Reinhard W.R. Loose

• PhD
• Paracelsus Medical University Hospital Nuremberg

The use of patient contact shielding provides an opportunity to reduce patient radiation exposure. Recently, the use has been the subject of controversy. The Radiation Protection Committee has published a recommendation on the use of patient radiation shields by considering the recent findings on dose savings but also the risks of incorrect use. In...

Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging ‘Clinical DRLs’ working group forme...

The transposition of EU Directive 2013/59/Euratom into German law requires that patients be informed about the radiation risk of radiological procedures. Such information is not the same as a medical informed consent about immediate risks associated with the procedure, such as deterministic radiation damage, risks of contrast media, or complication...

Facts and figures about the frequencies of fluoroscopically guided interventions (FGI), typical patient exposures and occupational exposures are listed. Limits of radiation exposure do not exist for patients but only for occupationally exposed medical personnel. Measures for radiation protection of patients and personnel are explained. Nearly all t...

The terms “notifications” and “alerts” for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluor...

This article introduces the European Society of Radiology’s EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative’s Call for Action in successfully achieving international radiation protection goals as set out by those fram...

This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity “effective dose” to compare doses delivered by different radiological procedures and different imaging modalities with its uncertain...

Background Magnetic Resonance Imaging (MRI) is a very innovative, but at the same time complex and technically demanding diagnostic method in radiology. It plays an increasing role in high-quality and efficient patient management. Quality assurance in MRI is of utmost importance to avoid patient risks due to errors before and during the examination...

In recent years, the issue of cumulative effective dose received from recurrent computed tomography examinations has become a subject of increasing concern internationally. Evidence, predominantly from the USA, has shown that a significant number of patients receive a cumulative effective dose of 100 mSv or greater. To obtain a European perspective...

Patients in fluoroscopically guided interventions (FGI) may be exposed to substantial radiation dose levels (SRDL). The most commonly reported adverse reactions are skin injuries with erythema or necrosis. It is therefore important for the interventional radiologist to know deterministic effects with their threshold doses. If possible all relevant...

The European Directive 2013/59/EURATOM requires member states of the European Union to ensure justification and optimisation of the radiological procedures and to include information on patient exposure as part of the report of the examinations. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on “Dosi...

The European Directive 2013/59/Euratom requires member states of the European Union to ensure justification and optimisation of radiological procedures and store information on patient exposure for analysis and quality assurance. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on “Dose Management” wit...

Fast alle klinischen Fächer treten mit den verschiedensten Fragestellungen an die Radiologie heran. Diese werden durch die Radiologie mit verschiedenen Methoden und Modalitäten beantwortet. Hierzu zählen viele Röntgenspezialaufnahmen, die in der Routine noch durchgeführt werden. Allerdings sind nur noch wenige indiziert. Dieser Artikel gibt einen Ü...

Purpose The implementation of EU Directive 2013/59 EURATOM (EU-BSS) of 2014 led to a reorganization of radiation protection legislation in Germany in the form of a new radiation protection law Strahlenschutzgesetz (StrlSchG) of 2017 and a new radiation protection ordinance Strahlenschutzverordnung (StrlSchV) of 2018. For application of ionizing rad...

Das ab dem 1. Januar 2019 geltende neue Strahlenschutzrecht bringt eine Reihe von Änderungen, die allerdings das hohe Niveau und die grundsätzlichen Regelungen des Strahlenschutzes in Deutschland nicht grundlegend verändern. Insbesondere in der Medizin bleiben die meisten der bisher geltenden Regelungen erhalten. Neuerungen in der medizinischen Str...

Die seit 31.12.2018 gültige Strahlenschutzverordnung (StrlSchV) und das Strahlenschutzgesetz (StrlSchG) haben viele Neuerungen gebracht: Ein System zur Erfassung und Bearbeitung von Vorkommnissen muss aufgebaut werden, und bedeutsame unbeabsichtigte Ereignisse werden meldepflichtig. Medizinphysik-Experten sind zukünftig bei Hochdosisarbeitsplätzen...

Purpose Recent developments in medical technology have broadened the spectrum of X-ray procedures and changed exposure practice in X-ray facilities. For this reason, diagnostic reference levels (DRLs) for diagnostic and interventional X-ray procedures were updated in 2016 and 2018, respectively. It is the aim of this paper to present the procedure...

Purpose Whole-body CT (wbCT) has been established as an internationally accepted diagnostic modality in multiple trauma. Until 2011, a uniform CT scanning protocol was used for all multiple trauma patients (pat.) at our hospital (OLD protocol = OP). In 2011, 2 new differently weighted protocols were introduced: TIME protocol (TP) for hemodynamicall...

