Ionizing radiation absorption of vascular surgeons during endovascular procedures

Abstract

Endovascular procedures have become an integral part of a vascular surgeon's practice. The exposure of surgeons to ionizing radiation and other safety issues have not been well studied. We investigated the radiation exposure of a team of vascular surgeons in an active endovascular unit and compared yearly dosages absorbed by various body parts among different surgeons. Patients' radiation exposure was also assessed. The radiation absorption of a team of vascular surgeons was prospectively monitored in a 12-month period. During each endovascular procedure, the effective body, eye, and hand radiation doses of all participating surgeons were measured by mini-thermoluminescent dosimeters (TLD) attached at the chest level under a lead apron, at the forehead at eye level, and at the hand. The type of procedure, fluoroscopy machine, fluoroscopy time, and personal and operating theatre radiation protection devices used in each procedure were also recorded. One TLD was attached to the patient's body near the operative site to measure the patient's dose. The yearly effective body, eye, and hand dose were compared with the safety limits of radiation for occupational exposure recommended by the International Commission on Radiation Protection (ICRP). The radiation absorption of various body parts per minute of fluoroscopy was compared among different surgeons. A total of 149 consecutive endovascular procedures were performed, including 30 endovascular aortic repairs (EVAR), 58 arteriograms with and without embolization (AGM), and 61 percutaneous transluminal angioplasty and stent (PTA/S) procedures. The cumulative fluoroscopy time was 1132 minutes. The median yearly effective body, eye, and hand dose for the surgeons were 0.20 mSv (range, 0.13 to 0.27 mSv), 0.19 mSv (range, 0.10 to 0.33 mSv) and 0.99 mSv (0.29 to 1.84 mSv) respectively, which were well below the safety limits of the ICRP. The mean body, eye, and hand dose of the chief surgeon per procedure were highest for EVAR. A significant discrepancy was observed for the average hand dose per minute of fluoroscopy among different surgeons. The mean radiation absorption of patients who underwent EVAR, AGM, and PTA/S was 12.7 mSv, 13.6 mSv, and 3.4 mSv, respectively. With current radiation protection practice, the radiation absorbed by vascular surgeons with a high endovascular workload did not exceed the safety limits recommended by ICRP. Variations in practice, however, can result in significant discrepancy of radiation absorption between surgeons.