A. Sulieman

Reduction of Radiation Doses to Patients and Staff During Endoscopic Retrograde Cholangiopancreatography

Background/Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a considerable radiation exposure for patients and staff. While optimization of the radiation dose is recommended, few studies have been published. The purpose of this study has been to measure patient and staff radiation dose, to estimate the effective dose and radiation risk using digital fluoroscopic images. Entrance skin dose (ESD), organ and effective doses were estimated for patients and staff. Materials and Methods: Fifty-seven patients were studied using digital X-ray machine and thermoluminescent dosimeters (TLD) to measure ESD at different body sites. Organ and surface dose to specific radiosensitive organs was carried out. The mean, median, minimum, third quartile and the maximum values are presented due to the asymmetry in data distribution. Results: The mean ESD, exit and thyroid surface dose were estimated to be 75.6 mGy, 3.22 mGy and 0.80 mGy, respectively. The mean effective dose for both gastroenterologist and assistant is 0.01 mSv. The mean patient effective dose was 4.16 mSv, and the cancer risk per procedure was estimated to be 2 × 10-5 Conclusion: ERCP with fluoroscopic technique demonstrate improved dose reduction, compared to the conventional radiographic based technique, reducing the surface dose by a factor of 2, without compromising the diagnostic findings. The radiation absorbed doses to the different organs and effective doses are relatively low.

High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study

Summary Background High-intensity focused ultrasound (HIFU) is a highly precise medical procedure used locally to heat and destroy diseased tissue through ablation. This study intended to review HIFU in uterine fibroid therapy, to evaluate the role of HIFU in the therapy of leiomyomas as well as to review the actual clinical activities in this field including efficacy and safety measures beside the published clinical literature. Material/Methods An inclusive literature review was carried out in order to review the scientific foundation, and how it resulted in the development of extracorporeal distinct devices. Studies addressing HIFU in leiomyomas were identified from a search of the Internet scientific databases. The analysis of literature was limited to journal articles written in English and published between 2000 and 2013. Results In current gynecologic oncology, HIFU is used clinically in the treatment of leiomyomas. Clinical research on HIFU therapy for leiomyomas began in the 1990s, and the majority of patients with leiomyomas were treated predominantly with HIFUNIT 9000 and prototype single focus ultrasound devices. HIFU is a non-invasive and highly effective standard treatment with a large indication range for all sizes of leiomyomas, associated with high efficacy, low operative morbidity and no systemic side effects. Conclusions Uterine fibroid treatment using HIFU was effective and safe in treating symptomatic uterine fibroids. Few studies are available in the literature regarding uterine artery embolization (UAE). HIFU provides an excellent option to treat uterine fibroids.

Optimisation of Radiation Exposure to Gastroenterologists and Patients during Therapeutic ERCP

This study intended to optimize the radiation doses for gastroenterologists and patients during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and to compare the doses based on available data obtained by other researchers. A total of 153 patients were studied in two Gastroenterology Departments, (group A, 111; group B, 42). Thermoluminescent dosimeters (TLD) were used to measure the staff and patients entrance surface air kerma (ESAK) at different body sites. The mean ESAK and effective doses per procedure were estimated to be 68.75 mGy and 2.74 mSv, respectively. Staff was exposed to a heterogonous doses. The third examiner (trainee) was exposed to a high dose compared with other examiners because no shield was located to protect him from stray radiation. Patients and examiners doses were lower compared to the lowest values found in previous studies taking into consideration the heterogeneity of patients and equipment. Staff doses during ERCP are within the safety limit in the light of the current practice.

High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment

Summary Background High-intensity focused ultrasound (HIFU) applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. This study intended to review HIFU to explain the fundamentals of HIFU, evaluate the evidence concerning the role of HIFU in the treatment of prostate cancer (PC), review the technologies used to perform HIFU and the published clinical literature regarding the procedure as a primary treatment for PC. Material/Methods Studies addressing HIFU in localized PC were identified in a search of internet scientific databases. The analysis of outcomes was limited to journal articles written in English and published between 2000 and 2013. Results HIFU is a non-invasive approach that uses a precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of PC. Clinical research on HIFU therapy for localized PC began in the 1990s, and the majority of PC patients were treated with the Ablatherm device. Conclusions HIFU treatment for localized PC can be considered as an alternative minimally invasive therapeutic modality for patients who are not candidates for radical prostatectomy. Patients with lower pre-HIFU PSA level and favourable pathologic Gleason score seem to present better oncologic outcomes. Future advances in technology and safety will undoubtedly expand the HIFU role in this indication as more of patient series are published, with a longer follow-up period.

Radiation doses in chest, abdomen and pelvis CT procedures

Computed tomography (CT) scanning is recognised as a high-radiation dose modality and estimated to be 17 % of the radiological procedure and responsible for 70 % of medical radiation exposure. Although diagnostic X rays provide great benefits, their use involves some risk for developing cancer. The objectives of this study are to estimate radiation doses during chest, abdomen and pelvis CT. A total of 51 patients were examined for the evaluation of metastasis of a diagnosed primary tumour during 4 months. A calibrated CT machine from Siemens 64 slice was used. The mean age was 48.0 ± 18.6 y. The mean patient weight was 73.8 ± 16.1 kg. The mean dose-length product was 1493.8 ± 392.1 mGy cm, Volume CT dose index (CTDI vol) was 22.94 ± 5.64 mGy and the mean effective dose was 22.4 ± 5.9 mSv per procedure. The radiation dose per procedure was higher as compared with previous studies. Therefore, the optimisation of patients radiation doses is required in order to reduce the radiation risk.

