Introduction of a Team Based Approach to Radiation Dose Reduction in the Enhancement of the Overall Radiation Safety Profile of FEVAR

Abstract

Implementation of a team-based approach to radiation reduction significantly reduces radiation dose. These findings suggest that the radiation safety awareness that accompanies the introduction of fusion imaging may improve the overall radiation safety profile of FEVAR for patients and providers.

Multicentre Evaluation of an Extra Low Dose Protocol to Reduce Radiation Exposure in Superior Mesenteric Artery Stenting

“…This study links to the overall work of the vascular surgery community on radiation safety and awareness to integrate radiation reduction into daily practice. 18,20,21 To reduce radiation, first, the starting point must be known, and that applies to all fields of vascular surgery: aortic disease, visceral and renal artery diseases, iliac stenting, complex peripheral disease, and so on. Reporting "radiation outcomes" will allow for definition of radiation level standards.…”

“…15,16 Sticking to the "as low as reasonably achievable" (ALARA) principle, the use of hybrid rooms with image fusion and a dedicated low dose protocol significantly reduces the dose of radiation during both standard and complex aortic repairs. 17,18 But these reports mainly address the aortic field, while data are lacking regarding other fields of vascular surgery, MOD in particular. Yet, MS can potentially lead to high levels of radiation because of the need for extreme beam angulation, which results in a higher radiation rate and alters imaging quality.…”

Endovascular robotics

“…Image fusion typically involves combining preoperative CT volumes with intra-operative cone-beam CT (CBCT) to provide an intra-operative 3D image overlay on the fluoroscopy. 21 Tystad Lund and colleagues have shown, using CBCT fusion techniques on a silicone aortic phantom, that it is possible to use electromagnetic tracking (EM) to localise catheters within the 3D phantom overlay, negating the need for intra-operative fluoroscopy. 22 A further report has shown that it is possible to use EM techniques to track the robotic catheter both in bi-plane fluoroscopic imaging and in 3D reconstructions.…”

“…The potential for zero-radiation procedures with the aid of robotic technology is certainly an attractive proposition for surgeons who will be performing increasing numbers of endovascular cases during the course of a professional lifetime 4% and 32% of the total effective dose in complex cases. 21 There is an ongoing need to develop and validate methods for the assessment of technology benefit that are more refined than traditional outcome measures in surgery. Although clinical evaluation of this technology is still at its early stage, an increasing number of reports highlight its use and benefit where conventional techniques have been attempted and failed as a result of anatomical complexity.…”

Hybrid Operating Room System for the Treatment of Thoracic and Abdominal Aortic Aneurysms: Evaluation of the Radiation Dose Received by Patients

“…We here attempted to optimize the radiation doses delivered during HORS-mediated treatment of patients with thoracic and abdominal aortic aneurysms. Direct methods of assessing radiation exposure [ 11 , 12 , 13 , 14 ] are cumbersome; thus, we used indirect methods (the dose–area product (DAP) and air karma (AK) parameters) to assess skin radiation doses [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. We determined the DAP and AK radiation dose indicators associated with EVAR and TEVAR delivered via a HORS.…”