Patient radiation dose from x-ray guided endovascular aneurysm repair: A Monte Carlo approach using voxel phantoms and detailed exposure information

Richard W. Harbron, Mohamed Abdelhalim, Elizabeth A. Ainsbury, Jonathan S. Eakins, Azeem Alam, Choonsik Lee, Bijan Modarai

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Endovascular aneurysm repair (EVAR) is a well-established minimally invasive technique that relies on x-ray guidance to introduce a stent through the femoral artery and manipulate it into place. The aim of this study was to estimate patient organ and effective doses from EVAR procedures using anatomically realistic computational phantoms and detailed exposure information from radiation dose structured reports (RDSR). Methods: Lookup tables of conversion factors relating kerma area product (PKA) to organ doses for 49 different beam angles were produced using Monte Carlo simulations (MCNPX2.7) with International Commission on Radiological Protection (ICRP) adult male and female voxel phantoms for EVAR procedures of varying complexity (infra-renal, fenestrated/branched and thoracic EVAR). Beam angle specific correction factors were calculated to adjust doses according to x-ray energy. A MATLAB function was written to find the appropriate conversion factor in the lookup table for each exposure described in the RDSR, perform energy corrections and multiply by the respective exposure PKA. Using this approach, organ doses were estimated for 183 EVAR procedures in which RDSRs were available. A number of simplified dose estimation methodologies were also investigated for situations in which RDSR data are not available. Results: Mean estimated bone marrow doses were 57 (range: 2-247), 86 (2-328) and 54 (8-250) mGy for infra-renal, fenestrated/branched and thoracic EVAR, respectively. Respective effective doses were 27 (1-208), 54 (1-180) and 37 (5-167) mSv. Dose estimates using non-individualised, average conversion factors, along with those produced using the alternative Monte Carlo code PCXMC, yielded reasonably similar results overall, though variation for individual procedures could exceed 100% for some organs. In conclusion, radiation doses from x-ray guided endovascular aneurysm repairs are potentially high, though this must be placed in the context of the life sparing nature and high success rate for this procedure.

Original languageEnglish
Pages (from-to)704-726
Number of pages23
JournalJournal of Radiological Protection
Issue number3
Publication statusPublished - Sep 2020

Bibliographical note

Publisher Copyright:
© 2020 Crown copyright. Reproduced with the permission of the Controller of Her Majesty's Stationery Office.


  • Monte Carlo
  • Voxel phantoms
  • endovascular aneurysm repair
  • radiation dose structured reports


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