Indirect estimated radiation during thoracoabdominal aneurysm repair found inaccurate

2010 Vascular Annual Meeting

Assessing indirect estimated radiation doses given to patients during endovascular thoracoabdominal aneurysm repair may not be an accurate method of assessing peak skin dose, according to study findings.

Researchers for the study included 47 patients who underwent endovascular thoracoabdominal aneurysm repair (eTAAA) had imaging system-generated indirect radiation parameters recorded concurrently with direct measurements of radiation exposure patterns using radiochromatic film. Researchers reproduced observed radiation exposure patterns in phantoms lined with dosimeters located within mock organs.

What resulted, according to researchers, was that fluoroscopy time, cumulative air kerma and kerma air product were shown to ineffective at estimating peak skin dose during aortic procedures when compared with direct measurement of peak skin dose. Specifically, direct measurements of cumulative air kerma, despite exceeding 15Gy in three patients, did not exceed 15Gy in any patient at any time point. Peak skin dose correlated minimally with fluoroscopy time, but correlated better with cumulative air kerma and kerma air product, particularly when researchers used a conversion formula. No patients in the study, according to the researchers, developed evidence of radiation induced skin injury.

Noting that the effective radiation dose of eTAAA “is equivalent to that of two perioperative CT scans,” the researchers said that the estimated radiation doses were typically off by 50% or more in the cases they handled.

“Given that JACHO standards are all based on the estimated dose, and the estimated dose for aortic procedures is very inaccurate, peripheral vascular/aortic procedures are not being assessed properly,” Roy Greenberg, MD, a vascular surgeon at the Cleveland Clinic, said in a press release. “We believe these are critical issues with regard to radiation exposure and this will result in problems with hospital documentation and reporting sentinel events.”

For more information:

Greenberg R. Abstract SS5. Presented at: 2010 Vascular Annual Meeting; June 10-13, 2010; Boston.

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