Radiation doses for endovascular aortic repairs performed on mobile and fixed C-arm fluoroscopes and procedure phase-specific radiation distribution

Johannes Frederik Schaefers; Kevin Wunderle; Marco Virgilio Usai; Giovanni Federico Torsello; Giuseppe Panuccio

doi:10.1016/j.jvs.2018.05.020

Radiation doses for endovascular aortic repairs performed on mobile and fixed C-arm fluoroscopes and procedure phase-specific radiation distribution

J Vasc Surg. 2018 Dec;68(6):1889-1896. doi: 10.1016/j.jvs.2018.05.020. Epub 2018 Jun 28.

Authors

Johannes Frederik Schaefers¹, Kevin Wunderle², Marco Virgilio Usai¹, Giovanni Federico Torsello³, Giuseppe Panuccio⁴

Affiliations

¹ Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany.
² Department of Radiology, Cleveland Clinic, Cleveland, Ohio.
³ Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
⁴ Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany. Electronic address: giuseppe.panuccio@ukmuenster.de.

PMID: 30473030
DOI: 10.1016/j.jvs.2018.05.020

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.

Keywords: Aorta; Endovascular; Hybrid room; Multispecialty; Radiation protection.

Publication types

Comparative Study

MeSH terms

Aged
Aged, 80 and over
Angiography, Digital Subtraction / adverse effects
Angiography, Digital Subtraction / instrumentation*
Aorta / diagnostic imaging*
Aorta / surgery*
Aortography / adverse effects
Aortography / instrumentation*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / instrumentation
Endovascular Procedures* / adverse effects
Endovascular Procedures* / instrumentation
Equipment Design
Female
Fluoroscopy
Humans
Male
Predictive Value of Tests
Radiation Dosage*
Radiation Exposure* / adverse effects
Radiation Monitoring
Radiography, Interventional / adverse effects
Radiography, Interventional / instrumentation*
Retrospective Studies
Risk Factors
Stents
Time Factors
Tomography Scanners, X-Ray Computed*
Treatment Outcome