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A novel personalized dosimetry method for endovascular aneurysm repair (EVAR) procedures

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To estimate radiation doses for the primarily irradiated organs/tissues of patients subjected to standard endovascular aneurysm repair (EVAR) procedures using a novel personalized dosimetry method.

Methods

Dosimetric and anthropometric data were collected prospectively for eight patients who underwent standard EVAR procedures. Patient-specific Monte Carlo simulations were performed to estimate organ/tissue doses from each of the fluoroscopic and digital subtraction angiography acquisitions involved in EVAR. Individual-specific cumulative absorbed doses were estimated for the skin, spinal bone marrow, heart, kidneys, liver, colon, bladder, pancreas, stomach, and spleen and compared to corresponding values estimated through a commercially available dosimetric software package that employs standardized phantoms.

Results

The highest organ/tissue radiation doses from EVAR were found for the skin, spinal bone marrow, kidneys, and spleen as 192.4 mGy, 96.7 mGy, 72.9 mGy, and 33.6 mGy respectively, while the doses to the heart, liver, colon, bladder, pancreas, and stomach were 6.3 mGy, 14.4 mGy, 18.4 mGy, 14.8 mGy, 21.6 mGy, and 11.2 mGy respectively. Corresponding dose values using standardized phantoms were found to differ up to 151%.

Conclusion

Considerable radiation doses may be received by primarily exposed organs/tissues during standard EVAR. The specific size/anatomy of the patient and the variation in exposure parameters/beam angulation between different projections commonly involved in EVAR procedures should be taken into account if reliable organ dose data are to be derived.

Key Points

• A novel patient-specific dosimetry method was utilized to estimate radiation doses to the primarily irradiated organs/tissues of patients subjected to standard endovascular aneurysm repair procedures.

• The use of standardized mathematical anthropomorphic phantoms to derive organ dose from fluoroscopically guided procedures may result in considerable inaccuracies due to differences in the assumed organ position/volume/shape compared to patients.

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Abbreviations

AEC:

Automatic exposure control

BMI:

Body mass index

CAU:

Caudal

CRA:

Cranial

DAP:

Dose area product

DSA:

Digital subtraction angiography

ED:

Effective dose

EVAR:

Endovascular aneurysm repair

FT:

Fluoroscopy time

IRP:

Interventional reference point

Ka,r:

Cumulative air kerma

LAO:

Left anterior oblique

MC:

Monte Carlo

RAO:

Right anterior oblique

ROIs:

Regions of interest

TD:

Distance between the tube and the image detector

TI:

Distance between the tube and the C-arm’s isocenter

TLD:

Thermoluminescence dosimeter

References

  1. Bacchim Neto FA, Alves AF, Mascarenhas YM, Nicolucci P, Pina DR (2016) Occupational radiation exposure in vascular interventional radiology: a complete evaluation of different body regions. Phys Med 32(8):1019–1024

    Article  Google Scholar 

  2. Patel AP, Gallacher D, Dourado R et al (2013) Occupational radiation exposure during endovascular aortic procedures. Eur J Vasc Endovasc Surg 46(4):424–430

    Article  CAS  Google Scholar 

  3. Tzanis E, Tsetis D, Kehagias E, Ioannou CV, Damilakis J (2019) Occupational exposure during endovascular aneurysm repair (EVAR) and aortoiliac percutaneous transluminal angioplasty (PTA) procedures. Radiol Med 124(6):539–545

    Article  Google Scholar 

  4. Sailer AM, Schurink GW, Bol ME et al (2015) Occupational radiation exposure during endovascular aortic repair. Cardiovasc Intervent Radiol 38(4):827–832

    Article  Google Scholar 

  5. Blaszak MA, Majewska N, Juszkat R, Majewski W (2009) Dose-area product to patients during stent-graft treatment of thoracic and abdominal aortic aneurysms. Health Phys 97(3):206–211

