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

Eleftherios Tzanis; Kostas Perisinakis; Christos V Ioannou; Dimitrios Tsetis; John Damilakis

doi:10.1007/s00330-021-07789-x

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

Eur Radiol. 2021 Sep;31(9):6547-6554. doi: 10.1007/s00330-021-07789-x. Epub 2021 Mar 6.

Authors

Eleftherios Tzanis¹, Kostas Perisinakis², Christos V Ioannou³, Dimitrios Tsetis⁴, John Damilakis⁵

Affiliations

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

PMID: 33675386
DOI: 10.1007/s00330-021-07789-x

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.

Keywords: Endovascular aneurysm; Fluoroscopy; Monte Carlo; Radiation dosimetry; Radiation protection.

MeSH terms

Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / surgery
Blood Vessel Prosthesis Implantation*
Endovascular Procedures*
Humans
Monte Carlo Method
Radiation Dosage
Radiometry