Intraoperative patient radiation dose from cone-beam computed tomography in thoracic surgery

Abstract Background Several methods can be used to intraoperatively identify pulmonary lesion using radiation technology. However, little is known about patient radiation exposure during chest surgery. We aimed to measure patients’ radiation exposure from cone-beam computed tomography (CBCT) used in...

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Main Authors: Shinya Kohmaru, Yuichi Saito, Takeshi Takata, Shizuka Morita, Ryo Takeyama, Yasuyuki Kanamoto, Tomoki Nishida, Hitoshi Dejima, Yoshikane Yamauchi, Ikuo Kobayashi, Masafumi Kawamura, Yukinori Sakao
Format: Article
Language:English
Published: BMC 2024-12-01
Series:Journal of Cardiothoracic Surgery
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Online Access:https://doi.org/10.1186/s13019-024-03182-z
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author Shinya Kohmaru
Yuichi Saito
Takeshi Takata
Shizuka Morita
Ryo Takeyama
Yasuyuki Kanamoto
Tomoki Nishida
Hitoshi Dejima
Yoshikane Yamauchi
Ikuo Kobayashi
Masafumi Kawamura
Yukinori Sakao
author_facet Shinya Kohmaru
Yuichi Saito
Takeshi Takata
Shizuka Morita
Ryo Takeyama
Yasuyuki Kanamoto
Tomoki Nishida
Hitoshi Dejima
Yoshikane Yamauchi
Ikuo Kobayashi
Masafumi Kawamura
Yukinori Sakao
author_sort Shinya Kohmaru
collection DOAJ
description Abstract Background Several methods can be used to intraoperatively identify pulmonary lesion using radiation technology. However, little is known about patient radiation exposure during chest surgery. We aimed to measure patients’ radiation exposure from cone-beam computed tomography (CBCT) used in a hybrid operating room. Methods This retrospective study included patients who underwent surgical treatment in a hybrid operating room between April 2019 and December 2023 at the Teikyo University Hospital. All data was obtained prospectively, but the study was approved by the IRB as a retrospective study because of repeated extensions of study period in order to collect more cases. Skin radiation exposure was measured using five wearable dosimeters per patient. The measurements were compared to cumulative Air Kerma. Furthermore, the radiation exposure dose on the surgical side, which cannot be measured, was estimated by computer simulation. Results Among 182 patients who underwent surgery in a hybrid operating room, radiation exposure measurements were conducted on 67 patients. The patients’ mean age was 60.7 years. The average number of CBCT scans was 2.1 (1–5) and the intraoperative identification rate was 100%, with no marking-related complications. Average patient’s skin radiation dose was 3.69 ± 5.48 mGy per dosimeter, and cumulative Air Kerma was 25.4 ± 19.3 mGy. The highest radiation exposure was recorded in the 5th intercostal space whereas the lowest was measured in the supraclavicular or 11th intercostal spaces. Referring to phantom and computer simulation data, the 5th and 8th intercostal spaces were significantly more exposed to radiation at not only measurement side but also the surgical field, particularly when the number of CT scans was four. Conclusion We found that the patient’s 5th to 8th intercostal space was the most radiation exposed area by intraoperative CBCT imaging because the CBCT movement was restricted by the patient’s arm, anesthesia machine, and operating table during chest surgery. In future, it is strongly required to research for radiation protection in this area. Furthermore, performing no more than three scans intraoperatively may be preferable in order to protect patients from radiation exposure during CBCT guided thoracic surgery.
