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Title: Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting

Abstract

IntroductionComputed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking.Materials and MethodsRadiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator’s finger skin was measured using thermoluminescent dosimeter rings.ResultsThe mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator’s finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA.ConclusionRadiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.

Authors:
; ; ; ; ;  [1]; ;  [2];  [1]
  1. Okayama University Medical School, Department of Radiology (Japan)
  2. Okayama University Hospital, Central Division of Radiology (Japan)
Publication Date:
OSTI Identifier:
22642501
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 6; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABLATION; CHEST; COMPUTERIZED TOMOGRAPHY; DOSE EQUIVALENTS; DOSE LIMITS; FLUOROSCOPY; KIDNEYS; LUNGS; NECK; NEOPLASMS; NITROGEN 20; RADIATION DOSES; RADIOWAVE RADIATION; SKIN; THERAPY; THERMOLUMINESCENT DOSEMETERS

Citation Formats

Matsui, Yusuke, E-mail: wckyh140@yahoo.co.jp, Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp, Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp, Iguchi, Toshihiro, E-mail: i10476@yahoo.co.jp, Fujiwara, Hiroyasu, E-mail: hirofujiwar@gmail.com, Kawabata, Takahiro, E-mail: tkhr-kwbt@yahoo.co.jp, Yamauchi, Takatsugu, E-mail: me9248@hp.okayama-u.ac.jp, Yamaguchi, Takuya, E-mail: me8738@hp.okayama-u.ac.jp, and Kanazawa, Susumu, E-mail: susumu@cc.okayama-u.ac.jp. Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1308-3.
Matsui, Yusuke, E-mail: wckyh140@yahoo.co.jp, Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp, Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp, Iguchi, Toshihiro, E-mail: i10476@yahoo.co.jp, Fujiwara, Hiroyasu, E-mail: hirofujiwar@gmail.com, Kawabata, Takahiro, E-mail: tkhr-kwbt@yahoo.co.jp, Yamauchi, Takatsugu, E-mail: me9248@hp.okayama-u.ac.jp, Yamaguchi, Takuya, E-mail: me8738@hp.okayama-u.ac.jp, & Kanazawa, Susumu, E-mail: susumu@cc.okayama-u.ac.jp. Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting. United States. doi:10.1007/S00270-016-1308-3.
Matsui, Yusuke, E-mail: wckyh140@yahoo.co.jp, Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp, Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp, Iguchi, Toshihiro, E-mail: i10476@yahoo.co.jp, Fujiwara, Hiroyasu, E-mail: hirofujiwar@gmail.com, Kawabata, Takahiro, E-mail: tkhr-kwbt@yahoo.co.jp, Yamauchi, Takatsugu, E-mail: me9248@hp.okayama-u.ac.jp, Yamaguchi, Takuya, E-mail: me8738@hp.okayama-u.ac.jp, and Kanazawa, Susumu, E-mail: susumu@cc.okayama-u.ac.jp. 2016. "Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting". United States. doi:10.1007/S00270-016-1308-3.
@article{osti_22642501,
title = {Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting},
author = {Matsui, Yusuke, E-mail: wckyh140@yahoo.co.jp and Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp and Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp and Iguchi, Toshihiro, E-mail: i10476@yahoo.co.jp and Fujiwara, Hiroyasu, E-mail: hirofujiwar@gmail.com and Kawabata, Takahiro, E-mail: tkhr-kwbt@yahoo.co.jp and Yamauchi, Takatsugu, E-mail: me9248@hp.okayama-u.ac.jp and Yamaguchi, Takuya, E-mail: me8738@hp.okayama-u.ac.jp and Kanazawa, Susumu, E-mail: susumu@cc.okayama-u.ac.jp},
abstractNote = {IntroductionComputed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking.Materials and MethodsRadiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator’s finger skin was measured using thermoluminescent dosimeter rings.ResultsThe mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator’s finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA.ConclusionRadiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.},
doi = {10.1007/S00270-016-1308-3},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 39,
place = {United States},
year = 2016,
month = 6
}
  • IntroductionOnce reserved solely for non-surgical cases, percutaneous ablation is becoming an increasingly popular treatment option for a wider array of patients with small renal masses and the radiation risk needs to be better defined as this transition continues.Materials and MethodsRetrospective review of our renal tumor ablation database revealed 425 patients who underwent percutaneous ablation for treatment of 455 renal tumors over a 5-year time period. Imparted radiation dose information was reviewed for each procedure and converted to effective patient dose and skin dose using established techniques. Statistical analysis was performed with each ablative technique.ResultsFor the 331 cryoablation procedures, the meanmore » DLP was 6987 mGycm (SD = 2861) resulting in a mean effective dose of 104.7 mSv (SD = 43.5) and the mean CTDI{sub vol} was 558 mGy (SD = 439) resulting in a mean skin dose of 563.2 mGy (SD = 344.1). For the 124 RFA procedures, the mean DLP was 3485 mGycm (SD = 1630) resulting in a mean effective dose of 50.3 mSv (SD = 24.0) and the mean CTDI{sub vol} was 232 mGy (SD = 149) resulting in a mean skin dose of 233.2 mGy (SD = 117.4). The difference in patient radiation exposure between the two renal ablation techniques was statistically significant (p < 0.001).ConclusionBoth cryoablation and RFA imparted an average skin dose that was well below the 2 Gy deterministic threshold for appreciable sequela. Renal tumor cryoablation resulted in a mean skin and effective radiation dose more than twice that for RFA. The radiation exposure for both renal tumor ablation techniques was at the high end of the medical imaging radiation dose spectrum.« less
