Patients' Radiation Doses During Thoracic Stent-Graft Implantation: The Problem of Long-Lasting Procedures

Majewska, Natalia; Stanišić, Michał; Kłos, Magdalena A.; Makalowski, Marcin; Frankiewicz, Maciej; Juszkat, Robert; Majewski, Wacław

doi:10.1016/j.athoracsur.2011.09.062

Cited by 15 publications

(17 citation statements)

References 26 publications

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“…6 Patients' characteristics such as age, weight, height, and medical history pose additional risk factor resulting from ionizing radiation. 6,[16][17][18][19][20][21][22][23][24][25] A thoracic stent-graft implantation study found higher levels of radiation dose when patients' body mass index (BMI) was greater than 25 kg/m 2 . 23 Certain procedures and technical factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of patients radiation dose during cardiac catheterization procedures

Osei

Johnston

et al. 2019

The British Journal of Radiology

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Objective: Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory. Methods: We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient’s clinical radiation dose data [kerma–area–product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital’s RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software. Results: The overall patient median age was 67.0 (range: 26.0–97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9–61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1–203.2), 80.2 (18.9–208.5), 83.7 (48.0–246.1), 113.8 (60.9–284.5), 91.7 (6.0–426.0) and 51.1 (7.0–175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3–3794.0), 1384.7 (291.7–4021.8), 1607.0 (883.5–4448.3), 2260.2 (867.4–5311.9), 1589.3 (100.2–7237.4) and 463.8 (67.7–1695.9) mGy respectively. Conclusion: We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories. Advances in knowledge: We have investigated local patients’ radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.

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Section: Discussionmentioning

confidence: 99%

Retrospective study of patients radiation dose during cardiac catheterization procedures

Osei

Johnston

et al. 2019

The British Journal of Radiology

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“…8 BMI >25 kg/m 2 has also been identified as a predictor for higher cumulative radiation doses. 9 However, these studies focused on a single outcome parameter by analyzing the cumulative DRs per intervention and did not account for the multifactorial effect of all of the radiation predictors or correct for the chosen protocols, field size, or air gap for DAP and AK. 9 Because these predictors vary within and between procedures, DRs are also constantly adapted to each status, resulting in varying cumulative radiation doses.…”

Section: Discussionmentioning

confidence: 99%

“…9 However, these studies focused on a single outcome parameter by analyzing the cumulative DRs per intervention and did not account for the multifactorial effect of all of the radiation predictors or correct for the chosen protocols, field size, or air gap for DAP and AK. 9 Because these predictors vary within and between procedures, DRs are also constantly adapted to each status, resulting in varying cumulative radiation doses. Additional DR-specific studies were performed to calculate the effect of rotation using a phantom 4,10 or cadaveric setup, 11 where outcomes limited to a single phantom model are in an experimental setting and are not related to varying body thickness or field size, as in the current study.…”

Section: Discussionmentioning

confidence: 99%

Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice

et al. 2017

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Purpose: To determine which patient and C-arm characteristics are the strongest predictors of intraoperative patient radiation dose rates (DRs) during endovascular aneurysm repair (EVAR) procedures and create a patient risk chart. Methods: A retrospective analysis was performed of 74 EVAR procedures, including 16,889 X-ray runs using fixed C-arm imaging equipment. Four multivariate log-linear mixed models (with patient as a random effect) were constructed. Mean air kerma DR (DRAK, mGy/s) and the mean dose area product DR (DRDAP, mGycm2/s) were the outcome variables utilized for fluoroscopy as differentiated from digital subtraction angiography (DSA). These models were used to predict the maximum radiation duration allowed before a 2-Gy skin threshold (for DRAK) or a 500-Gycm2 threshold (for DRDAP) was reached. Results: The strongest predictor of DRAK and DRDAP for fluoroscopy imaging was the radiation protocol, with an increase of 200% when changing from “low” to “medium” and 410% from “low” to “normal.” The strongest predictors of DRAK and DRDAP for DSA were C-arm angulation, with an increase of 47% per 30° of angulation, and body mass index (BMI), with an increase of 58% for every 5-point increase in BMI. Based on these models, a patient with a BMI of 30 kg/m2, combined with 45° of rotation and a field size of 800 cm2 in the medium fluoroscopy protocol has a predicted DRAK of 0.39 mGy/s (or 85.5 minutes until the 2-Gy skin threshold is reached). While using comparable settings but switching the acquisition to a DSA with a “2 frames per second” protocol, the predicted DRAK will be 6.6 mGy/s (or 5.0 minutes until the 2-Gy threshold is reached). Conclusion: X-ray radiation DRs are constantly fluctuating during and between patients based on BMI, the protocols, C-arm position, and the image acquisitions that are used. An instant patient risk chart visualizes these radiation dose fluctuations and provides an overview of the expected duration of X-ray radiation, which can be used to predict when follow-up dose thresholds are reached during abdominal endovascular procedures.

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“…The major drawbacks of this method include exposure to radiation and contrast agent administration. Repeated doses of radiation considerably increase the risk of cancerogenesis [ 10 , 11 ]. The estimated dose of acquired radiation is approximately 10–12 mSv per study [ 12 ].…”

Section: Computed Tomography Angiographymentioning

confidence: 99%

Diagnostic imaging methods applied in long-term surveillance after EVAR. Will computed tomography angiography be replaced by other methods?

Stefaniak

Stanišić

Gabriel

et al. 2016

pwki

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Endovascular implantation of a stent graft in the abdominal aorta (endovascular aneurysm repair – EVAR) is a widely accepted alternative to open surgery in treatment of abdominal aortic aneurysms. Although EVAR is connected with a significant reduction in the risk of peri- and post-operative complications, it does not eliminate them totally. Long-term surveillance of post-EVAR patients is aimed at early detection of and fast reaction to a group of complications called endovascular leaks. Currently, the gold standard in leak diagnostics is computed tomography angiography (CTA). The other methods are ultrasonography, magnetic resonance (MR) angiography, intra-aneurysm sac pressure measurement, X-ray, and digital subtraction angiography (DSA). Despite many analyses based on long-term research, emphasising the high value and competitiveness of less invasive tests such as US or X-ray compared to CTA, it is still difficult for them to win the trust and acceptance of clinicians. The persisting view is that computed tomography is the test that finally resolves any inaccuracies. Consequently, a patient with a number of concurrent diseases is subject to absurdly high radiation exposure and effects of a radiocontrast agent within a short time. It is therefore logical to acknowledge that the EVAR-related risk is catching up with the open surgery risk, while the endovascular procedure is much more costly. Nevertheless, the status of CTA as the gold standard ultimately seems to be unthreatened. This paper presents a description of the diagnostic imaging tests that make it possible to detect any vascular leaks and to develop strategies for therapeutic processes.

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Patients' Radiation Doses During Thoracic Stent-Graft Implantation: The Problem of Long-Lasting Procedures

Cited by 15 publications

References 26 publications

Retrospective study of patients radiation dose during cardiac catheterization procedures

Retrospective study of patients radiation dose during cardiac catheterization procedures

Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice

Diagnostic imaging methods applied in long-term surveillance after EVAR. Will computed tomography angiography be replaced by other methods?

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