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Radiation doses for endovascular aortic repairs performed on mobile and fixed C-arm fluoroscopes and procedure phase-specific radiation distribution.
J Vasc Surg 2018; 68(6):1889-1896JV

Abstract

OBJECTIVE

The objective of this study was to analyze radiation risk to patients during endovascular aneurysm repair (EVAR) using mobile C-arm (MA) or fixed C-arm (FA) fluoroscopes and to describe the dose distribution during the different phases of the procedure.

METHODS

Patients treated with EVAR using a single stent graft system between November 2009 and June 2016 were included in this study. The patients were divided into one of two groups (MA or FA) according to the type of C-arm used in the procedure. Data regarding patients' demographics and the total amount of contrast agent (CA) used, dose-area product, and fluoroscopy time for the procedures were prospectively recorded. Based on the dose report from the FA system, five standard and two optional phases of the procedure were identified to determine the dose distribution.

RESULTS

Overall, 160 patients were included (mean age, 73.30 ± 8.97 years; 146 men); of these, 107 were treated with an MA system and 53 were treated with an FA system. The mean amounts of CA used were 108.55 ± 42.28 mL in the MA group and 85.37 ± 38.79 mL in the FA group (P = .0014). The mean total dose-area product values were 49.93 ± 38.06 Gy·cm2 in the MA group and 168.34 ± 146.92 Gy·cm2 in the FA group (P < .0001). There was no significant difference in fluoroscopy time between the groups. Per-phase analysis demonstrated that identification of the proximal landing zone and main body deployment required the most radiation, accounting for 24% of the total radiation dose. Overall, 47.6% of the exposure was due to digital subtraction angiography.

CONCLUSIONS

Use of an FA system can significantly reduce the amount of CA needed but may also lead to higher radiation doses in EVAR procedures. Dose monitoring remains crucial for the safety of both patients and operators. A detailed analysis of dose distribution is possible with modern systems, which may improve the quality of monitoring in the future.

Authors+Show Affiliations

Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany.Department of Radiology, Cleveland Clinic, Cleveland, Ohio.Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany.Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany. Electronic address: giuseppe.panuccio@ukmuenster.de.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30473030

Citation

Schaefers, Johannes Frederik, et al. "Radiation Doses for Endovascular Aortic Repairs Performed On Mobile and Fixed C-arm Fluoroscopes and Procedure Phase-specific Radiation Distribution." Journal of Vascular Surgery, vol. 68, no. 6, 2018, pp. 1889-1896.
Schaefers JF, Wunderle K, Usai MV, et al. Radiation doses for endovascular aortic repairs performed on mobile and fixed C-arm fluoroscopes and procedure phase-specific radiation distribution. J Vasc Surg. 2018;68(6):1889-1896.
Schaefers, J. F., Wunderle, K., Usai, M. V., Torsello, G. F., & Panuccio, G. (2018). Radiation doses for endovascular aortic repairs performed on mobile and fixed C-arm fluoroscopes and procedure phase-specific radiation distribution. Journal of Vascular Surgery, 68(6), pp. 1889-1896. doi:10.1016/j.jvs.2018.05.020.
Schaefers JF, et al. Radiation Doses for Endovascular Aortic Repairs Performed On Mobile and Fixed C-arm Fluoroscopes and Procedure Phase-specific Radiation Distribution. J Vasc Surg. 2018;68(6):1889-1896. PubMed PMID: 30473030.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiation doses for endovascular aortic repairs performed on mobile and fixed C-arm fluoroscopes and procedure phase-specific radiation distribution. AU - Schaefers,Johannes Frederik, AU - Wunderle,Kevin, AU - Usai,Marco Virgilio, AU - Torsello,Giovanni Federico, AU - Panuccio,Giuseppe, Y1 - 2018/06/28/ PY - 2018/02/17/received PY - 2018/05/15/accepted PY - 2018/11/27/entrez PY - 2018/11/27/pubmed PY - 2019/3/15/medline KW - Aorta KW - Endovascular KW - Hybrid room KW - Multispecialty KW - Radiation protection SP - 1889 EP - 1896 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 68 IS - 6 N2 - OBJECTIVE: The objective of this study was to analyze radiation risk to patients during endovascular aneurysm repair (EVAR) using mobile C-arm (MA) or fixed C-arm (FA) fluoroscopes and to describe the dose distribution during the different phases of the procedure. METHODS: Patients treated with EVAR using a single stent graft system between November 2009 and June 2016 were included in this study. The patients were divided into one of two groups (MA or FA) according to the type of C-arm used in the procedure. Data regarding patients' demographics and the total amount of contrast agent (CA) used, dose-area product, and fluoroscopy time for the procedures were prospectively recorded. Based on the dose report from the FA system, five standard and two optional phases of the procedure were identified to determine the dose distribution. RESULTS: Overall, 160 patients were included (mean age, 73.30 ± 8.97 years; 146 men); of these, 107 were treated with an MA system and 53 were treated with an FA system. The mean amounts of CA used were 108.55 ± 42.28 mL in the MA group and 85.37 ± 38.79 mL in the FA group (P = .0014). The mean total dose-area product values were 49.93 ± 38.06 Gy·cm2 in the MA group and 168.34 ± 146.92 Gy·cm2 in the FA group (P < .0001). There was no significant difference in fluoroscopy time between the groups. Per-phase analysis demonstrated that identification of the proximal landing zone and main body deployment required the most radiation, accounting for 24% of the total radiation dose. Overall, 47.6% of the exposure was due to digital subtraction angiography. CONCLUSIONS: Use of an FA system can significantly reduce the amount of CA needed but may also lead to higher radiation doses in EVAR procedures. Dose monitoring remains crucial for the safety of both patients and operators. A detailed analysis of dose distribution is possible with modern systems, which may improve the quality of monitoring in the future. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30473030/Radiation_doses_for_endovascular_aortic_repairs_performed_on_mobile_and_fixed_C_arm_fluoroscopes_and_procedure_phase_specific_radiation_distribution_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)31084-X DB - PRIME DP - Unbound Medicine ER -