Patient dose during carotid artery stenting with embolic-protection devices: evaluation with radiochromic films and related diagnostic reference levels according to factors influencing the procedure
| Autor: | Pietro Quaretti, Loredana D'Ercole, Catherine Klersy, Milena Bocchiola, Francesco Lisciandro, Federico Zappoli Thyrion, Nicola Cionfoli, Andrea Azzaretti, Tommaso Cascella, Giuseppe Rodolico |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Carotid arteries Radiation Dosage Radiography Interventional Embolic Protection Devices Entrance skin dose Carotid artery disease medicine Fluoroscopy Dosimetry Humans Radiology Nuclear Medicine and imaging Carotid Stenosis Radiometry Aged Skin Aged 80 and over medicine.diagnostic_test business.industry Ultrasound Angiography Middle Aged medicine.disease Logistic Models Treatment Outcome Intracranial Embolism Linear Models Patient dose Female Stents Radiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Cardiovascular and interventional radiology. 36(2) |
| ISSN: | 1432-086X |
| Popis: | To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity.MESD were evaluated with radiochromic films in 31 patients (mean age 72 ± 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 ± 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included.MESD values (mean 0.96 ± 0.42 Gy) were2 Gy without relevant dependence on procedure complexity. Local DRL values for kerma area product (KAP), fluoroscopy time (FT), and number of frames (NFR) were 269 Gy cm(2), 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1-102.7, p0.05) and NFR overexposures (OR 10.8, 95 % CI 1.1-109.5, p0.05). Type I aortic arch decreased the risk of FT overexposure (OR 0.4, 95 % CI 0.1-0.9, p = 0.042), and stenosis ≥ 90 % increased the risk of NFR overexposure (OR 2.8, 95 % CI 1.1-7.4, p = 0.040). At multivariable analysis, stenosis ≥ 90 % (OR 2.8, 95 % CI 1.1-7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1-109.5, p = 0.027) were associated with overexposure for two or more parameters.Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses2 Gy. |
| Databáze: | OpenAIRE |
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