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Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

  • Clinical Investigation
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Abstract

Purpose

To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity.

Materials and Methods

MESD were evaluated with radiochromic films in 31 patients (mean age 72 ± 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 ± 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included.

Results

MESD values (mean 0.96 ± 0.42 Gy) were <2 Gy without relevant dependence on procedure complexity. Local DRL values for kerma area product (KAP), fluoroscopy time (FT), and number of frames (NFR) were 269 Gy cm2, 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1–102.7, p < 0.05) and NFR overexposures (OR 10.8, 95 % CI 1.1–109.5, p < 0.05). Type I aortic arch decreased the risk of FT overexposure (OR 0.4, 95 % CI 0.1–0.9, p = 0.042), and stenosis ≥ 90 % increased the risk of NFR overexposure (OR 2.8, 95 % CI 1.1–7.4, p = 0.040). At multivariable analysis, stenosis ≥ 90 % (OR 2.8, 95 % CI 1.1–7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1–109.5, p = 0.027) were associated with overexposure for two or more parameters.

Conclusion

Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Physics, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy

    Loredana D’Ercole, Milena Bocchiola & Francesco Lisciandro

  2. Department of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy

    Pietro Quaretti, Nicola Cionfoli, Giuseppe Rodolico, Andrea Azzaretti, Tommaso Cascella & Federico Zappoli Thyrion

  3. Biometry and Clinical Epidemiology Service, Research Department,, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy

    Catherine Klersy

Authors
  1. Loredana D’Ercole
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  2. Pietro Quaretti
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  3. Nicola Cionfoli
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  4. Catherine Klersy
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  5. Milena Bocchiola
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  6. Giuseppe Rodolico
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  7. Andrea Azzaretti
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  8. Francesco Lisciandro
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  9. Tommaso Cascella
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  10. Federico Zappoli Thyrion
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Corresponding author

Correspondence to Loredana D’Ercole.

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D’Ercole, L., Quaretti, P., Cionfoli, N. et al. Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure. Cardiovasc Intervent Radiol 36, 320–329 (2013). https://doi.org/10.1007/s00270-012-0392-2

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  • DOI: https://doi.org/10.1007/s00270-012-0392-2

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