Complexity-based local diagnostic reference levels (DRLs) for standard endovascular aneurysm repair (EVAR) procedures

Tzanis, Eleftherios; Ioannou, Christos; Tsetis, Dimitrios; Lioudaki, Stella; Matthaiou, Nikolas; Damilakis, John

doi:10.1016/j.ejmp.2020.04.015

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…Our findings and previous papers demonstrate a strong correlation between complexity within endovascular work with dose and fluoroscopy time [ 7 , 28 ]. Fluoroscopy time, however, is not necessarily correlated with increased doses [ 29 – 31 ].…”

Section: Discussionsupporting

confidence: 83%

“…Furthermore, the manufacturer, model, type (fixed vs mobile theatre C-arm) and age of imaging equipment play key roles in determining the patient dose. Tuthill and colleagues proposed an interim European DRL [ 6 ], and a local DRL was proposed in European countries such as Spain and Greece [ 4 , 7 ]. The UK does not presently have a nationally accepted DRL for such interventions.…”

Section: Introductionmentioning

confidence: 99%

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National UK Survey of Radiation Doses During Endovascular Aortic Interventions

Tsitsiou,

Velan,

Ross

et al. 2023

Cardiovasc Intervent Radiol

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Purpose Endovascular aortic repair (EAR) interventions, endovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), are associated with significant radiation exposures. We aimed to investigate the radiation doses from real-world practice and propose diagnostic reference level (DRL) for the UK. Materials and Methods Radiation data and essential demographics were retrospectively collected from 24 vascular and interventional radiology centres in the UK for all patients undergoing EAR—standard EVAR or complex, branched/fenestrated (BEVAR/FEVAR), and TEVAR—between 2018 and 2021. The data set was further categorised according to X-ray unit type, either fixed or mobile. The proposed national DRL is the 75th percentile of the collective medians for procedure KAP (kerma area product), cumulative air kerma (CAK), fluoroscopy KAP and CAK. Results Data from 3712 endovascular aortic procedures were collected, including 2062 cases were standard EVAR, 906 cases of BEVAR/FEVAR and 509 cases of TEVAR. The majority of endovascular procedures (3477/3712) were performed on fixed X-ray units. The proposed DRL for KAP was 162 Gy cm2, 175 Gy cm2 and 266 Gy cm2 for standard EVAR, TEVAR and BEVAR/FEVAR, respectively. Conclusion The development of DRLs is pertinent to EAR procedures as the first step to optimise the radiation risks to patients and staff while maintaining the highest patient care and paving the way for steps to reduce radiation exposures.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

National UK Survey of Radiation Doses During Endovascular Aortic Interventions

Tsitsiou,

Velan,

Ross

et al. 2023

Cardiovasc Intervent Radiol

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“…Still, analyses of the effect of various clinical factors on FT and radiation dose have rarely been documented ( 9 , 11 , 13 , 16 , 21 ) . The main findings from this study suggest that FT is directly associated with several anatomical, operative and clinical factors determining each EVAR procedure’s complexity ( 14 , 15 , 20 , 23 ) . More specifically, the presence of hypertension, dyslipidemia, age ≥ 70 y, aneurysm maximum diameter ≥ 6 cm and procedure duration ≥7200 s was associated with significantly increased FT ( p < 0.05) ( Table 2 ) since they are often related to the treatment of more demanding AAAs.…”

Section: Discussionmentioning

confidence: 77%

“…The investigation to identify factors influencing the FT during EVARs may therefore help vascular surgeons predict which procedures are associated with prolonged FT and make appropriate precautions to avoid adverse effects because of ionising radiation ( 6 ) . In this study, the FT has been found to be dependent on several parameters, such as stent-graft type, risk factors and comorbidities, as well as operative and clinical factors affecting the complexity of the procedure ( Table 2 ; Figures 1 and 2 ) ( 14 , 15 , 20 , 23 ) . Notably, additional radiation dose is required during frequent follow-up visits, utilising CTA scans, to verify that the stent-graft continues to function properly.…”

Section: Discussionmentioning

confidence: 80%

Factors Influencing Fluoroscopy Time in Endovascular Treatment of Abdominal Aneurysms: A Retrospective Study

