European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety.

A new angiographic imaging platform reduces radiation exposure for patients with liver cancer treated with transarterial chemoembolization

Angiography and embolization (AE) is a lifesaving, high radiation dose procedure for treatment of abdominal arterial hemorrhage (AAH). Interventional radiologists have utilized pre-procedure CT angiography (CTA) and newer fluoroscopic systems in an attempt to reduce radiation dose and procedure time.To study the factors contributing to the radiation dose of AE for AAH and to compare to the reference standard.This retrospective single-centre observational cohort study identified 154 consecutive AE procedures in 138 patients (median age 65 years; interquartile range 54-77; 103 men) performed with a C-arm fluoroscopic system (Axiom Artis DTA or Axiom Artis Q (Siemens Healthineers)), between January 2010 and December 2017. Parameters analysed included: demographics, fluoroscopy system, bleeding location, body mass index (BMI), preprocedural CT, air kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of digital subtraction angiography (DSA) runs. Factors affecting dose were assessed using Mann-Whitney U, Kruskal-Wallis one-way ANOVA and linear regression.Patients treated with the new angiographic system (NS) had a median PKA, median Ka,r, Q3 PKA and Q3 Ka,r that were 74% (p < 0.0005), 66%(p < 0.0005), 55% and 52% lower respectively than those treated with the old system (OS). This dose reduction was consistent for each bleeding location (upper GI, Lower GI and extraluminal). There was no difference in PKA (p = 0.452), Ka,r (p = 0.974) or FT (p = 0.179), between those who did (n = 137) or did not (n = 17) undergo pre-procedure CTA. Other factors significantly influencing radiation dose were: patient BMI and number of DSA runs. A multivariate model containing these variables accounts for 15.2% of the variance in Ka,r (p < 0.005) and 45.9% of the variance of PKA (p < 0.005).Radiation dose for AE in AAH is significantly reduced by new fluoroscopic technology. Higher patient body mass index is an independent key parameter affecting patient dose. Radiation dose was not influenced by haemorrhage site or performance of pre-procedure CTA. 

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Patient radiation dose during angiography and embolization for abdominal hemorrhage: the influence of CT angiography, fluoroscopy system, patient and procedural variables

‘Radiation Stewardship’ describes the essential leadership role that vascular surgeons must champion in order to deliver safe high-quality care utilising ionising radiation. The previous chapter highlighted the importance of appreciating basic science concepts to augment this role in clinical practice. An understanding of radiation physics, biology and dosimetry provide the foundation for the practical aspects of Radiation Stewardship. This chapter expands on the stochastic risk to interventionists and discusses radiation exposure during specific endovascular procedures such as EVAR. Practical steps to reduce radiation exposure in daily practice involve;

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Individual, team and institutional behaviours,




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A thorough knowledge of machine controls and how they can be altered to achieve lower doses,




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The use of various imaging equipment and workflows,




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The importance of utilising all of the shielding options available to achieve cumulative protection.

Radiation Stewardship: Radiation Exposure, Protection and Safety in Contemporary Endovascular Practice

Purpose:To evaluate the impact of a new angiographic imaging technology on radiation dose during visceral embolization procedures involving both fluoroscopy and digital subtraction angiography.Mate...

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James B Benenati

Papers

The Effect of a New Angiographic Imaging Technology on Radiation Dose in Visceral Embolization Procedures