Rofo 2017; 189(09): 820-827
DOI: 10.1055/s-0043-109690
Interventional Radiology
© Georg Thieme Verlag KG Stuttgart · New York

Analysis of Patients’ X-ray Exposure in 146 Percutaneous Radiologic Gastrostomies

Article in several languages: English | deutsch
Tim-Ole Petersen
,
Martin Reinhardt
,
Jochen Fuchs
,
Dieter Gosch
,
Alexey Surov
,
Patrick Stumpp
,
Thomas Kahn
,
Michael Moche
Further Information

Publication History

03 January 2017

10 April 2017

Publication Date:
13 June 2017 (online)

Abstract

Purpose Analysis of patient´s X-ray exposure during percutaneous radiologic gastrostomies (PRG) in a larger population.

Materials and Methods Data of primary successful PRG-procedures, performed between 2004 and 2015 in 146 patients, were analyzed regarding the exposition to X-ray. Dose-area-product (DAP), dose-length-product (DLP) respectively, and fluoroscopy time (FT) were correlated with the used x-ray systems (Flatpanel Detector (FD) vs. Image Itensifier (BV)) and the necessity for periprocedural placement of a nasogastric tube. Additionally, the effective X-ray dose for PRG placement using fluoroscopy (DL), computed tomography (CT), and cone beam CT (CBCT) was estimated using a conversion factor.

Results The median DFP of PRG-placements under fluoroscopy was 163 cGy*cm2 (flat panel detector systems: 155 cGy*cm2; X-ray image intensifier: 175 cGy*cm2). The median DLZ was 2.2 min. Intraprocedural placement of a naso- or orogastric probe (n = 68) resulted in a significant prolongation of the median DLZ to 2.5 min versus 2 min in patients with an already existing probe. In addition, dose values were analyzed in smaller samples of patients in which the PRG was placed under CBCT (n = 7, median DFP = 2635 cGy*cm2), or using CT (n = 4, median DLP = 657 mGy*cm). Estimates of the median DFP and DLP showed effective doses of 0.3 mSv for DL-assisted placements (flat panel detector 0.3 mSv, X-ray image converter 0.4 mSv), 7.9 mSv using a CBCT – flat detector, and 9.9 mSv using CT. This corresponds to a factor 26 of DL versus CBCT, or a factor 33 of DL versus CT.

Conclusion In order to minimize X-ray exposure during PRG-procedures for patients and staff, fluoroscopically-guided interventions should employ flat detector systems with short transmittance sequences in low dose mode and with slow image frequency. Series recordings can be dispensed with. The intraprocedural placement of a naso- or orogastric probe significantly extends FT, but has little effect on the overall dose of the intervention. Due to the significantly higher X-ray exposure, the use of a CBCT as well as PRG-placements using CT should be limited to clinically absolutely necessary exceptions with strict indication.

Key Points

  • Fluoroscopically-guided PRG placements are interventions with low X-ray exposure.

  • X-ray exposure from fluoroscopy is lower using flat panel detector systems as compared to image intensifier systems.

  • The concomitant placement of an oro- or nasogastric probe extends the fluoroscopy time.

  • Gastric probe placement is worthwhile to prevent the premature use of the significantly radiation-intensive CT.

  • The use of the C-arm CT or the CT increases the beam exposure by 26 or 33 times, respectively.

  • The PRG placement using C-arm CT and CT should only be performed in exceptional cases.

Citation Format

  • Petersen TO, Reinhardt M, Fuchs J et al. Analysis of Patients’ X-ray Exposure in 146 Percutaneous Radiologic Gastrostomies. Fortschr Röntgenstr 2017; 189: 820 – 827

