Television fluoroscopy--a necessity or an unsupportable luxury?
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Transbronchial lung biopsy under fluoroscopic guidance was attempted in 14 patients with discrete peripheral lesions and histological evidence of pathology was obtained in five (37.7%). The difficulties and limitations of the procedure are discussed. The radiation hazard to both patient and bronchoscope are assessed. From this study it is concluded that aspiration needle biopsy is preferred in the investigation of patients with peripheral lung lesions.
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In order to investigate the levels of radiation exposure resulting from fluoroscopic examinations, area-exposure product measurements were performed on 6532 patients whilst undergoing a variety of examinations at a large district general hospital. Results for both the same and different types of examinations, performed in two different X-ray rooms by a number of different radiologists, are compared in order to highlight some of the factors which influence the wide variations in patient exposure which frequently occur in radiological examinations. Variations in exposure of patients of different weights are also presented.
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The protocol for image intensifier (II) quality assurance recommended by the UK Hospital Physicists' Association (HPA) and the UK Department of Health and Social Security has been adapted for use in New Zealand for assessment of such systems. Test objects were constructed at the National Radiation Laboratory to match the specifications of those recommended by the HPA. Over 100 individual surveys have been made and, in a few cases, machines have been surveyed several times. Results are summarized in terms of key parameters: II input dose rate, low-contrast detectability, contrast-detail performance and limiting resolution. These are given as mean and standard deviation, and also as good, average or poor. Video waveforms, conversion factors and modulation transfer functions have also been determined on a number of systems. In several cases, video voltages were found to be seriously maladjusted.
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Doses to the salivary glands, thyroid gland, breast, lung, stomach and colon during mass radiological gastric screening, mass radiographic chest screening, upper gastrointestinal series and computed tomography were determined by exposing a female human phantom to simulated radiological X-ray examinations as performed in community hospitals. The doses were measured using thermoluminescent dosimeters, and the results will be used to document organ doses received by participants in the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation Adult Health Study.
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Since doses to skin of patients from fluoroscopically-guided interventional procedures can be very high, real-time monitoring of skin dose is important for both patient management and quality control. The use of a scintillation detector, placed on the X-ray port to measure potential skin dose, was investigated, focusing on the uncertainties related to the technique. Sources of uncertainty include performance characteristics of the dosemeter, errors in calibration, patient set-up and changes during the procedure. Some of the largest sources of error include uncertainty in source-to-skin distance, heel effect, difficulty in identifying the area of skin principally exposed, calibration error, energy dependence of the dosemeter and the dose rate dependence of the monitor. This technique is found to be beneficial for radiation management, but users must be cognizant of the potential errors of the method and the limitations that these place on quality control and patient management. Knowing the limitations and minimizing the sources of error enhance the utility of the technique.
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