Radiation Exposure Using Fiber Optic Realshape (FORS) Imaging During Fenestrated And Branched Endovascular Aortic Aneurysm Repair (FBEVAR)
Felipe L. Pavarino, MD, Jesus Porras-Colon, MD, Marilisa Soto Gonzalez, MD, Valentin Figueroa, MD, Carla K Scott, MD, Melissa Kirkwood, MD, Mirza S. Baig, MD, Carlos Timaran, MD.
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Objectives: Fenestrated and branched endovascular aortic aneurysm repairs (FBEVAR) are complex procedures that generate high radiation doses. Fiber Optic RealShape (FORS) imaging uses optical fibers built in catheters and wires for light-based real-time visualization of these devices, thereby reducing radiation. The purpose of this study was to evaluate the radiation doses before and after FORS implementation during FBEVAR. Methods: During a 7-year period, 295 patients underwent FBEVAR as part of Physician-Sponsored Investigational Device Exemption study. FORS was used during the last 7 months of the study period for target vessel and contralateral gate catheterization. Procedure duration, reference air kerma (RAK), dose area product (DAP), and contrast load were collected prospectively. Operating staff personal dosimetry was also collected using the DoseAware system (Philips Healthcare, Andover, MA). Digital zooming was used in all procedures. Chi-square and non-parametric t-tests were performed to compare radiation doses during FBEVAR with and without FORS.Results: Among 295 patients (69.8% male), 31 (10.5%) underwent FBEVAR with FORS-guidance. Procedures performed with FORS demonstrated slightly lower patient radiation doses (median RAK with FORS, 1575.5 mGy [interquartile range, 945.3-1962.9] vs. 1645.6 mGy [IQR, 1074.1 - 2453.2] without FORS; P = .33). Operating staff personal dosimetry revealed significantly lower radiation exposure with FORS, particularly for the primary operator (78 µSv [IQR, 36.3 - 172.5] vs. 120 µSv [IQR, 52 - 287]; P=.033) and the fellow (32.5 µSv [IQR, 16.5 - 54.5] vs 58 µSv [IQR, 26 - 133]; P < .001)(Table). No differences in procedure duration and fluoroscopy time were observed.Conclusions: Early results revealed a significant reduction in radiation exposure for the operating staff during FBEVAR using FORS guidance. Slightly lower radiation exposure for the patient was observed. Larger studies are required to assess the use of FORS for FBEVAR.
| Procedure duration, min | 312 [252 - 366] | 285 [238.3 - 344.5] | .11 |
| Total RAK, mGy | 1575.5 [945.3 - 1962.9] | 1645.6 [1074.1 - 2453.2] | .33 |
| Total DAP, Gycm2 | 193 [129 - 291] | 205.7 [125 - 321.1] | .60 |
| Fluoroscopy time, min | 71.2 [57.9 - 90.8] | 75.3 [62.2 - 94] | .34 |
| Contrast load, mL | 118 [95 - 185] | 95 [80 - 125] | .001 |
| Operator radiation, µSv | 78 [36.3 - 172.5] | 120 [52 - 287] | .033 |
| Fellow radiation, µSv | 32.5 [16.5 - 54.5] | 58 [26 - 133] | <.001 |
| Circulator nurse radiation, µSv | 2 [0 - 3] | 3 [0 - 6] | .006 |
| Scrub tech radiation, µSv | 5 [1 - 13] | 8 [3 - 21] | .024 |
| Anesthesia radiation, µSv | 3 [1.3 - 17] | 6 [1 - 26] | .069 |
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