Radiation Exposure for Patients and Staff during Different Interventional Procedures Using Anthropomorphic Phantoms:A Complete Evaluation of Different Body Regions

Interventional radiological procedures performed under the guidance of X-ray imaging tools are widely used to diagnose and treat various conditions.However,radiation exposure can result in many health problems,including cataracts,skin necrosis,radiation burns,hair loss,birth defects,and cancer^([1-2]).Patient exposure during an interventional radiology procedure involves a wide dose range and can reach a level at which deterministic effects may occur^([3]).Although knowledge of radiation safety has greatly improved over the past century,radiation exposure in the healthcare environment remains a risk to both patients and medical professionals.Recently,given the increasing number of interventions and complexity of cases,there has been growing concern about the radiation exposure of patients and surgical personnel.Therefore,a special evaluation of the exposure of patients and medical staff is necessary to ensure their protection.

Accuracy study of a binocular-stereo-vision-based navigation robot for minimally invasive interventional procedures

BACKGROUND Medical robot is a promising surgical tool,but no specific one has been designed for interventional treatment of chronic pain.We developed a computed tomography-image based navigation robot using a new registration method with binocular vision.This kind of robot is appropriate for minimal invasive interventional procedures and easy to operate.The feasibility,accuracy and stability of this new robot need to be tested.AIM To assess quantitatively the feasibility,accuracy and stability of the binocularstereo-vision-based navigation robot for minimally invasive interventional procedures.METHODS A box model was designed for assessing the accuracy for targets at different distances.Nine(three sets)lead spheres were embedded in the model as puncture goals.The entry-to-target distances were set 50 mm(short-distance),100 mm(medium-distance)and 150 mm(long-distance).Puncture procedure was repeated three times for each goal.The Euclidian error of each puncture was calculated and statistically analyzed.Three head phantoms were used to explore the clinical feasibility and stability.Three independent operators conducted foramen ovale placement on head phantoms(both sides)by freehand or under the guidance of robot(18 punctures with each method).The operation time,adjustment time and one-time success rate were recorded,and the two guidancemethods were compared.RESULTS On the box model,the mean puncture errors of navigation robot were 1.7±0.9 mm for the short-distance target,2.4±1.0 mm for the moderate target and 4.4±1.4 mm for the long-distance target.On the head phantom,no obvious differences in operation time and adjustment time were found among the three performers(P>0.05).The median adjustment time was significantly less under the guidance of the robot than under free hand.The one-time success rate was significantly higher with the robot(P<0.05).There was no obvious difference in operation time between the two methods(P>0.05).CONCLUSION In the laboratory environment,accuracy of binocular-stereo-vision-based navigation robot is acceptable for target at 100 mm depth or less.Compared with freehand,foramen ovale placement accuracy can be improved with robot guidance.

Evaluation of CdZnTe spectrometer performance in measuring energy spectra during interventional radiology procedure

Interventional radiology has been beneficial for patients for over 30 years of age with the combination of diagnostic and therapeutic methods. The radiation affecting occupationally exposed workers should be evaluated by means of the energy spectra and flux of X-rays in the treatment room. The present study aims to obtain the energy spectra of interventional procedures and study the capability of some detectors to evaluate the dose in interventional procedures. These measurements were taken by silicon-drift, CdTe, and CdZnTe detectors. The energy spectra were corrected by the energy-response curve of each detector. The energy-response curves of silicon-drift and CdTe detectors provided by the manufacturers specification were used. The energy response of the CdZnTe detector was measured by 133Ba and 152Eu γ sources. The experimental data were compared with the simulation results, and their perfect agreement provides a way to correct the energy or dose response, which can be used for the personal dosimeter developed by our group. Moreover, the measured energy spectra can be used in individual radiation protection. The present study shows that the CdZnTe detector is a good candidate detector in interventional procedures.

