title: Radiation exposure of the interventional radiologist during percutaneous biopsy using a multiaxis interventional C-arm CT system with 3D laser guidance: a phantom study.
abstract: OBJECTIVE
  Evaluation of absolute radiation exposure values for interventional radiologists (IRs) using a multiaxis interventional flat-panel C-arm cone beam CT (CBCT) system with three-dimensional laser guidance for biopsy in a triple-modality, abdominal phantom.
  
  
  METHODS
  In the phantom, eight lesions were punctured in two different angles (in- and out-of-plane) using CBCT. One C-arm CT scan was performed to plan the intervention and one for post-procedural evaluation. Thermoluminescent dosemeters (TLDs) were used for dose measurement at the level of the eye lens, umbilicus and ankles on a pole representing the IRs. All measurements were performed without any lead protection. In addition, the dose-area product (DAP) and air kerma at the skin entrance point was documented.
  
  
  RESULTS
  Mean radiation values of all TLDs were 190 µSv for CBCT (eye lens: 180 µS, umbilicus: 230 µSv, ankle: 150 µSv) without a significant difference (p > 0.005) between in- and out-of-plane biopsies. In terms of radiation exposure of the phantom, the mean DAP was not statistically significantly different (p > 0.05) for in- and out-of-plane biopsies. Fluoroscopy showed a mean DAP of 7 or 6 μGym(2), respectively. C-arm CT showed a mean DAP of 5150 or 5130 μGym(2), respectively.
  
  
  CONCLUSIONS
  In our setting, the radiation dose to the IR was distinctly high using CBCT. For dose reduction, it is advisable to pay attention to lead shielding, to increase the distance to the X-ray source and to leave the intervention suite for C-arm CT scans.
  
  
  CONCLUSIONS
  The results indicate that using modern navigation tools and CBCT can be accompanied with a relative high radiation dose for the IRs since detector angulation can make the use of proper lead shielding difficult.
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Rathmann
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kostrzewa
authors.affiliation: 2 Fraunhofer Project Group for Automation in Medicine and Biotechnology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Kerim
authors.initials: K
authors.lastname: Kara
authors.affiliation: 3 Department of Medical Physics in Radiology, German Cancer Research Center-DKFZ, Heidelberg, Germany.
authors.forename: Soenke
authors.initials: S
authors.lastname: Bartling
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Haubenreisser
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.affiliation: 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Steffen J
authors.initials: SJ
authors.lastname: Diehl
mesh_terms: D054893:Cone-Beam Computed Tomography; D005471:Fluoroscopy; D006801:Humans; D061705:Image-Guided Biopsy; D007834:Lasers; D016273:Occupational Exposure; D019047:Phantoms, Imaging; D000069079:Radiation Exposure; D015642:Radiology, Interventional; D013819:Thermoluminescent Dosimetry