Complexity-based local diagnostic reference levels (DRLs) for standard endovascular aneurysm repair (EVAR) procedures

Eleftherios Tzanis; Christos V Ioannou; Dimitrios Tsetis; Stella Lioudaki; Nikolas Matthaiou; John Damilakis

doi:10.1016/j.ejmp.2020.04.015

Complexity-based local diagnostic reference levels (DRLs) for standard endovascular aneurysm repair (EVAR) procedures

Phys Med. 2020 May:73:89-94. doi: 10.1016/j.ejmp.2020.04.015. Epub 2020 Apr 22.

Authors

Eleftherios Tzanis¹, Christos V Ioannou², Dimitrios Tsetis³, Stella Lioudaki⁴, Nikolas Matthaiou³, John Damilakis⁵

Affiliations

¹ Department of Medical Physics, Medical School, University of Crete, P.O. Box 2208, Heraklion 71003, Crete, Greece.
² Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece.
³ Department of Radiology, Interventional Radiology Unit, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece.
⁴ Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University Hospital of Heraklion, Crete, Greece.
⁵ Department of Medical Physics, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece. Electronic address: john.damilakis@med.uoc.gr.

PMID: 32334402
DOI: 10.1016/j.ejmp.2020.04.015

Abstract

Purpose: The aim of this study was to establish complexity-based local diagnostic reference levels (DRLs) for standard endovascular aneurysm repair (EVAR) procedures.

Methods: Dosimetric data for 73 consecutive patients were collected prospectively. All procedures were performed on a Siemens Axiom Artis FA angiographic unit (Siemens, Erlangen, Germany). Fluoroscopy time (FT), dose area product (DAP), air kerma (K_a.r) at reference point as well as patient's age, height and weight were recorded for each procedure. Moreover, the complexity level of each procedure was evaluated. Spearman rank correlation tests were used to evaluate the degree of association between variables.

Results: 2nd quartiles of DAP for low, medium and high complexity standard EVAR procedures were 144.2 Gycm², 160.1 Gycm² and 189.5 Gycm²respectively. The median DAP of the full sample was 153.2 Gycm². Statistical analysis showed a strong correlation between BMI and DAP (r = 0.68, p-value < 0.0001) and a moderate correlation between BMI and K_a.r (r = 0.52, p-value < 0.0001). Furthermore, a strong correlation was found between K_a.r and FT (r = 0.76, p-value < 0.0001) and a moderate correlation was found between DAP and FT (r = 0.57, p-value < 0.0001).

Conclusion: The complexity of an EVAR procedure is associated with the total burden of radiation. Establishment of complexity-based DRLs for interventional radiology procedures can contribute to the radiation protection of patients and staff.

Keywords: Complexity-based DRLs; Diagnostic reference levels (DRLs); EVAR; Radiation protection.

MeSH terms

Aortic Aneurysm, Abdominal / diagnostic imaging*
Aortic Aneurysm, Abdominal / surgery*
Endovascular Procedures / standards*
Fluoroscopy
Humans
Radiation Dosage
Reference Standards