National Diagnostic Reference Levels for Endovascular Aneurysm Repair and Optimisation Strategies
Por:
Rial R, Vañó E, Del Río-Solá ML, Fernández JM, Sánchez RM, Camblor Santervás LA, Bellmunt S, Blanco E, El Amrani Joutey M, González Cañas E, Gomez Palones FJ, González Fajardo JA, González Tabares E, Llagostera Pujol S, Rielo Arias F, Salmerón Febres LM, Aramendi Arieta-Araunabeña C, Iborra Ortega E and Guerra Requena M
Publicada:
1 dic 2020
Ahead of Print:
8 sep 2020
Resumen:
Objective: The International Commission on Radiological Protection (ICRP) has highlighted the large number of medical specialties using fluoroscopy outside imaging departments without programmes of radiation protection (RP) for patients and staff. Vascular surgery is one of these specialties and endovascular aneurysm repair (EVAR) is one of the most challenging procedures requiring RP guidance and optimisation actions. The recent European Directive on Basic Safety Standards requires the use and regular update of diagnostic reference levels (DRL) for interventional procedures. The objective of the study was to know the doses of patients undergoing EVAR with mobile Xray systems and with hybrid rooms (fixed Xray systems), to obtain national DRLs and suggest optimisation actions.
Methods: The Spanish Chapter of Endovascular Surgery launched a national survey that involved hospitals for 10 autonomous communities representing the 77% of the Spanish population (46.7 million inhabitants). Patient dose values from mobile Xray systems were available from nine hospitals (sample of 165 EVAR procedures) and data from hybrid rooms, from seven hospitals, with dosimetric data from 123 procedures. The initial national DRLs have been obtained, as the third quartile of the median values from the different centres involved in the survey.
Results: The proposed national DRLs are 278 Gy cm(2) for hybrid rooms and 87 Gy cm(2) for mobile Xray systems, and for cumulative air kerma (cumulative AK) at the patient entrance reference point, 1403 mGy for hybrid rooms, and 292 mGy for mobile systems.
Conclusion: An audit of patient doses for EVAR procedures to identify optimised imaging protocol strategies is needed. It is also appropriate to evaluate the diagnostic information required for EVAR procedures. The increase by a factor of 3.2 (for kerma area product) and 4.8 (for cumulative AK) in the DRLs needs to be justified when the procedures are performed in the hybrid rooms rather than with mobile Xray systems.
Filiaciones:
Rial R:
Vascular Surgery Department, University Hospital Clinico San Carlos, Madrid, Spain
Vañó E:
Medical Physics Service, Hospital Clínico San Carlos and IdISSC, Madrid, Spain
Radiology Department, Complutense University, Madrid, Spain
Del Río-Solá ML:
Vascular Surgery Department, University Hospital Clinico Valladolid, Valladolid, Spain
Fernández JM:
Medical Physics Service, Hospital Clínico San Carlos and IdISSC, Madrid, Spain
Sánchez RM:
Medical Physics Service, Hospital Clínico San Carlos and IdISSC, Madrid, Spain
Radiology Department, Complutense University, Madrid, Spain
Camblor Santervás LA:
Vascular Surgery Department, Asturias Central Universitery Hospital, Oviedo, Spain
Bellmunt S:
Vascular Surgery Department, University Hospital Vall D'hebron, Barcelona, Spain
Blanco E:
Vascular Surgery Department, Guadalajara University Hospital, Guadalajara, Spain
El Amrani Joutey M:
Vascular Surgery Department, University Hospital Ramon y Cajal, Madrid, Spain
González Cañas E:
Vascular Surgery Department, University Hospital Parc Tauli, Sabadell, Spain
:
Head of Vascular Surgery, Vascular Surgery Department, University Hospital Dr. Peset, Valencia, Spain
González Fajardo JA:
Vascular Surgery Department, University Hospital 12 Octubre, Madrid, Spain
González Tabares E:
University Hospital of Canarias, Tenerife, Spain
Llagostera Pujol S:
Vascular Surgery Department, University Hospital German Trias y Pujol, Badalona, Spain
Rielo Arias F:
Vascular Surgery Department, University Hospital Lucus Augusti, Lugo, Spain
Salmerón Febres LM:
Vascular Surgery Department, University Hospital, San Cecilio, Granada, Spain
Aramendi Arieta-Araunabeña C:
Vascular Surgery Department, Basurto Hospital, Bilbao, Spain
Iborra Ortega E:
Vascular Surgery Department, University Hospital Bellvitge, L'Hospitalet de Llobregat, Spain
Guerra Requena M:
Vascular Surgery Department, Guadalajara University Hospital, Guadalajara, Spain
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