Pre-operative Simulation of the Appropriate C-arm Position Using Computed Tomography Post-processing Software Reduces Radiation and Contrast Medium Exposure During EVAR Procedures
Objective/Background 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...
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description | Objective/Background 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). Conclusion 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. |
doi_str_mv | 10.1016/j.ejvs.2016.10.016 |
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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). Conclusion 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.</description><identifier>ISSN: 1078-5884</identifier><identifier>EISSN: 1532-2165</identifier><identifier>DOI: 10.1016/j.ejvs.2016.10.016</identifier><identifier>PMID: 27965020</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Abdominal aortic aneurysm ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Aorta - diagnostic imaging ; Aorta - surgery ; Aortography - methods ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - instrumentation ; Blood Vessel Prosthesis Implantation - methods ; Computed Tomography Angiography - methods ; Computer Simulation ; Contrast media ; Contrast Media - administration & dosage ; Digital subtraction angiography ; Endovascular Procedures - instrumentation ; Endovascular Procedures - methods ; Feasibility Studies ; Female ; Humans ; Iliac Artery - diagnostic imaging ; Iliac Artery - surgery ; Male ; Middle Aged ; Predictive Value of Tests ; Prosthesis Design ; Radiation Dosage ; Radiation exposure ; Radiation Exposure - adverse effects ; Radiation Exposure - prevention & control ; Radiographic Image Interpretation, Computer-Assisted - methods ; Retrospective Studies ; Software ; Stents ; Surgery ; Surgery, Computer-Assisted - instrumentation ; Surgery, Computer-Assisted - methods ; X-ray computed tomography</subject><ispartof>European journal of vascular and endovascular surgery, 2017-02, Vol.53 (2), p.269-274</ispartof><rights>European Society for Vascular Surgery</rights><rights>2016 European Society for Vascular Surgery</rights><rights>Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-217a857933328195836ef186b04dc3f870e5edfd07e15b78c847f0a32a85d63b3</citedby><cites>FETCH-LOGICAL-c455t-217a857933328195836ef186b04dc3f870e5edfd07e15b78c847f0a32a85d63b3</cites><orcidid>0000-0003-1574-8479 ; 0000-0002-1719-031X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ejvs.2016.10.016$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27965020$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stahlberg, E</creatorcontrib><creatorcontrib>Planert, M</creatorcontrib><creatorcontrib>Panagiotopoulos, N</creatorcontrib><creatorcontrib>Horn, M</creatorcontrib><creatorcontrib>Wiedner, M</creatorcontrib><creatorcontrib>Kleemann, M</creatorcontrib><creatorcontrib>Barkhausen, J</creatorcontrib><creatorcontrib>Goltz, J.P</creatorcontrib><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</title><title>European journal of vascular and endovascular surgery</title><addtitle>Eur J Vasc Endovasc Surg</addtitle><description>Objective/Background 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). Conclusion 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.</description><subject>Abdominal aortic aneurysm</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography, Digital Subtraction</subject><subject>Aorta - diagnostic imaging</subject><subject>Aorta - surgery</subject><subject>Aortography - methods</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Blood Vessel Prosthesis Implantation - methods</subject><subject>Computed Tomography Angiography - methods</subject><subject>Computer Simulation</subject><subject>Contrast media</subject><subject>Contrast Media - administration & dosage</subject><subject>Digital subtraction angiography</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Endovascular Procedures - methods</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Iliac Artery - diagnostic imaging</subject><subject>Iliac Artery - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Prosthesis Design</subject><subject>Radiation Dosage</subject><subject>Radiation exposure</subject><subject>Radiation Exposure - adverse effects</subject><subject>Radiation Exposure - prevention & control</subject><subject>Radiographic Image Interpretation, Computer-Assisted - methods</subject><subject>Retrospective Studies</subject><subject>Software</subject><subject>Stents</subject><subject>Surgery</subject><subject>Surgery, Computer-Assisted - instrumentation</subject><subject>Surgery, Computer-Assisted - methods</subject><subject>X-ray computed