FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1984600546> ?p ?o ?g. }

• W1984600546 endingPage "1773" @default.
• W1984600546 startingPage "1773" @default.
• W1984600546 abstract "I read with interest the article by Costantino et al (1Costantino M. Lee J. McCullough M. Nsouli-Maktabi H. Spies J.B. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial.J Vasc Interv Radiol. 2010; 21: 829-835Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar) regarding bilateral versus unilateral femoral access for uterine artery embolization. The authors are to be congratulated for the careful design and conduct of this randomized controlled trial. Unfortunately, their analysis of patient radiation dose places inappropriate emphasis on fluoroscopy time and inadequate emphasis on kerma–area product (KAP; referred to by the authors as dose–area product).Fluoroscopy time is measured in units of time, not dose, and does not incorporate the effects of fluoroscopy dose rate or dose from angiography images. Fluoroscopy time is not recommended for monitoring patient radiation dose during procedures such as embolization or for documenting radiation dose from these procedures (2Stecker M.S. Balter S. Towbin R.B. et al.Guidelines for patient radiation dose management.J Vasc Interv Radiol. 2009; 20: S263-S273Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar, 3Miller D.L. Balter S. Wagner L.K. et al.Quality improvement guidelines for recording patient radiation dose in the medical record.J Vasc Interv Radiol. 2004; 15: 423-429Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar). KAP is the integral of air kerma across the entire x-ray beam emitted from the x-ray tube. It is a surrogate measurement for the entire amount of energy delivered to the patient by the beam (2Stecker M.S. Balter S. Towbin R.B. et al.Guidelines for patient radiation dose management.J Vasc Interv Radiol. 2009; 20: S263-S273Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar). It is commonly used as a proxy for the risk of stochastic effects (4Tsapaki V. Ahmed N.A. AlSuwaidi J.S. et al.Radiation exposure to patients during interventional procedures in 20 countries: initial IAEA project results.AJR Am J Roentgenol. 2009; 193: 559-569Crossref PubMed Scopus (90) Google Scholar, 5Vano E. Sanchez R. Fernandez J.M. et al.Patient dose reference levels for interventional radiology: a national approach.Cardiovasc Intervent Radiol. 2009; 32: 19-24Crossref PubMed Scopus (53) Google Scholar). It is a more appropriate measure of patient radiation dose than fluoroscopy time.The authors demonstrated significant differences in fluoroscopy time and number of angiographic images between the unilateral and bilateral access techniques, but no difference in KAP. How is this possible? It is difficult to be certain without observing the operators performing procedures of each type, but I can offer a likely explanation. KAP is the product of the air kerma (without backscatter) at the radiation field and the area of the radiation field. Decreasing the size of the radiation field by 50% will decrease KAP by 50% if all other factors are unchanged. The authors are experienced interventional radiologists, and aware of the importance of collimation. I suspect that, when the bilateral access technique was used, the radiation field was coned to include both uterine arteries, but when the unilateral access technique was used, each radiation field was coned to half that size to limit the field to one uterine artery. Thus, imaging each uterine artery separately would yield approximately the same KAP as imaging both uterine arteries together.The important point is that KAP is the appropriate metric for estimating the risk of stochastic effects. Fluoroscopy time and the number of angiographic images are not appropriate metrics. Because Costantino et al (1Costantino M. Lee J. McCullough M. Nsouli-Maktabi H. Spies J.B. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial.J Vasc Interv Radiol. 2010; 21: 829-835Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar) were not able to demonstrate a difference in KAP between the two methods they investigated, they did not demonstrate a difference in stochastic risk. The data on fluoroscopy time and number of angiographic images are irrelevant in this regard.Regardless of the relative merits of the unilateral and bilateral techniques, Costantino et al (1Costantino M. Lee J. McCullough M. Nsouli-Maktabi H. Spies J.B. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial.J Vasc Interv Radiol. 2010; 21: 829-835Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar) are to be commended for their attention to the importance of optimizing patient radiation dose. Their patients received a mean dose of 130 or 162 Gy·cm2, depending on the technique used, approximately half that of the mean KAP of 298 Gy·cm2 for typical procedures earlier this decade (6Miller D.L. Balter S. Cole P.E. et al.Radiation doses in interventional radiology procedures: The RAD-IR study: part I Overall measures of dose.J Vasc Interv Radiol. 2003; 14: 711-727Abstract Full Text Full Text PDF PubMed Scopus (310) Google Scholar). (Note that there appears to be a misprint in table 2 of this publication (1Costantino M. Lee J. McCullough M. Nsouli-Maktabi H. Spies J.B. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial.J Vasc Interv Radiol. 2010; 21: 829-835Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar)—the Axiom Artis fluoroscope [Siemens, Erlangen, Germany] displays KAP in units of μGy·m2, not μGy/cm2.) I read with interest the article by Costantino et al (1Costantino M. Lee J. McCullough M. Nsouli-Maktabi H. Spies J.B. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial.J Vasc Interv Radiol. 