Guillou Marie, Maurel Blandine, Necib Hatem, Vent Pierre-Alexandre, Costargent Alain, Chaillou Philippe, Gouëffic Yann, Kaladji Adrien
Department of Vascular Surgery, Nantes University Hospital, Thorax Institute, Nantes, France.
Department of Vascular Surgery, Nantes University Hospital, Thorax Institute, Nantes, France; Laboratory of Pathophysiology of Bone Resorption, UMR-957, Nantes, France; University of Nantes, Nantes, France.
Ann Vasc Surg. 2018 Feb;47:104-113. doi: 10.1016/j.avsg.2017.08.036. Epub 2017 Sep 8.
Flat-panel detectors on mobile C-arm (MC-arm) systems are currently challenging fixed C-arm (FC-arm) systems used in hybrid operating rooms. MC-arm systems offer an alternative to FC-arm systems in the endovascular treatment of peripheral arterial disease (PAD) but their efficiency has not been evaluated comparatively.
Two series of patients undergoing arteriography with intention to treat were included. Each series consisted of 2 nonrandomized groups: an MC-arm group and an FC-arm group. Series 1 evaluated exposure to the patient (MC-arm, n = 113; FC-arm, n = 206) while series 2 evaluated exposure to patients and also health care personnel (MC-arm, n = 24; FC-arm, n = 76). The primary end points for evaluating exposure were air kerma (AK, in mGy) for patients and effective dose for health care personnel (in μSv).
After adjustment for the effect of body mass index (analysis of covariance test), AK was found to be lower in the MC-arm group than in the FC-arm group (124.1 ± 142 vs. 173.3 ± 248.7, P = 0.025). There was no difference between the groups with regard to effective dose recorded for senior surgeons or for operating room nurses. However, a higher effective dose was recorded by the MC-arm group external dosimeter for the trainee resident and for nurse anesthetists.
In endovascular treatment of lower limb PAD, use of an FC-arm system is associated with more radiation exposure to the patient than an MC-arm system. However, this type of imaging system does not appear to affect exposure to health care personnel.
移动C型臂（MC臂）系统上的平板探测器目前正在挑战混合手术室中使用的固定C型臂（FC臂）系统。MC臂系统在周围动脉疾病（PAD）的血管内治疗中为FC臂系统提供了一种替代方案，但尚未对其效率进行比较评估。
纳入两组有意接受动脉造影治疗的患者。每组包括2个非随机分组：MC臂组和FC臂组。系列1评估患者所受辐射（MC臂组，n = 113；FC臂组，n = 206），而系列2评估患者及医护人员所受辐射（MC臂组，n = 24；FC臂组，n = 76）。评估辐射暴露的主要终点指标为患者的空气比释动能（AK，单位为mGy）和医护人员的有效剂量（单位为μSv）。
在调整体重指数的影响后（协方差分析检验），发现MC臂组的AK低于FC臂组（124.1±142 vs. 173.3±248.7，P = 0.025）。两组在高级外科医生或手术室护士记录的有效剂量方面没有差异。然而，MC臂组外部剂量计记录的实习住院医生和麻醉护士的有效剂量较高。
在下肢PAD的血管内治疗中，使用FC臂系统比MC臂系统使患者受到更多的辐射暴露。然而，这种成像系统似乎不会影响医护人员所受辐射。