tomography</subject><issn>1078-5884</issn><issn>1532-2165</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uk2P0zAUjBCIXRb-AAfkI5cUf8SJKyGkqpQPaRFVu8vVcuOXXZckztpOob-LP8jLduHAgdN7Gs2M9WacZS8ZnTHKyjf7GewPccZxR2CG41F2zqTgOWelfIw7rVQulSrOsmcx7imlkgn5NDvj1byUlNPz7Nc6QO4HCCa5A5Ct68YWV98T35B0C2QxDMEPwZkEZJmb0JG1j-6ecR1df0OWvhvGBJZc-c7fBDPcHidKylFXQ7znbH2TfpgAZAN2RJBsjHWnZ0xv0aJPwcREvoB1Y0dWPwcfR6S_H8MkX31bbMh6srOIxufZk8a0EV48zIvs-sPqavkpv_z68fNycZnXhZQJQ6iMktVcCMEVm0slSmiYKne0sLVoVEVBgm0srYDJXaVqVVQNNYKjypZiJy6y1ydfvORuhJh052INbWt68GPUTEleVuVclkjlJ2odfIwBGo2RdSYcNaN6Kkvv9VSWnsqaMBwoevXgP-46sH8lf9pBwtsTAfDKg4OgY-2gxxhcgDpp693__d_9I69b17vatN_hCHHvx9BjfprpyDXV2-m7TL8FpVRKXojfMXS91w</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Stahlberg, E</creator><creator>Planert, M</creator><creator>Panagiotopoulos, N</creator><creator>Horn, M</creator><creator>Wiedner, M</creator><creator>Kleemann, M</creator><creator>Barkhausen, J</creator><creator>Goltz, J.P</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1574-8479</orcidid><orcidid>https://orcid.org/0000-0002-1719-031X</orcidid></search><sort><creationdate>20170201</creationdate><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</title><author>Stahlberg, E ; Planert, M ; Panagiotopoulos, N ; Horn, M ; Wiedner, M ; Kleemann, M ; Barkhausen, J ; Goltz, J.P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-217a857933328195836ef186b04dc3f870e5edfd07e15b78c847f0a32a85d63b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal aortic aneurysm</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiography, Digital Subtraction</topic><topic>Aorta - diagnostic imaging</topic><topic>Aorta - surgery</topic><topic>Aortography - methods</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Blood Vessel Prosthesis Implantation - methods</topic><topic>Computed Tomography Angiography - methods</topic><topic>Computer Simulation</topic><topic>Contrast media</topic><topic>Contrast Media - administration & dosage</topic><topic>Digital subtraction angiography</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Endovascular Procedures - methods</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Iliac Artery - diagnostic imaging</topic><topic>Iliac Artery - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Prosthesis Design</topic><topic>Radiation Dosage</topic><topic>Radiation exposure</topic><topic>Radiation Exposure - adverse effects</topic><topic>Radiation Exposure - prevention & control</topic><topic>Radiographic Image Interpretation, Computer-Assisted - methods</topic><topic>Retrospective Studies</topic><topic>Software</topic><topic>Stents</topic><topic>Surgery</topic><topic>Surgery, Computer-Assisted - instrumentation</topic><topic>Surgery, Computer-Assisted - methods</topic><topic>X-ray computed tomography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stahlberg, E</creatorcontrib><creatorcontrib>Planert, M</creatorcontrib><creatorcontrib>Panagiotopoulos, N</creatorcontrib><creatorcontrib>Horn, M</creatorcontrib><creatorcontrib>Wiedner, M</creatorcontrib><creatorcontrib>Kleemann, M</creatorcontrib><creatorcontrib>Barkhausen, J</creatorcontrib><creatorcontrib>Goltz, J.P</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of vascular and endovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stahlberg, E</au><au>Planert, M</au><au>Panagiotopoulos, N</au><au>Horn, M</au><au>Wiedner, M</au><au>Kleemann, M</au><au>Barkhausen, J</au><au>Goltz, J.P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pre-operative Simulation of the Appropriate C-arm Position Using Computed Tomography Post-processing Software Reduces Radiation and Contrast Medium Exposure During EVAR Procedures</atitle><jtitle>European journal of vascular and endovascular surgery</jtitle><addtitle>Eur J Vasc Endovasc Surg</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>53</volume><issue>2</issue><spage>269</spage><epage>274</epage><pages>269-274</pages><issn>1078-5884</issn><eissn>1532-2165</eissn><abstract>Objective/Background 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). Conclusion 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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>27965020</pmid><doi>10.1016/j.ejvs.2016.10.016</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-1574-8479</orcidid><orcidid>https://orcid.org/0000-0002-1719-031X</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Abdominal aortic aneurysm Aged Aged, 80 and over Angiography, Digital Subtraction Aorta - diagnostic imaging Aorta - surgery Aortography - methods Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - instrumentation Blood Vessel Prosthesis Implantation - methods Computed Tomography Angiography - methods Computer Simulation Contrast media Contrast Media - administration & dosage Digital subtraction angiography Endovascular Procedures - instrumentation Endovascular Procedures - methods Feasibility Studies Female Humans Iliac Artery - diagnostic imaging Iliac Artery - surgery Male Middle Aged Predictive Value of Tests Prosthesis Design Radiation Dosage Radiation exposure Radiation Exposure - adverse effects Radiation Exposure - prevention & control Radiographic Image Interpretation, Computer-Assisted - methods Retrospective Studies Software Stents Surgery Surgery, Computer-Assisted - instrumentation Surgery, Computer-Assisted - methods X-ray computed tomography |
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 |
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