Radiation Dose in Vascular Surgery Procedures K. Arsalaan Ahmed, Victoria Cha, Dr Farley, Dr. Sharon Kiang, Dr Roger Tomihama Departments of Interventional Radiology and Vascular Surgery Loma Linda University Medical Center

Intro Patterning our study after a seminal JVIR paper in early 2000s Cited 500+ times in the literature. Large, multicenter prospective study with over 2000 exams

Intro Conclusions: 6% of cases had dose > 5 Gy. Our goal was to replicate this study in Vascular Surgery procedures Previous literature has had a focus on Endovascular vs Open repair. No broad survey of vascular surgery procedures.

Methods Single center, retrospective review Catalogued approximately 100 cases beginning in 12/2015 3 variables: # of images, Fluoroscopic Time, & Cumulative Dose. Stratified by Fluoroscopy vs DSA; Magnification; and Pulsed Fluoroscopy

Methods: Subanalyses Increasing percentage of fluoroscopy vs DSA runs correlates with increasing dose Increasing percentage magnification correlates with increasing dose

Data

Data: Subanalyses

Data: Conclusions Broad survey of radiation dose in vascular surgery procedures: highest fluoroscopic times in aortoiliac work highest doses in extremity work No sentinel events with Dose > 5 Gy

Data: Conclusions Abdominal aortoiliac work: Increasing percentage of fluoroscopy correlates to increasing cumulative dose Increasing percentage of magnification correlates to increasing cumulative dose

References Miller, DL, Balter, S, Cole, PE et al. Radiation doses in interventional radiology procedures: the RAD-IR study. Part I: overall measures of dose. J Vasc Interv Radiol. 2003; 14: 711–727 Wagner, LK, Eifel, PJ, and Geise, RA. Potential biological effects following high x-ray dose interventional procedures. J Vasc Interv Radiol. 1994; 5: 71–84 Koenig, TR, Wolff, D, Mettler, FA, and Wagner, LK. Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. AJR Am J Roentgenol. 2001; 177: 3–11 Shope, TB. Radiation-induced skin injuries from fluoroscopy. RadioGraphics. 1996; 16: 1195–1199 Balter, S. Interventional fluoroscopy: physics, technology, safety. Wiley-Liss, New York; 2001 McParland, BJ. A study of patient radiation doses in interventional radiological procedures. Br J Radiol. 1998; 71: 175–185 Vano, E, Gonzalez, L, Ten, JI, Fernandez, JM, Guibelalde, E, and Macaya, C. Skin dose and dose-area product values for interventional cardiology procedures. Br J Radiol. 2001; 74: 48–55 van de Putte, S, Verhaegen, F, Taeymans, Y, and Thierens, H. Correlation of patient skin doses in cardiac interventional radiology with dose-area product. Br J Radiol. 2000; 73: 504–513 Waite, JC and Fitzgerald, M. An assessment of methods for monitoring entrance surface dose in fluoroscopically guided interventional procedures. Radiat Prot Dosimetry. 2001; 94: 89–92 Mahesh, M. Fluoroscopy: patient radiation exposure issues. RadioGraphics. 2001; 21: 1033–1045 Faulkner, K and Vañó, E. Deterministic effects in interventional radiology. Radiat Prot Dosimetry.2001; 94: 95–98 Zweers, D, Geleijns, J, Aarts, NJM et al. Patient and staff radiation dose in fluoroscopy-guided TIPS procedures and dose reduction, using dedicated fluoroscopy exposure settings. Br J Radiol. 1998; 71:672–676 Bergeron, P, Carrier, R, Roy, D, Blais, N, and Raymond, J. Radiation doses to patients in neurointerventional procedures. AJNR Am J Neuroradiol. 1994; 15: 1813–1816 Gkanatsios, NA, Huda, W, and Peters, KR. Adult patient doses in interventional neuroradiology. Med Phys. 2002; 29: 717–723 Tsakapi, V. Patient and staff dosimetry problems in interventional radiology. Radiat Prot Dosimetry.2001; 94: 113–116

Questions?

Preliminary Analyses by Surgery Type Fluoro Time (sec) Cumulative Dose (mGy) Amputation 3 257.1 16.2 Angioplasty 4 2213 129.7 Atherectomy 2 3717 364.5 AV Graft 10 289.4 545.3 Bypass 28 253.3 328.0 EVAR/TEVAR 18 1143.7 305.5 IVC Filter 6 Embolization 2674.1 1160

Preliminary Analyses... [100 cases] Surgical Field # of images Fluoro Time (sec) Cumulative Dose (mGy) Infrainguinal - Infrageniculate/popliteal 23.7 749.4 343.5 Infrainguinal - Suprapopliteal 18.8 201.8 186.5 Thoracoabdominal - aortoiliac 19.4 1131.8 348.9 Thoracoabdominal - thoracic 16.8 1032.8 249.9 Upper Extremity 16.6 250.7 438.4 Venous 6 491 294.8

Magnification effect on Dose Electronic Magnification (Zoom) Decrease FOV by 1/2 --> Phosphor input irradiated 1/4 Brightness decreases by 1/4 --> ABC increases dose to compensate Geometric Magnification (=SID/SOD)

Cumulative Dose Automatic Bright Control (ABC) Dose Increase :: Increase kVP, Increase mA, Increased Pulse length, less XR filtration