Andreas Patz

Clinical Marketing Manager VL

Toshiba Medical Systems Europe

DoseRite - Philosophy

Dose

Awareness

Dose

Saving

Bringing things together that belong together.

Interventional procedures have become more & more complex

which results in a significant prolongation of the fluoroscopic time

during a procedure.

DoseRite – Dose Saving Technology

DoseRite – Dose Saving Technology

Various dose saving techniques have been developed over the

years and belong to the standard configuration of an

interventional system nowadays.

Pulsed Fluoro

Variable dose rates

Variable pulse/frame rates

Virtual collimation

Advanced denoising algorithms

Flatpanel Technology

Adaptive Cu filtration

Fluoro store techniques

Etc.

Smart Magnification

DoseRite – Smart Magnification

FOV 30 = Mag 0 FOV 25 = Mag 1 FOV 20 = Mag 2 FOV 15 = Mag 3

FPD Dose =100 % FPD Dose =128% FPD Dose =158% FPD Dose =175%

FOV 11 = Mag 4 FOV 8 = Mag 5

FPD Dose =195% FPD Dose =215%

Conventional Magnification

FOV 30 = L-Zoom 1.0 Mag 1 = L-Zoom 1.2 Mag 2 = L-Zoom 1.4 Mag 3 = L-Zoom 1.8 Mag 4 = L-Zoom 2.4

FPD Dose =100% FPD Dose =100% FPD Dose =100% FPD Dose =100% FPD Dose =100%

Anatomical Magnification with constant FPD Dose

LIVE Zoom

Anatomical Magnification with increased FPD Dose

FOV Live zoom factor and its equalled FOV size

FPD Dose ratio 1,2 1,4 1,8 2,4

30x30 25x25 21x21 17x17 13x13

100% 100% 100% 100% 100%

25x25 21x21 18x18 14x14 10x10

125% 125% 125% 125% 125%

20x20 17x17 14x14 11x11 8x8

150% 150% 150% 150% 150%

15x15 12,5x 12,5 11x11 8x8 6x6

175% 175% 175% 175% 175%

LIVE Zoom

DoseRite – Smart Magnification

Live zoom factors can be applied to any FOV size

Live zoom is applicable for all acquisition modes such as

Fluoro, DA, DSA, Single Shot

Detector input dose stays constant for all Live Zoom factors

applied to a given FOV

Live Zoom can achieve a markedly reduced skin dose

to the patient

LIVE Zoom

DoseRite – Smart Magnification

Smart Collimation

Collimation is one of the most efficient techniques to save dose for

patients by reducing the anatomical volume to be exposed while reducing

the scatter radiation that hits the Lab staff accordingly

Collimation however has some limitations that limits its great dose saving

potential

anatomical Volume exposed = 100% anatomical Volume exposed ~ 30%

DoseRite – Smart Collimation

No lesion optimized collimation

possible

Leads to an exposure of larger areas

than necessary

Results in higher back scatter

radiation

Negative impact on Patient and

Operators

Current Limitations : # 1 – symmetric collimation

No need to

expose this area

DoseRite – Smart Collimation

Current Limitations: # 2 – loss of information

Blades hide anatomical or device

relevant informations

e.g. Ruler not visible anymore

DoseRite – Smart Collimation

Lesion optimized asymmetric collimation

No exposure of larger areas than necessary

Reduced back scatter radiation

Positive impact on Patient and Operators

Spot Fluoro capabilities

1. asymmetric collimation

DoseRite – Smart Collimation

» Two clinical studies have been performed

» Spot Fluoro dose savings in intracranial aneurysm

coiling procedures – Dr. Ljubisa Borota,Section of

Neuroradiology, University Hospital Uppsala,Sweden

» Spot Fluoro dose savings in electrophysiological

ablation procedures – Dr. Thomas Zerm, Albertinen Hospital

Group Hamburg, Germany

DoseRite – Smart Collimation

• Study results 3. Siginificant difference in total Fluoro Dose Area Product – DAP(cGycm²)

Spot Fluoro leads to a significant reduction of the Dose Area Product!

-55% -71%

Aneurysm coiling PVI Ablation

DoseRite – Smart Collimation

» Study Conclusions

SF is an easy to use function that does not require additional time or

effort to apply

Virtual collimation of any region of interest anywhere in the image is

possible and can be applied to both planes independently

Collimation determines dose savings

SF enables high quality fluoroscopy with up to 50% (mean value!)

reduced dose delivered to the patient and a considerable reduction

of scatter radiation hitting the operator

SF does not cause image quality degradation

No impact on efficacy and safety of the procedure

DoseRite – Smart Collimation

How to increase dose awareness in daily practise?

What kind of dose visualisation would increase your awareness better?

DoseRite – Dose Awareness

numerical Air Kerma graphical skin dose

» Difference Entrance Dose(Air Kerma) vs Skin dose

Air kerma (Entrance Dose) Skin Dose

excludes back scatter radiation includes back scatter radiation

DoseRite – Dose Awareness

» Awareness through real time visualisation

» Dose Tracking System is fully synchronised with C-arm movements, SID/

FOV changes etc.

DoseRite – Dose Awareness

» Dose Tracking- Be aware & act upon facts

» Real Time Dose Tracking helps

to adjust the X-ray technique

in time to avoid skin burn

» Dose report document can be

created

DoseRite – Dose Awareness

Thank you

for your

attention.

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