Value of low-dose and optimized-length computed tomography(CT)scan in CT-guided percutaneous transthoracic needle biopsy of pulmonary nodules

Objective:To investigate the value of application of low-dose and optimized length CT scan on puncture results,complications and patients’radiation dosage during CT-guided percutaneous biopsy of pulmonary nodules(PTNB).Methods:A total of 231 patients with PTNB under CT guidance were collected.Low dose scanning utilized tube current of 20 mA as compared with 40 mA in conventional dosage.Optimized length in CT is defined as intentionally narrowing the range of CT scanning just to cover 25 mm(5 layers)around the target layer during needle adjustment.According to whether low-dose scans and optimized length scans techniques were utilized,patients were divided into three groups:conventional group(conventional sequence+no optimization),optimized length group(conventional sequence+optimized length),and low-dose optimized length group(low dose sequence+optimized length).The ED(effective dose),the DLP(dose length product),the average CTDIvol(Volume CT dose index),total milliampere second between subgroups were compared.Results:Compared with the conventional group,ED,intraoperative guidance DLP,total milliseconds and operation time in the optimized length group were reduced by 18.2%(P=0.01),37%(P=0.003),17.5%(P=0.013)and13.3%(P=0.021)respectively.Compared with the optimized length group,the ED was reduced by 87%,preoperative positioning,intraoperative guidance and postoperative review DLP were also reduced by 88%,total milliampere second was reduced by 79%,with an average CTDIvol was reduced by 86%,in the low-dose optimized length group(P<0.001 for all).Conclusion:Optimizing the length during CT scanning can effectively reduce the intraoperative radiation dose and reduce the operation time compared with conventional plan;low-dose and optimized length CT scan can further reduce the total radiation dose compared with optimized length group with no differences on intraoperative complications,biopsy results and operation time.

Comparison of radiation doses between hepatic artery infusion chemotherapy and transarterial chemoembolization for liver cancer

Objective:To analyze the radiation dose received by patients during hepatic artery infusion chemotherapy(HAIC)and transarterial chemoembolization(TACE)procedures and the related influencing factors.Methods:Data of 162 cases in the HAIC group and 230 cases in the TACE group were collected.The included covariates were Age(<45/45-59/≥60 years),BMI levels(underweight/normal weight/obesity),focus Dye of tumor(present/absent),lesion size(<5 cm/≥5 cm),superselection(present/absent),hepatic vascular variation(present/absent).The endpoints were postoperative dose-area product(DAP),exposure time and Air kerma(AK).Results:Of all included patients,the HAIC group patients were younger than those in the TACE group(P=0.028).The proportion of patients with large lesions in the HAIC group was higher than the TACE group(45.7%vs.33.9%,P=0.019).The proportion of patients who had superselection was lower in the HAIC group as compared to the TACE group(61.7%vs.82.2%,P<0.001).Generally,the HAIC group has lower DAP,exposure time and AK by 36.3%(P<0.001),38.2%(P<0.001),and 41.3%(P<0.001)than the TACE group,respectively.Linear regression analysis showed the procedure method(HAIC/TACE,P<0.001),type of DSA machine(Pheno/FD20,P<0.001),BMI levels(P<0.001),age(P=0.021),lesion size(<5 cm/≥5 cm,P=0.031)significantly correlated with low DAP.In the HAIC group,the type of DSA machine and BMI correlated with the radiation dose,while in the TACE group,the type of DSA machine,BMI,and lesion size correlated with the radiation dose.Conclusion:Compared with TACE,HAIC enables doctors and patients to receive lower radiation doses.Obese patients in both HAIC and TACE groups increase the radiation exposure in interventional doctors and patients,but large lesions only affect the radiation dose in the TACE procedure.

Expert consensus on the clinical application of totally implantable venous access devices in the upper arm(2022 Edition)

With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.

Ultrasound delivery of Chinese rhubarb promotes early recovery of gastrointestinal function after gastrectomy:a prospective randomized controlled study

Objective: Chinese rhubarb is a promising Chinese medicine for the promotion of gastrointestinal function. This study was conducted to investigate the safety and efficacy of Chinese rhubarb administered via ultrasound delivery in promoting the early recovery of gastrointestinal function after gastrectomy.Methods: In this prospective randomized controlled study, 100 patients who were scheduled to undergo total or subtotal gastrectomy in Changzhi People’s Hospital or Subei People’s Hospital from August 2017 to January 2018 were recruited. These patients were randomly assigned into two equal groups before surgery: 50 in the experimental (Chinese rhubarb) group, and 50 in the control (routine nursing) group. After surgery, time to flatus, bowel movement, clear liquid diet, and removal of nasogastric tube were recorded and analyzed. In addition, postoperative pain, postoperative bowel movement-related complications, and postoperative hospital stay duration were also recorded and analyzed. The study was approved by The protocol was approved by the Institutional Review Board of Changzhi People’s Hospital and Subei People’s Hospital on July 1, 2017 and registered with the Chinese Clinical Trial Registry on December 17, 2018 (registration number: ChiCTR1800020143).Results: Time to flatus (control group 85.68±22.00 hours vs experimental group 73.06±23.42 hours;P=0.007), bowel movement (5.52±1.56 vs 4.40±1.21 days;P<0.001), clear liquid diet (6.72±1.16 vs 6.22±1.28 days;P=0.044), and removal of nasogastric tube (6.30±1.52 vs 5.65±1.58 days;P=0.044) were significantly shorter in the experimental group compared with the control group, as was the postoperative hospital stay duration (14.30±3.46 vs 12.86±1.36 days;P=0.006). In addition, better pain relief (P=0.003) and a lower incidence of postoperative bowel movement-related complications (6 vs 21;P=0.001) were noted in the experimental group.Conclusion: Ultrasound delivery of Chinese rhubarb is useful to promote the early recovery of gastrointestinal function after gastrectomy.