beam weights. We review here a direct solution of the inverse problem that is efficient and doesmore » not yield unphysical negative beam weights. In fast inverse dose optimization (FIDO) method the objective function for the optimization of a large number of beamlets is reformulated such that the optimization problem is reducible to a linear set of equations. The optimal set of intensities is then found through a matrix inversion, and negative beamlet intensities are avoided without the need for externally imposed ad hoc conditions. In its original version [S. P. Goldman, J. Z. Chen, and J. J. Battista, in Proceedings of the XIVth International Conference on the Use of Computers in Radiation Therapy, 2004, pp. 112-115; S. P. Goldman, J. Z. Chen, and J. J. Battista, Med. Phys. 32, 3007 (2005)], FIDO was tested on single two-dimensional computed tomography (CT) slices with sharp KERMA beams without scatter, in order to establish a proof of concept which demonstrated that FIDO could be a viable method for the optimization of cancer treatment plans. In this paper we introduce the latest advancements in FIDO that now include not only its application to three-dimensional volumes irradiated by beams with full scatter but include as well a complete implementation of clinical dose-volume constraints including maximum and minimum dose as well as equivalent uniform dose constraints. The method has been integrated into a commercial treatment planning system (Pinnacle, Philips Medical Systems) for beta testing using clinical radiotherapy cases and standard dose constraints set by radiation oncologists. Our FIDO method consistently delivered excellent treatment plans comparable and often better than those obtained using standard optimization techniques that are considerably slower. By design, FIDO is guaranteed to find a global minimum and will achieve highly conformal and homogeneous dose distributions without the need for artificial internal contours that must be created in conventional IMRT optimization systems to help the search engines better control some beam entry directions and in this way avoid the creation of hot and cold spots. This method provides a fast, intuitive and robust technique that yields excellent results for the inverse planning of IMRT. FIDO's ability to efficiently optimize very large numbers of beamlet weights also makes it an ideal tool for the optimization of helical tomotherapy. Future gains in speed will make it possible to use FIDO for instant treatment plan reoptimization using CT images produced at the radiotherapy machine, just prior to daily treatments of the patient.« less