Patient radiation dose during angiography and embolization for abdominal hemorrhage: the influence of CT angiography, fluoroscopy system, patient and procedural variables

Conor McCaughey; Gerard M Healy; Hanin Al Balushi; Patrice Maher; Jackie McCavana; Julie Lucey; Colin P Cantwell

doi:10.1186/s42155-022-00284-4

Patient radiation dose during angiography and embolization for abdominal hemorrhage: the influence of CT angiography, fluoroscopy system, patient and procedural variables

CVIR Endovasc. 2022 Feb 16;5(1):12. doi: 10.1186/s42155-022-00284-4.

Authors

Conor McCaughey¹, Gerard M Healy², Hanin Al Balushi³, Patrice Maher², Jackie McCavana⁴, Julie Lucey⁴, Colin P Cantwell^{2

3}

Affiliations

¹ St James Hospital, Dublin, Ireland. cmccaugh@tcd.ie.
² Department of Radiology, St Vincent's University Hospital, Dublin, Ireland.
³ School of Medicine, University College Dublin, Dublin, Ireland.
⁴ Department of Medical Physics and Clinical Engineering, St Vincent's University Hospital, Dublin, Ireland.

Abstract

Background: Angiography and embolization (AE) is a lifesaving, high radiation dose procedure for treatment of abdominal arterial hemorrhage (AAH). Interventional radiologists have utilized pre-procedure CT angiography (CTA) and newer fluoroscopic systems in an attempt to reduce radiation dose and procedure time.

Purpose: To study the factors contributing to the radiation dose of AE for AAH and to compare to the reference standard.

Materials and methods: This retrospective single-centre observational cohort study identified 154 consecutive AE procedures in 138 patients (median age 65 years; interquartile range 54-77; 103 men) performed with a C-arm fluoroscopic system (Axiom Artis DTA or Axiom Artis Q (Siemens Healthineers)), between January 2010 and December 2017. Parameters analysed included: demographics, fluoroscopy system, bleeding location, body mass index (BMI), preprocedural CT, air kerma-area product (PKA), reference air kerma (K_a,r), fluoroscopy time (FT) and the number of digital subtraction angiography (DSA) runs. Factors affecting dose were assessed using Mann-Whitney U, Kruskal-Wallis one-way ANOVA and linear regression.

Results: Patients treated with the new angiographic system (NS) had a median PKA, median K_a,r, Q3 PKA and Q3 K_a,r that were 74% (p < 0.0005), 66%(p < 0.0005), 55% and 52% lower respectively than those treated with the old system (OS). This dose reduction was consistent for each bleeding location (upper GI, Lower GI and extraluminal). There was no difference in PKA (p = 0.452), K_a,r (p = 0.974) or FT (p = 0.179), between those who did (n = 137) or did not (n = 17) undergo pre-procedure CTA. Other factors significantly influencing radiation dose were: patient BMI and number of DSA runs. A multivariate model containing these variables accounts for 15.2% of the variance in K_a,r (p < 0.005) and 45.9% of the variance of PKA (p < 0.005).

Conclusion: Radiation dose for AE in AAH is significantly reduced by new fluoroscopic technology. Higher patient body mass index is an independent key parameter affecting patient dose. Radiation dose was not influenced by haemorrhage site or performance of pre-procedure CTA.

Keywords: Abdominal: embolisation; Angiography; Gastrointestinal; Hemorrhage; Humans; Radiation dose; Safety.