 
  • References

  • 1 Preshaw RM. A percutaneous method for inserting a feeding gastrostomy tube. Surg Gynecol Obstet 1981; 152: 658-660
  • 2 de Baere T, Chapot R, Kuoch V. et al. Percutaneous gastrostomy with fluoroscopic guidance: single-center experience in 500 consecutive cancer patients. Radiology 1999; 210: 651-654
  • 3 Perona F, Castellazzi G, De Iuliis A. et al. Percutaneous Radiologic Gastrostomy: A 12-Year Series. Gut Liver 2010; 4: 44-49
  • 4 Wollman B, D’Agostino HB. Percutaneous radiologic and endoscopic gastrostomy: a 3-year institutional analysis of procedure performance. Am J Roentgenol 1997; 169: 1551-1553
  • 5 Silas AM, Pearce LF, Lestina LS. et al. Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: A comparison of indications, complications and outcomes in 370 patients. Eur J Radiol 2005; 56: 84-90
  • 6 Lang EK, Allaei A, Abbey-Mensah G. et al. Percutaneous radiologic gastrostomy: results and analysis of factors contributing to complications. J La State Med Soc 2013; 165: 254-259
  • 7 Ho SGF, Marchinkow LO, Legiehn GM. et al. Radiological Percutaneous Gastrostomy. Clin Radiol 2001; 56: 902-910
  • 8 Lowe AS, Laasch HU, Stephenson S. et al. Multicentre survey of radiologically inserted gastrostomy feeding tube (RIG) in the UK. Clin Radiol 2012; 67: 843-854
  • 9 Kloeckner R, Bersch A, dos Santos DP. et al. Radiation Exposure in Nonvascular Fluoroscopy-Guided Interventional Procedures. Cardiovasc Intervent Radiol 2012; 35: 613-620
  • 10 Baumann F, Katzen BT, Carelsen B. et al. The Effect of Realtime Monitoring on Dose Exposure to Staff Within an Interventional Radiology Setting. Cardiovasc Intervent Radiol 2015; 38: 1105-1111
  • 11 Thornton FJ, Fotheringham T, Haslam PJ. et al. Percutaneous Radiologic Gastrostomy With and Without T-Fastener Gastropexy: A Randomized Comparison Study. Cardiovasc Intervent Radiol 2002; 25: 467-471
  • 12 Mildenberger P, Oberholzer K, Kauczor HU. et al. Radiologically assisted percutaneous gastro-/enterostomy- a retrospective analysis of 90 procedures. Fortschr Röntgenstr 1996; 165: 74-79
  • 13 Thornton FJ, Fotheringham T, Alexander M. et al. Amyotrophic Lateral Sclerosis: Enteral Nutrition Provision – Endoscopic or Radiologic Gastrostomy?. Radiology 2002; 224: 713-717
  • 14 Chio A. Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS. J Neurol Neurosurg Psychiatry 2004; 75: 645-647
  • 15 Dorst J, Dupuis L, Petri S. et al. Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: a prospective observational study. J Neurol 2015; 262: 849-858
  • 16 Shin JH, Park AW. Updates on Percutaneous Radiologic Gastrostomy/Gastrojejunostomy and Jejunostomy. Gut Liver 2010; 4: 25-31
  • 17 Gosch D, Gosch K, Kahn T. Conversion coefficients for estimation of effective dose to patients from dose area product during fluoroscopy x-ray examinations. Fortschr Röntgenstr 2007; 179: 1035-1042
  • 18 Suzuki S, Furui S, Yamaguchi I. et al. Effective Dose during Abdominal Three-dimensional Imaging with a Flat-Panel Detector Angiography System. Radiology 2009; 250: 545-550
  • 19 Bongartz G, Golding SJ, Jurik AG. et al. European Guidelines for Multislice Computed Tomography. 2004
  • 20 Miraglia R, Maruzzelli L, Tuzzolino F. et al. Radiation Exposure in Biliary Procedures Performed to Manage Anastomotic Strictures in Pediatric Liver Transplant Recipients: Comparison Between Radiation Exposure Levels Using an Image Intensifier and a Flat-Panel Detector-Based System. Cardiovasc Intervent Radiol 2013; 36: 1670-1676
  • 21 Kuon E, Robinson DM, Empen K. et al. Fluoroscopy Time – An Overestimated Factor for Patient Radiation Exposure in Invasive Cardiology. Fortschr Röntgenstr 2005; 177: 812-817
  • 22 Bapst B, Lagadec M, Breguet R. et al. Cone Beam Computed Tomography (CBCT) in the Field of Interventional Oncology of the Liver. Cardiovasc Intervent Radiol 2016; 39: 8-20
  • 23 Möhlenbruch M, Nelles M, Thomas D. et al. Cone-Beam Computed Tomography–Guided Percutaneous Radiologic Gastrostomy. Cardiovasc Intervent Radiol 2010; 33: 315-320
  • 24 de Bucourt M, Collettini F, Althoff C. et al. CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients. Acta Radiol 2012; 53: 285-291
  • 25 Gottschalk A, Strotzer M, Feuerbach S. et al. CT-Guided Percutaneous Gastrostomy: Success Rate, Early and Late Complications. Fortschr Röntgenstr 2007; 179: 387-395
  • 26 Tamura A, Kato K, Suzuki M. et al. CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients. Cardiovasc Intervent Radiol 2016; 39: 271-278
  • 27 Tröltzsch M, Waurick C. Percutaneous sonographic gastrostomy. Fortschr Röntgenstr 1993; 158: 487-489
  • 28 Klek S, Hermanowicz A, Salowka J. et al. Ultrasound-guided percutaneous’ push-introducer’gastrostomy is a valuable method for accessing the gastrointestinal tract. Nutr Hosp 2014; 29: 365-369
  • 29 Gubler C, Bauerfeind P, Vavricka S. et al. Bedside sonographic control for positioning enteral feeding tubes: a controlled study in intensive care unit patients. Endoscopy 2006; 38: 1256-1260
  • 30 Wu TS, Leech SJ, Rosenberg M. et al. Ultrasound Can Accurately Guide Gastrostomy Tube Replacement and Confirm Proper Tube Placement at the Bedside. J Emerg Med 2009; 36: 280-284