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Procedure and step-based analysis of the occupational radiation dose during endovascular aneurysm repair in the hybrid operating room.
J Vasc Surg. 2018 06; 67(6):1881-1890.JV

Abstract

OBJECTIVE

This study measured the cumulative occupational X-ray radiation dose received by support staff during endovascular aortic procedures and during additional intraoperative steps in the hybrid operating room.

METHODS

Radiation dose measurements were performed during interventions on 65 patients receiving 90 stent grafts during endovascular aneurysm repair (EVAR), bifurcated EVAR, thoracic EVAR, iliac branched device deployment, aortouni-iliac stenting, and fenestrated/branched EVAR (F/BrEVAR). X-ray imaging was acquired using the Philips Allura FD20 Clarity System (Philips Medical Systems, Best, The Netherlands). The occupational radiation dose (also referred to as the estimated effective dose, E, measured in millisieverts) was measured with the DoseAware Xtend system (Philips Medical Systems) personal dosimeters. E was reported per staff member (ESTAFF), where "staff" was a generic term for each staff member included in the study: the first operator (FO), the second operator (ESO), a virtual maximum operator (MO), and all additional supporting staff, including the sterile nurse, nonsterile nurse, anaesthesiologist, and radiation technician. The primary outcome was the median cumulative ESTAFF (or EFO, EMO, and so on), which was presented as the median cumulative dose per intervention and stratified for several within-interventional EVAR and F/BrEVAR steps or stents. The second outcome was the percentage of the absorbed E by a supporting staff member in relation to the E measured by the reference badge attached on the C-arm (ESTAFF% or EFO%, EMO%, and so on). All outcomes are presented as median with interquartile range, unless stated differently.

RESULTS

The occupational effective dose in millisieverts of the MO (EMO) was 0.055 (0.029-0.082) for aortouni-iliac stenting (n = 6), 0.084 (0.054-0.141) during thoracic EVAR (n = 14), 0.036 (0.026-0.068) during bifurcated EVAR (n = 38), 0.054 (0.035-0.126) during iliac branched device deployment (n = 8), and 0.345 (0.235-0.757) during F/BrEVAR (n = 24). The median EMO in millisieverts was 0.025 (0.012-0.062) per renal target vessel (TV) and 0.146 (0.07-0.315) for a nonrenal visceral TV. During all noncomplex interventions, the EMO% was 4.4% (2.7%-7.3%), with the lowest median rate at 3.5% (2.5%-5%) for EVAR. The highest median rate EMO% was found for F/BrEVAR procedures: 8.2% (5.0%-14.4%).

CONCLUSIONS

With maximum operator shielding during femoral access, relative occupational radiation risk can be minimized. However, digital subtraction angiography image acquisition, recanalization of TVs, recanalization of superior mesenteric artery or celiac artery, and recanalization of branched TVs are predictors for increased occupational radiation dose risks caused by increased radiation doses to the patient and reduced options for shielding of the operator.

Authors+Show Affiliations

Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.Philips Healthcare, Best, The Netherlands.Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: j.a.vanherwaarden@umcutrecht.nl.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29801556

