title: Use of transabdominal ultrasound-guided transjugular portal vein puncture on radiation dose in transjugular intrahepatic portosystemic shunt formation.
abstract: OBJECTIVE
  Transjugular intrahepatic portosystemic shunt (TIPS) creation is used to treat portal hypertension complications. Often the most challenging and time-consuming step in the procedure is the portal vein (PV) puncture. TIPS procedures are associated with prolonged fluoroscopy time and high patient radiation exposures. We measured the impact of transabdominal ultrasound guidance for PV puncture on duration of fluoroscopy time and dose.
  
  
  METHODS
  We retrospectively analyzed the radiation dose for all TIPS performed over a four-year period with transabdominal ultrasound guidance for PV puncture (n=212, with 210 performed successfully and data available for 206); fluoroscopy time, dose area product (DAP) and skin dose were recorded.
  
  
  RESULTS
  Mean fluoroscopy time was 12 min 9 s (SD, ±14 min 38 s), mean DAP was 40.3±73.1 Gy·cm2, and mean skin dose was 404.3±464.8 mGy.
  
  
  CONCLUSIONS
  Our results demonstrate that ultrasound-guided PV puncture results in low fluoroscopy times and radiation doses, which are markedly lower than the only published dose reference levels.
authors.affiliation: Departments of Radiology, Royal Free London NHS Foundation Trust, London, UK. aniket.tavare@gmail.com.
authors.forename: Aniket N
authors.initials: AN
authors.lastname: Tavare
authors.forename: Andrew
authors.initials: A
authors.lastname: Wigham
authors.forename: Anastasia
authors.initials: A
authors.lastname: Hadjivassilou
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Alvi
authors.forename: Anthie
authors.initials: A
authors.lastname: Papadopoulou
authors.forename: Antony
authors.initials: A
authors.lastname: Goode
authors.forename: Nick
authors.initials: N
authors.lastname: Woodward
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Dominic
authors.initials: D
authors.lastname: Yu
authors.forename: Neil
authors.initials: N
authors.lastname: Davies
mesh_terms: D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D011169:Portal Vein / Q000293:injuries*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000379:methods*; D011677:Punctures; D000069079:Radiation Exposure / Q000009:adverse effects; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D014463:Ultrasonography; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*