Editor's Choice – Comprehensive Literature Review of Radiation Levels During Endovascular Aortic Repair in Cathlabs and Operating Theatres

Abstract

Objective: Occupational exposure is a growing concern among the endovascular specialist community. Several types of imaging equipment are available, such as mobile C arms or hybrid rooms, and some have been shown to deliver higher levels of radiation. A literature review was conducted to identify studies reporting dose data during standard (EVAR) and complex abdominal aortic endovascular repair (fenestrated/branched EVAR [F/BEVAR]). Methods: A search of the MEDLINE and the Cochrane databases was performed by two independent investigators using the medical subject heading terms "aortic aneurysms", "radiation", and "humans" over a search period of 10 years. Studies with full text available in English and reporting radiation data independently from the imaging equipment type were included. Experimental studies were excluded. Results: The lowest doseearea product levels during EVAR and F/BEVAR were identified in hybrid rooms, while the highest were with fixed systems. When adherence to the as low as reasonably achievable principles was stipulated by the authors, dose reports tended to be among the lowest. Several studies, especially of F/ BEVAR, report concerning levels of radiation for both patients and staff. Conclusion: Modern imaging equipment type, team involvement with radiation management, and the support of recent imaging technologies such as fusion help to reduce the dose delivered during standard and complex EVAR. Investment in modern imaging technology should be considered in every centre providing endovascular management of aortic aneurysms.

Fusion Imaging Guidance Does Not Affect Radiation Exposure During Endovascular Procedures for Lower Extremity Arterial Disease: A Randomized Controlled Trial

“…This advanced imaging technology has been associated in literature with up to 70% reduction of the procedure’s radiation reported in complex EVAR, a lower fluoroscopy time and a decreased volume of iodinated contrast agent. 14 However, little is known about the impact of fusion imaging guidance on radiation and contrast dose during lower limb revascularisation.…”

A Steerable and Electromagnetically Tracked Catheter: Navigation Performance Compared With Image Fusion in a Swine Model

“…Although improvements have been seen with the use of preloaded wires, image fusion, steerable instruments, and operator experience, the radiation dose is still considerable with F/BEVAR, potentially posing a risk to patients and personnel. 1 – 3 Electromagnetic (EM) tracking enables navigation without the use of radiographs and contrast media and provides accurate 3-dimensional (3D) visualization of anatomy and tracked instruments. While proposed and demonstrated in the research literature, commercial alternatives for endovascular use are lacking.…”

Occupational doses in interventional angiography after radiological protection training and use of a real-time direct display dosimeter

“…There are concerns about occupational doses in vascular surgery that involves a complex and long-lasting RI [12,13]. There are indications that technological aspects such as the use of fusion techniques and working in a hybrid room lead to lower occupational doses, but there is still a need for improved awareness about radiation risks via education [12,13].…”