title: Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation.
abstract: OBJECTIVE
  Transjugular intrahepatic portosystemic shunt (TIPS) creation is considered as being one of the most complex procedures in abdominal interventional radiology. Our aim was twofold: quantification of TIPS-related patient radiation exposure in our center and identification of factors leading to reduced radiation exposure.
  
  
  METHODS
  Three hundred and forty seven consecutive patients underwent TIPS in our center between 2007 and 2014. Three main procedure categories were identified: Group I (n = 88)-fluoroscopic-guided portal vein targeting, procedure done in an image intensifier-based angiographic system (IIDS); Group II (n = 48)--ultrasound-guided portal vein puncture, procedure done in an IIDS; and Group III (n = 211)--ultrasound-guided portal vein puncture, procedure done in a flat panel detector-based system (FPDS). Radiation exposure (dose-area product [DAP], in Gy cm(2) and fluoroscopy time [FT] in minutes) was retrospectively analyzed.
  
  
  RESULTS
  DAP was significantly higher in Group I (mean ± SD 360 ± 298; median 287; 75th percentile 389 Gy cm(2)) as compared to Group II (217 ± 130; 178; 276 Gy cm(2); p = 0.002) and Group III (129 ± 117; 70; 150 Gy cm(2) p < 0.001). The difference in DAP between Groups II and III was also significant (p < 0.001). Group I had significantly longer FT (25.78 ± 13.52 min) as compared to Group II (20.45 ± 10.87 min; p = 0.02) and Group III (19.76 ± 13.34; p < 0.001). FT was not significantly different between Groups II and III (p = 0.73).
  
  
  CONCLUSIONS
  Real-time ultrasound-guided targeting of the portal venous system during TIPS creation results in a significantly lower radiation exposure and reduced FT. Further reduction in radiation exposure can be achieved through the use of modern angiographic units with FPDS.
authors.affiliation: Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy. rmiraglia@ismett.edu.
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.affiliation: Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy. lmaruzzelli@ismett.edu.
authors.forename: Luigi
authors.initials: L
authors.lastname: Maruzzelli
authors.affiliation: Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy. kelvincortis@ismett.edu.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Cortis
authors.affiliation: Department of Radiology, University of Palermo, Palermo, Italy. mdamico@ismett.edu.
authors.forename: Mario
authors.initials: M
authors.lastname: D'Amico
authors.affiliation: Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy. gfloridia@ismett.edu.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Floridia
authors.affiliation: Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy. ggallo@ismett.edu.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gallo
authors.affiliation: Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy. ctafaro@ismett.edu.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tafaro
authors.affiliation: Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Ernesto Tricomi 5, 90127, Palermo, Italy. aluca@ismett.edu.
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
mesh_terms: D000792:Angiography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D000069079:Radiation Exposure; D011835:Radiation Protection; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
keywords: Fluoroscopy; Liver/hepatic; Portal vein hypertension; Radiation protection; Transjugular intrahepatic portosystemic shunt (TIPS/TIPSS); Ultrasound