Skip to main content

Advertisement

SpringerLink
Log in

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

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

Abstract

Objectives

Radiation exposure of patients during endovascular aneurysm repair (EVAR) procedures ranks in the upper sector of medical exposure. Thus, estimation of radiation doses achieved during EVAR is of great importance.

Material and methods

Organ doses (OD) and effective doses (ED) administered to 17 patients receiving EVAR were determined (1) from the exposure parameters by performing Monte Carlo simulations in mathematical phantoms and (2) by measurements with thermoluminescent dosimeters in a physical anthropomorphic phantom.

Results

The mean fluoroscopy time was 26 min, the mean dose area product was 24995 cGy cm2. The mean ED was 34.8 mSv, ODs up to 626 mSv were found. Whereas digital subtraction angiographies (DSA) and fluoroscopies each contributed about 50 % to the cumulative ED, the ED rates of DSAs were found to be ten times higher than those of fluoroscopies. Doubling of the field size caused an ED rate enhancement up to a factor of 3.

Conclusion

EVAR procedures cause high radiation exposure levels that exceed the values published thus far. As a consequence, (1) DSAs should be only performed when necessary and with a low image rate, (2) fluoroscopies should be kept as short as possible, and (3) field sizes should be minimized.

Key Points

• During endovascular aneurysm repair (EVAR) considerable patient doses are achieved.

• For each EVAR procedure organ (OD) and effective (ED) doses were determined.

• The mean ED was 34.8 mSv, the highest OD was 626 mSv.

• Number of DSAs, fluoroscopy durations and field sizes should be minimized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Drexler G, Panzer W, Petoussi N, Zankl M (1993) Effective dose – how effective for patients? Radiat Environ Biophys 32:209–290

    Article  CAS  PubMed  Google Scholar 

  2. Zankl M (1998) Methods for assessing organ doses using computational models. Radiat Prot Dosim 80:207–212

    Article  Google Scholar 

  3. Servomaa A, Tapiovaara M (1998) Organ dose calculation in medical X-ray examinations by the program PCXMC. Radiat Prot Dosim 80:213–219

    Article  Google Scholar 

  4. Tapiovaara M, Lakkisto M, Servomaa A (1997) PCXMC. A PC-based Monte Carlo program for calculating patient doses in medical X-ray examinations. Finnish Centre for Radiation and Nuclear Safety, Säteilyturvakeskus (STUK), Report STUK A-139

  5. ATOM Dosimetry Phantoms (2011) Whole body dose – organ dose – therapeutic radiation. Publication ATOM PB 061811, Norfolk, Virginia, USA: CIRS Computerized Imaging Reference Systems Inc

  6. Digital Imaging and Communications in Medicine (2013) DICOM web site. Available via http://medical.nema.org/. Accessed 27 May 2013

  7. International Commission on Radiological Protection (1991) 1990 recommendations of the International Commission on Radiological Protection, ICRP Publication 60

  8. International Commission on Radiological Protection (2007) The 2007 recommendations of the International Commission on Radiological Protection, ICRP Publication 103

  9. Cristy M (1980) Mathematical phantoms representing children of various ages for use in estimates of internal dose. Oak Ridge Laboratory, NUREG/CR-1159, ORNL/NUREG/TM-367

  10. International Commission on Radiological Protection (1975) Report of the task group on reference man: anatomical, physiological and metabolic characteristics. Pergamon Press, ICRP Publication 23, Oxford

    Google Scholar 

  11. Seidenbusch MC, Regulla DF, Schneider K (2008) Radiation exposure of children in pediatric radiology. Part 2: the PAEDOS algorithm for computer-assisted dose reconstruction in pediatric radiology and results for x-ray examinations of the skull. Fortschr Roentgenstr 180:522–539

    Article  CAS  Google Scholar 

  12. Birch R, Marshall M (1979) Computation of bremsstrahlung x-ray spectra and comparison with spectra measured with a Ge(Li) detector. Phys Med Biol 24:505–517

    Article  CAS  PubMed  Google Scholar 

  13. Seidenbusch MC, Schneider K (2014) Conversion coefficients for determining organ doses in paediatric spine radiography. Pediatr Radiol. doi:10.1007/s00247-013-2853-4