Monte Carlo Study of 3D Stray Radiation during Interventional Procedures

In interventional medical procedures, other than the highly important issue of optimizing image quality and patient exposure using the primary beam, there remains a continuing need for the study of staff exposure from the scattered radiation. Herein, investigation is made of the 3D stray-radiation distribution, the simulation being made of a realistic interventional scenario through use of the Monte Carlo code Geant4 (version 10.3). The simulation is conducted based on the high definition reference Korean-man (HDRK-man) computational phantom and a GE Infinia 3/8” C-arm machine, focusing on the effect of variation of kVp and field of view (FoV) on the scattered particles’ spatial distribution. With direct measurement of the absorbed dose remaining challenging, not least in respect of the organs at risk, we computed the scatter fractions, defined as the ratio of the air kerma free-in-air to the entrance surface air kerma (ESAK), which are both easily quantifiable. Scatter fraction distributions were simulated for X-ray tube outputs (and half-value layers, HVL) of 60 kVp (2.3 mm Al), 80 kVp (3.2 mm Al) and 120 kVp (4.3 mm Al) and FoV of 15, 20, 25 and 30 cm. The distributions are obtained for different height levels, corresponding to the lens of the eye, and the lung and prostate, all radiosensitive organs. Investigations are made for eight likely locations around the patient. At fixed FoV results reveal an inverse relationship between ESAK and kVp, also that change in kVp from 60 to 80 has a greater effect than from 80 to 120. For change in FoV at fixed kVp, the scatter fraction remains constant. The particular staff locations are found to be optimal in seeking mitigation of dose. Moreover, the combined usage of numerical human model and Monte Carlo simulation can be considered as an added value to the radiation safety research field, especially to the interventional radiology staff and to the patient.

Use of Bivalirudin for Anticoagulation in Interventional Cardiovascular Procedures

Anticoagulation is imperative to reduce the incidence of thrombotic complications in patients undergoing percutaneous interventional cardiovascular procedures;however,this is at the expense of increased risk of bleeding.The optimal anticoagulation strategy for these procedures remains unclear.Unfractionated heparin is the most commonly used anticoagulant during interventional procedures,but has several limitations,such as relatively high incidence of bleeding events,occurrence of heparin-induced thrombocytopenia,and a paradoxical thrombotic effect.Contemporary studies have demonstrated that bivalirudin decreases the occurrence of bleeding complications,but potentially increases the risk of acute stent thrombosis.This review discusses the pharmacology of bivalirudin and its current clinical application in patients undergoing percutaneous coronary intervention and transcatheter aortic valve replacement procedures.

Expert consensus on the procedure of interventional diagnosis and treatment of cancer patients during the COVID-19 epidemic

Since December 2019, coronavirus disease(COVID-19) has spread rapidly from Wuhan, Hubei province, to other regions of China. To reduce and prevent cross-over infections in the interventional diagnosis and treatment of tumor patients. The Interventional Oncology Branch of the China Anti-Cancer Association organized specialists to compile the corresponding expert consensus. The consensus summarizes the critical points for COVID-19 prevention, focusing on the management of outpatients, inpatients, and interventional operating room in this particular time.

Patient Peak Skin Dose and Dose Area Product from Interventional Cardiology Procedures

Information about the peak skin dose and Dose Area product (DAP) from percutaneous transluminal coronary angioplasty (PTCA) and coronary angiography (CA) was collected from three catheter application rooms. The range of maximum photon energy was 50 - 125 kVp and the fluoroscopy time was 0.6 - 52 seconds. Values of up to 143 Gy·cm2 for DAP and 0.752 mGy for cumulative dose (CD) were found in CA procedures. Otherwise the DAP and CD for PTCA were found to be 143 Gy·cm2 and 2.287 mGy respectively in 3rd Quartile. The relation between the fluoroscopy time and the DAP is also considered. Objectives: The objective of this study is to obtain information about patient peak skin doses (PSD), dose area product (DAP), Fluoroscopy Time (FT) and Cumulative Dose (CD) from PTCA and CA which is the most predominant with respect to high skin doses in addition to other procedures. The aim of this study is also to assess the radiation dose received by patients undergoing interventional radiology procedures, by identifying the procedures that deliver the highest doses. This study is also helpful to establish the reference dose level for adult patients undergoing interventional procedure, and to provide recommendations on how to reduce dose on selected procedures that have been identified to deliver patient dose values near the ICRP (International Commission on Radiological Protection) threshold values.

