Bilgisayarlı tomografi ve floroskopi kılavuzluğunda perkütan nefrostomi işlemlerindeki radyasyon maruziyeti için bir retrospektif kıyaslama

Yıl 2021, , 166 - 172, 29.05.2021

Yaşar Türk , İsmail Devecioğlu

https://doi.org/10.29058/mjwbs.852206

Öz

Amaç: Bu çalışmada BT eşliğinde gerçekleştirilen ilk perkütan nefrostomi işleminde ve floroskopi eşliğinde gerçekleştirilen nefrostomi değiştirme işleminde hasta tarafından emilen doz miktarının kıyaslanması amaçlanmıştır.
Gereç ve Yöntem: Bu retrospektif çalışmaya nefrostomi işlemine yönlendirilmiş 89 hidronefroz hasta dahil edilmiştir. Bu hastlardan 75’inde BT eşliğinde ilk defa nefrostomi işlemi gerçekleştirilmiştir. 14 hastada ise floroskopi eşliğinde nefrostomi değitirme işlemi yapılmıştır. Bu işlemler sırasında emilen doz miktarları kıyaslanmıştır.
Bulgular: Gruplar demografik (yaş, cinsiyet ve pataloji) ve işlem parametreler (müdahale tarafı ve komplikasyonlar) açısından istatistiksel farklılık göstermemiştir. Ancak emilen radyasyon doz miktarı açısından iki grup arasında istatistiksel farklılık gözlemlenmiştir. Ortanca emilen radyasyon dozu CT grubunda 1.18 mSv iken, floroskopi grubunda 1.68 mSv olarak tespit dilmiştir. İlk kez gerçekleştirilen BT eşliğinde nefrostomi işlemleri, floroskopi eşliğinde gerçekleştirilen nefrostomi değiştirme işlemlerine kıyasla istatistiksel olarak anlamlı bir şekilde daha düşük radyasyon dozu ile tamamlanmıştır (p < 0.001).
Sonuç: Ultra-düşük-doz ve hızlı BT eşliğinde nefrostomi güvenli, kullanımı kolay, hastaya beklenenden daha düşük doz uygulayan bir işlemdir. Farklı belirtiler gösteren geniş bir yaş aralığındaki hastalar için BT kılvuzluğu, düşük komplikasyon oranı ile nefrostomi yerleştirme için floroskopi’ye göre daha iyi bir alternatiftir.

Anahtar Kelimeler

Nefrostomi, hidronefroz, bilgisayarlı tomografi, floroskopi, radyasyon dozu

A retrospective comparison of computed tomography and fluoroscopic guided percutaneous nephrostomy for evaluating radiation exposure

Öz

Objective: The study aimed to compare the radiation doses absorbed by the patient in first-time percutaneous nephrostomy under CT and nephrostomy replacement under fluoroscopy.
Materials and Methods: 89 hydronephrotic patients referred for nephrostomy were included in this retrospective study. 75 of these patients had the nephrostomy for the first-time under CT-guidance. 14 patients had the nephrostomy replacement operation under fluoroscopy guidance. Absorbed radiation doses were compared between these operations.
Results: The groups showed no statistically significant differences in means of demography (age, sex, and pathology) and operational parameters (intervention side and complications) except the absorbed radiation dose. The median effective radiation doses were 1.18 mSv and 1.68 mSv for CT and fluoroscopy, respectively. The first-time nephrostomy operations under CT were completed with radiation doses significantly lower than those in nephrostomy replacement under fluoroscopy (p < 0.001).
Conclusion: Ultra-low-dose and fast-acting CT-guided nephrostomy is a safe, user-friendly procedure that leads patients to less radiation exposure than expected. CT guidance is a better alternative than fluoroscopy in percutaneous nephrostomy placement with a low complication rate in patients with different indications and a wide age interval.

