Brambilla Marco, Cerini Paolo, Lizio Domenico, Vigna Luca, Carriero Alessandro, Fossaceca Rita
Medical Physics Department, University Hospital "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy,
Radiol Med. 2015 Jun;120(6):563-70. doi: 10.1007/s11547-014-0485-x. Epub 2015 Jan 9.
This study was undertaken to quantify the cumulative effective dose (CED) of radiation and the dose to relevant organs in endovascular aortic repair (EVAR) patients, to assess radiation risks and to evaluate the clinical usefulness of multi-detector computed tomography (MDCT) follow-up.
The radiation exposures were obtained from 71 consecutive EVAR patients with a follow-up duration ≥1 year. Dose calculations were performed on an individual basis and expressed as effective doses and organ doses. Radiation risk was expressed as risk of exposure-induced death (%), using the biological effects of ionising radiation model. Two radiologists independently assessed the images for abdominal aortic aneurysm expansion without endoleaks, thrombotic occlusion, endoleaks and device migration. They first reviewed arterial imaging alone and subsequently added non-contrast and delayed phases to determine the overall performance.
The median total CED and annual CED were 224 and 104 mSv per patient-year. The median cumulative organ doses were 191, 205, 230, 269 and 271 mSv for lung, bone marrow, liver, colon and stomach, respectively. The average risk of exposure-induced death was 0.8 % (i.e., odds 1 in 130). All the findings related to EVAR outcome and leading to a change in patient management were visible during the arterial phase of the MDCT angiography. Omission of the unenhanced scan and the venous phase of the MDCT angiography would have led to a significant reduction of about 60 % of the associated MDCT radiation exposure in a single patient.
EVAR patients received high radiation doses and the excess cancer risk attributable to radiation exposure is not negligible. The unenhanced scan and the venous phase of the MDCT angiography could have been omitted without compromising the utility of the examination and with a significant reduction of doses and associated risks.
本研究旨在量化血管内主动脉修复（EVAR）患者的累积有效剂量（CED）及相关器官的剂量，评估辐射风险，并评价多排螺旋计算机断层扫描（MDCT）随访的临床实用性。
连续纳入71例随访时间≥1年的EVAR患者，获取其辐射暴露情况。基于个体进行剂量计算，并以有效剂量和器官剂量表示。采用电离辐射生物效应模型，将辐射风险表示为暴露诱发死亡风险（%）。两名放射科医生独立评估图像，观察腹主动脉瘤有无扩张、有无内漏、血栓闭塞、内漏及移植物移位情况。他们首先单独回顾动脉期成像，随后增加平扫及延迟期成像以确定整体诊断效能。
每位患者每年的中位总CED和年度CED分别为224 mSv和104 mSv。肺、骨髓、肝脏、结肠和胃的中位累积器官剂量分别为191、205、230、269和271 mSv。暴露诱发死亡的平均风险为0.8%（即130人中1人）。所有与EVAR结局相关且导致患者治疗方案改变的发现，在MDCT血管造影的动脉期均可见。在单例患者中，省略MDCT血管造影的平扫及静脉期成像，可使相关MDCT辐射暴露显著减少约60%。
EVAR患者接受的辐射剂量较高，辐射暴露所致的额外癌症风险不可忽视。省略MDCT血管造影的平扫及静脉期成像，在不影响检查效用的情况下，可显著降低剂量及相关风险。
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