Continuous Radiation Dose Optimisation through Analysis of Imaging System Procedure Logs during Fenestrated and
Lucas Ruiter Kanamori1, Bruno Pagnin Schmid2, Dora Babocs1
1Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Objective:
This retrospective analysis of prospectively collected observational cohort data aimed to investigate the impact of internal audit using imaging system procedure log analysis on radiation exposure during fenestrated and or branched endovascular aortic repair (FBEVAR).
Methods:
Patients who underwent FBEVAR for complex aortic aneurysms by a single operator between January 2016 and January 2024 were analysed. Procedures were performed using a historical hybrid imaging platform (system I, January 2016 - June 2020) and a subsequent platform (system II, July 2021 - January 2024), stratified into phase 1 (pre-optimisation) and phase 2 (post-optimisation) after implementation of audit derived radiation reduction strategies. Procedural log analysis identified contributors to increased radiation dose, prompting optimisation. Endpoints included procedural metrics, air kerma (AK), and dose area product (DAP).
Results:
Four hundred and ninety-one patients were included (system I: n = 346; system II: n = 145 [phase 1: n = 83; phase 2: n = 62]). The cohort after transition demonstrated greater anatomical complexity. Median AK increased from 0.9 Gy (interquartile range [IQR] 0.6, 1.6) in system I to 1.5 Gy (IQR 1.1, 2.0) in system II phase 1 (p < .001), with DAP increasing from 158 Gy·cm2 (IQR 111, 229) to 219 Gy·cm2 (IQR 167, 284) (p = .002). Following optimisation, AK decreased to 0.9 Gy (IQR 0.5, 1.4; p = .098 vs. system I) and DAP to 151 Gy·cm2 (IQR 101, 229; p = .32 vs. system I). In multivariable analysis, system II phase 1 was independently associated with increased AK and DAP compared with system I (AK: β = +425 mGy; 95% confidence interval 221 - 630; p < .001; DAP: β = +53 Gy·cm2; 95% confidence interval 24 - 82; p < .001), whereas no significant differences were observed in phase 2.
Conclusion:
A structured internal audit with targeted workflow and imaging optimisation mitigated radiation dose increases following hybrid platform transition, restoring exposure to baseline levels.
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