PubMed · 13051366
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JANKER. 1953. [Photofluorogram].. https://pubmed.ncbi.nlm.nih.gov/13051366/
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Because of serious radiographic-induced skin injuries that may have been caused by the inappropriate use of fluoroscopy during the performance of radiograph-guided invasive procedures, the US Food and Drug Administration (FDA) issued an advisory in 1994 suggesting that the key to preventing such unfortunate mishaps may be physician education, training, and credentialing in the safe operation of fluoroscopic equipment. The purpose of this article is to familiarize the interventional pain medicine physician with the physics of ionizing radiation and how to limit patient exposure through the optimum setting of tube current and voltage, the use of limited beam-on time, tight collimation, and the elimination of the nonessential use of the magnification mode on a fluoroscopy unit. In addition, the use of personal protection equipment and the knowledge needed to interpret the personal exposure record of each practitioner is discussed. All of this information will assist the interventional pain medicine physician in meeting the recommended FDA training and credentialing requirements.
Three-dimensional (3D) dose distribution has been improved by 3D conformation and intensity modulation in external radiotherapy. Interfractional uncertainty has been reduced by image-guided setup techniques. Reduction of ambiguity because of intrafractional target motion is the next step forward. Respiratory organ motion is known to be the largest intrafractional organ motion. Radiotherapy techniques controlling, gating, or tracking respiratory motion are under investigation to use smaller safety margins and higher doses for moving tumors. However, data on intrafractional tumor motion are sparse. We developed a fluoroscopic real-time tracking system and implantation techniques of fiducial markers for moving organs and have been accumulating knowledge about internal tumor motion. We also found the importance of 4-dimensional treatment planning to account for tumor motion in precision radiotherapy. This article reviews the current basic knowledge on respiratory physiology and summarizes the accumulating knowledge on internal motion of lung and liver tumors.