Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers

Lars Stangenberg; Fahad Shuja; I Martijn J van der Bom; Martine H G van Alfen; Allen D Hamdan; Mark C Wyers; Raul J Guzman; Marc L Schermerhorn

doi:10.1177/1538574417742211

Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers

Vasc Endovascular Surg. 2018 Jan;52(1):52-58. doi: 10.1177/1538574417742211. Epub 2017 Nov 21.

Authors

Lars Stangenberg^{1

2}, Fahad Shuja^{1

3}, I Martijn J van der Bom⁴, Martine H G van Alfen⁴, Allen D Hamdan¹, Mark C Wyers¹, Raul J Guzman¹, Marc L Schermerhorn¹

Affiliations

¹ 1 Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
² 2 Division of Vascular and Endovascular Surgery, Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
³ 3 Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
⁴ 4 Philips Healthcare, Image Guided Therapy Systems, Cambridge, MA, USA.

PMID: 29162024
DOI: 10.1177/1538574417742211

Abstract

High-definition fluoroscopic imaging is required to perform endovascular procedures safely and precisely, especially in complex cases, resulting in longer procedures and increased radiation exposure. This is of importance for training institutions as trainees, even with sound instruction in as low as reasonably achievable (ALARA) principles, tend to have high radiation exposures. Recently, there was an upgrade in the imaging system allowing for comparison of radiation exposure to patients and providers. We performed an analysis of consecutive endovascular aneurysm repair (EVAR) and superficial femoral artery (SFA) interventions in the years 2013 to 2014. We recorded body mass index (BMI) and fluoroscopy time (FT) and subsequently matched 1:1 based on BMI, FT, or both. We determined radiation dose using air kerma (AK) and also recorded individual surgeons' badge readings. Allura Xper FD20 was upgraded to AlluraClarity with ClarityIQ. We identified a total of 77 EVARs (52 pre and 25 post) and 134 SFA interventions (99 pre and 35 post). Unmatched results for EVAR were BMI pre 26.2 versus post 25.8 (kg/m², P = .325), FT 28.1 versus 21.2 (minutes, P = .051), and AK 1178.5 versus 581 (mGy, P < .001), respectively. After matching, there was a 53.2% reduction in AK (846.1 vs 395.9 mGy; P = .004) for EVAR. Unmatched results for SFA interventions were BMI pre 28.1 versus post 26.6 ( P = .327), FT 18.7 versus 16.2 ( P = .282), and AK 285.6 versus 106.0 ( P < .001), respectively. After matching, there was a 57.0% reduction in AK (305.0 vs 131.3, P < .001). The total deep dose equivalent from surgeons' badge readings decreased from 39.5 to 17 mrem ( P = .029). Aortic and peripheral endovascular interventions can be performed with reduced radiation exposure to patients and providers, employing modern fixed imaging systems with advanced dose reduction technology. This is of particular importance in the light of the increasing volume and complexity of endovascular and hybrid procedures as well as the prospect of decades of radiation exposure during training and practice.

Keywords: endovascular; exposure; fixed imaging system; radiation; safety.

MeSH terms

Aortic Aneurysm, Abdominal / diagnostic imaging
Aortic Aneurysm, Abdominal / therapy*
Body Mass Index
Endovascular Procedures / adverse effects
Endovascular Procedures / instrumentation*
Equipment Design
Female
Femoral Artery / diagnostic imaging*
Fluoroscopy
Humans
Male
Occupational Exposure / adverse effects
Occupational Exposure / prevention & control*
Occupational Health*
Patient Safety*
Peripheral Arterial Disease / diagnostic imaging
Peripheral Arterial Disease / therapy*
Radiation Dosage*
Radiation Exposure / adverse effects
Radiation Exposure / prevention & control*
Radiation Monitoring / instrumentation
Radiography, Interventional / adverse effects
Radiography, Interventional / instrumentation*
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Workload