Role of Portable C-arm Imaging as a Low Radiation Alternative to Fixed Systems in Vascular Surgery

Introduction: Intraoperative imaging in endovascular surgery is performed with conventional fixed imaging (FI) systems or with mobile C-arm machines. FI systems provide good image quality but deliver higher patient radiation doses and have higher acquisition and maintenance costs. Conversely, modern mobile C-arm machines have a lower radiation exposure profile, lower acquisition and running costs, and integrate easily into existing theater infrastructure. Aims: We aim to compare the radiation exposure profile using a C-arm with existing FI data for selected endovascular procedures. Subjects and Methods: We conducted a retrospective study at the vascular surgery unit of a tertiary referral teaching center where we recorded the patient dose area product (DAP, Gy. cm2) for 249 consecutive patients undergoing an endovascular procedure using a mobile C-arm machine. The primary outcome measure was patient radiation exposure (DAP in Gy.cm 2) . The measured radiation exposure and fluoroscopy times were compared to published data for FI for each corresponding procedure. Results: There were 249 patients in the study period. We achieved operative technical success in 98% of patients. Comparison of mean DAP levels to published FI radiation data found the overall radiation exposure with C-arm was less than half for aortoiliac, femoropopliteal, and tibial procedures. Multi-level procedures had similar values with FI. Conclusions: Modern mobile C-arm devices offer a lower radiation alternative to fixed systems with comparable outcomes and safety profile. There is a need to establish national India-specific diagnostic reference levels for different endovascular procedures to guide local practice and facilitate clinical audit practices. Disseminating information on as low as reasonably achievable principles and radiation safety is crucial to ensure safe clinical outcomes.