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series Journal of Cardiothoracic Surgery
spelling doaj-art-cdc587c5d8834b5c9b76eee0fa90f5b12024-12-22T12:47:16ZengBMCJournal of Cardiothoracic Surgery1749-80902024-12-0119111110.1186/s13019-024-03182-zIntraoperative patient radiation dose from cone-beam computed tomography in thoracic surgeryShinya Kohmaru0Yuichi Saito1Takeshi Takata2Shizuka Morita3Ryo Takeyama4Yasuyuki Kanamoto5Tomoki Nishida6Hitoshi Dejima7Yoshikane Yamauchi8Ikuo Kobayashi9Masafumi Kawamura10Yukinori Sakao11Department of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineAdvanced Comprehensive Research Organization, Teikyo UniversityDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineDepartment of Surgery, Teikyo University School of MedicineResearch Institute of Nuclear Engineering, University of FukuiTeikyo University Shinjuku ClinicDepartment of Surgery, Teikyo University School of MedicineAbstract Background Several methods can be used to intraoperatively identify pulmonary lesion using radiation technology. However, little is known about patient radiation exposure during chest surgery. We aimed to measure patients’ radiation exposure from cone-beam computed tomography (CBCT) used in a hybrid operating room. Methods This retrospective study included patients who underwent surgical treatment in a hybrid operating room between April 2019 and December 2023 at the Teikyo University Hospital. All data was obtained prospectively, but the study was approved by the IRB as a retrospective study because of repeated extensions of study period in order to collect more cases. Skin radiation exposure was measured using five wearable dosimeters per patient. The measurements were compared to cumulative Air Kerma. Furthermore, the radiation exposure dose on the surgical side, which cannot be measured, was estimated by computer simulation. Results Among 182 patients who underwent surgery in a hybrid operating room, radiation exposure measurements were conducted on 67 patients. The patients’ mean age was 60.7 years. The average number of CBCT scans was 2.1 (1–5) and the intraoperative identification rate was 100%, with no marking-related complications. Average patient’s skin radiation dose was 3.69 ± 5.48 mGy per dosimeter, and cumulative Air Kerma was 25.4 ± 19.3 mGy. The highest radiation exposure was recorded in the 5th intercostal space whereas the lowest was measured in the supraclavicular or 11th intercostal spaces. Referring to phantom and computer simulation data, the 5th and 8th intercostal spaces were significantly more exposed to radiation at not only measurement side but also the surgical field, particularly when the number of CT scans was four. Conclusion We found that the patient’s 5th to 8th intercostal space was the most radiation exposed area by intraoperative CBCT imaging because the CBCT movement was restricted by the patient’s arm, anesthesia machine, and operating table during chest surgery. In future, it is strongly required to research for radiation protection in this area. Furthermore, performing no more than three scans intraoperatively may be preferable in order to protect patients from radiation exposure during CBCT guided thoracic surgery.https://doi.org/10.1186/s13019-024-03182-zCone-beam computed tomographyNavigation surgeryRadiation exposureSmall lung cancerVideo-assisted thoracoscopic surgery
spellingShingle Shinya Kohmaru
Yuichi Saito
Takeshi Takata
Shizuka Morita
Ryo Takeyama
Yasuyuki Kanamoto
Tomoki Nishida
Hitoshi Dejima
Yoshikane Yamauchi
Ikuo Kobayashi
Masafumi Kawamura
Yukinori Sakao
Intraoperative patient radiation dose from cone-beam computed tomography in thoracic surgery
Journal of Cardiothoracic Surgery
Cone-beam computed tomography
Navigation surgery
Radiation exposure
Small lung cancer
Video-assisted thoracoscopic surgery
title Intraoperative patient radiation dose from cone-beam computed tomography in thoracic surgery
title_full Intraoperative patient radiation dose from cone-beam computed tomography in thoracic surgery
title_fullStr Intraoperative patient radiation dose from cone-beam computed tomography in thoracic surgery
title_full_unstemmed Intraoperative patient radiation dose from cone-beam computed tomography in thoracic surgery
title_short Intraoperative patient radiation dose from cone-beam computed tomography in thoracic surgery
title_sort intraoperative patient radiation dose from cone beam computed tomography in thoracic surgery
topic Cone-beam computed tomography
Navigation surgery
Radiation exposure
Small lung cancer
Video-assisted thoracoscopic surgery
url https://doi.org/10.1186/s13019-024-03182-z
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