Anahtar Kelimeler

Nephrostomy, hydronephrosis, computed tomography, fluoroscopy, radiation dose

Kaynakça

• [1] Sood G, Sood A, Jindal A, et al. (2006) Ultrasound guided percutaneous nephrostomy for obstructive uropathy in benign and malignant diseases. International Braz J Urol 32:281–286. https://doi.org/10.1590/S1677-55382006000300004
• [2] Egilmez H, Oztoprak I, Atalar M, et al. (2007) The place of computed tomography as a guidance modality in percutaneous nephrostomy: Analysis of a 10-year single-center experience. Acta Radiologica 48:806–813. https://doi.org/10.1080/02841850701416528
• [3] Dagli M, Ramchandani P (2011) Percutaneous nephrostomy: Technical aspects and indications. Seminars in Interventional Radiology 28:424–437. https://doi.org/10.1055/s-0031-1296085
• [4] LeMaitre L, Mestdagh P, Marecaux-Delomez J, et al. (2000) Percutaneous nephrostomy: Placement under laser guidance and real-time CT fluoroscopy. European Radiology 10:892–895. https://doi.org/10.1007/s003300051030
• [5] Matlaga BR, Shah OD, Zagoria RJ, et al. (2003) Computerized tomography guided access for percutaneous nephrostolithotomy. Journal of Urology. https://doi.org/10.1097/01.ju.0000065288.83961.e3
• [6] Thanos L, Mylona S, Stroumpouli E, et al. (2006) Percutaneous CT-guided nephrostomy: A safe and quick alternative method in management of obstructive and nonobstructive uropathy. Journal of Endourology. https://doi.org/10.1089/end.2006.20.486
• [7] Barbaric ZL, Hall T, Cochran ST, et al. (1997) Percutaneous nephrostomy: Placement under CT and fluoroscopy guidance. American Journal of Roentgenology 169:151–155. https://doi.org/10.2214/ajr.169.1.9207516
• [8] Sommer CM, Huber J, Radeleff BA, et al (2011) Combined CT-and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures. European journal of radiology, 80(3), 686-691.
• [9] Graser A, Johnson TRC, Hecht EM, et al (2009) Dual-energy CT in patients suspected of having renal masses: Can virtual nonenhanced images replace true nonenhanced images? Radiology 252:433–440. https://doi.org/10.1148/radiol.2522080557
• [10] McParland BJ (1998) A study of patient radiation doses in interventional radiological procedures. British Journal of Radiology 71:175–185. https://doi.org/10.1259/bjr.71.842.9579182
• [11] Matlaga BR, Shah OD, Zagoria RJ, Dyer RB, Streem SB, et al. Computerized tomography guided access for percutaneous nephrostolithotomy. Journal of Urology 2003;170:45-47. doi:10.1097/01.ju.0000065288.83961.e3.
• [12] Özden E. Sonography guided percutaneous nephrostomy: Success rates according to the grade of the hydronephrosis. Journal of Ankara Medical School 2002;24:69-72.
• [13] Dyer RB, Regan JD, Kavanagh P V., Khatod EG, Chen MY, et al. Percutaneous nephrostomy with extensions of the technique: Step by step 1. Radiographics 2002;22:503-525. doi:10.1148/radiographics.22.3.g02ma19503.
• [14] Tyng CJ, Almeida MFA, Barbosa PNV, Bitencourt AGV, Berg JAAG, et al. Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis. World Journal of Gastroenterology 2015; 21:3579. doi:10.3748/wjg.v21.i12.3579.
• [15] Gruber-Rouh T, Thalhammer A, Klingebiel T, Nour-Eldin NEA, Vogl TJ, et al. Computed tomography-guided biopsies in children: accuracy, efficiency and dose usage. Italian Journal of Pediatrics 2017; 43:1-6. doi:10.1186/s13052-016-0319-7.
• [16] Liu B, Limback J, Kendall M, Valente M, Armaly J, et al. Safety of CT-Guided Bone Marrow Biopsy in Thrombocytopenic Patients: A Retrospective Review. Journal of Vascular and Interventional Radiology 2017; 28:1727-1731. doi:10.1016/j.jvir.2017.08.009.
• [17] Radecka E, Brehmer M, Holmgren K, Magnusson A. Complications associated with percutaneous nephrolithotripsy: Supra- versus subcostal access. A retrospective study. Acta Radiologica 2003;44:447-451. doi:10.1034/j.1600-0455.2003.00083.x.
• [18] Brook AD, Burns J, Dauer E, Schoendfeld AH, Miller TS. Comparison of CT and fluoroscopic guidance for lumbar puncture in an obese population with prior failed unguided attempt. Journal of NeuroInterventional Surgery 2014;6:323-327. doi:10.1136/neurintsurg-2013-010745.
• [19] Riis J, Lehman RR, Perera RA, Quinn JR, Rinehart P, et al. A retrospective comparison of intraoperative CT and fluoroscopy evaluating radiation exposure in posterior spinal fusions for scoliosis. Patient Safety in Surgery 2017; 11:1-6. doi:10.1186/s13037-017-0142-0.
• [20] Schmid G, Schmitz A, Borchardt D, et al. (2006) Effective dose of CT- and fluoroscopy-guided perineural/epidural injections of the lumbar spine: a comparative study. Cardiovasc Intervent Radiol. 29(1):84-91. doi: 10.1007/s00270-004-0355-3.
• [21] Silverman SG, Tuncali K, Adams DF, Nawfel RD, Zou KH, et al. CT fluoroscopy-guided abdominal interventions: Techniques, results, and radiation exposure. Radiology 1999;212:673-681. doi:10.1148/radiology.212.3.r99se36673.
• [22] Shah V, Hillen T, Jennings J. Comparison of low-dose CT with CT/CT fluoroscopy guidance in percutaneous sacral and supra-acetabular cementoplasty. Diagnostic and Interventional R