Significant Radiation Dose Reduction in the Hybrid Operating Room Using a Novel X-ray Imaging Technology.
OBJECTIVE
To prospectively quantify radiation dose change in aortoiliac endovascular procedures in the hybrid operating room (OR) for patients and medical staff with a novel X-ray imaging technology (ClarityIQ technology), and to assess whether procedure or fluoroscopy time or dose of iodinated contrast was affected.


METHODS
A prospective study including 138 patients was performed to compare radiation dose before and after installation of a novel X-ray imaging technology. Endovascular aneurysm repair (EVAR) was performed in 37 patients and an endovascular procedure for aortoiliac occlusive disease (AIOD) in 101. Patient radiation dose in air kerma (AK) and dose area product (DAP), patient demographics, and procedural data were recorded. Staff radiation dose was measured with real time personal dosimetry measurements. In both the EVAR and AIOD groups the reference system, ALX (AlluraXper FD20; Philips Healthcare, Best, the Netherlands), was compared with the upgraded X-ray system, CIQ (AlluraClarity FD20; Philips Healthcare). Procedure time, fluoroscopy time, and iodinated contrast dose were recorded.


RESULTS
Patient radiation dose reduction in the EVAR group, in median AK, was 56% (ALX = 1,262.5 mGy; CIQ = 556.0 mGy [p < .01]); and in median DAP it was 57% (ALX = 224.4 Gycm(2) and CIQ = 95.8 Gycm(2) [p < .01]). Patient radiation dose reduction in the AIOD group, in median AK, was 76% (ALX = 1,011.0 mGy; CIQ = 248.0 mGy [p < .01]); and in median DAP it was 73% (ALX = 138.1 Gycm(2); CIQ = 38.0 Gycm(2) [p < .01]). Staff dose reduction in the EVAR group was 16% (ALX = 70.1 μSv; CIQ = 59.2 μSv [p = .43]) and in the AIOD group it was 69% (ALX = 96.2 μSv; CIQ = 30.1 μSv [p < .01]). There was no statistically significant difference between patient demographics, procedure time, fluoroscopy time, and iodinated contrast medium use in the two treatment groups before and after installation.


CONCLUSIONS
A novel X-ray imaging technology in the hybrid OR suite resulted in a significant reduction of patient and staff radiation dose without affecting procedure length, fluoroscopy time, or use of contrast.
Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. Electronic address: r.v.d.haak@jbz.nl.
R F F
RF
van den Haak
Medical Physics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
B C
BC
Hamans
Philips Healthcare, Best, The Netherlands.
K
K
Zuurmond
Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
B A N
BA
Verhoeven
Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
O H J
OH
Koning
D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D003287:Contrast Media / Q000008:administration & dosage; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D009873:Operating Rooms; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011834:Radiation Monitoring / Q000295:instrumentation; D011835:Radiation Protection / Q000295:instrumentation; D015641:Radiography, Interventional / Q000009:adverse effects / Q000295:instrumentation*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media
Aneurysm repair; Dosimetry; Endovascular; Radiation; Radiation exposure