Circumspectus Medicinae: Texts and ContextsJustifying the Use of Abdominal Wall Computed Tomographic Angiography in Deep Inferior Epigastric Artery Perforator Flap PlanningMidgley, Stewart M. BSc (Hons), MSc, PhD*†; Einsiedel, Paul F. BSc (Hons)*; Phillips, Timothy J. MBBS*; Stella, Damien L. MBBS, FRANZCR*Author Information From the *Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia; and †School of Physics, Faculty of Science, Monash University, Clayton, Victoria, Australia. Received September 23, 2010, and accepted for publication, after revision, November 17, 2010. Conflicts of interest and sources of funding: none declared. Reprints: Damien L. Stella, MBBS, FRANZCR, Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Grattan St, Parkville, Victoria 3050, Australia. E-mail: [email protected]. Annals of Plastic Surgery: November 2011 - Volume 67 - Issue 5 - p 457-459 doi: 10.1097/SAP.0b013e318208589d Buy Metrics Abstract Abdominal wall computed tomography angiography (CTA) is used to guide preoperative planning and intraoperative technique for deep inferior epigastric artery perforator free flap breast reconstructive surgery. This study considers the amount of radiation delivered to the patient, outlining how scan parameters can be optimized to minimize the radiation exposure whilst maintaining image quality. Results of scan parameters and dose reports for 34 patients undergoing abdominal wall CTA are compared with those patients undergoing routine abdominal computed tomography. The links between computed tomography dose quantities are explained, including their conversion to effective dose (in mSv) and risk as the probability for inducing deterministic effects (eg, skin burns) and stochastic effects (ie, cancer induction). The mean effective dose by using our technique for routine abdominal computed tomography is 9.9 and for abdominal wall CTA is 6.0 mSv. All doses are far below the thresholds for deterministic effects to the skin. Abdominal wall CTA can be justified before major reconstructive surgery if the surgeon believes that the very low estimated risk of fatal radiation-induced cancer (1 in 4270 for 6 mSv) is outweighed by the benefits. © 2011 Lippincott Williams & Wilkins, Inc.