Variability in Fluoroscopic Time during Interventional Non-Cardiac Procedures Performed Outside of the Radiology Department

Purpose: Increasing physician awareness of patient exposure to radiation is an important step towards the reduction of potentially harmful effects of radiation. Published studies demonstrated that providing physicians with feedback regarding their fluoroscopy time leads to a reduction in average fluoroscopy times. The aim of this work was to analyze and publish our medical center data observed during the past year;fluoroscopy time (FT), Dose Area Product (DAP) and cumulative dose (CD) were monitored for radiation protection purposes. Methods: Fluoroscopy time is one of multiple radiation dose indices used in radiation safety auditing. Such auditing is nowadays turning into requirement of patient care safety and quality improvement;as indicated by accreditation bodies both nationally and internationally. All non-cardiac procedures performed outside radiology department by surgeons and interventionists are viewed. FT, DAP and CD are extracted for analysis. Results: a total of 846 cases were studied (643 orthopedic, 99 others, 73 urology, 17 chest, 7 vascular and 4 ERCP cases). Mean FT was 1.3 minutes, mean CD to the patient was 12.98 mGy and the mean DAP was 4.53 Gy/cm2. The longest FT noted was 55 min. The maximum CD was 904 mGy and the maximum DAP was 689 Gy/cm2. Using spearman’s correlation test we found out that there is a significant correlation between FT and DAP (correlation coefficient = 0.615, p. value 0.001). There is a significant correlation between FT and CD (correlation coefficient = 0.628, p. value 0.001). Conclusion: Information about FT that used in each procedure can be used as a tool for patient dose optimization. As we found a significant correlation between DAP as well as CD. Reducing fluoroscopic time (FT) is a radiation protection goal, since it serves the purpose of protection for both the patient and the workers.

Anaesthetic Challenges in Cardiac Interventional Procedures

The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety.

Novel Biomarkers of Contrast-Induced Kidney Injury after Endovascular Procedures: An Interventional Cardiologists Notion

Modern achievements of interventional cardiology in treatment of coronary heart disease (CHD) have significantly increased frequency of interventions and volume of contrast media (CM). Contrast-induced acute kidney injury (CIAKI) associated with CM administration is determined by 26.5 μmol/l increase in serum creatinine (SCr) within 48 - 72 hours or >?1.5-fold SCr increase versus its known or estimated level in the previous 7 days. Without effective disease management, prevention with early CIAKI risk stratification and cessation of nephrotoxic medications taken by patients are important. Given significant complexity in existing CIAKI treatment, modern therapeutic options are limited only to adequate renal injury prevention. The problem’s significance and diagnostic limitations associated with SCr definition require search for clinically and diagnostically significant AKI biomarkers. In terms of coronarography and percutaneous coronary interventions, several studies have been conducted on clinical and diagnostic significance of some biomarkers. This article characterizes and discloses prospective practical use of neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid binding protein (L-FABP), kidney injury molecule-1 (KIM-1), cystatin C (CysC) and interleukins-6,8,18 (IL-6,8,18) in interventional cardiology.

Diagnostic imaging and interventional procedures in a growing problem: Hepatic alveolar echinococcosis

Alveolar echinococcosis(AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis(E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potentially fatal infestation which always affects the liver primarily and metastasizes to any part of the body. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiological imaging and in serological analyses. The alveolar cysts grow by exogenous proliferation and behave like a malignant neoplasm. Since AE lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Therefore, AE lesions can cause physicians to generate a long list of differential diagnoses, including malignant tumors. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. For diagnosis, ultrasonography(US) remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computed tomography(CT), magnetic resonance imaging(MRI), including magnetic resonance cholangiography(MRC) imaging, are of importance, providing useful complementary information. However, making the correct diagnosis is possible if imaging findings are correlated with appropriate clinical findings. We present an overview of the radiological patterns produced by E. multilocularis lesions as seen on US, CT and MRI and discuss the interventional procedures in hepatic AE lesions.

