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Objectives-The purpose of this study is to demonstrate to what extent an evidence based decision model can improve physicians' decisions and whether a selective use of the decision model is feasible. Methods-Four experienced vascular surgeons were asked to make a treatment decision for 137 "paper patient" cases with asymptomatic abdominal aneurysms. Their decisions were compared with the optimal treatment as calculated by a computerised evidence based decision analytical model. Results-Surgeons agreed with the model's advice based on life expectancy in 81% of the cases, and decided to operate in only 12% of the cases for which there was no agreement. Surgeons' decisions diVered from the decision model's calculated optimal treatment, in particular, for older patients with aneurysms of intermediate size and with many risk factors, and for younger patients with small aneurysms and few risk factors. Not all these decisions, however, were reported to be more diYcult. Conclusion-Use of a decision analytical model might lead to more appropriate decisions and a better quality of care. Selective use of the decision tool for diYcult decisions only would be more eYcient but is not yet feasible because reported decision diYculty is not strongly related to disagreement with the decision tool.

Purpose: To assess cumulative patient dose and to calculate associated radiation risks for patients undergoing abdominal endovascular aortic aneurysm repair (EVAR). Method and Materials: A traditional protocol and a reduced dose scenario for medical imaging in EVAR planning, repair and surveillance was assumed and patient dose was assessed. The excess relative radiation risk was calculated using a model for age‐, gender‐ and site‐specific solid cancer mortality. Life tables were used to calculate risk related parameters for patients that underwent EVAR at 55, 65, 75 and 85 years of age. In addition to radiation risk, mortality rates that are typical for the EVAR population were taken into account, knowingly the probability of 30‐day mortality and the mortality rate from AAA‐related causes in general during follow‐up. Results: Effective dose for EVAR planning was 18 (8) mSv; for EVAR repair 10 (10) mSv; and during the first, second and subsequent years of surveillance 87.5 (35) mSv/y, 35 (17.5) mSv/y and 17.5 (17.5) mSv/y. The number of radiation induced deaths per 1000 EVAR patients was 12 (10), 8 (6), 4 (3) and 1 (1) for patients treated at ages 55, 65, 75 and 85 years (respectively traditional protocol and between brackets reduced dose scenario). The corresponding number of abdominal aortic aneurysm (AAA) related deaths per 1000 EVAR patients was: 126, 91, 67 and 47, respectively (for both the traditional protocol and the reduced dose scenario). The average radiation induced and AAA related reduction of life expectancy will be presented. Conclusion: Radiation exposure accumulates rapidly for patients undergoing surveillance after abdominal EVAR. However, associated radiation risks are modest, even for the traditional surveillance protocol that is associated with a relatively high patient dose. Radiation risks are much smaller compared to AAA‐related risks.

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