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Radiation exposure to patients and operating staff during FEVAR
David E. Timaran, MD1, Martyn Knowles2, Marilisa Soto-Gonzalez1, Tarik Ali1, Carlos Timaran1
1University of Texas Southwestern Medical Center, Dallas, TX, 2University of North Carolina Health Care, Chapel Hill, NC

Fenestrated endovascular aneurysm repair (FEVAR) is an alternative of treatment for patients with complex AAAs unfit for open repair and not eligible for standard EVAR. FEVAR is, however, a challenging procedure that requires a significant radiation exposure when compared to other fluoroscopically guided interventions (FGI). The aim of this study is to characterize radiation exposure to patients and operating room (OR) personnel during FEVAR.
During a six-month period 25 patients (18 men [72%], and 7 women [28%]) underwent FEVAR using investigational fenestrated Custom Made Devices (CMDs). An upgraded X-ray system was used (AlluraClarity FD20; Philips Healthcare). Patient dose information was collected from the imaging equipment. Dose Aware Personal Dose Meter System (Philips, Göteborg, Sweden) was used to prospectively measure surgeon and staff radiation exposure during FEVAR. Effective radiation doses for OR personnel were calculated using the Webster methodology. Pearson-Spearman correlation analysis was used to compare patient radiation dose and operating room personnel radiation doses.
Median patients age was 73 years (Interquartile [IQR], 69-79 years). The median BMI was 26.5 kg/m2 (IQR, 24.4-30 26.5 kg/m2). The median number of fenestrations was 3. The median cumulative air kerma (CAK) was 3.6 Gy (IQR, 1.4-3.6 Gy). Median effective operating room personnel doses were as follows: surgeon effective dose was 82 ?Sv (IQR, 49.8-111 ?Sv), attending fellow 91.5 ?Sv (58.5-129 ?Sv), scrub nurse 12 ?Sv (8.4-12 ?Sv), anesthesia staff 4.5 ?Sv (IQR 1,8-17.8) and nurse circulator 3.7 ?Sv (1.3-9 ?Sv). Surgeon and fellow effective doses were correlated with patient dose as measured by kerma area product (KAP) (r=0.51 and r=0.75, respectively [p<0.05]), and CAK (r=0.34 and r=0.54, respectively [p<0,01]). The amount of energy delivered at right anterior oblique projection, as measured by millamperage second (mAs) was correlated with surgeon and fellow effective radiation dose (r=0.51 and r=0.59, respectively [p=0.01]). Patients CAK and KAP were correlated with number of stents used (r=0.45 and r=0.42, respectively [p=0.05]) and BMI (r=0.62 and r=0.53, respectively [p<0.01]).
Effective radiation dose was higher for surgeon and the attending fellow when compared to the rest of operating room personnel. Surgeon and fellow doses were best correlated with KAP and less with well correlated with CAK. Right lateral rotation exposes surgeon and fellow to higher radiation doses.

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