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5. Radiation Safety Performance is More than Simply Measuring Doses!

Author

Doyen B., Maurel B., Hertault A., Vlerick P., Mastracci T., Van Herzeele I., Bech B., Bertoglio L., Bicknell C., Bockler D., Brodmann M., Brountzos E., Carrell T., Cohnert T., De Vries J. P., Dick F., Ferraresi R., Goueffic Y., Haulon S., Karkos C., Koncar I., Lammer J., Martin Z., McWilliams R., Melissano G., Muller-Hulsbeck S., Nienaber C., Resch T., Riambau V., Williams R., Szeberin Z., Teijink J., Van Den Berg J., van Herwaarden J., Vermassen F., Verzini F., Wanhainen A., RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, ​Robotics and image-guided minimally-invasive surgery (ROBOTICS), Doyen, B., Maurel, B., Hertault, A., Vlerick, P., Mastracci, T., Van Herzeele, I., Bech, B., Bertoglio, L., Bicknell, C., Bockler, D., Brodmann, M., Brountzos, E., Carrell, T., Cohnert, T., De Vries, J. P., Dick, F., Ferraresi, R., Goueffic, Y., Haulon, S., Karkos, C., Koncar, I., Lammer, J., Martin, Z., Mcwilliams, R., Melissano, G., Muller-Hulsbeck, S., Nienaber, C., Resch, T., Riambau, V., Williams, R., Szeberin, Z., Teijink, J., Van Den Berg, J., van Herwaarden, J., Vermassen, F., Verzini, F., and Wanhainen, A.

Subjects
medicine.medical_specialty, Consensus, education, Radiology, Interventional, Rating scale, Radiation Dosage, PATIENT, Education, 030218 nuclear medicine & medical imaging, Likert scale, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Cronbach's alpha, Radiologists, Safety behaviors, medicine, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, EXPOSURE, PROTECTION, Radiation Injuries, Personal protective equipment, OSATS, Reliability (statistics), Endovascular, Radiation safety behavior, DELPHI, OBJECTIVE STRUCTURED ASSESSMENT, business.industry, ANEURYSM REPAIR, Reproducibility of Results, EDUCATION, Intra-rater reliability, ENDOVASCULAR PROCEDURES, REDUCTION, Clinical Competence, Cardiology and Cardiovascular Medicine, business
Abstract

Purpose Radiation safety performance is often evaluated using dose parameters measured by personal dosimeters and/or the C-arm, which provide limited information about teams' actual radiation safety behaviors. This study aimed to develop a rating scale to evaluate team radiation safety behaviors more accurately and investigate its reliability. Materials and Methods A modified Delphi consensus was organized involving European vascular surgeons (VS), interventional radiologists, and interventional cardiologists. Initial items and anchors were drafted a priori and rated using five-point Likert scales. Participants could suggest additional items or adjustments. Consensus was defined as >= 80% agreement (rating >= 4) with Cronbach's alpha >= .80. Two VS with expertise in radiation safety evaluated 15 video-recorded endovascular repairs of infrarenal aortic aneurysms (EVAR) to assess usability, inter and intrarater reliability. Results Thirty-one of 46 invited specialists completed three rating rounds to generate the final rating scale. Five items underwent major adjustments. In the final round, consensus was achieved for all items (alpha = .804; agreement > 87%): 'Pre-procedural planning', 'Preparation in angiosuite/operating room', 'Shielding equipment', 'Personal protective equipment', 'Position of operator/team', 'Radiation usage awareness', 'C-arm handling', 'Adjusting image quality', 'Additional dose reducing functions', 'Communication/leadership', and 'Overall radiation performance and ALARA principle'. All EVARs were rated, yielding excellent Cronbach's alpha (.877) with acceptable interrater and excellent intrarater reliability (ICC = .782; ICC = .963, respectively). Conclusion A reliable framework was developed to assess radiation safety behaviors in endovascular practice and provide teams with formative feedback. The final scale is provided in this publication.

