Radiation exposure of adrenal vein sampling: a German Multicenter Study

Area of Science:

• Endocrinology
• Interventional Radiology
• Medical Physics

Background:

• Adrenal vein sampling (AVS) is the gold standard for diagnosing primary aldosteronism (PA).
• Current AVS procedures are invasive, costly, require specialized expertise, and involve radiation exposure.
• The precise radiation dose to patients undergoing AVS has not been systematically evaluated.

Purpose of the Study:

• To quantify the radiation exposure to patients during adrenal vein sampling (AVS).
• To identify variations in radiation exposure among different medical centers performing AVS.
• To provide recommendations for optimizing AVS protocols and reducing patient radiation dose.

Main Methods:

• Retrospective analysis of 656 AVS procedures conducted between 1999 and 2017 across four university hospitals.
• Primary outcome measures included dose area product (DAP) and fluoroscopy time (FT).
• Effective dose (ED) was calculated based on DAP and FT measurements.

Main Results:

• Median DAP was 32.5 Gy*cm², median FT was 18 minutes, and median calculated ED was 6.4 mSv.
• Significant variations in median DAP (16–147 Gy*cm²), FT (16–27 min), and ED (3.2–29 mSv) were observed among participating centers.
• Differences in AVS protocols, including sampling locations, frame rates, and use of digital subtraction angiography, contributed to the observed variations.

Conclusions:

• This study provides the first systematic assessment of radiation exposure during AVS, revealing substantial patient doses.
• Notable inter-center variability in radiation exposure underscores the need for standardized AVS protocols.
• Recommendations include considering radiation risk in patient referrals and implementing improved standard operating procedures to minimize unnecessary radiation exposure.