Besides diagnostic imaging devices, in particular computed tomography (CT) and magnetic resonance imaging (MRI), numerous reading workstations contribute to the high energy consumption of radiological departments. It was investigated whether switching off workstations after core working hours can relevantly lower energy consumption considering both ecological and economical aspects. Besides calculating different theoretical energy consumption scenarios, we measured power consumption of 3 workstations in our department over a 6-month period under routine working conditions and another 6-month period during which users were asked to switch off workstations after work. Staff costs arising from restarting workstations manually were calculated. Our approach to switching off workstations after core working hours reduced energy consumption by about 5.6 %, corresponding to an extrapolated saving of 3.2 tons in carbon dioxide (CO2) emissions and 2100.70 USD/year in electricity costs for 227 workstations. Theoretical calculations indicate that consistent automatic shutdown after core working hours could result in a potential total reduction of energy consumption of 38.6 %, equaling 22.2 tons of CO2 and 14,388.28 USD/year. However, staff costs resulting from waiting times after manually restarting workstations would amount to 36,280.02 USD/year. Switching off workstations after core working hours can considerably reduce energy consumption and costs, but varies with user adherence. Staff costs caused by waiting time after manually starting up workstations outweigh energy savings by far. Therefore, an energy-saving plan with automated shutdown/restart besides enabling an energy-saving mode would be the most effective way of saving both energy and costs.

Background/Aim: Thermal-ablative therapies are limited to tumors of 3-4 cm diameter. The purpose of this study was to evaluate the local tumor control (LTC) of CT-guided High-Dose-Rate-Brachytherapy (CT-HDRBT) for ablation of cholangiocarcinomas (CCA) ≥4 cm compared to smaller tumors. Patients and Methods: Sixty-one patients (tumors: 142, interventions: 91) were treated from March 2008 to January 2017. LTC, progression-free survival (PFS) and overall survival (OS) after first CT-HDRBT were identified for two subgroups (A:<4 cm, B:≥4 cm) and the influence of coverage and target-dose were evaluated. Log-Rank- and Mann-Whitney-U-Tests were performed for statistical analyses with p-values <0.05 considered as significant. Results: Better coverage was achieved for smaller tumors (A: 99.22-0.25%, B: 95.10-1.40%, p<0.001). LTC was better in subgroup A (A: 8, B: 6 months, p=0.006). Larger tumors (4-7 cm) with incomplete coverage showed the poorest LTC (p=0.032). There were no statistical significances in PFS (A: 5, B: 3 months, p=0.597) and OS (A:15.5; B:10.0 months, p=0.107). Conclusion: CT-HDRBT is sufficient in CCA ≥4 cm, if full coverage with therapeutic doses can be achieved.

During transarterial chemoembolization (TACE), cone-beam computed tomography (CBCT) can be used for tumor and feeding vessel detection as well as postembolization CT imaging. However, there will be additional radiation exposure from CBCT. To evaluate the additional dose raised through CBCT-assisted guidance in comparison to TACE procedures guided with pulsed digital subtraction angiography (DSA) alone. In 70 of 140 consecutive patients undergoing TACE for liver cancer, CBCT was used to facilitate the TACE. Cumulative dose area product (DAP), cumulative kerma(air), DAP values of DSA, total and cine specific fluoroscopy times (FT) of 1375 DSA runs, and DAP of 91 CBCTs were recorded and analyzed using Spearman's correlation, Mann–Whitney U-test, and Kruskal–Wallis test. P values < 0.05 were considered significant. Additional CBCT increased DAP by 2% (P = 0.737), kerma(air) by 24.6% (P = 0.206), and FT by 0.02% (P = 0.453). Subgroup analysis revealed that postembolization CBCT for detection of ethiodized oil deposits added more DAP to the procedure. Performing CBCT-assisted TACE, DSA until first CBCT contributed about 38% to the total DAP. Guidance CBCT acquisitions conduced to 6% of the procedure's DAP. Additional DSA for guidance after CBCT acquisition required approximately 46% of the mean DAP. The last DSA run for documentation purposes contributed about 10% of the DAP. CBCT adds radiation exposure in TACE. However, the capability of CBCT to detect vessels and overlay in real-time during fluoroscopy facilitates TACE with resultant reduction of DAPs up to 46%.

To date there is no therapy consensus in patients with multifocal hepatocellular carcinoma (mHCC). To compare outcome of trans-arterial chemoembolization (TACE) with degradable starch microspheres (DSM-TACE) versus selective internal radiation therapy (SIRT) in mHCC. In this single-center study, 36 patients without portal vein invasion, treated between May 2014 and May 2018, were enrolled retrospectively. Eighteen consecutive patients received DSM-TACE and were matched by age, gender, BCLC stage, Child-Pugh status, and tumor volume and 18 patients underwent SIRT. Overall survival (OS), progression-free survival (PFS), and local tumor control (LTC) were evaluated. Toxicity profiles for both therapies were also evaluated and compared. In the entire collective, median OS was 9.5, PFS 5.0, and LTC 5.5 months. Subgroup analysis revealed an OS of 9.5 months in both groups (P = 0.621). PFS was 6 months for the SIRT and 4 months for the DSM-TACE cohort (P = 0.065). Although not significantly, LTC was lower (4 months) in the SIRT compared to the DSM-TACE cohort (7 months; P = 0.391). When DSM-TACE was performed ≥3 times (n = 11), OS increased, however without statistical difference compared to SIRT, to 11 months, PFS to 7 months, and LTC to 7 months. When DSM-TACE was performed 0.05). DSM-TACE might be an alternative to SIRT in multifocal HCC patients as OS, PFS, and LTC did not differ significantly and toxicity profiles seem to be comparable.

Background: Due to the broad variability of the prostatic artery (PA), its origin, small calibers, and tortuous courses, prostatic arterial embolization (PAE) is challenging, time-consuming, and results in high radiation doses. Purpose: To evaluate the accuracy of PA detection using cone-beam computed tomography (CBCT) performed from the aortic bifurcation in combination with a semi-automatic detection software in comparison to oblique view digital subtraction angiography (DSA) with internal iliac artery (IIA) injection. Material and Methods: Twenty-two consecutive patients were included in this retrospective, IRB-approved study between July and December 2017. CBCT from the aorta and 30° oblique-view DSA from both IIAs were obtained for PA detection. Results of suggested PAs from the semi-automatic vessel detection software after CBCT and IIA DSA were compared. Moreover, dose area product (DAP) was recorded. Statistical analysis included Spearman’s correlation, Mann–Whitney U test, and the Wilcoxon test considering P<0.05 as significant. Results: PA type was classified significantly better with CBCT compared to DSA ( P=0.047). In IIA DSA, PAs could not be identified in 18% on the left and in 17% on the right side. CBCT detected all PAs, although truncation occurred in 59% because of the limited field of view. Mean DAP of the whole procedure was 257,161.32±127,909.36 mGy*cm². Mean DAPs were for a single DSA 14,502.51±9,437.67 mGy*cm² and for one CBCT 15,589.23±2,722.49 mGy*cm². A mean of 14.82 DSAs and only one CBCT were performed. CBCT accounted for 6% and DSA for 84% of the entire DAP of the procedure. Conclusion: CBCT with semi-automatic feeding vessel detection software detects PAs more accurately than IIA DSA and may reduce radiation dose.