Efthymiou

Kakkos

Metaxas

et al. 2023

Radiation Protection Dosimetry

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Patients who undergo endovascular aortic aneurysm repair (EVAR) may require prolonged radiation exposure affected by several factors. The objectives of this study were to document fluoroscopy time (FT) during EVAR and identify possible factors that influence it. A retrospective analysis of a 180 patients’ database with abdominal infrarenal aortic aneurysms submitted to EVAR during a 7-y period was performed. The FT is evaluated regarding risk factors and comorbidities, graft type and patient-related, clinical and technical parameters. FT’s median (interquartile range) was 1011 (698–1500) s. Excluder and C3 Excluder were associated with significantly lower FT values when compared with other grafts. Hypertension, dyslipidemia, age ≥ 70 y, maximum aneurysm diameter ≥ 6 cm and procedure duration ≥2 h resulted in higher FT values. A significantly lower FT was found for the operations performed in the 7th y of the study’s period compared with the previous 6 y, mainly because of the use of Excluder or C3 Excluder grafts. However, these grafts did not show any significant difference in FT values during the 7 y. A significant correlation between FT with age and procedure duration was found. Nevertheless, procedure duration is a poor FT predictor in linear and logistic regressions, although is significantly correlated with FT. Dyslipidemia, procedure duration and graft type are independent predictors of FT larger than the median, whereas only the procedure duration is a predictor for FT larger than the 75th percentile value. The identified factors regarding radiation protection issues should be considered when contemplating abdominal aortic aneurysm repair, however, without compromising the procedure’s efficacy. Further work is necessary to identify more potential anatomical, clinical and technical factors affecting procedures’ complexity and FT and patient radiation dose during EVAR interventions.

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“…The ICRP distinguishes between obtaining national, regional and local DRLs and introduced the term 'typical dose/typical value' for single facilities [6]. Our results represent TD and TV which equal the median value of the distribution of dose parameters [6,13]. TD were established for DAP in Gycm 2 and for CAK in mGy and TV for FT in min for the five most common procedures on each device.…”

Section: Calculation Of Typical Dosesmentioning

confidence: 99%

Typical doses and typical values for fluoroscopic diagnostic and interventional procedures

et al. 2022

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Purpose To implement typical doses (TD) and typical values (TV) for fluoroscopic diagnostic and interventional procedures. Material and Methods 3811 fluoroscopic procedures performed within 34 months on three devices were included in this retrospective study. Dose-, patient- and procedure-related information were extracted using the institutional dose management system (DMS). TD/TV were defined as median dose and calculated for the five most frequent procedures per device for dose area product (DAP), cumulative air kerma (CAK) and fluoroscopy time (FT). National DRLs and other single facility studies were compared to our results. Additionally, the five procedures with the highest doses of each device were analyzed. To evaluate the data coverage of the DMS compared to the picture archiving and communication system (PACS), procedure lists were extracted from the PACS and compared to the procedure information extracted from the DMS. Results TD/TV for 15 procedures were implemented. Among all devices, TD for DAP ranged between 0.6 Gycm² for port catheter control (n=64) and 145.9 Gycm² for transarterial chemoembolization (n=84). TD for CAK ranged between 5 mGy for port catheter control and 1397 mGy for aneurysm treatment (n=129) and TV for FT ranged between 0.3 minutes for upper cavography (n=67) and 51.4 minutes for aneurysm treatment. TD for DAP and CAK were lower or within the range of other single facility studies. The five procedures with the highest median DAP per device were identified, 6 of 15 procedures were also found to be among the most frequent procedures. Data coverage of the DMS compared to the PACS ranged between 71% (device 2, stroke treatment) and 78% (device 1, lower limb angiography) for the most common procedure per device. Thus, in 22-29% of cases dose data of the performed procedure was not transferred into the DMS. Conclusion We implemented TD/TV for fluoroscopic diagnostic and interventional procedures which enable a comprehensive dose analysis and comparison with previously published values.

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Complexity-based local diagnostic reference levels (DRLs) for standard endovascular aneurysm repair (EVAR) procedures

Cited by 6 publications

References 20 publications

National UK Survey of Radiation Doses During Endovascular Aortic Interventions

National UK Survey of Radiation Doses During Endovascular Aortic Interventions

Factors Influencing Fluoroscopy Time in Endovascular Treatment of Abdominal Aneurysms: A Retrospective Study

Typical doses and typical values for fluoroscopic diagnostic and interventional procedures

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