Dose-Area Product to Patients During Stent-Graft Treatment of Thoracic and Abdominal Aortic Aneurysms

Abstract

This article is the first investigation that studies patient doses (air kerma and DAP) during digital subtraction angiography (DSA) for stent-graft treatment of both thoracic (TAAs) and abdominal (AAAs) aortic aneurysms. Fluoroscopy and exposure time, air kerma and dose-area product (DAP) were analyzed from 100 patients. In 41% of the analyzed patients total air kerma was between 1-2 Gy and for 7% exceeded 2 Gy. Median DAP values for fluoroscopy were 87.6 (TAAs) and 142.2 (AAAs) (Gy cm2) and for exposure 364.7 and 238.7 (Gy cm2), respectively. A 10-min prolongation of treatment causes about 83 Gy cm increase of DAP for fluoroscopy and 390 Gy cm for each 1 s of exposure. A good correlation between DAP and examination times was found for both exposure (r = 0.78) and fluoroscopy (r = 0.7). Moreover, sex was found to be a differential factor for DAP: DAP values for females were about 25% lower for both clinical procedures. For this kind of treatment the radiation doses were obtained for patients. Total air kerma in this kind of treatment for TAAs might be high and can even reach 4 Gy.

Endovascular Repair: Radiation Risks

“…Similar correlations were observed by Blaszak, et al (2009, and Kuhelj, et al (2010), but not by Pannucio (2011). found that the radiation burden is also influenced by the operative strategy chosen by the surgeon, that depends on the clinical presentation.…”

Meta-analysis of Cumulative Radiation Duration and Dose During EVAR Using Mobile, Fixed, or Fixed/3D Fusion C-Arms

“…Of 52 full-text publications examined (Figure 1), 22 articles 1,13 -33 were excluded based on exclusion criteria and an additional 3 articles 34-36 that could not be assigned to an equipment group because 2 articles 34,35 failed to report the type of C-arm (mobile or fixed) and 1 article 36 reported only the primary outcomes for a mixed group use of mobile and fixed C-arms. These latter 3 studies were excluded from the meta-analysis but were included in the overall correlation plot between FT and KAP (Supplementary Table S1; supplementary material available at http://jet.sagepub.com/content/by/supplemental-data).…”

Identification of Factors Influencing Cumulative Long-Term Radiation Exposure in Patients Undergoing EVAR

“…In addition to factors relating to the level of experience available at a given institution, to operators, learning curves and the continuity of team composition, an influence on the ED delivered during the EVAR procedure is of course also exerted by the equipment used. While we were able to show that the type of scanner used to implement CTAs does not give rise to statistically significant differences between the EDs delivered, comparison between the values published by previous authors showed that the highest EDs resulting from the EVAR procedure were reported by institutions where EVAR was performed in angiography suites, for example, 354 Gycm 2 reported by Blaszak et al [ 33 ] or 160 Gycm 2 determined in our study population, while values reported by investigators using mobile C arms were lower. This is confirmed by Geijer et al [ 12 ] and Fossaceca et al [ 34 ] and most likely explained by the higher performance of the DSA systems used in angiographic suites.…”

“…As alternative imaging methods such as ultrasound, in particular, frequently yield poor results in obese patients, too, the opportunities to reduce radiation exposure in this particular subset of patients are limited to providing them with adequate information and lengthening the intervals between CTA follow-ups as well as limiting the number of scans per CTA where appropriate. Weight loss should of course be recommended, especially as obesity was recently found to be an independent predictor of outcome after endovascular abdominal aortic aneurysm repair [ 33 ].…”