PD40-11 COMPARING RADIATION DOSE AND IMAGE QUALITY IN THREE DIFFERENT FLAT-PANEL DETECTOR C-ARMS DURING SIMULATED PCNL (2022)

You have accessJournal of UrologyCME1 May 2022PD40-11 COMPARING RADIATION DOSE AND IMAGE QUALITY IN THREE DIFFERENT FLAT-PANEL DETECTOR C-ARMS DURING SIMULATED PCNL Daniel R. Peverini, Akin S. Amasyali, Avi Assidon, Ricky Chen, John C. Hartman, Eun Hye Joo, Catalina Baas, Cayde Ritchie, Joshua D. Belle, Elizabeth Baldwin, and D. Duane Baldwin Daniel R. PeveriniDaniel R. Peverini More articles by this author , Akin S. AmasyaliAkin S. Amasyali More articles by this author , Avi AssidonAvi Assidon More articles by this author , Ricky ChenRicky Chen More articles by this author , John C. HartmanJohn C. Hartman More articles by this author , Eun Hye JooEun Hye Joo More articles by this author , Catalina BaasCatalina Baas More articles by this author , Cayde RitchieCayde Ritchie More articles by this author , Joshua D. BelleJoshua D. Belle More articles by this author , Elizabeth BaldwinElizabeth Baldwin More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002601.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Flat-Panel Detector C-arms (FPDs) are reported to reduce radiation exposure and improve image quality compared to conventional image intensifier C-arms. Because FPDs employ proprietary designs, radiation doses and image quality may differ between manufacturers. The purpose of this study was to compare radiation exposure and image quality between three FPD manufacturers. METHODS: A male cadaver (BMI=33.4) was placed prone on an operating table to simulate percutaneous nephrolithotomy (PCNL). For each trial, three optically stimulated luminescence dosimeters (OSLDs) were placed on the cadaver skin: one ventrally overlying the renal pelvis and two dorsally overlying the upper and lower kidney poles. FPDs from three manufacturers (GE, Philips, and Ziehm) were positioned to maintain 35.5 cm between the source and the bottom of the operating table. For each FPD, five trials were conducted under three different conditions: automatic exposure control (AEC), AEC with low-dose (LD), and low-dose with lowest pulse rate (LDLP). Each trial applied 300 seconds of radiation. Radiation doses were measured using a Landauer microStar OSLD reader. 10 blinded urologists (5 attendings and 5 residents) completed a survey of image quality. Results were analyzed using ANOVA and Tukey’s B post-hoc analysis. RESULTS: At the AEC setting, the Philips C-arm produced significantly less exposure to the ventral OSLD than both GE and Ziehm (42,446 vs. 51,076 vs. 83,178 mrad, p<0.001, respectively). Similarly, at the LD setting, the Philips C-arm produced significantly less exposure to the ventral OSLD than both GE and Ziehm (25,926 vs. 30,956 vs. 38,209 mrad, p<0.001, respectively). At the LDLP setting, the Ziehm C-arm produced significantly less exposure to the ventral OSLD than both GE and Philips (4,019 vs. 7,418 vs. 8,229 mrad, p<0.001, respectively). Under all three conditions, dorsal OSLD exposures paralleled ventral exposures. At all three settings, the GE C-arm had the highest image quality, but image quality was rated adequate for clinical procedures at AEC and LD settings in all three manufacturers. At LDLP, the Ziehm C-arm was rated inadequate in 8% of images, compared to 0% of GE and 0% of Philips (p=0.016). CONCLUSIONS: Radiation produced by flat-panel C-arms varies dramatically, with the highest exposure (Ziehm) being almost double the lowest (Philips) in AEC. Improved picture quality may come at the cost of increased radiation dose. Surgeons must use care to select the device and settings to minimize radiation exposure while still maintaining adequate image quality. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e687 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel R. Peverini More articles by this author Akin S. Amasyali More articles by this author Avi Assidon More articles by this author Ricky Chen More articles by this author John C. Hartman More articles by this author Eun Hye Joo More articles by this author Catalina Baas More articles by this author Cayde Ritchie More articles by this author Joshua D. Belle More articles by this author Elizabeth Baldwin More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...