Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers
| Autor: | Fahad Shuja, Mark C. Wyers, Raul J. Guzman, Martine H.G. van Alfen, Marc L. Schermerhorn, Lars Stangenberg, I Martijn J van der Bom, Allen D. Hamdan |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Time Factors medicine.medical_treatment Workload 030204 cardiovascular system & hematology Radiation Dosage Radiography Interventional Risk Assessment Endovascular aneurysm repair Body Mass Index Peripheral Arterial Disease 03 medical and health sciences Kerma 0302 clinical medicine Radiation Monitoring Risk Factors Occupational Exposure medicine Humans Fluoroscopy 030212 general & internal medicine Occupational Health Retrospective Studies medicine.diagnostic_test Superficial femoral artery business.industry Endovascular Procedures Deep-dose equivalent Equipment Design General Medicine Radiation Exposure Femoral Artery Radiation exposure Female Surgery Dose reduction Patient Safety Cardiology and Cardiovascular Medicine Nuclear medicine business Body mass index Aortic Aneurysm Abdominal |
| Zdroj: | Vascular and Endovascular Surgery. 52:52-58 |
| ISSN: | 1938-9116 1538-5744 |
| DOI: | 10.1177/1538574417742211 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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