Abstract
Introduction: Endobronchial radiofrequency ablation (RFA) is a novel minimally invasive approach to management of peripheral non-small-cell lung cancer (NSCLC) in medically inoperable patients. Minimally invasive ablative techniques are generally delivered with cone-beam computed tomography (CBCT) guidance. CBCT requires a significant number of two dimensional imaging projections to be acquired which is then reconstructed as a three-dimensional cone-beam image. The objective of this study was to determine the radiation dosimetry consequent to use of CBCT guidance for bronchoscopic RFA. Methods: Post hoc analysis of data following bronchoscopic RFA of stage I biopsy-confirmed NSCLC performed with CBCT. Effective dose estimates for these patients were calculated using PCXMC2.0 software. Results: Ten patients underwent bronchoscopic RFA, with a median 3 (range 2–4) CBCT spins per procedure. Mean dose area product (DAP) per procedure was 7,778 μGy.m2 (±4,743) with an effective dose of 11.6 mSv (±7.4). The DAP per spin for these 10 patients varied from 83.8 to 8,625.6 μGy.m2 (effective dose range 0.15–13.81 mSv). Conclusion: This is the first study to report radiation dosimetry consequent to CT guidance for bronchoscopic RFA procedures. Effective doses appear comparable to other CT fluoroscopic procedures.
Journal Section:
Interventional Pulmonology
References
1.
Sung
H
, Ferlay
J
, Siegel
RL
, Laversanne
M
, Soerjomataram
I
, Jemal
A
, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries
. CA Cancer J Clin
. 2021
;71
(3
):209
–49
. 2.
Howington
JA
, Blum
MG
, Chang
AC
, Balekian
AA
, Murthy
SC
. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines
. Am Coll Chest Physicians Evid Based Clin Pract Guidel Chest
. 2013
;143
(5 Suppl l
):e278S
–313S
. 3.
Gressen
EL
, Curran
WJ
Jr.. Inoperable localized stage I and stage II non-small-cell lung cancer
. Curr Treat Options Oncol
. 2002
;3
(1
):75
–83
. 4.
Steinfort
DP
, Herth
FJF
. Bronchoscopic treatments for early-stage peripheral lung cancer: are we ready for prime time
. Respirology
. 2020
;25
(9
):944
–52
. 5.
Tsalafoutas
IA
, Tsapaki
V
, Triantopoulou
C
, Gorantonaki
A
, Papailiou
J
. CT-guided interventional procedures without CT fluoroscopy assistance: patient effective dose and absorbed dose considerations
. AJR Am J Roentgenol
. 2007
;188
(6
):1479
–84
. 6.
Morrish
OW
, Goldstone
KE
. An investigation into patient and staff doses from X-ray angiography during coronary interventional procedures
. Br J Radiol
. 2008
;81
(961
):35
–45
. 7.
Verhoeven
RLJ
, van der Sterren
W
, Kong
W
, Langereis
S
, van der Tol
P
, van der Heijden
EHFM
. Cone-beam CT and augmented fluoroscopy-guided navigation bronchoscopy: radiation exposure and diagnostic accuracy learning curves
. J Bronchology Interv Pulmonol
. 2021
;28
(4
):262
–71
. 8.
Steinfort
DP
, D’Agostino
RD
, Vrjlic
I
, Einsiedel
P
, Prasad
JD
, Jennings
BR
, et al. CT-fluoroscopic guidance for performance of targeted transbronchial cryobiopsy: a preliminary report
. Respiration
. 2018
;96
(5
):472
–9
. 9.
Steinfort
DP
, Antippa
P
, Rangamuwa
K
, Irving
LB
, Christie
M
, Chan
E
, et al. Safety and feasibility of a novel externally cooled bronchoscopic radiofrequency ablation catheter for ablation of peripheral lung tumours: a first-in-human dose escalation study
. Respiration
. 2023
;102
(3
):211
–9
. 10.
Tapiovaara
M
, Lakkisto
M
, Servomaa
A
. PCXMC A PC-based Monte Carlo program for calculating patient doses in medical x-ray examinations
. Finland
; 1997
. p. 57
.11.
Amouyal
G
, Pernot
S
, Déan
C
, Cholley
B
, Scotté
F
, Sapoval
M
, et al. Percutaneous radiofrequency ablation of lung metastases from colorectal carcinoma under C-arm cone beam CT guidance
. Diagn Interv Imaging
. 2017
;98
(11
):793
–9
. 12.
Hurwitz
LM
, Reiman
RE
, Yoshizumi
TT
, Goodman
PC
, Toncheva
G
, Nguyen
G
, et al. Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction
. Radiology
. 2007
;245
(3
):742
–50
. 13.
Wall
BF
, Hart
D
. Revised radiation doses for typical X-ray examinations. Report on a recent review of doses to patients from medical X-ray examinations in the UK by NRPB. National Radiological Protection Board
. Br J Radiol
. 1997
;70
(833
):437
–9
. 14.
Regulla
DF
, Eder
H
. Patient exposure in medical X-ray imaging in Europe
. Radiat Prot Dosimetry
. 2005
;114
(1–3
):11
–25
. 15.
Steinfort
DP
, Einsiedel
P
, Irving
LB
. Radiation dose to patients and clinicians during fluoroscopically-guided biopsy of peripheral pulmonary lesions
. Respir Care
. 2010
;55
(11
):1469
–74
.16.
ARPANSA
. Ionising radiation and Health: Australian radiation protection and nuclear safety agency
. 2015
. [cited 2023].17.
Brenner
DJ
. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer
. Radiology
. 2004
;231
(2
):440
–5
. 18.
Xiang
ZJ
, Wang
Y
, Du
EF
, Xu
L
, Jiang
B
, Li
H
, et al. The value of Cone-Beam CT-guided radiofrequency ablation in the treatment of pulmonary malignancies (≤3 cm)
. Biosci Rep
. 2019
;39
(2
). 19.
Salahuddin
M
, Bashour
SI
, Khan
A
, Chintalapani
G
, Kleinszig
G
, Casal
RF
. Mobile cone-beam CT-assisted bronchoscopy for peripheral lung lesions
. Diagnostics
. 2023
;13
(5
):827
. 20.
Zhang
HM
, Huo
XB
, Wang
HL
, Zhang
X
, Fu
YF
. Computed tomography-guided cutting needle biopsy for lung nodules: a comparative study between low-dose and standard dose protocols
. Medicine
. 2021
;100
(3
):e24001
. 21.
Tsang
MW
. Stereotactic body radiotherapy: current strategies and future development
. J Thorac Dis
. 2016
;8
(Suppl 6
):S517
–27
. 22.
Wei
J
, Meng
L
, Hou
X
, Qu
C
, Wang
B
, Xin
Y
, et al. Radiation-induced skin reactions: mechanism and treatment
. Cancer Manag Res
. 2019
;11
:167
–77
. 23.
Little
MP
. Comparison of the risks of cancer incidence and mortality following radiation therapy for benign and malignant disease with the cancer risks observed in the Japanese A-bomb survivors
. Int J Radiat Biol
. 2001
;77
(4
):431
–64
. © 2024 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2024
You do not currently have access to this content.
