The impact of radiological equipment on patient radiation exposure during endovascular aortic aneurysm repair

Objectives To compare the patient radiation dose during endovascular aortic aneurysm repair (EVAR) using different types of radiological systems: a mobile fluoroscopic C-arm, mobile angiographic and fixed angiographic equipment. Methods Dose-area products (DAP) were obtained from a retrospective study of 147 consecutive patients, subjected to 153 EVAR procedures during a 3.5-year period. On the basis of these data, entrance surface dose (ESD) and effective dose (ED) were calculated. EVARs were performed using a fluoroscopic C-arm, mobile or fixed angiographic equipment in 79, 26 and 48 procedures, respectively. Results Fluoroscopy times were essentially equivalent for all the systems, ranging from 15 to 19 min. The clinical outcomes were not significantly different among the systems. Statistically significant differences among radiological equipment grouping were found for DAP (mobile C-arm: 32±20 Gy cm²; mobile angiography: 362±164 Gy cm²; fixed angiography: 464±274 Gy cm²; P<10^-6), for ESD (mobile C-arm: 0.18±0.11 Gy; mobile angiography: 2.0± 0.8 Gy; fixed angiography: 2.5±1.5 Gy; P<10^-6) and ED (mobile C-arm: 6.2±4.5 mSv; mobile angiography: 64± 26 mSv; fixed angiography: 129±76 mSv; P<10^-6). Conclusions Radiation dose in EVAR is substantially less with a modern portable C-arm than with a fixed or mobile dedicated angiographic system. Key Points • Fluoroscopy during endovascular aortic aneurysm repair can impart a substantial radiation dose. • Radiation doses during EVAR are higher when using mobile/fixed angiographic systems. • Mobile C-arm fluoroscopy imparts a lower dose with an equivalent clinical outcome. • Procedures need to be dose-optimised when using mobile/ fixed angiographic systems.