Purpose: To evaluate the effect of radiation dose reduction with the Allura ClarityIQ image processing technology for fixed C-arms in comparison with a mobile C-arm and an Allura fixed C-arm without ClarityIQ technology during endovascular aneurysm repair (EVAR) procedures. Methods: Radiation dose data from 85 patients (mean age 74.2±7.8 years; 68 men) undergoing EVAR with mobile and fixed C-arm fluoroscopy were retrospectively analyzed. The radiation dose parameters included the kerma area product (KAP), fluoroscopic time (FT), and number of digital subtraction angiography (DSA) frames (FrDSA). KAPtotal consisted of KAPfluoro (KAP for fluoroscopic imaging) and KAPDSA (KAP for DSA and single shots). Linear regression analysis was used to explore differences in the association of KAP with the FT, FrDSA, and body mass index (BMI) among the 3 C-arms. Results: The mean KAPtotal values for mobile, Allura C-arm, and AlluraClarity C-arm for noncomplex EVARs were 56±39, 245±142, and 157±120 Gy·cm2 (p<0.001); for complex EVARs, the values were 110±43, 874±653, and 598±319 Gy·cm2 (p<0.001), respectively. On average, KAPfluoro tripled when the mobile C-arm was replaced by the fixed C-arm. There were no significant differences in the KAPfluoro adjusted for the FT between Allura and AlluraClarity (p=0.69). However, there was a major 61% reduction in KAPDSA from 1.36 Gy·cm2 per DSA frame for Allura to 0.54 Gy·cm2 per DSA frame with AlluraClarity (p=0.03). For the mobile C-arm, BMI was not associated with KAP (p=0.13). The associations of BMI with KAPfluoro and KAPDSA were significant for both fixed C-arms but were more robust for Allura compared to AlluraClarity (p=0.02 for KAPfluoro and p<0.001 for KAPDSA). Conclusion: Changing a mobile C-arm for a fixed C-arm in a hybrid operating suite increased the average intraoperative dose during EVAR. Upgrading the Allura fixed C-arm with ClarityIQ technology resulted in a 61% reduction in the radiation per DSA frame.
KanekoTDavidsonMJ. Use of the hybrid operating room in cardiovascular medicine. Circulation. 2014;130:910–917.
2.
EderSPRegisterJL. 10 management considerations for implementing an endovascular hybrid OR. AORN J. 2014;100:260–270.
3.
FossacecaRBrambillaMGuzzardiG. The impact of radiological equipment on patient radiation exposure during endovascular aortic aneurysm repair. Eur Radiol. 2012;22:2424–2431.
4.
MajewskaNStanisicMGKlosMA. Patients’ radiation doses during thoracic stent-graft implantation: the problem of long-lasting procedures. Ann Thorac Surg. 2012;93:465–472.
5.
TacherVLinMDesgrangesP. Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion. J Vasc Interv Radiol. 2013;24:1698–1706.
6.
ThakorASWinterbottomAMercuriM. The radiation burden from increasingly complex endovascular aortic aneurysm repair. Insights Imaging. 2011;2:699–704.
7.
PanuccioGGreenbergRKWunderleK. Comparison of indirect radiation dose estimates with directly measured radiation dose for patients and operators during complex endovascular procedures. J Vasc Surg. 2011;53:885–894.e1.
8.
KirkwoodMLArbiqueGMGuildJB. Surgeon education decreases radiation dose in complex endovascular procedures and improves patient safety. J Vasc Surg. 2013;58:715–721.
9.
DekkerLRvan der VoortPHSimmersTA. New image processing and noise reduction technology allows reduction of radiation exposure in complex electrophysiologic interventions while maintaining optimal image quality: a randomized clinical trial. Heart Rhythm. 2013;10:1678–1682.
10.
SödermanMMautiMBoonS. Radiation dose in neuroangiography using image noise reduction technology: a population study based on 614 patients. Neuroradiology. 2013;55:1365–1372.
11.
HaasNAHappelCMMautiM. Substantial radiation reduction in pediatric and adult congenital heart disease interventions with a novel X-ray imaging technology. IJC Heart Vasculature. 2015;6:101–109.
12.
NakamuraSKobayashiTFunatsuA. Patient radiation dose reduction using an X-ray imaging noise reduction technology for cardiac angiography and intervention [published online April4, 2015]. Heart Vessels. doi:10.1007/s00380-015-0667-z.
van StrijenMJGrunhagenTMautiM. Evaluation of a noise reduction imaging technology in iliac digital subtraction angiography: noninferior clinical image quality with lower patient and scatter dose. J Vasc Interv Radiol. 2015;26:642–650.e1.
15.
MohapatraAGreenbergRKMastracciTM. Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg. 2013;58:702–709.
