Radiation Dose Associated with Dialysis Vascular Access Interventional Procedures in the Interventional Nephrology Facility

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Abstract

The number of dialysis access procedures performed by interventional nephrologists using a mobile C-arm fluoroscopy machine in freestanding centers continues to rise. With this activity comes the risk of radiation exposure to patients being treated and staff. This study was conducted to assess the levels of radiation dosage involved with these procedures. Dosimetry information including kerma area product (KAP), reference point air kerma (RPAK) and fluoroscopy time (FT) was collected prospectively. Radiation dosage data were collected from 24 centers in various parts of the United States and reflected cases managed by 69 different interventional nephrologists. The data were tabulated separately for eight procedures – fistula angioplasty and thrombectomy, graft angioplasty and thrombectomy, tunneled catheter placement and exchange, vein mapping and cases in which only angiographic evaluation was performed.

The range for all of the measured parameters was large. Additionally there was considerable inter-operator variability. The dosage levels noted in this series were well below the threshold for deterministic effects. FT for AVF procedures was higher than for other types of access. The highest values were observed for thrombectomies. The highest KAP values were recorded for venous mapping. Thrombectomy procedures were associated with the highest RPAK levels. All dosage metrics were considerably lower than those previously reported.

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