Seit der bahnbrechenden Entdeckung Röntgens 1895 werden Röntgenstrahlen in Verbindung mit Röntgenfilmen zur medizinischen Diagnostik eingesetzt. Fortschritte auf dem Gebiet der Röntgen- und insbesondere der Computertechnik führten in den letzten Jahrzehnten zu neuen bildgebenden Verfahren, die das Spektrum radiologischer Untersuchungsmöglichkeiten...

In recent publications, such as Publications 117 and 120, the Commission provided practical advice for physicians and other healthcare personnel on measures to protect their patients and themselves during interventional procedures. These measures can only be effective if they are encompassed by a framework of radiological protection elements, and b...

Zusammenfassung Es gibt immer wieder klinische Situationen, in denen die radiologische Bildgebung während der Schwangerschaft unumgänglich ist. Typische Beispiele sind internistische oder chirurgische Notfälle, insbesondere Unfälle. Bei einer streng gestellten, rechtfertigenden Indikation unter Einbeziehung von Ultraschall und MRT als Alternativen...

Heute scheint die Anwendung ionisierender Strahlung in der Medizin sowohl für Patienten als auch für beruflich exponierte Personen sicher zu sein. Die interventionellen Entwicklungen der letzten Jahre mit sehr durchleuchtungs- und dosisintensiven Eingriffen erfordern allerdings eine Intensivierung des Strahlenschutzes. Es empfiehlt sich hierzu die...

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived f...

German regulations require a license for using ionizing radiation in medicine. This license-called "Fachkunde"-varies for different medical procedures such as CT, fluoroscopy, radiography, or mammography. The required frequencies and training times also vary for different medical disciplines such as radiology, cardiology, vascular surgery, traumato...

Purpose The purpose of this paper is the retrospective analysis of endovascular therapy for the treatment of superior vena cava syndrome (SVCS) of malignant cause. This study focuses on the effectiveness of the therapy regarding the duration of remission, symptom control and practicability. Materials and Methods From January 2003 to November 2012,...

Purpose: Evaluation of the benefit of selective venous blood sampling (SVS) for the preoperative identification of parathyroid adenomas with unclear localization in non-invasive diagnostics. Materials and Methods: In a retrospective study, all patients (n = 23) with primary (n = 21) or tertiary (n = 2) hyperparathyroidism were evaluated from 2005 t...

The application of ionizing radiation in medicine seems to be a safe procedure for patients as well as for occupational exposition to personnel. The developments in interventional radiology with fluoroscopy and dose-intensive interventions require intensified radiation protection. It is recommended that all available tools should be used for this p...

Purpose: Cardiac magnetic resonance (CMR) has increasingly proved to be a valuable diagnostic tool for evaluating patients with suspected myocarditis. The objective of this study was to evaluate the diagnostic value of functional and morphological parameters including tissue characterization in patients with “infarct-like myocarditis”. Materials an...

The aspects of the new European Directive 2013/59/Euratom most relevant to diagnostic imaging and intervention are summarised. The Directive, laying down basic safety standards for protection against the dangers from exposure to ionising radiation, emphasises the need for justification of medical exposure (including asymptomatic individuals), intro...

This article presents a discussion on how to calculate the lifetime risk of cancer associated with very low radiation exposures below 1 mSv effective dose. Currently this is done by assuming a linear no threshold model (LNT) even for the lowest exposures, although there is evidence suggesting the existence of a negligible dose threshold. In an exam...

Die Anwendung ionisierender Strahlung in der medizinischen Heilkunde wird durch Gesetze, Verordnungen und Richtlinien geregelt. Beispiele sind das Atomgesetz, die Rontgen- und Strahlenschutzverordnung und die Fachkunderichtlinie. Weiterhin existieren fur das tagliche Handeln Leitlinien medizinisch-wissenschaftlicher Fachgesellschaften sowie der Bun...

Dem Thema sei ein Interviewzitat mit dem Berliner Kardinal Woelki (FAS, 2.3.14) vorangestellt: „Beim Thema Sex fallen die Praxis und die Lehre der Kirche auseinander“. Ahnlich verhalt es sich in vielen Fallen mit Theorie und Praxis im Zusammenspiel zwischen Rontgenverordnung (RoV), Stellen einer Rechtfertigenden Indikation (RI), Umgang mit Selbstzu...

To avoid non-targeted embolization in liver tumors, arteries important for embolization must be detected. In transarterial chemoembolization (TACE) arteries for particle embolization have to be detected and in selective internal radiotherapy (SIRT) extrahepatic arteries which must be protected from embolization have to be detected. In transjugular...