Citation

de Ruiter, Quirina M B., et al. "Procedure and Step-based Analysis of the Occupational Radiation Dose During Endovascular Aneurysm Repair in the Hybrid Operating Room." Journal of Vascular Surgery, vol. 67, no. 6, 2018, pp. 1881-1890.
de Ruiter QMB, Jansen MM, Moll FL, et al. Procedure and step-based analysis of the occupational radiation dose during endovascular aneurysm repair in the hybrid operating room. J Vasc Surg. 2018;67(6):1881-1890.
de Ruiter, Q. M. B., Jansen, M. M., Moll, F. L., Hazenberg, C. E. V. B., Kahya, N. N., & van Herwaarden, J. A. (2018). Procedure and step-based analysis of the occupational radiation dose during endovascular aneurysm repair in the hybrid operating room. Journal of Vascular Surgery, 67(6), 1881-1890. https://doi.org/10.1016/j.jvs.2017.09.043
de Ruiter QMB, et al. Procedure and Step-based Analysis of the Occupational Radiation Dose During Endovascular Aneurysm Repair in the Hybrid Operating Room. J Vasc Surg. 2018;67(6):1881-1890. PubMed PMID: 29801556.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Procedure and step-based analysis of the occupational radiation dose during endovascular aneurysm repair in the hybrid operating room. AU - de Ruiter,Quirina M B, AU - Jansen,Marloes M, AU - Moll,Frans L, AU - Hazenberg,Constantijn E V B, AU - Kahya,Nicoletta N, AU - van Herwaarden,Joost A, PY - 2017/01/25/received PY - 2017/09/21/accepted PY - 2018/5/27/entrez PY - 2018/5/29/pubmed PY - 2018/7/17/medline SP - 1881 EP - 1890 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 67 IS - 6 N2 - OBJECTIVE: This study measured the cumulative occupational X-ray radiation dose received by support staff during endovascular aortic procedures and during additional intraoperative steps in the hybrid operating room. METHODS: Radiation dose measurements were performed during interventions on 65 patients receiving 90 stent grafts during endovascular aneurysm repair (EVAR), bifurcated EVAR, thoracic EVAR, iliac branched device deployment, aortouni-iliac stenting, and fenestrated/branched EVAR (F/BrEVAR). X-ray imaging was acquired using the Philips Allura FD20 Clarity System (Philips Medical Systems, Best, The Netherlands). The occupational radiation dose (also referred to as the estimated effective dose, E, measured in millisieverts) was measured with the DoseAware Xtend system (Philips Medical Systems) personal dosimeters. E was reported per staff member (ESTAFF), where "staff" was a generic term for each staff member included in the study: the first operator (FO), the second operator (ESO), a virtual maximum operator (MO), and all additional supporting staff, including the sterile nurse, nonsterile nurse, anaesthesiologist, and radiation technician. The primary outcome was the median cumulative ESTAFF (or EFO, EMO, and so on), which was presented as the median cumulative dose per intervention and stratified for several within-interventional EVAR and F/BrEVAR steps or stents. The second outcome was the percentage of the absorbed E by a supporting staff member in relation to the E measured by the reference badge attached on the C-arm (ESTAFF% or EFO%, EMO%, and so on). All outcomes are presented as median with interquartile range, unless stated differently. RESULTS: The occupational effective dose in millisieverts of the MO (EMO) was 0.055 (0.029-0.082) for aortouni-iliac stenting (n = 6), 0.084 (0.054-0.141) during thoracic EVAR (n = 14), 0.036 (0.026-0.068) during bifurcated EVAR (n = 38), 0.054 (0.035-0.126) during iliac branched device deployment (n = 8), and 0.345 (0.235-0.757) during F/BrEVAR (n = 24). The median EMO in millisieverts was 0.025 (0.012-0.062) per renal target vessel (TV) and 0.146 (0.07-0.315) for a nonrenal visceral TV. During all noncomplex interventions, the EMO% was 4.4% (2.7%-7.3%), with the lowest median rate at 3.5% (2.5%-5%) for EVAR. The highest median rate EMO% was found for F/BrEVAR procedures: 8.2% (5.0%-14.4%). CONCLUSIONS: With maximum operator shielding during femoral access, relative occupational radiation risk can be minimized. However, digital subtraction angiography image acquisition, recanalization of TVs, recanalization of superior mesenteric artery or celiac artery, and recanalization of branched TVs are predictors for increased occupational radiation dose risks caused by increased radiation doses to the patient and reduced options for shielding of the operator. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/29801556/Procedure_and_step_based_analysis_of_the_occupational_radiation_dose_during_endovascular_aneurysm_repair_in_the_hybrid_operating_room_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(17)32506-5 DB - PRIME DP - Unbound Medicine ER -