1. 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

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

4. 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.

5. 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

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

10. Data

11. Data: Subanalyses

13. 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

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

15. 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
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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
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16. Questions?

17. 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

18. 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

19. 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)

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