A embolização intra-arterial é rotineiramente utilizada na prática clinica como co-adjuvante pré-operatório ou controle de tumores, tratamento de malformações arteriovenosas e outras doenças vasculares. Em vários casos é realizada com uso de partículas de diferentes formas e composições. Um agente embolizante esférico e utilizado com bons resultados é o trisacryl (Embosphere®; BioSphere® Medical). Um novo agente embólico - polivinil acetato esférico cobertas com polivinil álcool (PVAc) foi desenvolvido recentemente no Brasil. Este trabalho tem objetivo de avaliar, após embolização renal, o grau de oclusão vascular, recanalização da luz vascular e a necrose da parede vascular provocados por partículas de PVAc, utilizando como parâmetro partículas de trisacryl. Setenta e nove fêmeas de coelhos do tipo albino New Zealand foram submetidas a cateterização arterial do rim direito; trinta e três animais foram embolizados com trisacryl, trinta e um com PVAc e quinze animais compuseram o grupo de simulação, tendo sido excluídos quatro animais (três trisacryl e um PVAc) devido a óbito precoce. Foram criados cinco subgrupos de seis animais, que foram sacrificados após 48 horas, 5 dias, 10 dias, 30 dias e 90 dias após a embolização. O grupo de simulação seguiu a mesma ordem temporal com três animais em cada grupo. As técnicas de coloração utilizadas foram os métodos de hematoxilina-eosina (HE) e tricrômico de Masson com observação por microscopia óptica. Os resultados mostraram diferença significativa entre o grau de oclusão vascular nos grupos de 5 dias e 10 dias e necrose no grupo de 48 horas em favor do grupo embolizado com PVAc, que apresentou reação tecidual adequada (redução volumétrica e isquemia) e menor grau de recanalização que o trisacryl / Intra-arterial embolization is often utilized in medical practice preoperatively as adjuvant in controlling tumors, treatment of arteriovenous malformations and other vascular diseases. Often times, particles of different forms and compositions are employed. trisacryl (Embosphere®; BioSphere® Medical), a spheric embolic agent, is nowadays used with very satisfactory results. However, a new embolic agent spheric polyvinyl alcohol-covered polivinyl acetate (PVAc)- has been developed in Brazil. This study evaluates the degree of vascular occlusion, vascular recanalization and the necrosis of vascular wall caused by PVAc particles, compared with trisacryl, after renal embolization. Seventy-nine female albine New Zealand rabbits underwent arterial catheterization of the right kidney; Thirty-three animals were embolized with trisacryl, thirty-one with PVAc and fifteen were kept as control group, four animals were excluded (three trisacryl and one PVAc) due to early death. Five subgroups of six animals were created. The animals in the different groups were sacrificed 48 hours, 5 days, 10 days, 30 days and 90 days after embolization. The control group was divided into subgroups of three animals, for the same period of time. Their kidneys were dyed with hematoxylin-eosin (HE) and Masson tricromic and examined using optic microscopy. The results showed a significant difference between the five-day and ten-day groups with regard to the degree of vascular occlusion, and the amount of necrosis in the forty-eight-hour group. Both findings favor the PVAc group, with adequate tissue reaction (ischemia and volumetric reduction) and less recanalization than with trisacryl

La prévention des effets biologiques radio-induits en radiologie interventionnelle nécessite une estimation complète de l’exposition à la peau et aux organes du patient. Dans ce contexte, un logiciel permettant une reconstruction post-opératoire précise et rapide de la dosimétrie du patient par méthode Monte Carlo, a été développé. L’utilisation de techniques de réduction de variance et de navigation voxélisée avancées permet une amélioration significative du temps de calcul. Des fantômes anthropomorphes de dernière génération, couplés à la lecture des paramètres d’irradiation, permettent une prise en compte réaliste de l’anatomie du patient et de la géométrie de la machine. La précision de la modélisation Monte Carlo associée à un temps d’exécution réduit ainsi qu’à une complète automatisation rend cet outil particulièrement adapté à un calcul systématique en radiologie interventionnelle. / The prevention of the radio-induced biological effects in interventional radiology require a complete estimation of the patient skin and organs exposition. In this context, a software allowing a precise and fast postoperative reconstruction of the patient’s dosimetry using the Monte Carlo method was developed. The use of advanced methods of variance reduction and voxelized navigation allows a significant improvement in computing time. Last generation anthropomorphic phantoms, coupled with the reading of the irradiation parameters, allow to take realistic account of the patient's anatomy and the geometry of the machine. The precision of the Monte Carlo modelization associated with a reduced execution time as well as a complete automation makes this tool particularly suitable for a systematic calculation in interventional radiology.

