Analysis of Intraoperative Radiation Use in Vascular Surgery: Catalyst for Quality Improvement

Introduction and Objectives: There is paucity of literature reporting radiation usage in vascular surgery. In the era of endovascular surgeries, intraoperative C-arm fluoroscopy is often used by vascular surgeons in both percutaneous and hybrid surgeries. Analyzing the use of radiation in vascular procedures can help identify patterns and establish quality improvement initiatives. Methods: A retrospective review was undertaken of intraoperative fluoroscopic guided vascular surgery procedures at a single institution from 2010-2017. Mobile C-arms were utilized to gather six radiation usage metrics including fluoroscopic time (FT), cumulative dose (CD) and percentage of dose reduction techniques. Cases were categorized into six anatomic surgical fields and ten surgical procedure types. Results: 318 vascular surgery cases were included in this study. There were notable trends in all the analyzed radiation usage metrics both across the surgical field location and type of surgical procedure. The highest CD was identified in embolization cases with a mean of 932.5 mGy. The highest FT was seen in atherectomies with a mean of 2629.6 sec. In terms of surgical field, the highest CD and FT was identified in abdominal/pelvic procedures with a mean of 352.1 mGy and 1186.8 sec, respectively. The lowest percentage use of dose reduction techniques was seen in surgical bypass and in the abdominal/pelvic surgical field. Conclusions: There were notable trends in radiation usage variables associated with the location of the surgical field and type of surgical procedure. Cases that involve the abdomen/pelvis, embolization and atherectomy have the highest radiation use. These types of cases can be targeted for future increased dose reduction techniques or consideration of staged procedures. This data serves as baseline information for future quality improvement initiatives regarding patient and practitioner radiation exposure.