Comparison of indirect radiation dose estimates with directly measured radiation dose for patients and operators during complex endovascular procedures

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Comparison of indirect radiation dose estimates with directly measured radiation dose for patients and operators during complex endovascular procedures Giuseppe Panuccio, MD, Roy K. Greenberg, MD, Kevin Wunderle, MSc, Tara M. Mastracci, MD, Matthew G. Eagleton, MD, William Davros, PhD Journal of Vascular Surgery Volume 53, Issue 4, Pages 885-894.e1 (April 2011) DOI: 10.1016/j.jvs.2010.10.106 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 Skin dose distribution in patients treated with an endovascular branched graft for a type IV thoracoabdominal aortic aneurysm (TAAA) is depicted here. The body habitus in relation to the Gafchromic film is displayed in (A). The film is then automatically analyzed to construct a plot of the peak skin dose (PSD) and the isodose areas (B) where it can be displayed as a 3-dimensional (3D) histogram (C). The blue, orange, and red regions on (B) correspond to 50%, 75%, and 95% isodose areas, respectively. Journal of Vascular Surgery 2011 53, 885-894.e1DOI: (10.1016/j.jvs.2010.10.106) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 Maximal protection for the operators is emphasized in the operating room environment. These images depict the two mobile transparent lead shields (Mavig Inc, Munich, Germany) that are placed between the operator and flat panel detector (black arrows). Additionally, a lead skirt is mounted on either side of the table (BT Medical Company, Inc, Bridgeport, Pa) that is intended to reside between the image generator and operators (white arrow). A shoulder attached to the under table skirt further helps to prevent scatter (red arrow). Journal of Vascular Surgery 2011 53, 885-894.e1DOI: (10.1016/j.jvs.2010.10.106) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 Localization of the peak skin dose (PSD). In most of the cases, the PSD was focused on the central part of the back and attributed to work related to the renal branches. High PSD in the lateral regions occurred when challenges with the celiac or superior mesenteric artery (SMA) were encountered Journal of Vascular Surgery 2011 53, 885-894.e1DOI: (10.1016/j.jvs.2010.10.106) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 Scatter plot with trend line and formulas demonstrating the strong correlation between the direct parameter versus cumulative air kerma (CAK) and dose area product (DAP; respectively, A and B). C, Scatter plot showing the weak correlation between the direct parameter and the fluoroscopy time (FT). Gy, Gray; PSD, peak skin dose; KAP, kerma area product. Journal of Vascular Surgery 2011 53, 885-894.e1DOI: (10.1016/j.jvs.2010.10.106) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 5 To establish a pattern in an effort to simulate the procedure, projection patterns were determined using the kerma area product (KAP) and the magnification data from each acquisition. These data were replicated for phantom exposure intended to assess effective dose during the endovascular thoracoabdominal aneurysm repair (eTAAA) repair. The average KAP used in each sector is reported as a percentage of the average KAP per procedure. (On the left side is depicted the pattern for types 2 and 3 TAAAs and on the right for type 4.) Journal of Vascular Surgery 2011 53, 885-894.e1DOI: (10.1016/j.jvs.2010.10.106) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 6 Scatter plot with trend line demonstrating the correlation between the operator exposure detected with a dosimeter worn externally to the apron and the kerma area product (KAP). Gy, Gray. Journal of Vascular Surgery 2011 53, 885-894.e1DOI: (10.1016/j.jvs.2010.10.106) Copyright © 2011 Society for Vascular Surgery Terms and Conditions