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Title: SU-D-209-05: Sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to Procedural Factors in Fluoroscopy

Abstract

Purpose: To evaluate the sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams (SMPB) to be used in measuring the DRIP. Methods: A series of clinical and factorial Monte Carlo simulations were conducted to determine the shape of the scattered X-ray spectra incident on the operator in different clinical fluoroscopy scenarios. Two clinical evaluations studied the sensitivity of the scattered spectrum to gantry angle and patient size while technical factors were varied according to measured automatic dose rate control (ADRC) data. Factorial evaluations studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size and beam quality for constant technical factors. Average energy was the figure of merit used to condense fluence in each energy bin to a single numerical index. Results: Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affected the scattered spectrum indirectly through their effects on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in interventional cardiology, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effectmore » of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. Conclusion: The scattered spectrum striking the operator in fluoroscopy, and therefore the DRIP, is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle. These results will help determine an appropriate set of SMPB to be used for measuring the DRIP.« less

Authors:
 [1];  [2];  [3]
  1. UT MD Anderson Cancer Center, Houston, TX (United States)
  2. University of Tennessee Medical Center, Knoxville, TN (United States)
  3. UT Medical School, Houston, TX (United States)
Publication Date:
OSTI Identifier:
22624410
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; BEAMS; COMPUTERIZED SIMULATION; DOSE RATES; EVALUATION; FLUOROSCOPY; MONTE CARLO METHOD; PATIENTS; RADIATION DOSES; RADIOSENSITIVITY; SAFETY; X-RAY SPECTRA

