Imaging guidance with C-arm CT

Prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization

Nishita Kothary, Mohamed H K Abdelmaksoud, Alessia Tognolini, Rebecca Fahrig, Jarrett Rosenberg, David M. Hovsepian, Arundhuti Ganguly, John D. Louie, William T. Kuo, Gloria L. Hwang, Alison Holzer, Daniel Y. Sze, Lawrence V. Hofmann

Research output: Contribution to journalArticle

Abstract

Purpose: To prospectively evaluate the impact of C-arm CT on radiation exposure to hepatocellular carcinoma (HCC) patients treated by chemoembolization. Materials and Methods: Patients with HCC (N = 87) underwent digital subtraction angiography (DSA; control group) or combined C-arm CT/DSA (test group) for chemoembolization. Dose-area product (DAP) and cumulative dose (CD) were measured for guidance and treatment verification. Contrast agent volume and C-arm CT utility were also measured. Results: The marginal DAP increase in the test group was offset by a substantial (50%) decrease in CD from DSA. Use of C-arm CT allowed reduction of DAP and CD from DSA imaging (P =.007 and P =.017). Experienced operators were more efficient in substituting C-arm CT for DSA, resulting in a negligible increase (7.5%) in total DAP for guidance, compared with an increase of 34% for all operators (P =.03). For treatment verification, DAP from C-arm CT exceeded that from DSA, approaching that of conventional CT. The test group used less contrast medium (P =.001), and C-arm CT provided critical or supplemental information in 20% and 17% of patients, respectively. Conclusions: Routine use of C-arm CT can increase stochastic risk (DAP) but decrease deterministic risk (CD) from DSA. However, the increase in DAP is operator-dependent, thus, with experience, it can be reduced to under 10%. C-arm CT provides information not provided by DSA in 33% of patients, while decreasing the use of iodinated contrast medium. As with all radiation-emitting modalities, C-arm CT should be used judiciously.

Original languageEnglish (US)
Pages (from-to)1535-1543
Number of pages9
JournalJournal of Vascular and Interventional Radiology
Volume22
Issue number11
DOIs
StatePublished - Nov 2011
Externally publishedYes

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Contrast Media
Hepatocellular Carcinoma
Digital Subtraction Angiography
Radiation
Control Groups
Radiation Exposure
Therapeutics

Keywords

  • 3D
  • CD
  • cumulative dose
  • DAP
  • digital subtraction angiography
  • dose-area product
  • DSA
  • HCC
  • hepatocellular carcinoma
  • maximum-intensity projection
  • MIP
  • peak skin dose
  • PSD
  • three-dimensional

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Imaging guidance with C-arm CT : Prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization. / Kothary, Nishita; Abdelmaksoud, Mohamed H K; Tognolini, Alessia; Fahrig, Rebecca; Rosenberg, Jarrett; Hovsepian, David M.; Ganguly, Arundhuti; Louie, John D.; Kuo, William T.; Hwang, Gloria L.; Holzer, Alison; Sze, Daniel Y.; Hofmann, Lawrence V.

In: Journal of Vascular and Interventional Radiology, Vol. 22, No. 11, 11.2011, p. 1535-1543.