Published
2020

28. Corrigendum to “Angulation of the C-Arm During Complex Endovascular Aortic Procedures Increases Radiation Exposure to the Head” [Eur J Vasc Endovasc Surg 49 (2015) 396–402]

Author

Albayati, M.A., primary, Kelly, S., additional, Gallagher, D., additional, Dourado, R., additional, Patel, A.S., additional, Saha, P., additional, Bajwa, A., additional, El-Sayed, T., additional, Salter, R., additional, Gkoutzios, P., additional, Carrell, T., additional, Abisi, S., additional, and Modarai, B., additional

Published
2015
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30. A Novel Reverse Thermosensitive Polymer to Achieve Temporary Atraumatic Vessel Occlusion in Infra-popliteal Bypasses

Author

Mani, Kevin, Campbell, A, Fitzpatrick, J, Modarai, B, Carrell, T, Rashid, H, Zayed, H, Mani, Kevin, Campbell, A, Fitzpatrick, J, Modarai, B, Carrell, T, Rashid, H, and Zayed, H

Abstract

OBJECTIVE: The study aims to assess a novel thermosensitive polymer (LeGoo(®)) for distal vessel control during infra-popliteal (crural/pedal) bypass surgery in severe leg ischaemia. METHOD: Retrospective analysis of all distal bypasses from October 2009 to February 2012. Technical success, patency, limb salvage and amputation-free survival rates were analysed. RESULTS: Fifty-four infra-popliteal bypasses using the polymer were performed in 46 patients. The distal anastomosis was at the anterior tibial (n = 15, 28%), posterior tibial (n = 12, 22%), peroneal (n = 8, 15%), tibio-peroneal trunk (n = 8, 15%) and dorsalis pedis arteries (n = 11, 20%). Technical success was achieved in 51/54 (94.4%; failures: two inadequate haemostasis, one un-dissolved polymer). In-hospital duplex of the distal anastomosis showed a significant stenosis in two cases (4.3%). Outflow angioplasty was performed in three cases (two distal anastomotic, one run-off vessel, 5.6%). The 1-year patency rate was 76.2% (standard error (SE) 6.7%), limb salvage rate 79.3% (SE 6.7%). Amputation-free survival was 93.5% at 30 days (SE 3.6%) and 67.5% at 1 year (SE 7.5%). CONCLUSION: This thermosensitive polymer is a potentially safe and useful atraumatic device to achieve a blood-less distal anastomotic field in infra-popliteal bypasses. The technique avoids other potentially traumatic methods of vessel control, which may be particularly important in patients with calcified distal vessels.

Published
2013
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31. Predictors of Outcome after Endovascular Repair for Chronic Type B Dissection

Author

Mani, Kevin, Clough, R. E., Lyons, O. T. A., Bell, R. E., Carrell, T. W., Zayed, H. A., Waltham, M., Taylor, P. R., Mani, Kevin, Clough, R. E., Lyons, O. T. A., Bell, R. E., Carrell, T. W., Zayed, H. A., Waltham, M., and Taylor, P. R.

Abstract

Objectives: To assess the durability of endovascular repair (TEVAR) in chronic type B dissection (CD) and identify factors predictive of outcome. Design: Retrospective analysis of a prospective database. Materials: Patients undergoing TEVAR for CD at a tertiary referral centre 2000-2010. Methods: Analysis of pre-operative characteristics, operative outcome, false lumen thrombosis, aortic diameter and survival. Results: 58 consecutive patients were included (49 elective, 9 urgent, mean age 66 years). Mean aortic diameter was 6.4 cm (Standard deviation SD 1.3 cm). Three patients died perioperatively (5%, 1 urgent, 2 elective). Complications included retrograde type A dissection (n = 3), paraplegia (1), and transient ischaemic attack (1). Estimated survival (Kaplan-Meier) was 89% (1-year) and 64% (3-years). Forty-seven patients had mid-term imaging follow-up at mean 38 months. Reintervention rate was 15% at 1-year and 29% at 3-years. Aortic diameter decreased in 24, was stable in 15 and increased in 8. Mid-term survival was higher in patients with aortic remodelling (reduction of aortic diameter >0.5 cm; 3-year 89%) than without (54%; Log Rank p = 0.005). Remodelling occurred with extensive false lumen thrombosis. Conclusion: Satisfactory mid-term outcome after TEVAR for CD remains a challenge. Survival is associated with aortic remodelling, which is related to persistence of flow in the false lumen.

