Determinants of radiation exposure during mobile cone-beam CT-guided robotic-assisted bronchoscopy.

Autor: Kalchiem-Dekel O; Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Bergemann R; Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Ma X; Division of Biostatistics and Epidemiology, Weill Cornell School of Medicine, New York, New York, USA., Christos PJ; Division of Biostatistics and Epidemiology, Weill Cornell School of Medicine, New York, New York, USA., Miodownik D; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Gao Y; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Mahmood U; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Adusumilli PS; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Bott MJ; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Dycoco J; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Gelblum DY; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Lee RP; Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Park BJ; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Rocco G; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Solomon SB; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Jones DR; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Chawla M; Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Husta BC; Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Jazyk: angličtina
Zdroj: Respirology (Carlton, Vic.) [Respirology] 2024 Sep; Vol. 29 (9), pp. 803-814. Date of Electronic Publication: 2024 May 28.
DOI: 10.1111/resp.14765
Abstrakt: Background and Objective: Robotic-assisted bronchoscopy (RAB) is an emerging modality to sample pulmonary lesions. Cone-beam computed tomography (CBCT) can be incorporated into RAB. We investigated the magnitude and predictors of patient and staff radiation exposure during mobile CBCT-guided shape-sensing RAB.
Methods: Patient radiation dose was estimated by cumulative dose area product (cDAP) and cumulative reference air kerma (cRAK). Staff equivalent dose was calculated based on isokerma maps and a phantom simulation. Patient, lesion and procedure-related factors associated with higher radiation doses were identified by logistic regression models.
Results: A total of 198 RAB cases were included in the analysis. The median patient cDAP and cRAK were 10.86 Gy cm 2 (IQR: 4.62-20.84) and 76.20 mGy (IQR: 38.96-148.38), respectively. Among staff members, the bronchoscopist was exposed to the highest median equivalent dose of 1.48 μSv (IQR: 0.85-2.69). Both patient and staff radiation doses increased with the number of CBCT spins and targeted lesions (p < 0.001 for all comparisons). Patient obesity, negative bronchus sign, lesion size <2.0 cm and inadequate sampling by on-site evaluation were associated with a higher patient dose, while patient obesity and inadequate sampling by on-site evaluation were associated with a higher bronchoscopist equivalent dose.
Conclusion: The magnitude of patient and staff radiation exposure during CBCT-RAB is aligned with safety thresholds recommended by regulatory authorities. Factors associated with a higher radiation exposure during CBCT-RAB can be identified pre-operatively and solicit procedural optimization by reinforcing radiation protective measures. Future studies are needed to confirm these findings across multiple institutions and practices.
(© 2024 Asian Pacific Society of Respirology.)
Databáze: MEDLINE
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