National UK Survey of Radiation Doses During Endovascular Aortic Interventions
Yvonne Tsitsiou, Bar Velan, Rebecca E. Ross, Raghu Lakshminarayan, Andy Rogers, Mohamad Hamady, RADEVAIR, Lamran Khan, Ananth Krishnan, Martin Hennessy, Ram Kasthuri, Zenaib Al-Rekabi, Said Abisi, Mark Hampshire, Panos Goutzios, Muhammad Hanif, Emma Olivier, Andrew Wood, Andrew Macey, Sachin Modi, Robert D. Allison, Clare Bent, Peter M. Bungay, Robert Whiteman, Robin Williams, Zaid Aldin, Josephine Weaver, Robert Kaikini, David Wells, John A. Hancock, Anil Madhavan, Sapna Puppala, Matthew Matson, Katharine L. Lewis, Raman Uberoi, Andrew Winterbottom, Bella Huasen, Michael Jenkins, Trevor Cleveland, Rachel Butcher
Abstract
Abstract Purpose Endovascular aortic repair (EAR) interventions, endovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), are associated with significant radiation exposures. We aimed to investigate the radiation doses from real-world practice and propose diagnostic reference level (DRL) for the UK. Materials and Methods Radiation data and essential demographics were retrospectively collected from 24 vascular and interventional radiology centres in the UK for all patients undergoing EAR—standard EVAR or complex, branched/fenestrated (BEVAR/FEVAR), and TEVAR—between 2018 and 2021. The data set was further categorised according to X-ray unit type, either fixed or mobile. The proposed national DRL is the 75th percentile of the collective medians for procedure KAP (kerma area product), cumulative air kerma (CAK), fluoroscopy KAP and CAK. Results Data from 3712 endovascular aortic procedures were collected, including 2062 cases were standard EVAR, 906 cases of BEVAR/FEVAR and 509 cases of TEVAR. The majority of endovascular procedures (3477/3712) were performed on fixed X-ray units. The proposed DRL for KAP was 162 Gy cm 2 , 175 Gy cm 2 and 266 Gy cm 2 for standard EVAR, TEVAR and BEVAR/FEVAR, respectively. Conclusion The development of DRLs is pertinent to EAR procedures as the first step to optimise the radiation risks to patients and staff while maintaining the highest patient care and paving the way for steps to reduce radiation exposures.