2010; 21: 829-835Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar) regarding bilateral versus unilateral femoral access for uterine artery embolization. The authors are to be congratulated for the careful design and conduct of this randomized controlled trial. Unfortunately, their analysis of patient radiation dose places inappropriate emphasis on fluoroscopy time and inadequate emphasis on kerma–area product (KAP; referred to by the authors as dose–area product). Fluoroscopy time is measured in units of time, not dose, and does not incorporate the effects of fluoroscopy dose rate or dose from angiography images. Fluoroscopy time is not recommended for monitoring patient radiation dose during procedures such as embolization or for documenting radiation dose from these procedures (2Stecker M.S. Balter S. Towbin R.B. et al.Guidelines for patient radiation dose management.J Vasc Interv Radiol. 2009; 20: S263-S273Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar, 3Miller D.L. Balter S. Wagner L.K. et al.Quality improvement guidelines for recording patient radiation dose in the medical record.J Vasc Interv Radiol. 2004; 15: 423-429Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar). KAP is the integral of air kerma across the entire x-ray beam emitted from the x-ray tube. It is a surrogate measurement for the entire amount of energy delivered to the patient by the beam (2Stecker M.S. Balter S. Towbin R.B. et al.Guidelines for patient radiation dose management.J Vasc Interv Radiol. 2009; 20: S263-S273Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar). It is commonly used as a proxy for the risk of stochastic effects (4Tsapaki V. Ahmed N.A. AlSuwaidi J.S. et al.Radiation exposure to patients during interventional procedures in 20 countries: initial IAEA project results.AJR Am J Roentgenol. 2009; 193: 559-569Crossref PubMed Scopus (90) Google Scholar, 5Vano E. Sanchez R. Fernandez J.M. et al.Patient dose reference levels for interventional radiology: a national approach.Cardiovasc Intervent Radiol. 2009; 32: 19-24Crossref PubMed Scopus (53) Google Scholar). It is a more appropriate measure of patient radiation dose than fluoroscopy time. The authors demonstrated significant differences in fluoroscopy time and number of angiographic images between the unilateral and bilateral access techniques, but no difference in KAP. How is this possible? It is difficult to be certain without observing the operators performing procedures of each type, but I can offer a likely explanation. KAP is the product of the air kerma (without backscatter) at the radiation field and the area of the radiation field. Decreasing the size of the radiation field by 50% will decrease KAP by 50% if all other factors are unchanged. The authors are experienced interventional radiologists, and aware of the importance of collimation. I suspect that, when the bilateral access technique was used, the radiation field was coned to include both uterine arteries, but when the unilateral access technique was used, each radiation field was coned to half that size to limit the field to one uterine artery. Thus, imaging each uterine artery separately would yield approximately the same KAP as imaging both uterine arteries together. The important point is that KAP is the appropriate metric for estimating the risk of stochastic effects. Fluoroscopy time and the number of angiographic images are not appropriate metrics. Because Costantino et al (1Costantino M. Lee J. McCullough M. Nsouli-Maktabi H. Spies J.B. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial.J Vasc Interv Radiol. 2010; 21: 829-835Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar) were not able to demonstrate a difference in KAP between the two methods they investigated, they did not demonstrate a difference in stochastic risk. The data on fluoroscopy time and number of angiographic images are irrelevant in this regard. Regardless of the relative merits of the unilateral and bilateral techniques, Costantino et al (1Costantino M. Lee J. McCullough M. Nsouli-Maktabi H. Spies J.B. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial.J Vasc Interv Radiol. 2010; 21: 829-835Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar) are to be commended for their attention to the importance of optimizing patient radiation dose. Their patients received a mean dose of 130 or 162 Gy·cm2, depending on the technique used, approximately half that of the mean KAP of 298 Gy·cm2 for typical procedures earlier this decade (6Miller D.L. Balter S. Cole P.E. et al.Radiation doses in interventional radiology procedures: The RAD-IR study: part I Overall measures of dose.J Vasc Interv Radiol. 2003; 14: 711-727Abstract Full Text Full Text PDF PubMed Scopus (310) Google Scholar). (Note that there appears to be a misprint in table 2 of this publication (1Costantino M. Lee J. McCullough M. Nsouli-Maktabi H. Spies J.B. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial.J Vasc Interv Radiol. 2010; 21: 829-835Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar)—the Axiom Artis fluoroscope [Siemens, Erlangen, Germany] displays KAP in units of μGy·m2, not μGy/cm2.) Bilateral Versus Unilateral Femoral Access for Uterine Artery Embolization: Results of a Randomized Comparative TrialJournal of Vascular and Interventional RadiologyVol. 21Issue 6PreviewTo determine if uterine embolization via bilateral femoral puncture reduces fluoroscopy time with a similar frequency of puncture site complications compared with unilateral puncture. Full-Text PDF Drs. Constantino et al respondJournal of Vascular and Interventional RadiologyVol. 21Issue 11PreviewWe appreciate Dr. Miller's interest in our research and his very insightful comments. We would agree with many of the points made by Dr. Miller and provide the following additional thoughts. Full-Text PDF" @default.