A embolização intra-arterial é rotineiramente utilizada na prática clinica como co-adjuvante pré-operatório ou controle de tumores, tratamento de malformações arteriovenosas e outras doenças vasculares. Em vários casos é realizada com uso de partículas de diferentes formas e composições. Um agente embolizante esférico e utilizado com bons resultados é o trisacryl (Embosphere®; BioSphere® Medical). Um novo agente embólico - polivinil acetato esférico cobertas com polivinil álcool (PVAc) foi desenvolvido recentemente no Brasil. Este trabalho tem objetivo de avaliar, após embolização renal, o grau de oclusão vascular, recanalização da luz vascular e a necrose da parede vascular provocados por partículas de PVAc, utilizando como parâmetro partículas de trisacryl. Setenta e nove fêmeas de coelhos do tipo albino New Zealand foram submetidas a cateterização arterial do rim direito; trinta e três animais foram embolizados com trisacryl, trinta e um com PVAc e quinze animais compuseram o grupo de simulação, tendo sido excluídos quatro animais (três trisacryl e um PVAc) devido a óbito precoce. Foram criados cinco subgrupos de seis animais, que foram sacrificados após 48 horas, 5 dias, 10 dias, 30 dias e 90 dias após a embolização. O grupo de simulação seguiu a mesma ordem temporal com três animais em cada grupo. As técnicas de coloração utilizadas foram os métodos de hematoxilina-eosina (HE) e tricrômico de Masson com observação por microscopia óptica. Os resultados mostraram diferença significativa entre o grau de oclusão vascular nos grupos de 5 dias e 10 dias e necrose no grupo de 48 horas em favor do grupo embolizado com PVAc, que apresentou reação tecidual adequada (redução volumétrica e isquemia) e menor grau de recanalização que o trisacryl / Intra-arterial embolization is often utilized in medical practice preoperatively as adjuvant in controlling tumors, treatment of arteriovenous malformations and other vascular diseases. Often times, particles of different forms and compositions are employed. trisacryl (Embosphere®; BioSphere® Medical), a spheric embolic agent, is nowadays used with very satisfactory results. However, a new embolic agent spheric polyvinyl alcohol-covered polivinyl acetate (PVAc)- has been developed in Brazil. This study evaluates the degree of vascular occlusion, vascular recanalization and the necrosis of vascular wall caused by PVAc particles, compared with trisacryl, after renal embolization. Seventy-nine female albine New Zealand rabbits underwent arterial catheterization of the right kidney; Thirty-three animals were embolized with trisacryl, thirty-one with PVAc and fifteen were kept as control group, four animals were excluded (three trisacryl and one PVAc) due to early death. Five subgroups of six animals were created. The animals in the different groups were sacrificed 48 hours, 5 days, 10 days, 30 days and 90 days after embolization. The control group was divided into subgroups of three animals, for the same period of time. Their kidneys were dyed with hematoxylin-eosin (HE) and Masson tricromic and examined using optic microscopy. The results showed a significant difference between the five-day and ten-day groups with regard to the degree of vascular occlusion, and the amount of necrosis in the forty-eight-hour group. Both findings favor the PVAc group, with adequate tissue reaction (ischemia and volumetric reduction) and less recanalization than with trisacryl

<p>Interventional radiological procedures often require long fluoroscopic exposure times and high levels of radiation exposure to patients, which often are higher than most radiological examinations except for computed tomography (CT) whose effective doses can be higher, and in addition to having radiation risks that are higher for both patient and medical staff. Therefore it is important to monitor and map the radiation entrance exposure to the patients, to minimize the probability of skin injury, and to detect areas of overlapping radiation fields. The aim of this thesis is to evaluate patient doses in interventional radiology procedures using a new GAFCHROMIC-XR TYPE R DOSIMETER MEDIA X-ray Dosimetry film, which allows mapping of the skin dose distribution, when placed closer to the skin. These radiochromic films can be characterized by a power response dose function when plotting pixel value versus air kerma and have been calibrated up to 5 Gy when using a flatbed scanner. Image analysis was performed using the red channel component of standard the RGB (Red, Green, and Blue) color space image. The association between the Maximum Entrance Skin Doses (MESD) and Dose Area Product (DAP) values for two interventional procedures; coronary angiography (CA), and percutaneous transluminal coronary angiography (PTCA) is investigated.</p>

Interventional radiological procedures often require long fluoroscopic exposure times and high levels of radiation exposure to patients, which often are higher than most radiological examinations except for computed tomography (CT) whose effective doses can be higher, and in addition to having radiation risks that are higher for both patient and medical staff. Therefore it is important to monitor and map the radiation entrance exposure to the patients, to minimize the probability of skin injury, and to detect areas of overlapping radiation fields. The aim of this thesis is to evaluate patient doses in interventional radiology procedures using a new GAFCHROMIC-XR TYPE R DOSIMETER MEDIA X-ray Dosimetry film, which allows mapping of the skin dose distribution, when placed closer to the skin. These radiochromic films can be characterized by a power response dose function when plotting pixel value versus air kerma and have been calibrated up to 5 Gy when using a flatbed scanner. Image analysis was performed using the red channel component of standard the RGB (Red, Green, and Blue) color space image. The association between the Maximum Entrance Skin Doses (MESD) and Dose Area Product (DAP) values for two interventional procedures; coronary angiography (CA), and percutaneous transluminal coronary angiography (PTCA) is investigated.

