PMID- 32473339 OWN - NLM STAT- MEDLINE DCOM- 20210830 LR - 20210830 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 73 IP - 2 DP - 2021 Feb TI - Dual fluoroscopy with live-image digital zooming significantly reduces patient and operating staff radiation during fenestrated-branched endovascular aortic aneurysm repair. PG - 601-607 LID - S0741-5214(20)31286-6 [pii] LID - 10.1016/j.jvs.2020.05.031 [doi] AB - OBJECTIVE: Fenestrated-branched endovascular aneurysm repair (F/B-EVAR) is a complex procedure that generates high radiation doses. Magnification aids in vessel cannulation but increases radiation. The aim of the study was to compare radiation doses to patients and operating room staff from two fluoroscopy techniques, standard magnification vs dual fluoroscopy with live-image digital zooming during F/B-EVAR. METHODS: An observational, prospective, single-center study of F/B-EVAR procedures using Philips Allura XperFD20 equipment (Philips Healthcare, Amsterdam, The Netherlands) was performed during a 42-month period. Intravascular ultrasound, three-dimensional fusion, and extreme collimation were used in all procedures. Intraoperative live-image processing was performed with two imaging systems: standard magnification in 123 patients (81%) and dual fluoroscopy with live-image digital zooming in 28 patients (18%). In the latter, the live "processed" zoomed images are displayed on examination displays and live images are displayed on reference displays. The reference air kerma was collected for each case and represents patient dose. Operating staff personal dosimetry was collected using the DoseAware system (Philips Healthcare). Patient and staff radiation doses were compared using nonparametric tests. RESULTS: Mean age was 71.6 +/- 11.4 years. The median body mass index was 27 kg/m(2) (interquartile range [IQR], 24.4-30.6 kg/m(2)) and was the same for both groups. Procedures performed with dual fluoroscopy with digital zooming demonstrated significantly lower median patient (1382 mGy [IQR, 999-2045 mGy] vs 2458 mGy [IQR, 1706-3767 mGy]; P < .01) and primary operator radiation doses (101 muSv [IQR, 34-235 muSv] vs 266 muSv [IQR, 104-583 muSv]; P < .01) compared with standard magnification. Similar significantly reduced radiation doses were recorded for first assistant, scrub nurse, and anesthesia staff in procedures performed with dual fluoroscopy. According to device design, procedures performed with four-fenestration/branch devices generated higher operator radiation doses (262 muSv [IQR, 116.5-572 muSv] vs 171 muSv [IQR, 44-325 muSv]; P < .01) compared with procedures with three or fewer fenestration/branches. Among the most complex design (four-vessel), operator radiation dose was significantly lower with digital zooming compared with standard magnification (128.5 muSv [IQR, 70.5-296 muSv] vs 309 muSv [IQR, 150-611 muSv]; P = .01). CONCLUSIONS: Current radiation doses to patients and operating personnel are within acceptable limits; however, dual fluoroscopy with live-image digital zooming results in dramatically lower radiation doses compared with the standard image processing with dose-dependent magnification. Operator radiation doses were reduced in half during procedures performed with more complex device designs when digital zooming was used. CI - Copyright (c) 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Timaran, Laura I AU - Timaran LI AD - Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pa. FAU - Timaran, Carlos H AU - Timaran CH AD - Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex. FAU - Scott, Carla K AU - Scott CK AD - Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex. FAU - Soto-Gonzalez, Marilisa AU - Soto-Gonzalez M AD - Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex. FAU - Timaran-Montenegro, David E AU - Timaran-Montenegro DE AD - Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex. FAU - Guild, Jeffrey B AU - Guild JB AD - Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex. FAU - Kirkwood, Melissa L AU - Kirkwood ML AD - Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex. Electronic address: melissa.kirkwood@utsouthwestern.edu. LA - eng SI - ClinicalTrials.gov/NCT02266719 PT - Comparative Study PT - Journal Article PT - Observational Study DEP - 20200527 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Aged MH - Aged, 80 and over MH - Aortic Aneurysm/diagnostic imaging/*surgery MH - Blood Vessel Prosthesis MH - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation MH - *Endovascular Procedures/adverse effects/instrumentation MH - Female MH - Fluoroscopy MH - Humans MH - Male MH - Middle Aged MH - Occupational Exposure/adverse effects/*prevention & control MH - Occupational Health MH - Patient Safety MH - Prospective Studies MH - Radiation Exposure/adverse effects/*prevention & control MH - *Radiographic Magnification/adverse effects MH - *Radiography, Interventional/adverse effects MH - Risk Assessment MH - Risk Factors OTO - NOTNLM OT - Dual fluoroscopy OT - Fenestrated-branched EVAR OT - Live-image digital zooming OT - Radiation safety OT - Standard electronic magnification EDAT- 2020/05/31 06:00 MHDA- 2021/08/31 06:00 CRDT- 2020/05/31 06:00 PHST- 2020/01/25 00:00 [received] PHST- 2020/05/10 00:00 [accepted] PHST- 2020/05/31 06:00 [pubmed] PHST- 2021/08/31 06:00 [medline] PHST- 2020/05/31 06:00 [entrez] AID - S0741-5214(20)31286-6 [pii] AID - 10.1016/j.jvs.2020.05.031 [doi] PST - ppublish SO - J Vasc Surg. 2021 Feb;73(2):601-607. doi: 10.1016/j.jvs.2020.05.031. Epub 2020 May 27.