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Dual Fluoroscopy with Live-Image Digital Zooming Significantly Reduces Patient and Operating Staff Radiation During Fenestrated/Branched Endovascular Aortic Aneurysm Repair (F-BEVAR).
J Vasc Surg. 2020 May 27 [Online ahead of print]JV

Abstract

OBJECTIVE

Fenestrated/branched endovascular aneurysm repair (F-BEVAR) is a complex procedure that generates high radiation doses. Magnification aids in vessel cannulation but increases radiation. The aim of the study was to compare radiation doses to patients and operating room staff from two fluoroscopic techniques, standard magnification vs. dual fluoroscopy with live-image digital zooming during F-BEVAR.

METHODS

An observational, prospective, single center study of F-BEVAR procedures using Philips Allura XperFD20 equipment was performed over a 42-month period. Intravascular ultrasound, 3D-fusion and extreme collimation were used in all procedures. Intraoperative live imaging processing was performed using two imaging systems: standard magnification in 123 (81%) and dual fluoroscopy with live-image digital zooming in 28 patients (18%). In the latter, the live 'processed' zoomed images are displayed on examination displays and live images are displayed on reference displays. The reference air kerma was collected for each case and represents patient dose. Operating staff personal dosimetry was collected using the DoseAware system (Philips Healthcare, Amsterdam, The Netherlands). Patient and staff radiation doses were compared using non-parametric tests.

RESULTS

Mean age was 71.6 ± 11.4 years. The median BMI was 27 kg/m2 (interquartile range [IQR], 24.4- 30.6) and was the same for both groups. Procedures performed with dual fluoroscopy with digital zooming demonstrated significantly lower median patient (1382 mGy [IQR, 999-2045] vs 2458 mGy [IQR, 1706-3767]) (P < .01) and primary operator radiation doses (101 μSv [IQR, 34-235] vs 266 μSv [IQR, 104-583]) (P < .01) when compared to standard magnification. Similar significantly reduced radiation doses were recorded for first assistant, scrub nurse and anesthesia staff in procedures performed with dual fluoroscopy. According to device design, procedures performed with 4-fenestration/branch devices generated higher operator radiation doses (262 μSv [IQR, 116.5-572] vs 171[IQR, 44-325]) (P < .01) compared to procedures with 3 or less fenestration/branches. Among the most complex design (4-vessel), operator radiation dose was significantly lower with digital zooming compared to standard magnification (128.5 μSv [IQR, 70.5-296] vs 309 μSv [IQR, 150-611]) (P = .01).

CONCLUSION

Current radiation doses to patients and operating personnel are within acceptable limits; however, dual fluoroscopy with live-image digital zooming results in dramatically lower radiation dosages compared to the standard image processing with dose-dependent magnification.. Operator radiation doses were reduced in half during procedures performed using more complex device designs when digital zooming was used.

Authors+Show Affiliations

Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA.Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center.Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center.Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center.Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center.Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center.Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center. Electronic address: melissa.kirkwood@utsouthwestern.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32473339