    Google Scholar 

  14. European Commission (2000) Recommendations for patient dosimetry in diagnostic radiology using TLD. Report EUR 19604 EN

  15. Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ (2010) Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology 254:326–341

    Article  PubMed  Google Scholar 

  16. Hymes SR, Strom EA, Fife C (2006) Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol 54:28–46

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  18. Weerakkody RA, Walsh R, Cousins C, Goldstone KE, Tang TY, Gaunt ME (2008) Radiation exposure during endovascular aneurysm repair. Br J Surg 95:699–702

    Article  CAS  PubMed  Google Scholar 

  19. 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 49:283–287

    Article  PubMed  Google Scholar 

  20. 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 52:298–302

    Article  PubMed  Google Scholar 

  21. Badger SA, Jones C, Boyd CS, Soong CV (2010) Determinants of radiation exposure during EVAR. Eur J Vasc Endovasc Surg 40:320–325

    Article  CAS  PubMed  Google Scholar 

  22. Molyvda-Athanasopoulou E, Karlatira M, Gotzamani-Psarrakou A, Koulouris C, Siountas A (2011) Radiation exposure to patients and radiologists during interventional procedures. Radiat Prot Dosim 147:86–89

    Article  CAS  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  24. Fossaceca R, Brambilla M, Guzzardi G et al (2012) The impact of radiological equipment on patient radiation exposure during endovascular aortic aneurysm repair. Eur Radiol 22:2424–2431

    Article  PubMed  Google Scholar 

  25. Howells P, Eaton R, Patel AS, Taylor P, Modarai B (2012) Risk of radiation exposure during endovascular aortic repair. Eur J Vasc Endovasc Surg 43:393–397

    Article  CAS  PubMed  Google Scholar 

  26. 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 43:534–539

    Article  CAS  PubMed  Google Scholar 

  27. Mohapatra A, Greenberg RK, Mastracci TM, Eagleton MG, Thornsberry B (2013) Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg 58:702–709

    Article  PubMed  Google Scholar 

  28. International Commission on Radiological Protection (2000) Avoidance of radiation injuries from medical interventional procedures, ICRP Publication 85

  29. Koenig TR, Wolff D, Mettler FA (2001) Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. AJR 177:3–11

    Article  CAS  PubMed  Google Scholar 

  30. Staton RJ, Pazik FD, Nipper JC, Williams JL, Bolch WE (1991) A comparison of newborn stylized and tomographic models for dose assessment in paediatric radiology. Phys Med Biol 48:805–820

    Article  Google Scholar 

Download references

Acknowledgements

The scientific guarantor of this publication is PD Dr. Marcus Treitl. The authors of this manuscript declare relationships with the following companies: Treitl: Covidien, Biotronik, Endoscout, C4 biomedical. All other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because no study-related use of X-ray or medical procedures took place. All patients gave their written informed consent for the anonymized use of the exposure data. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, observational, performed at one institution.

Author Monika Foerth and author Michael C. Seidenbusch contributed equally to this work.

Author information

Authors and Affiliations

  1. Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich, Germany

    Monika Foerth, Michael C. Seidenbusch, Karla Maria Treitl & Marcus Treitl

  2. Department of Vascular Surgery, Clinical Centre of the County of Erding, Erding, Germany

    Mojtaba Sadeghi-Azandaryani

  3. Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Oberschleissheim, Germany

    Ursula Lechel

  4. Institute for Clinical Radiology, Clinical Centre of the Ludwig Maximilian University of Munich, Lindwurmstr. 4, 80337, Munich, Germany

    Michael C. Seidenbusch

Authors
  1. Monika Foerth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael C. Seidenbusch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mojtaba Sadeghi-Azandaryani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ursula Lechel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karla Maria Treitl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcus Treitl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael C. Seidenbusch.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Foerth, M., Seidenbusch, M.C., Sadeghi-Azandaryani, M. et al. 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, 2617–2626 (2015). https://doi.org/10.1007/s00330-015-3673-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-3673-8

Keywords

Search

Navigation