title: Fluoroscopy time is not accurate as a surrogate for radiation exposure.
abstract: Objective The Food and Drug Administration and the Vascular Quality Initiative still utilize fluoroscopy time as a surrogate marker for procedural radiation exposure. This study demonstrates that fluoroscopy time does not accurately represent radiation exposure and that dose area product and air kerma are more appropriate measures. Methods Lower extremity endovascular interventions ( N = 145) between 2013 and 2015 performed at an academic medical center on a Siemens Artis-Zee floor mounted c-arm were identified. Data was collected from the summary sheet after every case. Scatter plots with Pearson correlation coefficients were created. A strong correlation was indicated by an r value approaching 1. Results Overall mean AK and DAP was 380.27 mGy and 4919.2 µGym2. There was a poor correlation between fluoroscopy time and total AK or DAP ( r = 0.27 and 0.32). Total DAP was strongly correlated to cine DAP and fluoroscopy DAP ( r = 0.92 vs. 0.84). The number of DSA runs and average frame rate did not affect AK or DAP levels. Mean magnification level was significantly correlated with total AK ( r = 0.53). Conclusions Fluoroscopy time shows minimal correlation with radiation delivered and therefore is a poor surrogate for radiation exposure during fluoroscopy procedures. DAP and AK are more suitable markers to accurately gauge radiation exposure.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Health Sciences Center, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Edvard
authors.initials: E
authors.lastname: Skripochnik
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Health Sciences Center, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Shang A
authors.initials: SA
authors.lastname: Loh
mesh_terms: D000046:Academic Medical Centers; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D061214:Patient Safety; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013997:Time Factors
keywords: Radiation exposure; air kerma; dose area product; endovascular intervention; fluoroscopy time