Citation

Timaran, Laura I., et al. "Dual Fluoroscopy With Live-Image Digital Zooming Significantly Reduces Patient and Operating Staff Radiation During Fenestrated/Branched Endovascular Aortic Aneurysm Repair (F-BEVAR)." Journal of Vascular Surgery, 2020.
Timaran LI, Timaran CH, Scott CK, et al. Dual Fluoroscopy with Live-Image Digital Zooming Significantly Reduces Patient and Operating Staff Radiation During Fenestrated/Branched Endovascular Aortic Aneurysm Repair (F-BEVAR). J Vasc Surg. 2020.
Timaran, L. I., Timaran, C. H., Scott, C. K., Soto-Gonzalez, M., Timaran-Montenegro, D. E., Guild, J. B., & Kirkwood, M. L. (2020). Dual Fluoroscopy with Live-Image Digital Zooming Significantly Reduces Patient and Operating Staff Radiation During Fenestrated/Branched Endovascular Aortic Aneurysm Repair (F-BEVAR). Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2020.05.031
Timaran LI, et al. Dual Fluoroscopy With Live-Image Digital Zooming Significantly Reduces Patient and Operating Staff Radiation During Fenestrated/Branched Endovascular Aortic Aneurysm Repair (F-BEVAR). J Vasc Surg. 2020 May 27; PubMed PMID: 32473339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual Fluoroscopy with Live-Image Digital Zooming Significantly Reduces Patient and Operating Staff Radiation During Fenestrated/Branched Endovascular Aortic Aneurysm Repair (F-BEVAR). AU - Timaran,Laura I, AU - Timaran,Carlos H, AU - Scott,Carla K, AU - Soto-Gonzalez,Marilisa, AU - Timaran-Montenegro,David E, AU - Guild,Jeffrey B, AU - Kirkwood,Melissa L, Y1 - 2020/05/27/ PY - 2020/01/25/received PY - 2020/05/10/accepted PY - 2020/5/31/entrez PY - 2020/5/31/pubmed PY - 2020/5/31/medline KW - Dual fluoroscopy KW - Fenestrated/branched EVAR KW - Live-image Digital Zooming KW - Radiation Safety KW - Standard Electronic Magnification JF - Journal of vascular surgery JO - J. Vasc. Surg. N2 - OBJECTIVE: Fenestrated/branched endovascular aneurysm repair (F-BEVAR) is a complex procedure that generates high radiation doses. Magnification aids in vessel cannulation but increases radiation. The aim of the study was to compare radiation doses to patients and operating room staff from two fluoroscopic techniques, standard magnification vs. dual fluoroscopy with live-image digital zooming during F-BEVAR. METHODS: An observational, prospective, single center study of F-BEVAR procedures using Philips Allura XperFD20 equipment was performed over a 42-month period. Intravascular ultrasound, 3D-fusion and extreme collimation were used in all procedures. Intraoperative live imaging processing was performed using two imaging systems: standard magnification in 123 (81%) and dual fluoroscopy with live-image digital zooming in 28 patients (18%). In the latter, the live 'processed' zoomed images are displayed on examination displays and live images are displayed on reference displays. The reference air kerma was collected for each case and represents patient dose. Operating staff personal dosimetry was collected using the DoseAware system (Philips Healthcare, Amsterdam, The Netherlands). Patient and staff radiation doses were compared using non-parametric tests. RESULTS: Mean age was 71.6 ± 11.4 years. The median BMI was 27 kg/m2 (interquartile range [IQR], 24.4- 30.6) and was the same for both groups. Procedures performed with dual fluoroscopy with digital zooming demonstrated significantly lower median patient (1382 mGy [IQR, 999-2045] vs 2458 mGy [IQR, 1706-3767]) (P < .01) and primary operator radiation doses (101 μSv [IQR, 34-235] vs 266 μSv [IQR, 104-583]) (P < .01) when compared to standard magnification. Similar significantly reduced radiation doses were recorded for first assistant, scrub nurse and anesthesia staff in procedures performed with dual fluoroscopy. According to device design, procedures performed with 4-fenestration/branch devices generated higher operator radiation doses (262 μSv [IQR, 116.5-572] vs 171[IQR, 44-325]) (P < .01) compared to procedures with 3 or less fenestration/branches. Among the most complex design (4-vessel), operator radiation dose was significantly lower with digital zooming compared to standard magnification (128.5 μSv [IQR, 70.5-296] vs 309 μSv [IQR, 150-611]) (P = .01). CONCLUSION: Current radiation doses to patients and operating personnel are within acceptable limits; however, dual fluoroscopy with live-image digital zooming results in dramatically lower radiation dosages compared to the standard image processing with dose-dependent magnification.. Operator radiation doses were reduced in half during procedures performed using more complex device designs when digital zooming was used. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/32473339/Dual_Fluoroscopy_with_Live-Image_Digital_Zooming_Significantly_Reduces_Patient_and_Operating_Staff_Radiation_During_Fenestrated/Branched_Endovascular_Aortic_Aneurysm_Repair_(F-BEVAR) L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(20)31286-6 DB - PRIME DP - Unbound Medicine ER -
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