Key result
Upgrading to a modern fixed imaging system with advanced dose reduction technology significantly reduced air kerma by 53.2% for EVAR (P=0.004) and 57.0% for SFA interventions (P<0.001).
Why the study?
Does a modern fixed imaging system with advanced dose reduction technology reduce radiation exposure to patients and providers during endovascular interventions?
Cohort (n=211)
Does a modern fixed imaging system with advanced dose reduction technology reduce radiation exposure to patients and providers during endovascular interventions?
Effect estimate: 53.2% reduction
Absolute Event Rate: 395.9% vs 846.1%
p-value: p=0.004
Upgrading to modern fixed imaging systems with advanced dose reduction technology significantly reduces radiation exposure to both patients and providers during endovascular interventions.
Supports consideration of imaging upgrades to minimize radiation in endovascular cases; extends observational data but leaves randomized confirmation open.
High-definition fluoroscopic imaging is required to perform endovascular procedures safely and precisely, especially in complex cases, resulting in longer procedures and increased radiation exposure. This is of importance for training institutions as trainees, even with sound instruction in as low as reasonably achievable (ALARA) principles, tend to have high radiation exposures. Recently, there was an upgrade in the imaging system allowing for comparison of radiation exposure to patients and providers. We performed an analysis of consecutive endovascular aneurysm repair (EVAR) and superficial femoral artery (SFA) interventions in the years 2013 to 2014. We recorded body mass index (BMI) and fluoroscopy time (FT) and subsequently matched 1:1 based on BMI, FT, or both. We determined radiation dose using air kerma (AK) and also recorded individual surgeons’ badge readings. Allura Xper FD20 was upgraded to AlluraClarity with ClarityIQ. We identified a total of 77 EVARs (52 pre and 25 post) and 134 SFA interventions (99 pre and 35 post). Unmatched results for EVAR were BMI pre 26.2 versus post 25.8 (kg/m 2 , P = .325), FT 28.1 versus 21.2 (minutes, P = .051), and AK 1178.5 versus 581 (mGy, P < .001), respectively. After matching, there was a 53.2% reduction in AK (846.1 vs 395.9 mGy; P = .004) for EVAR. Unmatched results for SFA interventions were BMI pre 28.1 versus post 26.6 ( P = .327), FT 18.7 versus 16.2 ( P = .282), and AK 285.6 versus 106.0 ( P < .001), respectively. After matching, there was a 57.0% reduction in AK (305.0 vs 131.3, P < .001). The total deep dose equivalent from surgeons’ badge readings decreased from 39.5 to 17 mrem ( P = .029). Aortic and peripheral endovascular interventions can be performed with reduced radiation exposure to patients and providers, employing modern fixed imaging systems with advanced dose reduction technology. This is of particular importance in the light of the increasing volume and complexity of endovascular and hybrid procedures as well as the prospect of decades of radiation exposure during training and practice.
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Stangenberg et al. (2017) conducted a cohort in Endovascular aneurysm repair (EVAR) and superficial femoral artery (SFA) interventions (n=211). Modern fixed imaging system with advanced dose reduction technology (AlluraClarity with ClarityIQ) vs. Older imaging system (Allura Xper FD20) was evaluated on Radiation dose using air kerma (AK) for EVAR (matched) (53.2% reduction, p=0.004). Upgrading to a modern fixed imaging system with advanced dose reduction technology significantly reduced air kerma by 53.2% for EVAR (P=0.004) and 57.0% for SFA interventions (P<0.001).
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