Long-term follow-up of two interventional procedures for achalasia

Objective To observed the long-term follow-up of the two types of interventional procedure for achalasia. Methods The study cohort was comprised of 140 patients of achalasia including 70 patients treated under fluoroscopy with pneumatic dilation (group A) and 70 with temporary partially covered metal stent dilation (group B). Results One hundred and forty dilations were performed on the 70 patients of group A with complications of chest pain (n=35), reflux (n=18), and bleeding (n=8); 38 patients of relapsing dysphagia during a 12-month follow-up, and 50 patients out of 60 of recurrent dysphagia during a 36-month follow-up. Seventy partially covered expandable metal stents were temporarily placed in the 70 patients of group B and withdrawn after 3-7 days via gastroscopy with complications of chest pain (n=28), reflux (n=15), and bleeding (n=9); 7 patients out of 70 exhibited dysphagia relapse during a 12-month follow-up, and 9 out of 58 patients exhibited dysphagia relapse during a 36-month follow-up. All the stents were inserted and withdrawn successfully. The follow-up in groups A-B lasted for 12-96 months. Conclusion Temporary partially covered metal stent dilation is one of the best methods of interventional procedure for achalasia in long-term follow-up.

Reports of a Possible Causal Link between Brain,Head,and Neck Tumors and Radiation Exposure during Coronary Interventional Procedures:A Sobering Look at the Data

Radiation exposure is a hazard for patients and physicians during fluoroscopically-guided procedures.Invasive cardiologists are exposed to high levels of scatter radiation and both increasing procedural complexity and higher operator volumes contribute to exposure above recommended thresholds.Standard shielding does not offer suffi cient protection to the head and neck region and the potential for negative biological,subclinical,and clinical effects exists.Large population studies suggest that cranial exposure to low dose radiation increases the risks of tumor development.In addition,modest doses of therapeutic cranial radiation have been linked with the development of brain cancer.Although a causal association between scatter radiation in the cath lab and brain cancer does not currently exist,given the known detrimental effects of radiation exposure to the head and neck region support a focus on potential methods of protection for both the patient and the operator.

Education Programs for Invasive Procedures Involving Nurses: A Scoping Review

Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.

Coordinated Mining Procedures of Open Pit Mines Based on River Management

This paper primarily concerns the effective coordination of the procedures and methods employed in open pit mining operations under the background of river management.The central objective of this study is to identify a viable approach for ensuring rational and efficient development of open pit mineral resources while simultaneously protecting and restoring the ecological environment of the river.This approach should facilitate the realization of a harmonious symbiosis between mining and river management.The intricate mutual influence relationship between river management and open pit mining is first analyzed in depth,which provides a solid foundation for the subsequent coordination strategy development.In light of the aforementioned considerations,a set of coordination procedures for open pit mining based on river management conditions is proposed.These procedures emphasize the integration of river protection into the overall layout of mining at the planning stage.The implementation of scientific mining schemes,accompanied by rigorous control of the scope and depth of mining operations,has proven to be an effective means of reducing the impact of mining activities on river environments.This approach has also facilitated the achievement of a balance and coordination between mining and river management.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.

