Vanmaele Alexander, Ruiter Kanamori Lucas, Vacirca Andrea, Babocs Dora, Mesnard Thomas, Maximus Steven, Huang Ying, Feng Ching Mei J, Huynh Jimmy, Oderich Gustavo S
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, John P. and Kathrine G. McGovern Medical School, Houston, TX; Department of Cardiology, Thorax Centre, Cardiovascular Institute, Erasmus MC, Rotterdam, the Netherlands; Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands.
Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
J Vasc Surg. 2025 Aug;82(2):646-654. doi: 10.1016/j.jvs.2025.04.033. Epub 2025 Apr 28.
Fenestrated and branched endovascular aneurysm repairs (FB-EVAR) stand out as interventions with the highest radiation exposure to patients, operators, and staff, raising concerns for accumulating radiation doses to the eye lens. Therefore, this study aimed to describe the absorbed dose of radiation to the eyes of the patient and primary operator and relate this to indirect metrics of radiation exposure.
All consecutive patients undergoing FB-EVAR between March 2022 and September 2024 as part of a prospective, nonrandomized cohort for investigational devices, were included in this cross-sectional study. To the measure absorbed dose of radiation and translate this into equivalent eye lens dose, we placed three nanoDot dosimeters (Landauer, Inc, Glenwood, IL) on each lateral periorbital skin of the patient and primary operator, and one on each eyelid of the patient. The absorbed dose left and right, and between patient and operator were compared using paired t tests. Additionally, these direct measurements were correlated (Pearson) with the indirect radiation metrics recorded by the imaging unit.
There were 114 patients who were included (78 male [68%]; mean age, 71.0 ± 9.8 years). Investigational devices were off-the-shelf in 34 patients (30%) and patient-specific in 80 (70%). Among patients, the median (25th-75th percentile) absorbed dose of radiation was 0.25 mGy (0.18, 0.36 mGy) mGy at the left and 0.18 mGy (0.13, 0.26 mGy) at the right periorbital skin (mean fold difference, 1.4; 95% confidence interval, 1.3-1.5; P < .001). In the operator, the median (25th-75th percentile) absorbed dose of radiation to the periorbital skin was 0.12 mGy (0.08, 0.18 mGy) on the left (equivalent lens dose: 0.20 (0.13, 0.30) mSv) and 0.02 mGy (0.01, 0.03 mGy) on the right (equivalent lens dose: 0.03 mGy (0.02, 0.05 mGy) (mean fold difference, 7.0; 95% confidence interval, 5.7-8.6; P < .001). The indirect metrics of the radiation unit correlated weakly with the patient's absorbed dose, with correlation coefficients ranging between 0.19 (P = .048) and 0.21 (P = .025). Similarly, the correlation coefficient between fluoroscopy time and the operator's direct radiation exposure was lower at 0.29 (P = .002), whereas total dose (0.45; P < .001) and dose area product (0.49; P < .001) correlated moderately with the operator's absorbed dose.
The study suggests that the left eye lens of high-volume FB-EVAR operators could accumulate doses that exceed the European and Japanese, but not United States', annual occupational limits. Metrics recorded by the radiation unit give only a moderate indication of the absorbed radiation.
开窗和分支型血管内动脉瘤修复术（FB-EVAR）是对患者、术者及工作人员辐射暴露最高的手术，这引发了对晶状体累积辐射剂量的担忧。因此，本研究旨在描述患者和主刀医生眼睛的辐射吸收剂量，并将其与辐射暴露的间接指标相关联。
本横断面研究纳入了2022年3月至2024年9月期间接受FB-EVAR的所有连续患者，这些患者作为研究器械的前瞻性、非随机队列的一部分。为了测量辐射吸收剂量并将其转化为等效晶状体剂量，我们在患者和主刀医生双侧眶周皮肤各放置三个纳米Dot剂量仪（Landauer公司，伊利诺伊州格伦伍德），并在患者双侧眼睑各放置一个。使用配对t检验比较左右两侧以及患者和术者之间的吸收剂量。此外，将这些直接测量值与成像设备记录的间接辐射指标进行相关性（Pearson）分析。
共纳入114例患者（78例男性[68%]；平均年龄71.0±9.8岁）。34例患者（30%）使用的是现成的研究器械，80例患者（70%）使用的是定制器械。患者中，左侧眶周皮肤辐射吸收剂量的中位数（第25至75百分位数）为0.25 mGy（0.18，0.36 mGy），右侧为0.18 mGy（0.13，0.26 mGy）（平均倍数差异为1.4；95%置信区间为1.3 - 1.5；P <.001）。在术者中，左侧眶周皮肤辐射吸收剂量的中位数（第25至75百分位数）为0.12 mGy（0.08，0.18 mGy）（等效晶状体剂量：0.20（0.13，0.30）mSv），右侧为0.02 mGy（0.01，0.03 mGy）（等效晶状体剂量：0.03 mGy（0.02，0.05 mGy））（平均倍数差异为7.0；95%置信区间为5.7 - 8.6；P <.001）。辐射设备的间接指标与患者的吸收剂量弱相关，相关系数在0.19（P = 0.048）至0.21（P = 0.025）之间。同样，透视时间与术者直接辐射暴露的相关系数较低，为0.29（P = 0.002），而总剂量（0.45；P <.001）和剂量面积乘积（0.49；P <.001）与术者的吸收剂量中度相关。
该研究表明，高手术量的FB-EVAR术者的左眼晶状体累积剂量可能超过欧洲和日本，但未超过美国的年度职业限值。辐射设备记录的指标仅能适度反映吸收的辐射量。
