title: Cumulative radiation exposure during thoracic endovascular aneurysm repair and subsequent follow-up.
abstract: OBJECTIVE
  Thoracic endovascular aneurysm repair (TEVAR) is an appealing alternative to the standard surgical approach, but requires rigorous radiological follow-up. The cumulative radiation exposure (RE) of patients undergoing TEVAR-including pre-operative workup, the procedure and subsequent follow-up computed tomography (CT) imaging-has not previously been investigated.
  
  
  METHODS
  From August 2003 to February 2011, 48 patients underwent TEVAR at our institution. Mean age was 66 ± 11 years, with 10 patients (21%) aged <60 years. Forty-one (85%) patients were male; 7 (15%) had urgent/emergent operation; 21 (44%) had undergone previous aortic surgery. Mean aortic diameter was 7.3 ± 2.1 cm. Intra-operative screening time and RE were reviewed, and typical institutional thoracic CT scan RE was calculated (17.8 mSv). Life expectancy of an age- and sex-matched population was estimated to assess the cumulative RE from recurrent CT follow-up.
  
  
  RESULTS
  The average screening time was 15.7 ± 11.4 min, with an RE of 11.3 ± 9 mSv. Obese patients had significantly higher RE during TEVAR (Pearson's coefficient = 0.388, P = 0.019). The RE dropped from 14.9 ± 9.4 mSv to 8.6 ± 7.9 mSv (P = 0.033) after a hybrid suite was established. Our institutional TEVAR protocol involves one pre-operative thoracoabdominal CT scan and three follow-up thoracic CT scans for the first year, with a yearly evaluation thereafter. The life expectancy of an age- and sex-matched population was 17 years. A patient adhering to our surveillance protocol would be subjected to an overall exposure of 89 mSv at 1 year and 161 mSv at 5 years, with a projected lifetime RE >350 mSv.
  
  
  CONCLUSIONS
  A 2-year RE exceeding the threshold of 100 mSv with a life expectancy >15 years can be estimated to lead to a lifetime risk increase in radiation-induced leukaemia and solid-tumour cancer >2.7%. The risks of cumulative RE especially in younger and/or obese patients must be balanced with the expected morbidity and mortality reduction in TEVAR versus traditional open repair, and the anticipated benefits of recurrent radiographic imaging.
authors.affiliation: Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy. stefano.zoli@ccfm.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Zoli
authors.forename: Piero
authors.initials: P
authors.lastname: Trabattoni
authors.forename: Luca
authors.initials: L
authors.lastname: Dainese
authors.forename: Andrea
authors.initials: A
authors.lastname: Annoni
authors.forename: Claudio
authors.initials: C
authors.lastname: Saccu
authors.forename: Miriam
authors.initials: M
authors.lastname: Fumagalli
authors.forename: Rita
authors.initials: R
authors.lastname: Spirito
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000009:adverse effects; D011300:Preoperative Care / Q000009:adverse effects; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D055815:Young Adult