Tags

Type your tag names separated by a space and hit enter

Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices.
J Vasc Surg. 2018 11; 68(5):1281-1286.JV

Abstract

INTRODUCTION

Fenestrated endovascular aneurysm repair (FEVAR) is the highest radiation dose procedure performed by vascular surgeons. We sought to characterize the radiation dose to patients and staff during FEVAR procedures with different premanufactured devices.

METHODS

A single-center prospective study of FEVARs was performed over 24 months. Three FEVAR devices were included: off-the-shelf (OTS; t-Branch, p-Branch), Zenith Fenestrated (ZFen), and investigational custom-made devices (CMDs). Radiation doses to the surgeon, trainee, anesthesiologist, and scrub/circulating nurses were measured using a personal dosimetry system (DoseAware, Philips Healthcare, Amsterdam, The Netherlands). Procedure type, patient body mass index (BMI), reference air kerma (RAK), and kerma area product (KAP) were recorded. RAK and KAP were corrected for BMI based on an exponential fit of fluoroscopy dose rate and the dose per radiographic frame. Operator dose was corrected for BMI by the ratio of corrected to actual KAP. A one-sided Wilcox rank-sum test was used to compare personnel radiation doses, RAKs, and KAPs between procedure types. Statistical significance was set at P ≤ .05.

RESULTS

There were 80 FEVARs performed by a single surgeon on a Philips Allura XperFD20 fluoroscopy system equipped with Clarity technology. Average BMI was 27 kg/m2. Sixty CMDs (36 four-, 21 three-, and 3 two-vessel fenestrations), 11 ZFens (8 three- and 3 two-vessel fenestrations), and 9 OTS devices (4 p-Branch, 5 t-Branch) were included. ZFens had significantly lower patient (1800 mGy vs 2950 mGy; P = .004), operator (120 μSv vs 370 μSv; P = .004), assistant (60 μSv vs 210 μSv; P = .003), circulator (10 μSv vs 30 μSv; P = .049), and scrub nurse dose (10 μSv vs 40 μSv; P = .02) compared with CMDs. OTS devices had significantly lower operator (220 μSv vs 370 μSv; P = .04), assistant (110 μSv vs 210 μSv; P = .02), and circulator doses (4 μSv vs 30 μSv; P = .001) compared with CMDs. Four-vessel fenestrated devices had significantly higher patient dose (3020 mGy) compared with three-vessel FEVARs (2670 mGy; P = .03) and two-vessel FEVARs (1600 mGy; P = .0007), and significantly higher operator dose (440 μSv) compared with three-vessel FEVARs (170 μSv; P = .0005). Patient dose was lowest with ZFens. Operating room personnel dose was lower with ZFens and OTS devices compared with CMDs. Four-vessel fenestrations required significantly more radiation compared with those involving three-vessel fenestrations; however, the dose increase was only 12% and should not preclude operators from extending coverage, if anatomically required.

CONCLUSIONS

Overall, patient and personnel radiation doses during FEVAR with all devices were within acceptable limits and lower in our series than previously reported.

Authors+Show Affiliations

Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: melissa.kirkwood@utsouthwestern.edu.Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.Division of Medical Physics, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex.Division of Medical Physics, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex.Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.Division of Medical Physics, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex.Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30369410

