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
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.
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.
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).
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.