Mobile vs Fixed Fluoroscopy System for EVAR Image Quality and Radiation Doses for Patients and Professionnals: Mobile C-Arm vs Hybrid Room for EVAR

Abstract Background Allowing less invasive treatments, endovascular aortic repair (EVAR) has become the gold standard worldwide for the treatment of abdominal aortic aneurysms, leading to questions regarding staff and patients’ exposure to radiation. Widely performed in our center, EVAR was initially carried out on mobile C-arm (Cios-alpha, Siemens). Since 2022, EVAR was then performed in a hybrid room (Artis-Pheno, Siemens). Aims The aim of this study is to compare image quality and patients and professionals’ radiation exposure between both systems. Methods Image quality has been tested for fluoroscopy and fluorography mode on the moving system, with PMMA plates and copper disc. A Radcal ionization chamber was used to measure patient skin dose. Dosimetric and clinical parameters (e.i. Kerma, fluoroscopy time, BMI…) were recorded for 79 and 43 patients, respectively, on mobile C-arm and hybrid room. Staff exposure was measured with thermoluminescent detectors, on an anthropomorphic phantom, representative of the physician. Scattered radiation was created by irradiating PMMA plates. Different radiation protection gears have been tested comparable to daily clinical use. Results We showed that using the fluoroscopy mode, Cios-alpha was more irradiating for similar image quality as compared to the Artis-Pheno. Moreover, using the fluorography mode, Artis-Pheno provided a comparable dose rate but significantly better image quality. When comparing similar patient cohorts (BMI, sex), kerma was twice higher on Artis-Pheno due to fluorography, accounting for 27% of the total dose. In terms of staff exposure, the dose rate decreased by 51% and 99% in fluoroscopy, and 22% and 99% in fluorography when using Artis-Pheno compared to Cios-alpha (respectively, without any and with radiation protection gear). Conclusion Our study highlights the advantage of a fixed system (hybrid room) in term of both image quality and staff exposure compared to mobile system. However, particular attention must be paid to optimize protocols of such a machine to guarantee the best possible radiation protection for the patient.