Published
2012
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33. Imaging vascular trauma

Author

Patterson, B O, primary, Holt, P J, additional, Cleanthis, M, additional, Tai, N, additional, Carrell, T, additional, and Loosemore, T M, additional

Published
2011
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36. Endovascular management of mycotic aortic aneurysms

Author

Clough, R E, primary, Black, S A, additional, Lyons, O T, additional, Bell, R E, additional, Zayed, H, additional, Carrell, T, additional, Waltham, M, additional, Sabharwal, T, additional, Reidy, J, additional, and Taylor, P R, additional

Published
2009
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37. Ruggedized gamma radiation detector Final report

Author

Carrell, T. E

Subjects
Instrumentation And Photography
Abstract

Design, fabrication and performance testing of gamma radiation detector capable of operating in vicinity of nuclear powered rocket engines

Published
1969

42. Pathology Specific Early Outcome after Thoracic Endovascular Aortic Repair.

Author

Clough, R. E., Patel, A. S., Lyons, O. T., Bell, R. E., Zayed, H. A., Carrell, T. W., and Taylor, P. R.

Abstract

Objectives Endovascular intervention is established for treatment of thoracic aortic dissection and aneurysm. The aim of this study was to compare the incidence of all-cause and aortic-related in-hospital mortality, stroke, spinal cord ischaemia, and major adverse event rate for patients undergoing thoracic aortic endovascular intervention to see if there is a pathology-specific effect. Methods Data were collected prospectively and analysed retrospectively for a cohort of 309 consecutive patients with either thoracic aortic dissection or aneurysm over a 14-year period. Results There were 209 men and 100 women with a median age of 72 years (interquartile range [IQR] 63-78 years). Aneurysm affected 62% (193/309) of patients and 37% (116/309) had complicated type B aortic dissection, of whom 43% (50/116) had acute and 57% (66/116) chronic presentations. In patients with aortic dissection compared to aneurysm, there was no significant difference in all-cause in-hospital mortality (6.9% vs. 8.3% respectively, p = 0.827, relative risk [RR] 0.83, 95% confidence interval [CI] 0.37-1.88), stroke (6.0% vs 6.2%, p = 1.00, RR 0.971, CI 0.39-2.39), spinal cord ischaemia (6.0% vs 6.2%, p = 1.00, RR 1.030, CI 0.42-2.54), or major adverse event rate (16.4% vs. 16.6%, p = 1.00, RR 0.988, CI 0.59-1.66). The rate of aortic related death was four times greater in the dissection than in the aneurysm group (4/8 = 50% vs 2/16 = 12.5%, p = 0.06, RR 6.99, CI 0.92-52.5) although this did not reach statistical significance. Conclusions There was no difference in the incidence of in-hospital mortality, stroke, and spinal cord ischaemia between aneurysm and dissection. The higher rate of aortic related death in the dissection group may indicate the need to refine the clinical management of these patients, including procedural planning, endograft design, and operative technique. [ABSTRACT FROM AUTHOR]

Published
2014
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50. Predictors of reintervention after endovascular repair of isolated iliac artery aneurysm.

Author

Zayed HA, Attia R, Modarai B, Clough RE, Bell RE, Carrell T, Sabharwal T, Reidy J, Taylor PR, Zayed, Hany A, Attia, Rizwan, Modarai, Bijan, Clough, Rachel E, Bell, Rachel E, Carrell, Tom, Sabharwal, Tarun, Reidy, John, and Taylor, Peter R

Abstract

The objective of this study was to identify factors predicting the need for reintervention after endovascular repair of isolated iliac artery aneurysm (IIAA). We reviewed prospectively collected database records of all patients who underwent endovascular repair of IIAA between 1999 and 2008. Detailed assessment of the aneurysms was performed using computed tomography angiography (CTA). Follow-up protocol included CTA at 3 months. If this showed no complication, then annual duplex scan was arranged. Multivariate analysis and analysis of patient survival and freedom from reintervention were performed using Kaplan-Meier life tables. Forty IIAAs (median diameter 44 mm) in 38 patients were treated (all men; median age 75 years), and median follow-up was 27 months. Endovascular repair of IIAA was required in 14 of 40 aneurysms (35%). The rate of type I endoleak was significantly higher with proximal landing zone (PLZ) diameter >30 mm in the aorta or >24 mm in the common iliac artery or distal landing zone (DLZ) diameter >24 mm (P = 0.03, 0.03, and 0.0014, respectively). Reintervention rate (RR) increased significantly with increased diameter or decreased length of PLZ; increased DLZ diameter; and endovascular IIAA repair (P = 0.005, 0.005, 0.02, and 0.02 respectively); however, RR was not significantly affected by length of PLZ or DLZ. Freedom-from-reintervention was 97, 93, and 86% at 12, 24, and 108 months. There was no in-hospital or aneurysm-related mortality. Endovascular IIAA repair is a safe treatment option. Proper patient selection is essential to decrease the RR. [ABSTRACT FROM AUTHOR]

Published
2011
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