El uso de modelos animales constituye una herramienta esencial para investigar la etiología y patogenia de la diabetes, así como para desarrollar tratamientos efectivos: el transplante de islotes pancreáticos o ingeniería genética. El éxito de estas terapias depende en gran medida de la correcta elección de la vía de administración. Objetivos: 1.- Estudiar la anatomía e histología del páncreas porcino; 2.- Describir la anatomía seccional de la región pancreática mediante RM y secciones anatómicas plastinadas; 3.- Confirmar que las arterias pancreáticas terminales en el cerdo constituyen una ruta potencial para la administración selectiva mediante técnicas endovasculares mínimamente invasivas.Diseño de la investigación y métodos: Cerdos Large White jóvenes fueron examinados con RM y posteriormente sacrificados de forma humanitaria. Criosecciones transversales finas (2-3 mm) en las que se interesaba el páncreas fueron plastinadas mediante el método E-12 (Biodur®). 19 páncreas se procesaron para el estudio histológico. El análisis vascular de las ramas terminales del páncreas se realizó mediante la inyección de ocho cadáveres de cerdo con resina epoxy. En 20 cerdos vivos se llevaron a cabo angiografías superselectivas en ramas terminales.Resultados: El porcentaje y tamaño de los islotes de parénquima endocrino fueron mayores en el lóbulo derecho que en el resto del páncreas. Las secciones a nivel de la vértebra T15 interesaron las mayores áreas del páncreas, en concreto el lóbulo izquierdo. Una rama pancreática terminal de la arteria esplénica se presentó en todos los animales. Conclusión: se ha desarrollado un valioso abordaje mínimamente invasivo al páncreas porcino. Ello puede contribuir al ensayo de nuevas terapias para diabetes en este modelo animal. No obstante, nuevos estudios se hacen necesarios para poder evaluar la eficacia del abordaje referido en terapia para diabetes. / Animal models are essential tools for investigating the etiology and pathogenesis of diabetes and for the development of effective treatments: islet transplantation or genetic engineering. Successful of these new therapies will depend on the appropriate choice of the route of administration. Objectives: 1. Study the anatomy and histology of the porcine pancreas; 2. Describe the normal sectional anatomy of the pig pancreatic region by MRI and plastinated anatomic sections; 3. Confirm that the pancreatic terminal arteries in pigs are a potential route for the selective delivery of islet cells or gene products to the pancreas by minimally invasive endovascular techniques. Research design and methods: Large White juvenile pigs were examined by MRI and then euthanized according to human procedure. Thin transversal cryosections (2-3mm) containing the pancreas were plastinated by the E12 method (Biodur®). 19 pancreases were process for histology study. Anatomic vascular study of pancreatic terminal arteries was obtained by epoxy resin injection of eight pig cadavers. Super selective angiography in the pancreatic terminal branch was conducted in vivo in 20 pigs. Results: Frequency and size of endocrine parenchyma islets was higher in right lobe of the pancreas than in the rest of the pancreas. Sections at the level of vertebra T15 showed the highest areas of pancreas and were related with left lobe. A constant pancreatic terminal branch from the splenic artery was present in all animals. Conclusion: a valuable minimally invasive approach to the porcine pancreas has been developed. It may contribute to assay new diabetes therapies in swine models. Further studies are needed to examine the specific efficiency of this approach in diabetes therapies.

