title: Risk factors of radiation dose in patients undergoing peripherally-inserted central catheter procedure using conventional angiography equipment and flat panel detector-based mobile C-arm fluoroscopy.
abstract: BACKGROUND
  Although peripherally-inserted central catheter (PICC) insertion is commonly performed under fluoroscopic guidance, few reports have addressed performance and dosimetry when PICC is inserted under C-arm fluoroscopy.
  
  
  OBJECTIVE
  To evaluate the risk factors of radiation dose in performing PICC insertion using flat panel detector-based mobile C-arm fluoroscopy and a conventional angiography machine.
  
  
  METHODS
  Ninety-eight patients underwent the PICC procedure using conventional angiography equipment (n=49) or flat panel detector-based mobile C-arm fluoroscopy (n=49). Data were prospectively analyzed from July to November 2012. Dose-area product (DAP), tube voltage, tube current, fluoroscopy time, and image quality measured on a 5-point scale were estimated and compared using appropriate statistical tests.
  
  
  RESULTS
  There were no significant differences in tube voltage, fluoroscopy time, and image quality between conventional angiography and mobile C-arm fluoroscopy. DAP, mean arm tube current, and tube current in chest fluoroscopy were significantly lower in mobile C-arm fluoroscopy than using the conventional angiography machine (P < 0.05). Multivariate analysis identified tube current in chest fluoroscopy, arm tube current, and fluoroscopy equipment as significant risk factors for elevated radiation dose in PICC insertion.
  
  
  CONCLUSIONS
  PICC insertion can be performed using flat panel detector-based mobile C-arm fluoroscopy instead of a conventional angiography machine. Image quality and fluoroscopy time were not different between the two systems and the use of C-arm fluoroscopy significantly reduced radiation dose.
authors.affiliation: Advanced Medical Device Research Center, Korea Electrotechnology Research Institute, Gyeonggi-do, Republic of Korea.
authors.forename: TaeBum
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea swshin@skku.edu.
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Shin
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Dongil
authors.initials: D
authors.lastname: Choi
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Ki
authors.initials: SK
authors.lastname: Cho
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Dongho
authors.initials: D
authors.lastname: Hyun
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Do
authors.affiliation: Advanced Medical Device Research Center, Korea Electrotechnology Research Institute, Gyeonggi-do, Republic of Korea.
authors.forename: SungChae
authors.initials: S
authors.lastname: Jeon
authors.affiliation: Advanced Medical Device Research Center, Korea Electrotechnology Research Institute, Gyeonggi-do, Republic of Korea.
authors.forename: BoKyung
authors.initials: B
authors.lastname: Cha
authors.affiliation: Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Bok
authors.affiliation: Biostatistics Unit, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Seonwoo
authors.initials: S
authors.lastname: Kim
mesh_terms: D000792:Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002406:Catheterization, Peripheral / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D012307:Risk Factors
keywords: Peripherally-inserted central catheter; angiography; dose-area product; mobile C-arm fluoroscopy; radiation dose