Citation Formats

Jones, A, Pasciak, A, and Wagner, L. SU-D-209-05: Sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to Procedural Factors in Fluoroscopy. United States: N. p., 2016. Web. doi:10.1118/1.4955666.
Jones, A, Pasciak, A, & Wagner, L. SU-D-209-05: Sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to Procedural Factors in Fluoroscopy. United States. doi:10.1118/1.4955666.
Jones, A, Pasciak, A, and Wagner, L. 2016. "SU-D-209-05: Sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to Procedural Factors in Fluoroscopy". United States. doi:10.1118/1.4955666.
@article{osti_22624410,
title = {SU-D-209-05: Sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to Procedural Factors in Fluoroscopy},
author = {Jones, A and Pasciak, A and Wagner, L},
abstractNote = {Purpose: To evaluate the sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams (SMPB) to be used in measuring the DRIP. Methods: A series of clinical and factorial Monte Carlo simulations were conducted to determine the shape of the scattered X-ray spectra incident on the operator in different clinical fluoroscopy scenarios. Two clinical evaluations studied the sensitivity of the scattered spectrum to gantry angle and patient size while technical factors were varied according to measured automatic dose rate control (ADRC) data. Factorial evaluations studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size and beam quality for constant technical factors. Average energy was the figure of merit used to condense fluence in each energy bin to a single numerical index. Results: Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affected the scattered spectrum indirectly through their effects on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in interventional cardiology, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effect of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. Conclusion: The scattered spectrum striking the operator in fluoroscopy, and therefore the DRIP, is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle. These results will help determine an appropriate set of SMPB to be used for measuring the DRIP.},
doi = {10.1118/1.4955666},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • PurposeTo assess the impact of anatomical, procedural, and operator skill factors on the success and duration of fluoroscopy-guided transjugular intrahepatic portoystemic shunt following standard operating procedure (SOP).Material and MethodsDuring a 32-month period, 102 patients underwent transjugular intrahepatic portosystemic shunt creation (TIPS) by two interventional radiologists (IR) following our institutional SOP based on fluoroscopy guidance. Both demographic and procedural data were assessed. The duration of the intervention (D{sub Int}) and of the portal vein puncture (D{sub Punct}) was analyzed depending on the skill level of the IR as well as the anatomic or procedural factors.ResultsIn 99 of the 102 patients, successfulmore » TIPS without peri-procedural complications was performed. The mean D{sub Int} (IR1: 77 min; IR2: 51 min, P < 0.005) and the mean D{sub Punct} (IR1: 19 min; IR2: 13 min, P < 0.005) were significantly higher in TIPS performed by IR1 (with 2 years of clinical experience performing TIPS, n = 38) than by IR2 (>10 years of clinical experience performing TIPS, n = 61), (P < 0.005 both, Mann–Whitney U test). D{sub Int} showed a higher correlation with D{sub Punct} for IR2 (R{sup 2} = 0.63) than for IR1 (R{sup 2} = 0.13). There was no significant difference in the D{sub Punct} for both IRs with regard to the success of the wedged portography (P = 0.90), diameter of the portal vein (P = 0.60), central right portal vein length (P = 0.49), or liver function (MELD-Score before the TIPS procedure; P = 0.14).ConclusionTIPS following SOP is safe, fast, and reliable. The only significant factor for shorter D{sub Punct} and D{sub Int} was the clinical experience of the IR. Anatomic variability, successful portography, or liver function did not alter the duration or technical success of TIPS.« less
  • Purpose: Previously, the diagnostic radiological index of protection (DRIP) was proposed as a metric for quantifying the protective value of radioprotective garments. The DRIP is a weighted sum of the percent transmissions of different radiation beams through a garment. Ideally, the beams would represent the anticipated stray radiation encountered during clinical use. However, it is impractical to expect a medical physicist to possess the equipment necessary to accurately measure transmission of scattered radiation. Therefore, as a proof of concept, the authors tested a method that applied the DRIP to clinical practice. Methods: Primary beam qualities used in interventional cardiology andmore » radiology were observed and catalogued. Based on the observed range of beam qualities, five representative clinical primary beam qualities, specified by kV and added filtration, were selected for this evaluation. Monte Carlo simulations were performed using these primary beams as source definitions to generate scattered spectra from the clinical primary beams. Using numerical optimization, ideal scatter mimicking primary beams, specified by kV and added aluminum filtration, were matched to the scattered spectra according to half- and quarter-value layers and spectral shape. To within reasonable approximation, these theoretical scatter-mimicking primary beams were reproduced experimentally in laboratory x ray beams and used to measure transmission through pure lead and protective garments. For this proof of concept, the DRIP for pure lead and the garments was calculated by assigning equal weighting to percent transmission measurements for each of the five beams. Finally, the areal density of lead and garments was measured for consideration alongside the DRIP to assess the protective value of each material for a given weight. Results: The authors identified ideal scatter mimicking primary beams that matched scattered spectra to within 0.01 mm for half- and quarter-value layers in copper and within 5% for the shape function. The corresponding experimental scatter-mimicking primary beams matched the Monte Carlo generated scattered spectra with maximum deviations of 6.8% and 6.6% for half- and quarter-value layers. The measured DRIP for 0.50 mm lead sheet was 2.0, indicating that it transmitted, on average, 2% of incident radiation. The measured DRIP for a lead garment and one lead-alternative garment closely matched that for pure lead of 0.50 mm thickness. The DRIP for other garments was substantially higher than 0.50 mm lead (3.9–5.4), indicating they transmitted about twice as much radiation. When the DRIP was plotted versus areal density, it was clear that, of the garments tested, none were better than lead on a weight-by-weight basis. Conclusions: A method for measuring the DRIP for protective garments using scatter-mimicking primary beams was developed. There was little discernable advantage in protective value per unit weight for lead-alternative versus lead-only garments. Careful consideration must be given to the balance of protection and weight when choosing a lead-alternative protective garment with a lower specified “lead equivalence,” e.g., 0.35 mm. The DRIP has the potential to resolve this dilemma. Reporting the DRIP relative to areal density is an ideal metric for objective comparisons of protective garment performance, considering both protective value in terms of transmission of radiation and garment weight.« less
  • Purpose: Lightweight lead-free or lead-composite protective garments exploit k-edge interactions to attenuate scattered X-rays. Manufacturers specify the protective value of garments in terms of lead equivalence at a single kVp. This is inadequate, as the protection provided by such garments varies with radiation quality in different use conditions. We present a method for matching scattered X-ray spectra to primary X-ray spectra. The resulting primary spectra can be used to measure penetration through protective garments, and such measurements can be weighted and summed to determine a Diagnostic Radiation Index for Protection (DRIP). Methods: Scattered X-ray spectra from fluoroscopic procedures were modeledmore » using Monte Carlo techniques in MCNP-X 2.7. Data on imaging geometry, operator position, patient size, and primary beam spectra were gathered from clinical fluoroscopy procedures. These data were used to generate scattered X-ray spectra resulting from procedural conditions. Technical factors, including kV and added filtration, that yielded primary X-ray spectra that optimally matched the generated scattered X-ray spectra were identified through numerical optimization using a sequential quadratic programming (SQP) algorithm. Results: The primary spectra generated with shape functions matched the relative flux in each bin of the scattered spectra within 5%, and half and quarter-value layers matched within 0.1%. The DRIP for protective garments can be determined by measuring the penetration through protective garments using the matched primary spectra, then calculating a weighted average according to the expected clinical use of the garment. The matched primary spectra are specified in terms of first and second half-value layers in aluminum and acrylic. Conclusion: Lead equivalence is inadequate for completely specifying the protective value of garments. Measuring penetration through a garment using full scatter conditions is very difficult. The primary spectra determined in this work allow for practical primary penetration measurements to be made with equipment readily available to clinical medical physicists.« less
  • Technical and methodological factors might affect the reported accuracies of diagnostic tests. To assess their influence on the accuracy of exercise thallium scintigraphy, the medical literature (1977 to 1986) was non-selectively searched and meta-analysis was applied to the 56 publications thus retrieved. These were analyzed for year of publication, sex and mean age of patients, percentage of patients with angina pectoris, percentage of patients with prior myocardial infarction, percentage of patients taking beta-blocking medications, and for angiographic referral (workup) bias, blinding of tests, and technical factors. The percentage of patients with myocardial infarction had the highest correlation with sensitivity (0.45,more » p = 0.0007). Only the inclusion of subjects with prior infarction and the percentage of men in the study group were independently and significantly (p less than 0.05) related to test sensitivity. Both the presence of workup bias and publication year adversely affected specificity (p less than 0.05). Of these two factors, publication year had the strongest association by stepwise linear regression. This analysis suggests that the reported sensitivity of thallium scintigraphy is higher and the specificity lower than that expected in clinical practice because of the presence of workup bias and the inappropriate inclusion of post-infarct patients.« less