Dual Fluoroscopy With Live-image Zooming Significantly Reduces Patient And Operating Staff Radiation During Fenestrated/branched Endovascular Aortic Aneurysm Repair(F-BEVAR)
Laura Timaran1, Carlos H. Timaran2, Marilisa Soto-Gonzalez, MD2, Carla Scott, MD2, David Timaran-Montenegro, MD2, Melissa Kirkwood, MD2.
1University of Pittsburgh, Pittsburgh, TX, USA, 2UT Southwestern Medical Center, Dallas, TX, USA.
Objective: F-BEVAR generates high radiation doses. Magnification views aid in vessel cannulation but increase radiation. The aim of the study was to compare radiation doses to patients and operating room staff using two fluoroscopic techniques, standard magnification vs. dual fluoroscopy with live-image digital zooming during F-BEVAR.
Methods: An observational prospective single study of F-BEVAR procedures using Philips Allura XperFD20 equipment was performed over a 42-month period. Intravascular ultrasound, 3D-fusion and extreme collimation were routinely used. Intraoperative live imaging processing was performed using two systems: standard magnification in 123(81%) and dual fluoroscopy with live-image digital zooming in 28(18%). In the latter, the live zoomed/subtracted images are displayed on examination monitors and live images on reference monitors. Reference air kerma represents patient dose. Operating staff dosimetry was collected using the DoseAware system (Philips Healthcare, Amsterdam, The Netherlands). Patient and staff radiation doses were compared using non-parametric tests.
Results: Mean age was 71.6±11.4 years. The median BMI was 27 g/m2 (Interquartile range[IQR], 24.41- 30.55 kg/m2) and was the same for both groups. Procedures performed with dual fluoroscopy with live-image zooming demonstrated significantly lower median patient (1382 mGy[IQR, 999-2045] vs 2458 mGy[IQR, 1706-3767])(P<0.01) and primary operator radiation doses (101μSv [IQR, 34-235] vs 266μSv [IQR, 104-583])(P<0.01) when compared to standard magnification(Fig). Similar significantly reduced radiation doses were recorded for first assistant, scrub nurse and anesthesia staff with dual fluoroscopy (Table). According to device design, procedures performed with 4-fenestration/branch devices generated higher operator radiation doses (262 µSv[IQR, 116.5-572] vs 171µSv[IQR, 44-325])(P<0.01) compared to procedures with ≤3 fenestration/branches. Among the most complex design (4-vessel), operator radiation dose was significantly lower with dual fluoroscopy (59.5 µSv[IQR, 19.5-155] vs (309 µSv[IQR, 150-611])(P=0.01)..
Conclusions: Current radiation doses to patients and operating personnel are within acceptable limits; however, dual fluoroscopy with live-image zooming results in dramatically lower radiation dosages compared to standard magnification. Operator radiation doses were up to 5 times lower during procedures performed using more complex device designs when dual fluoroscopy was used. 
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