Radiation doses to paediatric patients and comforters undergoing chest X rays

Pneumonia is an important cause of hospital admission among children in the developed world and it is estimated to be responsible for 3-18 % of all paediatric admissions. Chest X ray is an important examination for pneumonia diagnosis and for evaluation of complications. This study aims to determine the entrance surface dose (ESD), organ, effective doses and propose a local diagnostic reference level. The study was carried out at the university hospital of Larissa, Greece. Patients were divided into three groups: organ and effective doses were estimated using National Radiological Protection Board software. The ESD was determined by thermoluminescent dosemeters for 132 children and 76 comforters. The average ESD value was 55 ± 8 µGy. The effective dose for patients was 11.2 ± 5 µSv. The mean radiation dose for comforter is 22 ± 3 µGy. The radiation dose to the patients is well within dose constraint, in the light of the current practice.

Occupational exposure to staff during endoscopic retrograde cholangiopancreatography in Sudan.

Endoscopic retrograde cholangiopancreatography (ERCP) procedure is an invasive technique that requires fluoroscopic and radiographic exposure. The purpose of this study was to determine the occupational dose of ionising radiation at three gastroenterology departments (Fedial, Soba and Ibn seena hospitals) in Khartoum, Sudan. The radiation dose was measured during 55 therapeutic ERCP procedures. Thermoluminescence dosemeters were used. The mean radiation dose for the first operator was 0.27 mGy for the eye lens, 0.21 for the thyroid, 0.32 for the chest, 0.17 for the hand and 0.22 for the leg. The mean radiation dose for the second operator was 0.21 mGy for the hand and 0.20 mGy for the chest, while the mean radiation dose for the nurse was 0.44 mGy for the hand and 0.19 for the chest. The radiation dose received by the staff in these hospitals was found to be higher than most of the values in the literature. The radiation absorbed dose received by the different organs is relatively low. Additional studies need to be conducted for radiation dose optimisation.

Dose reduction in chest CT examination

Computed tomography (CT) examinations involve relatively high doses to patients. The objectives of this study were to optimise the radiation dose for patient during CT chest scan and to estimate the lifetime cancer risk. A total of 50 patients were studied: control group (A) (38 patients) and optimisation group (B) (12 patients). The optimisation protocol was based on CT pitch increment and lowering tube current. The mean volume CT dose index (CTDI vol) was 21.17 mGy and dose length product (DLP) was 839.0 mGy cm for Group A, and CTDI vol was 8.3 mGy and DLP was 339.7 for Group B. The overall cancer risk was estimated to be 8.0 and 3.0 cancer incidence per million for Groups A and B, respectively. The patient dose optimisation during CT chest was investigated. Lowering tube current and pitch increment achieved a radiation dose reduction of up to 60 % without compromising the diagnostic findings.

Radiation exposure during paediatric CT in Sudan: CT dose, organ and effective doses

The purpose of this study was to assess the magnitude of radiation exposure during paediatric CT in Sudanese hospitals. Doses were determined from CT acquisition parameters using CT-Expo 2.1 dosimetry software. Doses were evaluated for three patient ages (0-1, 1-5 and 5-10 y) and two common procedures (head and abdomen). For children aged 0-1 y, volume CT air kerma index (Cvol), air Kerma-length product and effective dose (E) values were 19.1 mGy, 265 mGy.cm and 3.1 mSv, respectively, at head CT and those at abdominal CT were 8.8 mGy, 242 mGy.cm and 7.7 mSv, respectively. Those for children aged 1-5 y were 22.5 mGy, 305 mGy.cm and 1.1 mSv, respectively, at head CT and 12.6 mGy, 317 mGy.cm, and 5.1 mSv, respectively, at abdominal CT. Dose values and variations were comparable with those reported in the literature. Organ equivalent doses vary from 7.5 to 11.6 mSv for testes, from 9.0 to 10.0 mSv for ovaries and from 11.1 to 14.3 mSv for uterus in abdominal CT. The results are useful for dose optimisation and derivation of national diagnostic reference levels.

Measurement of patient radiation doses in certain urography procedures

Patients are exposed to significant radiation doses during diagnostic and interventional urologic procedures. This study aimed to measure patient entrance surface air kerma (ESAK) and to estimate the effective dose during intravenous urography (IVU), extracorporeal shock-wave lithotripsy (ESWL), and ascending urethogram (ASU) procedures. ESAK was measured in patients using calibrated thermo luminance dosimeters, GR200A). Effective doses (E) were calculated using the National Radiological Protection Board (NRPB) software. A total of 179 procedures were investigated. 27.9 % of the patients underwent IVU procedures, 27.9 % underwent ESWL procedures and 44.2 % underwent ASU procedures. The mean ESAK was 2.1, 4.18 and 4.9 mGy for IVU, ESWL, and ASU procedures, respectively. Differences in patient ESAK for the same procedure were observed. The mean ESAK values were comparable with those in previous studies.