Citation

Kirkwood, Melissa L., et al. "Patient and Operating Room Staff Radiation Dose During Fenestrated/branched Endovascular Aneurysm Repair Using Premanufactured Devices." Journal of Vascular Surgery, vol. 68, no. 5, 2018, pp. 1281-1286.
Kirkwood ML, Chamseddin K, Arbique GM, et al. Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices. J Vasc Surg. 2018;68(5):1281-1286.
Kirkwood, M. L., Chamseddin, K., Arbique, G. M., Guild, J. B., Timaran, D., Anderson, J. A., & Timaran, C. (2018). Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices. Journal of Vascular Surgery, 68(5), 1281-1286. https://doi.org/10.1016/j.jvs.2018.02.031
Kirkwood ML, et al. Patient and Operating Room Staff Radiation Dose During Fenestrated/branched Endovascular Aneurysm Repair Using Premanufactured Devices. J Vasc Surg. 2018;68(5):1281-1286. PubMed PMID: 30369410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices. AU - Kirkwood,Melissa L, AU - Chamseddin,Khalil, AU - Arbique,Gary M, AU - Guild,Jeffrey B, AU - Timaran,David, AU - Anderson,Jon A, AU - Timaran,Carlos, Y1 - 2018/06/28/ PY - 2017/10/04/received PY - 2018/02/17/accepted PY - 2018/10/30/entrez PY - 2018/10/30/pubmed PY - 2019/3/15/medline KW - FEVAR KW - Fenestrated endovascular aneurysm repair KW - Fluoroscopically guided interventions KW - Occupational radiation dose KW - Radiation dose SP - 1281 EP - 1286 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 68 IS - 5 N2 - INTRODUCTION: Fenestrated endovascular aneurysm repair (FEVAR) is the highest radiation dose procedure performed by vascular surgeons. We sought to characterize the radiation dose to patients and staff during FEVAR procedures with different premanufactured devices. METHODS: A single-center prospective study of FEVARs was performed over 24 months. Three FEVAR devices were included: off-the-shelf (OTS; t-Branch, p-Branch), Zenith Fenestrated (ZFen), and investigational custom-made devices (CMDs). Radiation doses to the surgeon, trainee, anesthesiologist, and scrub/circulating nurses were measured using a personal dosimetry system (DoseAware, Philips Healthcare, Amsterdam, The Netherlands). Procedure type, patient body mass index (BMI), reference air kerma (RAK), and kerma area product (KAP) were recorded. RAK and KAP were corrected for BMI based on an exponential fit of fluoroscopy dose rate and the dose per radiographic frame. Operator dose was corrected for BMI by the ratio of corrected to actual KAP. A one-sided Wilcox rank-sum test was used to compare personnel radiation doses, RAKs, and KAPs between procedure types. Statistical significance was set at P ≤ .05. RESULTS: There were 80 FEVARs performed by a single surgeon on a Philips Allura XperFD20 fluoroscopy system equipped with Clarity technology. Average BMI was 27 kg/m2. Sixty CMDs (36 four-, 21 three-, and 3 two-vessel fenestrations), 11 ZFens (8 three- and 3 two-vessel fenestrations), and 9 OTS devices (4 p-Branch, 5 t-Branch) were included. ZFens had significantly lower patient (1800 mGy vs 2950 mGy; P = .004), operator (120 μSv vs 370 μSv; P = .004), assistant (60 μSv vs 210 μSv; P = .003), circulator (10 μSv vs 30 μSv; P = .049), and scrub nurse dose (10 μSv vs 40 μSv; P = .02) compared with CMDs. OTS devices had significantly lower operator (220 μSv vs 370 μSv; P = .04), assistant (110 μSv vs 210 μSv; P = .02), and circulator doses (4 μSv vs 30 μSv; P = .001) compared with CMDs. Four-vessel fenestrated devices had significantly higher patient dose (3020 mGy) compared with three-vessel FEVARs (2670 mGy; P = .03) and two-vessel FEVARs (1600 mGy; P = .0007), and significantly higher operator dose (440 μSv) compared with three-vessel FEVARs (170 μSv; P = .0005). Patient dose was lowest with ZFens. Operating room personnel dose was lower with ZFens and OTS devices compared with CMDs. Four-vessel fenestrations required significantly more radiation compared with those involving three-vessel fenestrations; however, the dose increase was only 12% and should not preclude operators from extending coverage, if anatomically required. CONCLUSIONS: Overall, patient and personnel radiation doses during FEVAR with all devices were within acceptable limits and lower in our series than previously reported. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30369410/Patient_and_operating_room_staff_radiation_dose_during_fenestrated/branched_endovascular_aneurysm_repair_using_premanufactured_devices_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)30430-0 DB - PRIME DP - Unbound Medicine ER -