Optimization of Open-cast Mining Procedure Based on RSR Method

To explore the optimal evaluation mechanism of open-cast mining procedure,this paper takes the actual operation status of Huolinhe No.1 Open-cast Mine as the research basis,and makes a deep analysis of the four representative mining procedures proposed by this mine.A detailed and comprehensive evaluation system is constructed using rank-sum ratio(RSR)method.The system covers 17 key indicators and aims to evaluate the advantages and disadvantages of each scheme in an all-round and multi-angle manner.Through the calculation and analysis by RSR method,the comprehensive evaluation of the four types of mining procedure schemes is carried out,and finally the secondary river improvement project is determined as the optimal mining implementation scheme,and the joint mining scheme of the south and north areas is the alternative strategy.The research results of this paper are objective,clear and definite,can not only reveal the effectiveness and feasibility of RSR method in solving the problem of open-cast mining procedure optimization,but also provide a strong technical support and decision-making basis for the future production development of Huolinhe No.1 Open-cast Mine.Thus,this study is expected to further promote the scientific and refined process of mining operations.

Clinical Study on the Treatment of Low Anal Fistula in Infants and Young Children by Anal Gland Excision and Virtual Hanging Procedure

Objective:To compare the efficacy of anal adenectomy with virtual hanging wire and anal fistulotomy in the treatment of low anal fistula in infants and children.Methods:60 children with low anal fistula who were admitted to our hospital from October 2021 to March 2022 and met the inclusion criteria were randomly divided into two groups of 30 cases each;the treatment group was treated with anal adenectomy and virtual hanging wire surgery,and the control group was treated with anal fistula resection.The clinical efficacy after treatment was compared.Results:The total effective rate of both groups was 96.67%and the difference between the two groups was not statistically significant(P>0.05).The postoperative pain score of the treatment group was lower than that of the control group(P<0.05).The length of hospitalization and healing time of the treatment group was lower than that of the control group(P<0.05).The anal function of the patients in both groups was normal,and there was no adverse reaction.Conclusion:Anal gland excision and virtual hanging surgery for the treatment of low anal fistula in infants and children have the advantages of mild pain,reduced length of hospitalization,short healing time,and better patient experience as compared to anal fistula excision.

The Interventional Capacity of Community Health Volunteers for Screening and Linkages of Non-Communicable Diseases in Nyeri County, Kenya

Non-communicable diseases (NCDs) account for 63% of mortalities. Approximately 80% of these NCD-related deaths occur in LMICs. A quasi-experimental study utilizing a non-equivalent pre-and post-test was conducted from May 2022 to March 2023 with 370 study participants. Multistage cluster and random sampling were used to select ten community units, and therefore, 150 CHVs were chosen for the control unit, and 150 were used to form the interventional group. Data was collected from the KOBO app. Six (6) homogenous FGDs comprised ten members, and 10 KII were conducted across study sites. Quantitative data was analyzed using SPSS version 28.0, and qualitative data was audio-recorded, transcribed, and analyzed via N-Vivo 12. The study shows that 59.3% of respondents have minimal information, and 92.7% (n = 139) have no clear understanding of NCDs, with a pre-intervention capacity of 48.8%. Independent sample t-test showed a significant difference in capacity from a pre-intervention average of 48.75 (SD ± 5.7)%, which increased to 68.28 (SD ± 7.6)%, p < 0.001. A well-designed community interventional model plays a pivotal role in grassroots healthcare delivery but requires optimization for NCD management.

Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma

Primary biliary tract tumors are malignancies that originate in the liver,bile ducts,or gallbladder.These tumors often present with jaundice of unknown etiology,leading to delayed diagnosis and advanced disease.Currently,several palliative treatment options are available for primary biliary tract tumors.They include percutaneous transhepatic biliary drainage(PTBD),biliary stenting,and surgical interventions such as biliary diversion.Systemic therapy is also commonly used for the palliative treatment of primary biliary tract tumors.It involves the administration of chemotherapy drugs,such as gemcitabine and cisplatin,which have shown promising results in improving overall survival in patients with advanced biliary tract tumors.PTBD is another palliative treatment option for patients with unresectable or inoperable malignant biliary obstruction.Biliary stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary obstruction.Surgical interventions,such as biliary diversion,have traditionally been used as palliative options for primary biliary tract tumors.However,biliary diversion only provides temporary relief and does not remove the tumor.Primary biliary tract tumors often present in advanced stages,making palliative treatment the primary option for improving the quality of life of patients.