title: Pre-operative Simulation of the Appropriate C-arm Position Using Computed Tomography Post-processing Software Reduces Radiation and Contrast Medium Exposure During EVAR Procedures.
abstract: OBJECTIVE
  The aim was to evaluate the feasibility and efficacy of a new method for pre-operative calculation of an appropriate C-arm position for iliac bifurcation visualisation during endovascular aortic repair (EVAR) procedures by using three dimensional computed tomography angiography (CTA) post-processing software.
  
  
  METHODS
  Post-processing software was used to simulate C-arm angulations in two dimensions (oblique, cranial/caudal) for appropriate visualisation of distal landing zones at the iliac bifurcation during EVAR. Retrospectively, 27 consecutive EVAR patients (25 men, mean ± SD age 73 ± 7 years) were identified; one group of patients (NEW; n = 12 [23 iliac bifurcations]) was compared after implementation of the new method with a group of patients who received a historic method (OLD; n = 15 [23 iliac bifurcations]), treated with EVAR before the method was applied.
  
  
  RESULTS
  In the OLD group, a median of 2.0 (interquartile range [IQR] 1-3) digital subtraction angiography runs were needed per iliac bifurcation versus 1.0 (IQR 1-1) runs in the NEW group (p = .007). The median dose area products per iliac bifurcation were 11951 mGy*cm2(IQR 7308-16663 mGy*cm2) for the NEW, and 39394 mGy*cm2(IQR 19066-53702 mGy*cm2) for the OLD group, respectively (p = .001). The median volume of contrast per iliac bifurcation was 13.0 mL (IQR: 13-13 mL) in the NEW and 26 mL (IQR 13-39 mL) in the OLD group (p = .007).
  
  
  CONCLUSIONS
  Pre-operative simulation of the appropriate C-arm angulation in two dimensions using dedicated computed tomography angiography post-processing software is feasible and significantly reduces radiation and contrast medium exposure.
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany. Electronic address: erik.stahlberg@uksh.de.
authors.forename: E
authors.initials: E
authors.lastname: Stahlberg
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Planert
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Panagiotopoulos
authors.affiliation: Department for Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Horn
authors.affiliation: Department for Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wiedner
authors.affiliation: Department for Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kleemann
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Barkhausen
authors.affiliation: Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Goltz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001011:Aorta / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D003198:Computer Simulation; D003287:Contrast Media / Q000008:administration & dosage*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D012984:Software; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Abdominal aortic aneurysm; Contrast media; Digital subtraction angiography; Radiation exposure; X-ray computed tomography