  • We performed percutaneously radiofrequency (RF) ablation of 5 renal cell carcinomas (mean diameter 26 {+-} 15 mm) with computed-tomography (CT) fluoroscopic guidance using the transhepatic route. The RF electrode was successfully advanced into all tumors. RF ablation caused one minor complication (small asymptomatic perirenal hematoma); no major complications occurred. The follow-up contrast-enhanced CT images showed no local tumor progression of any tumors in a median period of 10 months (range 3-14 months). In conclusion, it seems that this transhepatic approach is safe and can be an alternative method for electrode insertion during RF ablation of selected renal tumors.
  • Objective. To retrospectively determine the frequency and risk factors of various side effects and complications after percutaneous computed tomography-guided radiofrequency (RF) ablation of lung tumors. Methods. We reviewed and analyzed records of 112 treatment sessions in 57 of our patients (45 men and 12 women) with unresectable lung tumors treated by ablation. Risk factors, including sex, age, tumor diameter, tumor location, history of surgery, presence of pulmonary emphysema, electrode gauge, array diameter, patient position, maximum power output, ablation time, and minimum impedance during ablation, were analyzed using univariate and multivariate analyses. Results. Total rates of side effects and minor andmore » major complications occurred in 17%, 50%, and 8% of treatment sessions, respectively. Side effects, including pain during ablation (46% of sessions) and pleural effusion (13% of sessions), occurred with RF ablation. Minor complications, including pneumothorax not requiring chest tube drainage (30% of sessions), subcutaneous emphysema (16% of sessions), and hemoptysis (9% of sessions) also occurred after the procedure. Regarding major complications, three patients developed fever >38.5 deg. C; three patients developed abscesses; two patients developed pneumothorax requiring chest tube insertion; and one patient had air embolism and was discharged without neurologic deficit. Univariate and multivariate analyses suggested that a lesion located {<=}1 cm of the chest wall was significantly related to pain (p < 0.01, hazard index 5.76). Risk factors for pneumothorax increased significantly with previous pulmonary surgery (p < 0.05, hazard index 6.1) and presence of emphysema (p <0.01, hazard index 13.6). Conclusion. The total complication rate for all treatment sessions was 58%, and 25% of patients did not have any complications after RF ablation. Although major complications can occur, RF ablation of lung tumors can be considered a safe and minimally invasive procedure.« less
  • The purpose of this study was to retrospectively determine the local control rate and contributing factors to local progression after computed tomography (CT)-guided radiofrequency ablation (RFA) for unresectable lung tumor. This study included 138 lung tumors in 72 patients (56 men and 16 women; age 70.0 {+-} 11.6 years (range 31-94); mean tumor size 2.1 {+-} 1.2 cm [range 0.2-9]) who underwent lung RFA between June 2000 and May 2009. Mean follow-up periods for patients and tumors were 14 and 12 months, respectively. The local progression-free rate and survival rate were calculated to determine the contributing factors to local progression.more » During follow-up, 44 of 138 (32%) lung tumors showed local progression. The 1-, 2-, 3-, and 5-year overall local control rates were 61, 57, 57, and 38%, respectively. The risk factors for local progression were age ({>=}70 years), tumor size ({>=}2 cm), sex (male), and no achievement of roll-off during RFA (P < 0.05). Multivariate analysis identified tumor size {>=}2 cm as the only independent factor for local progression (P = 0.003). For tumors <2 cm, 17 of 68 (25%) showed local progression, and the 1-, 2-, and 3-year overall local control rates were 77, 73, and 73%, respectively. Multivariate analysis identified that age {>=}70 years was an independent determinant of local progression for tumors <2 cm in diameter (P = 0.011). The present study showed that 32% of lung tumors developed local progression after CT-guided RFA. The significant risk factor for local progression after RFA for lung tumors was tumor size {>=}2 cm.« less
  • Purpose. This study was designed to evaluate the clinical efficacy of CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma (RCC) and to analyze specific technical aspects between both technologies. Methods. We included 22 consecutive patients (3 women; age 74.2 {+-} 8.6 years) after 28 CT-guided bipolar or multipolar RF ablations of 28 RCCs (diameter 2.5 {+-} 0.8 cm). Procedures were performed with a commercially available RF system (Celon AG Olympus, Berlin, Germany). Technical aspects of RF ablation procedures (ablation mode [bipolar or multipolar], number of applicators and ablation cycles, overall ablation time and deployed energy, andmore » technical success rate) were analyzed. Clinical results (local recurrence-free survival and local tumor control rate, renal function [glomerular filtration rate (GFR)]) and complication rates were evaluated. Results. Bipolar RF ablation was performed in 12 procedures and multipolar RF ablation in 16 procedures (2 applicators in 14 procedures and 3 applicators in 2 procedures). One ablation cycle was performed in 15 procedures and two ablation cycles in 13 procedures. Overall ablation time and deployed energy were 35.0 {+-} 13.6 min and 43.7 {+-} 17.9 kJ. Technical success rate was 100 %. Major and minor complication rates were 4 and 14 %. At an imaging follow-up of 15.2 {+-} 8.8 months, local recurrence-free survival was 14.4 {+-} 8.8 months and local tumor control rate was 93 %. GFR did not deteriorate after RF ablation (50.8 {+-} 16.6 ml/min/1.73 m{sup 2} before RF ablation vs. 47.2 {+-} 11.9 ml/min/1.73 m{sup 2} after RF ablation; not significant). Conclusions. CT-guided bipolar and multipolar RF ablation of RCC has a high rate of clinical success and low complication rates. At short-term follow-up, clinical efficacy is high without deterioration of the renal function.« less