Comparison of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease with Flat-Panel Detectors on Mobile C-arm versus Fixed Systems

Marie Guillou (1, 2) , Blandine Maurel (3) , Hatem Necib (4) , Pierre-Alexandre Vent (1, 2) , Alain Costargent (1, 2) , Philippe Chaillou (1, 2) , Yann Gouëffic (3) , Adrien Kaladji (5, 6)

1 CHU Nantes - Centre Hospitalier Universitaire de Nantes
2 ITX - ITX - unité de recherche de l'institut du thorax
3 PhAN - Physiopathologie des Adaptations Nutritionnelles
4 CRCINA-ÉQUIPE 13 - Nuclear Oncology
5 LTSI - Laboratoire Traitement du Signal et de l'Image
6 Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes]

Background: Flat-panel detectors on mobile C-arm (MC-arm) systems are currently challenging fixed C-arm (FC-arm) systems used in hybrid operating rooms. MC-arm systems offer an alternative to FC-arm systems in the endovascular treatment of peripheral arterial disease (PAD) but their efficiency has not been evaluated comparatively. Methods: Two series of patients undergoing arteriography with intention to treat were included. Each series consisted of 2 nonrandomized groups: an MC-arm group and an FC-arm group. Series 1 evaluated exposure to the patient (MC-arm, n = 113; FC-arm, n = 206) while series 2 evaluated exposure to patients and also health care personnel (MC-arm, n = 24; FC-arm, n = 76). The primary end points for evaluating exposure were air kerma (AK, in mGy) for patients and effective dose for health care personnel (in μSv). Results: After adjustment for the effect of body mass index (analysis of covariance test), AK was found to be lower in the MC-arm group than in the FC-arm group (124.1 ± 142 vs. 173.3 ± 248.7, P = 0.025). There was no difference between the groups with regard to effective dose recorded for senior surgeons or for operating room nurses. However, a higher effective dose was recorded by the MC-arm group external dosimeter for the trainee resident and for nurse anesthetists. Conclusions: In endovascular treatment of lower limb PAD, use of an FC-arm system is associated with more radiation exposure to the patient than an MC-arm system. However, this type of imaging system does not appear to affect exposure to health care personnel. © 2017 Elsevier Inc.

Mots clés: major clinical study; intention to treat analysis; chronic total occlusion; radiation dose reduction; radiation exposure; signal noise ratio; endovascular aneurysm repair; controlled study; lower limb; image quality; image display; radiation dose; endovascular surgery; fluoroscopy; health care personnel; human; artery thrombosis; Article; body mass; priority journal; nurse; stenosis; operating room personnel; peripheral occlusive artery disease; aged; arteriography

Domaines: Ingénierie biomédicale; Chirurgie; Cardiologie et système cardiovasculaire

Marie Guillou, Blandine Maurel, Hatem Necib, Pierre-Alexandre Vent, Alain Costargent, et al.. Comparison of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease with Flat-Panel Detectors on Mobile C-arm versus Fixed Systems. Annals of Vascular Surgery, 2018, 47, pp.104-113. ⟨10.1016/j.avsg.2017.08.036⟩. ⟨hal-01713546⟩