    Article  CAS  Google Scholar 

  6. Tuthill E, O’Hora L, O’Donohoe M et al (2017) Investigation of reference levels and radiation dose associated with abdominal EVAR (endovascular aneurysm repair) procedures across several European Centres. Eur Radiol 27(11):4846–4856

    Article  CAS  Google Scholar 

  7. Hertault A, Rhee R, Antoniou GA et al (2018) Radiation dose reduction during EVAR: results from a prospective multicentre study (The REVAR Study). Eur J Vasc Endovasc Surg 56(3):426–433

    Article  Google Scholar 

  8. Monastiriotis S, Comito M, Labropoulos N (2015) Radiation exposure in endovascular repair of abdominal and thoracic aortic aneurysms. J Vasc Surg 62(3):753–761

    Article  Google Scholar 

  9. Kalender G, Lisy M, Stock UA, Endisch A, Kornberger A (2017) Identification of factors influencing cumulative long-term radiation exposure in patients undergoing EVAR. Int J Vasc Med 2017:9763075

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Stangenberg L, Shuja F, van der Bom IMJ et al (2018) Modern fixed imaging systems reduce radiation exposure to patients and providers. Vasc Endovascular Surg 52(1):52–58

    Article  Google Scholar 

  11. Wermelink B, Willigendael EM, Smit C et al (2019) Radiation exposure in an endovascular aortic aneurysm repair program after introduction of a hybrid operating theater. J Vasc Surg 70(6):1927–1934.e2

    Article  Google Scholar 

  12. Hertault A, Maurel B, Sobocinski J et al (2014) Impact of hybrid rooms with image fusion on radiation exposure during endovascular aortic repair. Eur J Vasc Endovasc Surg 48(4):382–390

    Article  CAS  Google Scholar 

  13. Foerth M, Seidenbusch MC, Sadeghi-Azandaryani M, Lechel U, Treitl KM, Treitl M (2015) Typical exposure parameters, organ doses and effective doses for endovascular aortic aneurysm repair: comparison of Monte Carlo simulations and direct measurements with an anthropomorphic phantom. Eur Radiol 25(9):2617–2626

    Article  Google Scholar 

  14. Blaszak MA, Juszkat R (2014) Monte Carlo simulations for assessment of organ radiation doses and cancer risk in patients undergoing abdominal stent-graft implantation. Eur J Vasc Endovasc Surg 48(1):23–28

    Article  CAS  Google Scholar 

  15. Harbron RW, Abdelhalim M, Ainsbury EA et al (2020) Patient radiation dose from x-ray guided endovascular aneurysm repair: a Monte Carlo approach using voxel phantoms and detailed exposure information. J Radiol Prot 40(3):704–726

  16. Hupfer M, Kolditz D, Nowak T, Eisa F, Brauweiler R, Kalender WA (2012) Dosimetry concepts for scanner quality assurance and tissue dose assessment in micro-CT. Med Phys 39(2):658–670

    Article  CAS  Google Scholar 

  17. Chen W, Kolditz D, Beister M, Bohle R, Kalender WA (2012) Fast on-site Monte Carlo tool for dose calculations in CT applications. Med Phys 39(6):2985–2996

    Article  Google Scholar 

  18. Deak P, van Straten M, Shrimpton PC, Zankl M, Kalender WA (2008) Validation of a Monte Carlo tool for patient-specific dose simulations in multi-slice computed tomography. Eur Radiol 18(4):759–772

    Article  Google Scholar 

  19. Kyriakou Y, Deak P, Langner O, Kalender WA (2008) Concepts for dose determination in flat-detector CT. Phys Med Biol 53(13):3551–3566

    Article  Google Scholar 

  20. Kelaranta A, Toroi P, Vock P (2016) Incident air kerma to absorbed organ dose conversion factors for breast and lung in PA thorax radiography: the effect of patient thickness and radiation quality. Phys Med 32:1594–1601