Research output: Contribution to journalArticle

Kothary, N, Abdelmaksoud, MHK, Tognolini, A, Fahrig, R, Rosenberg, J, Hovsepian, DM, Ganguly, A, Louie, JD, Kuo, WT, Hwang, GL, Holzer, A, Sze, DY & Hofmann, LV 2011, 'Imaging guidance with C-arm CT: Prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization', Journal of Vascular and Interventional Radiology, vol. 22, no. 11, pp. 1535-1543. https://doi.org/10.1016/j.jvir.2011.07.008
Kothary, Nishita ; Abdelmaksoud, Mohamed H K ; Tognolini, Alessia ; Fahrig, Rebecca ; Rosenberg, Jarrett ; Hovsepian, David M. ; Ganguly, Arundhuti ; Louie, John D. ; Kuo, William T. ; Hwang, Gloria L. ; Holzer, Alison ; Sze, Daniel Y. ; Hofmann, Lawrence V. / Imaging guidance with C-arm CT : Prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization. In: Journal of Vascular and Interventional Radiology. 2011 ; Vol. 22, No. 11. pp. 1535-1543.
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title = "Imaging guidance with C-arm CT: Prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization",
abstract = "Purpose: To prospectively evaluate the impact of C-arm CT on radiation exposure to hepatocellular carcinoma (HCC) patients treated by chemoembolization. Materials and Methods: Patients with HCC (N = 87) underwent digital subtraction angiography (DSA; control group) or combined C-arm CT/DSA (test group) for chemoembolization. Dose-area product (DAP) and cumulative dose (CD) were measured for guidance and treatment verification. Contrast agent volume and C-arm CT utility were also measured. Results: The marginal DAP increase in the test group was offset by a substantial (50{\%}) decrease in CD from DSA. Use of C-arm CT allowed reduction of DAP and CD from DSA imaging (P =.007 and P =.017). Experienced operators were more efficient in substituting C-arm CT for DSA, resulting in a negligible increase (7.5{\%}) in total DAP for guidance, compared with an increase of 34{\%} for all operators (P =.03). For treatment verification, DAP from C-arm CT exceeded that from DSA, approaching that of conventional CT. The test group used less contrast medium (P =.001), and C-arm CT provided critical or supplemental information in 20{\%} and 17{\%} of patients, respectively. Conclusions: Routine use of C-arm CT can increase stochastic risk (DAP) but decrease deterministic risk (CD) from DSA. However, the increase in DAP is operator-dependent, thus, with experience, it can be reduced to under 10{\%}. C-arm CT provides information not provided by DSA in 33{\%} of patients, while decreasing the use of iodinated contrast medium. As with all radiation-emitting modalities, C-arm CT should be used judiciously.",
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T2 - Prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization

AU - Kothary, Nishita

AU - Abdelmaksoud, Mohamed H K

AU - Tognolini, Alessia

AU - Fahrig, Rebecca

AU - Rosenberg, Jarrett

AU - Hovsepian, David M.

AU - Ganguly, Arundhuti

AU - Louie, John D.

AU - Kuo, William T.

AU - Hwang, Gloria L.

AU - Holzer, Alison

AU - Sze, Daniel Y.

AU - Hofmann, Lawrence V.

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N2 - Purpose: To prospectively evaluate the impact of C-arm CT on radiation exposure to hepatocellular carcinoma (HCC) patients treated by chemoembolization. Materials and Methods: Patients with HCC (N = 87) underwent digital subtraction angiography (DSA; control group) or combined C-arm CT/DSA (test group) for chemoembolization. Dose-area product (DAP) and cumulative dose (CD) were measured for guidance and treatment verification. Contrast agent volume and C-arm CT utility were also measured. Results: The marginal DAP increase in the test group was offset by a substantial (50%) decrease in CD from DSA. Use of C-arm CT allowed reduction of DAP and CD from DSA imaging (P =.007 and P =.017). Experienced operators were more efficient in substituting C-arm CT for DSA, resulting in a negligible increase (7.5%) in total DAP for guidance, compared with an increase of 34% for all operators (P =.03). For treatment verification, DAP from C-arm CT exceeded that from DSA, approaching that of conventional CT. The test group used less contrast medium (P =.001), and C-arm CT provided critical or supplemental information in 20% and 17% of patients, respectively. Conclusions: Routine use of C-arm CT can increase stochastic risk (DAP) but decrease deterministic risk (CD) from DSA. However, the increase in DAP is operator-dependent, thus, with experience, it can be reduced to under 10%. C-arm CT provides information not provided by DSA in 33% of patients, while decreasing the use of iodinated contrast medium. As with all radiation-emitting modalities, C-arm CT should be used judiciously.

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KW - DSA

KW - HCC

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KW - MIP

KW - peak skin dose

KW - PSD

KW - three-dimensional

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