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

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Abstract

Purpose: 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. Materials and Methods: 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. Results: MESD values (mean 0.96 ± 0.42 Gy) were FR) were 269 Gy cm2, 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 NFR 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 NFR 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. Conclusion: Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

Original languageEnglish
Pages (from-to)320-329
Number of pages10
JournalCardioVascular and Interventional Radiology
Volume36
Issue number2
DOIs
Publication statusPublished - Apr 2013

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Keywords

  • Carotid artery disease
  • Dosimetry
  • Endovascular treatment
  • Neurointerventions
  • Radiation protection
  • Stenting/stent graft/drug eluting stents

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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