Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

Journal Article · Mon Apr 15 04:00:00 EDT 2013 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-012-0392-2· OSTI ID:22156391

D'Ercole, Loredana ^[1]; Quaretti, Pietro; Cionfoli, Nicola ^[2]; Klersy, Catherine ^[3]; Bocchiola, Milena ^[1]; Rodolico, Giuseppe; Azzaretti, Andrea ^[2]; Lisciandro, Francesco ^[1]; Cascella, Tommaso; Zappoli Thyrion, Federico ^[2]

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1. Fondazione IRCCS Policlinico San Matteo, Department of Medical Physics (Italy)
2. Fondazione IRCCS Policlinico San Matteo, Department of Radiology (Italy)
3. Fondazione IRCCS Policlinico San Matteo, Biometry and Clinical Epidemiology Service, Research Department, (Italy)

To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity. MESD were evaluated with radiochromic films in 31 patients (mean age 72 {+-} 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 {+-} 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included. MESD values (mean 0.96 {+-} 0.42 Gy) were <2 Gy without relevant dependence on procedure complexity. Local DRL values for kerma area product (KAP), fluoroscopy time (FT), and number of frames (N{sub FR}) were 269 Gy cm{sup 2}, 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1-102.7, p < 0.05) and N{sub FR} overexposures (OR 10.8, 95 % CI 1.1-109.5, p < 0.05). Type I aortic arch decreased the risk of FT overexposure (OR 0.4, 95 % CI 0.1-0.9, p = 0.042), and stenosis {>=} 90 % increased the risk of N{sub FR} overexposure (OR 2.8, 95 % CI 1.1-7.4, p = 0.040). At multivariable analysis, stenosis {>=} 90 % (OR 2.8, 95 % CI 1.1-7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1-109.5, p = 0.027) were associated with overexposure for two or more parameters. Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

• OSTI ID: 22156391
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 2 Vol. 36; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CALCIUM SULFIDES
CAROTID ARTERIES
DOSES
EVALUATION
FILMS
FLUOROSCOPY
KERMA
MEN
PATIENTS
SKIN
WOMEN