• W1984600546 created "2016-06-24" @default.
• W1984600546 creator A5009578430 @default.
• W1984600546 date "2010-11-01" @default.
• W1984600546 modified "2023-09-27" @default.
• W1984600546 title "Re: Bilateral versus Unilateral Femoral Access for Uterine Artery Embolization—Results of a Randomized Comparative Trial" @default.
• W1984600546 cites W2003687704 @default.
• W1984600546 cites W2013506546 @default.
• W1984600546 cites W2058406656 @default.
• W1984600546 cites W2119099821 @default.
• W1984600546 cites W2119608252 @default.
• W1984600546 cites W2146902849 @default.
• W1984600546 doi "https://doi.org/10.1016/j.jvir.2010.07.015" @default.
• W1984600546 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21029952" @default.
• W1984600546 hasPublicationYear "2010" @default.
• W1984600546 type Work @default.
• W1984600546 sameAs 1984600546 @default.
• W1984600546 citedByCount "0" @default.
• W1984600546 crossrefType "journal-article" @default.
• W1984600546 hasAuthorship W1984600546A5009578430 @default.
• W1984600546 hasBestOaLocation W19846005461 @default.
• W1984600546 hasConcept C126838900 @default.
• W1984600546 hasConcept C141071460 @default.
• W1984600546 hasConcept C168563851 @default.
• W1984600546 hasConcept C2776035437 @default.
• W1984600546 hasConcept C2779607476 @default.
• W1984600546 hasConcept C2779723990 @default.
• W1984600546 hasConcept C71924100 @default.
• W1984600546 hasConceptScore W1984600546C126838900 @default.
• W1984600546 hasConceptScore W1984600546C141071460 @default.
• W1984600546 hasConceptScore W1984600546C168563851 @default.
• W1984600546 hasConceptScore W1984600546C2776035437 @default.
• W1984600546 hasConceptScore W1984600546C2779607476 @default.
• W1984600546 hasConceptScore W1984600546C2779723990 @default.
• W1984600546 hasConceptScore W1984600546C71924100 @default.
• W1984600546 hasIssue "11" @default.
• W1984600546 hasLocation W19846005461 @default.
• W1984600546 hasLocation W19846005462 @default.
• W1984600546 hasOpenAccess W1984600546 @default.
• W1984600546 hasPrimaryLocation W19846005461 @default.
• W1984600546 hasRelatedWork W2073309540 @default.
• W1984600546 hasRelatedWork W2093619131 @default.
• W1984600546 hasRelatedWork W2136422970 @default.
• W1984600546 hasRelatedWork W2347429623 @default.
• W1984600546 hasRelatedWork W2349237910 @default.
• W1984600546 hasRelatedWork W2352010740 @default.
• W1984600546 hasRelatedWork W2373171152 @default.
• W1984600546 hasRelatedWork W2373393772 @default.
• W1984600546 hasRelatedWork W2394995151 @default.
• W1984600546 hasRelatedWork W2434081275 @default.
• W1984600546 hasVolume "21" @default.
• W1984600546 isParatext "false" @default.
• W1984600546 isRetracted "false" @default.
• W1984600546 magId "1984600546" @default.
• W1984600546 workType "article" @default.