Im radiologischen und nuklearmedizinischen Alltag zeigt sich oft, dass die Begriffe Weiterbildung, Facharzt und Facharztstandard, Fachkunde und Sachkunde miteinander verwechselt bzw. missverstanden werden. Bei den Regelungen des Strahlenschutzes mit Fachkunden und Sachkundeerwerb sowie der Weiterbildung handelt es sich um vollig verschiedene Rechts...

The purpose of this study is to elucidate the accuracy of a clinical classification system for acute diverticulitis with special regard to "phlegmonous diverticulitis". A consecutive patient series (n = 318; General Hospital Nuremberg, 1/2004-12/2006) was classified preoperatively (imaging with 4/16-slice spiral CT scanner) according to the Hansen...

Dynamic flat-panel detectors have been introduced into clinical routine about 10 years ago and now, step by step replace the 40 years old technique of image intensifiers. They represent an ongoing development of static flat-panel detectors which, in terms of most physical imaging parameters, are superior to image intensifiers. This article is focus...

Periinterventional Cone-Beam CT (CBCT) today is a valuable tool in complex radiological interventions. Only little experience exists about CBCT in transarterial chemoembolisations (TACE) of liver tumors. 25 patients underwent periinterventional CBCT. We used a C-arc DSA with 30 × 40 cm flat panel detector. Image data with axial, coronal and 3D-reco...

During the last years most embolizations with the liquid agent Onyx have been performed in the field of neuroradiological interventions. There is minimal experience with arterial embolizations of the body trunk. 23 patients suffering from acute abdominal or thoracic bleeding underwent 28 embolizations with Onyx (17 male, 6 female, mean age 69 years...

Ziele: Evaluation der Durchfuhrbarkeit der Implantation eines Nitinolkopplers zur Shuntbildung zwischen Vena und Arteria iliaca externa zur Verbesserung der pulmonalen Oxygenierung bei schwerer COPD Methode: Im Rahmen einer Multizenterstudie wurde an einer Flachdetektor DSA Anlage unter Durchleuchtung bei bisher 6 Patienten unter Analgosedierung na...

Wahrend die verlustfreie Kompression zur Speicherung und Ubermittlung radiologischer Bilddaten schon lange eingesetzt wird, konnte sich die verlustbehaftete Kompression von Bilddaten in der Radiologie bisher nicht durchsetzen. Dies ist vor allem auf bei den verantwortlichen Radiologen und teilweise auch in der Industrie existierenden Unsicherheiten...

Ziel: In einem 2400 Betten Klinikum wurde an einem randomisierten Patientenkollektiv die medizinische Strahlenexposition bestimmt. Das durch die diagnostischen und interventionellen Maßnahmen bedingte Strahlungsrisiko wurde mit der Schwere der zugrunde liegenden Erkrankungen nach ICD verglichen. Mit einer Modellrechnung wurde der durch die Strahlen...

PURPOSE The effect of Iobitridol and Iopamidol on renal function was investigated in routine CT examinations of hospital patients . The estimated glomerular filtration rate (eGFR) was taken for the assessment of renal function. METHOD AND MATERIALS eGFR was determined before and/or after CT with 100 ml iodine contrast in 3,911 patients. 1,767 pati...

The medical X-ray exposure was determined in a 2400-bed hospital. The radiation-related risk was compared with the severity of disease (ICD) to verify the justification for X-ray procedures. A model to estimate radiation and disease-related "loss of lifetime" was applied. X-ray exposure from radiography, fluoroscopy and CT was determined for diagno...

The purpose of this study was to prevent transjugular intrahepatic portosystemic shunt (TIPS) puncture failure by using three-dimensional (3D) path planning. This study was approved by the institutional review board; informed consent was obtained for the TIPS procedure. In four patients, a 3D path was planned from two two-dimensional (2D) CO2 porto...

Recommendations for lossy compression of digital radiological DICOM images in Germany by means of a consensus conference. The compression of digital radiological images was evaluated in many studies . Even though the results demonstrate full diagnostic image quality of modality-dependent compression between 1:5 and 1:200, there are only a few clini...

Ziel: Empfehlungen zur verlustbehafteten (lossy) Kompression digitaler radiologischer DICOM Bilddaten in Deutschland durch eine Konsensuskonferenz. Die Kompression digitaler radiologischer Bilddaten wurde in vielen Studien [1] [2] [3] [4] [5] evaluiert. Obwohl unter Erhalt der diagnostischen Bildqualität Kompressionen je nach Modalität zwischen 1:5...

The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents w...