Key result
Operators may reach their yearly 20 mSv dose limit after 358 minutes of digital subtraction angiography radiation from brachial access versus 941 minutes from femoral access.
Why the study?
While operator and patient radiation dose rates are correlated, discrepancies may exist in the effect size of individual radiation dose predictors.
What are the predictors of operator radiation dose rates compared to patient dose rates during endovascular aortic repair?
Observational (n=50)
What are the predictors of operator radiation dose rates compared to patient dose rates during endovascular aortic repair?
C-arm angulation and changing from femoral to brachial vascular access site disproportionally increase operator radiation risk compared with patient radiation risk during EVAR.
Operator-specific dose models may differ from patient models; leaves open whether risk charts improve safety in endovascular procedures.
Introduction: While the operator radiation dose rates are correlated to patient radiation dose rates, discrepancies may exist in the effect size of each individual radiation dose predictors. An operator dose rate prediction model was developed, compared with the patient dose rate prediction model, and converted to an instant operator risk chart. Materials and Methods: The radiation dose rates (DR operator for the operator and DR patient for the patient) from 12,865 abdomen X-ray acquisitions were selected from 50 unique patients undergoing standard or complex endovascular aortic repair (EVAR) in the hybrid operating room with a fixed C-arm. The radiation dose rates were analyzed using a log-linear multivariable mixed model (with the patient as the random effect) and incorporated varying (patient and C-arm) radiation dose predictors combined with the vascular access site. The operator dose rate models were used to predict the expected radiation exposure duration until an operator may be at risk to reach the 20 mSv year dose limit. The dose rate prediction models were translated into an instant operator radiation risk chart. Results: In the multivariate patient and operator fluoroscopy dose rate models, lower DR operator than DR patient effect size was found for radiation protocol (2.06 for patient vs 1.4 for operator changing from low to medium protocol) and C-arm angulation. Comparable effect sizes for both DR operator and DR patient were found for body mass index (1.25 for patient and 1.27 for the operator) and irradiated field. A higher effect size for the DR operator than DR patient was found for C-arm rotation (1.24 for the patient vs 1.69 for the operator) and exchanging from femoral access site to brachial access (1.05 for patient vs 2.5 for the operator). Operators may reach their yearly 20 mSv year dose limit after 941 minutes from the femoral access vs 358 minutes of digital subtraction angiography radiation from the brachial access. Conclusion: The operator dose rates were correlated to patient dose rate; however, C-arm angulation and changing from femoral to brachial vascular access site may disproportionally increase the operator radiation risk compared with the patient radiation risk. An instant risk chart may improve operator dose awareness during EVAR.
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Ruiter et al. (2021) conducted an observational in Endovascular aortic repair (EVAR) (n=50). Vascular access site (brachial vs femoral) and C-arm positioning was evaluated on Operator and patient radiation dose rates. Operators may reach their yearly 20 mSv dose limit after 358 minutes of digital subtraction angiography radiation from brachial access versus 941 minutes from femoral access.
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