Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Technical Medicine, University of Twente, Enschede, the Netherlands.
Ann Vasc Surg. 2022 Aug;84:336-343. doi: 10.1016/j.avsg.2022.01.030. Epub 2022 Mar 5.
A chronic exposure to low dose radiation, as encountered in endovascular procedures, may impact the health of surgeons and radiologists over a timespan of several months to a lifetime. This study evaluates the feasibility and efficacy of a radiation absorbing sterile drape (RADPAD) to reduce operator exposure during the endovascular treatment of obstructive peripheral artery disease (PAD).
Between February 2016 and September 2017, patients with PAD who received percutaneous transluminal angioplasty, stent placement, remote endarterectomy, or a combination thereof were included in this nonrandomized study. Patients were equally divided over a study cohort (with RADPAD) and a control cohort (without RADPAD). The unshielded body dose (E) of the staff was measured via electronic dosimeters placed at a chest height of the first operator (FO), second operator (SO), and sterile nurse (SN). A virtual maximum operator (MO) dose was constructed, yielding the highest dose per fluoroscopy run for either of the operators. Simultaneously, the dose area product (DAP) and C-arm settings for each fluoroscopy run were extracted. Staff exposures of the study cohort and control cohort were compared in terms of relative exposure (E/DAP). A secondary analysis involved an analysis of the individual fluoroscopy runs using a multivariate generalized linear mixed effect model.
In total, 49 patients were included in this study. The use of RADPAD was technically feasible. Significant reductions of relative exposure were observed when comparing the study cohort with the control cohort. The relative exposure of the FO was reduced with 66.5% (1.82 vs. 0.61 μSv/Gycm, P < 0.001), the relative exposure of the SO with 68.3% (0.55 vs. 0.17 μSv/Gycm, P = 0.02), and the relative exposure of the MO with 65.8% (2.06 vs. 0.71 μSv/Gycm, P < 0.001). Dose levels of SN were too low to draw conclusions under the current sample size. The multivariate generalized linear mixed effect model showed a significant correlation between absolute exposure of the MO and the use of the RADPAD (odds: 0.51, P < 0.001).
Usage of a radiation absorbing drape (RADPAD) during endovascular treatment of PAD results in statistically significant reduction in a relative operator dose while presenting no drawbacks. The use of these drapes is advised in future peripheral endovascular procedures.
在血管内手术过程中，长期接触低剂量辐射可能会影响外科医生和放射科医生的健康，这种影响可能会在数月至数年内逐渐显现。本研究旨在评估一种辐射吸收无菌罩（RADPAD）在减少外周血管疾病（PAD）腔内治疗过程中操作人员辐射暴露的可行性和效果。
2016 年 2 月至 2017 年 9 月，本研究纳入了接受经皮腔内血管成形术、支架置入术、远程内膜切除术或其联合治疗的 PAD 患者。患者随机分为研究组（使用 RADPAD）和对照组（不使用 RADPAD）。通过在第一术者（FO）、第二术者（SO）和无菌护士（SN）胸部高度放置电子剂量计，测量工作人员的未屏蔽体剂量（E）。根据每次透视运行的最高剂量，构建虚拟最大术者（MO）剂量，得出每个操作人员的最高剂量。同时，提取每次透视运行的剂量面积乘积（DAP）和 C 臂设置。研究组和对照组的工作人员暴露情况分别以相对暴露（E/DAP）进行比较。二次分析包括使用多变量广义线性混合效应模型对个体透视运行进行分析。
本研究共纳入 49 例患者。使用 RADPAD 在技术上是可行的。与对照组相比，研究组的相对暴露显著降低。FO 的相对暴露降低了 66.5%（1.82 比 0.61 μSv/Gycm，P<0.001），SO 的相对暴露降低了 68.3%（0.55 比 0.17 μSv/Gycm，P=0.02），MO 的相对暴露降低了 65.8%（2.06 比 0.71 μSv/Gycm，P<0.001）。由于当前样本量较小，SN 的剂量水平无法得出结论。多变量广义线性混合效应模型显示，MO 的绝对暴露与 RADPAD 的使用之间存在显著相关性（比值比：0.51，P<0.001）。
在 PAD 的血管内治疗过程中使用辐射吸收罩（RADPAD）可显著降低操作人员的相对剂量，且无任何弊端。建议在未来的外周血管腔内手术中使用这些罩具。