    Article  CAS  Google Scholar 

  21. ICRP (1975) Report of the task group on reference man. ICRP Publication 23. Pergamon Press, Oxford

  22. Nyheim T, Staxrud LE, Jørgensen JJ, Jensen K, Olerud HM, Sandbæk G (2017) Radiation exposure in patients treated with endovascular aneurysm repair: what is the risk of cancer, and can we justify treating younger patients? Acta Radiol 58(3):323–330

    Article  Google Scholar 

  23. Kalender G, Lisy M, Stock UA, Endisch A, Kornberger A (2019) Long-term radiation exposure in patients undergoing EVAR: Reflecting clinical day-to-day practice to assess realistic radiation burden. Clin Hemorheol Microcirc 71(4):451–461

    Article  CAS  Google Scholar 

  24. Kalef-Ezra JA, Karavasilis S, Ziogas D, Dristiliaris D, Michalis LK, Matsagas M (2009) Radiation burden of patients undergoing endovascular abdominal aortic aneurysm repair. J Vasc Surg 49(2):283–287

    Article  Google Scholar 

  25. Walsh C, O’Callaghan A, Moore D et al (2012) Measurement and optimization of patient radiation doses in endovascular aneurysm repair. Eur J Vasc Endovasc Surg 43(5):534–539

    Article  CAS  Google Scholar 

  26. Geijer H, Larzon T, Popek R, Beckman KW (2005) Radiation exposure in stent-grafting of abdominal aortic aneurysms. Br J Radiol 78(934):906–912

    Article  CAS  Google Scholar 

  27. Jones C, Badger SA, Boyd CS, Soong CV (2010) The impact of radiation dose exposure during endovascular aneurysm repair on patient safety. J Vasc Surg 52(2):298–302

    Article  Google Scholar 

  28. Brambilla M, Cerini P, Lizio D, Vigna L, Carriero A, Fossaceca R (2015) Cumulative radiation dose and radiation risk from medical imaging in patients subjected to endovascular aortic aneurysm repair. Radiol Med 120(6):563–570

    Article  Google Scholar 

  29. Thakor AS, Winterbottom A, Mercuri M, Cousins C, Gaunt ME (2011) The radiation burden from increasingly complex endovascular aortic aneurysm repair. Insights Imaging 2(6):699–704

    Article  Google Scholar 

  30. Borrego D, Lowe EM, Kitahara CM, Lee C (2018) Assessment of PCXMC for patients with different body size in chest and abdominal x ray examinations: a Monte Carlo simulation study. Phys Med Biol 63(6):065015

    Article  Google Scholar 

  31. Wood TJ, Moore CS, Saunderson JR, Beavis AW (2015) Validation of a technique for estimating organ doses for kilovoltage cone-beam CT of the prostate using the PCXMC 2.0 patient dose calculator. J Radiol Prot 35(1):153–163

    Article  CAS  Google Scholar 

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Medical Physics, Medical School, University of Crete, P.O. Box 2208, Heraklion, 71003, Crete, Greece

    Eleftherios Tzanis

  2. Department of Medical Physics, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece

    Kostas Perisinakis & John Damilakis

  3. Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece

    Christos V. Ioannou

  4. Department of Radiology, Interventional Radiology Unit, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece

    Dimitrios Tsetis

Authors
  1. Eleftherios Tzanis
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  2. Kostas Perisinakis
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  3. Christos V. Ioannou
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  4. Dimitrios Tsetis
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  5. John Damilakis
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Corresponding author

Correspondence to John Damilakis.

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The scientific guarantor of this publication is Prof. John Damilakis.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Tzanis, E., Perisinakis, K., Ioannou, C.V. et al. A novel personalized dosimetry method for endovascular aneurysm repair (EVAR) procedures. Eur Radiol 31, 6547–6554 (2021). https://doi.org/10.1007/s00330-021-07789-x

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  • DOI: https://doi.org/10.1007/s00330-021-07789-x

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