Kiang Sharon C, Ahmed Khwaja A, Cha Victoria J, Farley Donald V, Oyoyo Udochukwu E, Abou-Zamzam Ahmed M, Tomihama Roger T
1 Department of Surgery, Division of Vascular Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.
2 Department of Surgery, Division of Vascular Surgery, VA Loma Linda Healthcare System, Redlands, CA, USA.
Vascular. 2019 Apr;27(2):144-152. doi: 10.1177/1708538118806749. Epub 2018 Oct 18.
There is paucity in the literature reporting radiation usage analysis in vascular surgery. In the era of endovascular surgeries, analyzing the surgeons' use of radiation in vascular procedures can help establish quality improvement initiatives.
A retrospective review was undertaken of intraoperative fluoroscopic-guided vascular surgery procedures at a single institution from 2010 to 2017. Mobile C-arms were utilized to gather the six radiation usage metrics and cases were categorized into 6 anatomic surgical fields and 10 surgical procedure types.
Three hundred and eighteen vascular surgery cases were analyzed and notable trends in all radiation usage metrics were identified both across the surgical field location and type of surgical procedure. The highest cumulative dose was identified in embolization cases with a mean of 932.5 mGy. The highest fluoroscopic time was seen in atherectomies with a mean of 2629.6 s. In terms of surgical field, the highest cumulative does and fluoroscopic time was identified in abdomen/pelvis procedures with a mean of 352.1 mGy and 1186.8 s, respectively. Analysis of dose reduction techniques also demonstrated notable trends.
There were notable trends in the analyzed radiation usage variables both across the surgical field location and type of surgical procedure. Specifically, cases that involve the abdomen/pelvis, embolization and atherectomy have the highest radiation use. These types of cases can be targeted for future improved dose reduction techniques or staged procedures. This data can serve as baseline information for future quality improvement initiatives for patient and personnel radiation exposure safety.
文献中报道血管外科放射使用分析的内容较少。在血管内手术时代，分析外科医生在血管手术中放射的使用情况有助于制定质量改进措施。
对2010年至2017年在单一机构进行的术中透视引导血管外科手术进行回顾性研究。使用移动C形臂收集六个放射使用指标，并将病例分为6个解剖手术区域和10种手术类型。
分析了318例血管外科病例，在手术区域位置和手术类型方面均发现了所有放射使用指标的显著趋势。栓塞病例的累积剂量最高，平均为932.5毫戈瑞。旋切术的透视时间最长，平均为2629.6秒。在手术区域方面，腹部/盆腔手术的累积剂量和透视时间最高，分别平均为352.1毫戈瑞和1186.8秒。对剂量降低技术的分析也显示出显著趋势。
在手术区域位置和手术类型方面，分析的放射使用变量均存在显著趋势。具体而言，涉及腹部/盆腔、栓塞和旋切术的病例放射使用量最高。这些类型的病例可作为未来改进剂量降低技术或分期手术的目标。这些数据可作为未来患者和人员放射暴露安全质量改进措施的基线信息。