A number of interventional procedures such as cardiac catheterization, angiography and the deployment of endovascular devices are routinely performed using x-ray fluoroscopy. To minimize the patient’s exposure to ionizing radiation, each fluoroscopic image is acquired using a very low x-ray exposure (~ 1 uR at the detector). At such an exposure, most semiconductor-based digital flat panel detectors (FPD) are not x-ray quantum noise limited (QNL) due to the presence of electronic noise which substantially degrades their imaging performance. The goal of this thesis was to investigate how a FPD based on amorphous selenium (a-Se) with internal avalanche multiplication gain could be used for QNL fluoroscopic imaging at the lowest clinical exposures while satisfying all of the requirements of a FPD for interventional radiology. Towards this end, it was first determined whether a-Se can reliably provide avalanche multiplication gain in the solid-state. An experimental method was developed which enabled the application of sufficiently large electric field strengths across the a-Se. This method resulted in avalanche gains as high as 10000 at an applied field of 105 V/um using optical excitation. This was the first time such high avalanche gains have been reported in a solid-state detector based on an amorphous material. Secondly, it was investigated how the solid-state a-Se avalanche detector could be used to image X-rays at diagnostic radiographic energies (~ 75 kVp). A dual-layered direct-conversion FPD architecture was proposed. It consisted of an x-ray drift region and a charge avalanche multiplication region and was found to eliminate depth-dependent gain fluctuation noise. It was shown that electric field strength non-uniformities in the a-Se do not degrade the detective quantum efficiency (DQE). Lastly, it was determined whether the solid-state a-Se avalanche detector satisfies all of the requirements of interventional radiology. Experimental results have shown that the total noise produced by the detector is negligible and that QNL operation at the lowest fluoroscopic exposures is indeed possible without any adverse effects occurring at much larger radiographic exposures. In conclusion, no fundamental obstacles were found preventing the use of avalanche a-Se in next-generation solid-state QNL FPDs for use in interventional radiology.

A number of interventional procedures such as cardiac catheterization, angiography and the deployment of endovascular devices are routinely performed using x-ray fluoroscopy. To minimize the patient’s exposure to ionizing radiation, each fluoroscopic image is acquired using a very low x-ray exposure (~ 1 uR at the detector). At such an exposure, most semiconductor-based digital flat panel detectors (FPD) are not x-ray quantum noise limited (QNL) due to the presence of electronic noise which substantially degrades their imaging performance. The goal of this thesis was to investigate how a FPD based on amorphous selenium (a-Se) with internal avalanche multiplication gain could be used for QNL fluoroscopic imaging at the lowest clinical exposures while satisfying all of the requirements of a FPD for interventional radiology. Towards this end, it was first determined whether a-Se can reliably provide avalanche multiplication gain in the solid-state. An experimental method was developed which enabled the application of sufficiently large electric field strengths across the a-Se. This method resulted in avalanche gains as high as 10000 at an applied field of 105 V/um using optical excitation. This was the first time such high avalanche gains have been reported in a solid-state detector based on an amorphous material. Secondly, it was investigated how the solid-state a-Se avalanche detector could be used to image X-rays at diagnostic radiographic energies (~ 75 kVp). A dual-layered direct-conversion FPD architecture was proposed. It consisted of an x-ray drift region and a charge avalanche multiplication region and was found to eliminate depth-dependent gain fluctuation noise. It was shown that electric field strength non-uniformities in the a-Se do not degrade the detective quantum efficiency (DQE). Lastly, it was determined whether the solid-state a-Se avalanche detector satisfies all of the requirements of interventional radiology. Experimental results have shown that the total noise produced by the detector is negligible and that QNL operation at the lowest fluoroscopic exposures is indeed possible without any adverse effects occurring at much larger radiographic exposures. In conclusion, no fundamental obstacles were found preventing the use of avalanche a-Se in next-generation solid-state QNL FPDs for use in interventional radiology.

During image guided interventional radiology (IR) procedures, acute X-ray induced skin injuries may occur due to high absorbed patient skin dose. These procedures are highly dependent on X-ray imaging both for guiding fluoroscopy and high quality diagnostic image acquisitions. A dose metric that quantifies the peak absorbed skin dose (PSD) is therefore of great importance, both in terms of patient specific follow-up and for imaging protocol optimization. Presently, the cumulative interventional reference point (IRP) air Kerma is the most common skin dose estimation metric in use. This metric lacks several important dose contributions, such as pre-patient attenuation, air-to-skin medium correction, scattering from the patient and the support table, and fluence correction for actual source-to-skin distance. In this manuscript, we present a novel methodology for estimating the maximum absorbed skin dose by using dose related X-ray equipment parameters, such as peak tube voltage, support table position and IRP air Kerma obtained from radiation dose structured reports (RDSR) generated by modern IR equipment. In particular, Siemens Artis Zee (Siemens Healthineers, Erlangen, Germany) and Philips Allura Clarity (Philips, Amsterdam, Netherlands). The calculation process was automated by the development of a series of programming scripts in the PythonTM programming language v3.6 (Python Software Foundation), together with a database storing correction factors and machine specific parameters such as half-value layer (HVL). The proposed calculation model enables the implementation of a dose metric which corresponds better to absorbed skin dose than IRP air Kerma in clinical settings. However, extensive future work is required for a complete PSD implementation, in particular, the development of a skin dose map in which the spatial location of each irradiation event is tracked.

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