AlluraClarity Radiation Dose–Reduction Technology in the Hybrid Operating Room During Endovascular Aneurysm Repair

Ruiter, Quirina M.B. de; Moll, Frans L.; Gijsberts, Crystel M.; Herwaarden, Joost A. van

doi:10.1177/1526602815622433

Cited by 29 publications

(31 citation statements)

References 21 publications

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“…The disadvantage, however, is that the radiation dose is 3.5 times higher on average compared to mobile systems. 6,8,19 ClarityIQ is an imaging platform that is designed to address these issues. It utilizes reduced radiation dose settings, which inherently leads to decreased signal-to-noise ratio (SNR) of the images.…”

Section: Discussionmentioning

confidence: 99%

Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers

Stangenberg

Shuja

Bom

et al. 2017

Vasc Endovascular Surg

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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, 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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Section: Discussionmentioning

confidence: 99%

Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers

Stangenberg

Shuja

Bom

et al. 2017

Vasc Endovascular Surg

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“…To address this issue, low-dose CTA protocols have been reported to show the feasibility of reducing both radiation dose (reduce tube voltage from 120 to 100 or 80 kV) and contrast volume (lower contrast medium to 30 mL) while capturing diagnostic-quality images. [46][47][48] Another strategy to solve this issue is to use duplex ultrasound as an alternative to CTA in the follow-up of EVAR patients. Several authors have shown that contrast-enhanced ultrasound is as accurate as or better than CTA in detecting endoleaks, monitoring aneurysm dimensional changes, and assessing stented vessel patency by analyzing hemodynamic flow to the renal arteries.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of Synchrotron Radiation to Accurately Assess Cross-Sectional Area Reduction of the Aortic Branch Ostia Caused by Suprarenal Stent Wires

Sun

2017

J Endovasc Ther

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“…In an H-OR, an operating table is interconnected to a motorized flat panel detector C-arm with 2D/3D imaging, along with x-ray based image guidance tools. 10,11 In this study, we introduce an H-OR surgical navigation platform with optical cameras for augmented reality in intraoperative imaging and tracking. The optical platform was integrated with the standard flat detector frame of a motorized C-arm.…”

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confidence: 99%

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

Elmi-Terander

Skúlason

Söderman

et al. 2016

Spine

136

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Study Design.A cadaveric laboratory study.Objective.The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN).Summary of Background Data.Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine.Methods.ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches.Results.ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method.Conclusion.ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement.Level of Evidence: N/A

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AlluraClarity Radiation Dose–Reduction Technology in the Hybrid Operating Room During Endovascular Aneurysm Repair

Abstract: Changing a mobile C-arm for a fixed C-arm in a hybrid operating suite increased the average intraoperative dose during EVAR. Upgrading the Allura fixed C-arm with ClarityIQ technology resulted in a 61% reduction in the radiation per DSA frame.

Cited by 29 publications

References 21 publications

Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers

Modern Fixed Imaging Systems Reduce Radiation Exposure to Patients and Providers

Use of Synchrotron Radiation to Accurately Assess Cross-Sectional Area Reduction of the Aortic Branch Ostia Caused by Suprarenal Stent Wires

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

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