Radiation dose during endovascular aneurysm repair (EVAR): upgrade of an angiographic system from standard to Eco mode

Purpose To evaluate the radiation dose reduction during endovascular aneurysm repair (EVAR) after the reconfiguration of a Philips AlluraXper FD20 X-ray system. Methods Between 2013 and 2015, we implemented a low-dose protocol (Eco dose) increasing the filtration with 1 mm of Al and 0.1 of Cu on both fluoroscopy and fluorography and halving the frames per second in fluoroscopy. The switch was complemented by hybrid operating room staff education and training in radiation protection. We compared two samples of 50 patients treated before the switch (normal dose) with 50 patients treated after the switch (Eco dose). Procedures were categorized into two different grades of complexity, standard and complex, intended as fenestrated/chimney/snorkel and EVAR plus additional embolization to prevent endoleak type II. We evaluated patient demographics, Air Kerma (AK), dose area product (DAP), and procedural data (fluoroscopy time, number of fluorographies, and iodinated contrast). Staff radiation dose was measured with film badge dosimeter on C-arm. Results The Eco-dose protocol witnessed a DAP reduction of 53% in standard EVARs and of 57% in complex EVARs and an AK reduction of 45% in standard and 57% in complex EVAR. The image quality in 2016 was perceived acceptable, as proven by the fact that fluoroscopy time, number of fluorographies, and contrast medium volumes did not have to be increased. We achieved a reduction in staff dose of 25.6%. Conclusions Optimized angiographic system setting significantly reduced the radiation dose both to the patients and to the staff assuring safe EVAR procedures.