Occupational Radiation Dose:Percutaneous Interventional Procedures on Hemodialysis Arteriovenous Fistulas and Grafts

Abstract

To evaluate operator radiation exposure during percutaneous interventions on hemodialysis arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). Seventy-seven procedures were performed in 57 patients while the interventional radiologist wore two ring dosimeters, two thermoluminescent dosimeters at the lower legs, and a thermoluminescent dosimeter on the forehead. Dose-area product, fluoroscopy time, total procedure time, and radiation exposures to eye lens, hands, and legs were recorded. Variables were procedure type, access site side, and angiography equipment. Statistical analysis was performed with the signed-rank and Mann-Whitney U tests. Mean operator radiation doses for the left hand, right hand, eye lens, left leg, and right leg were 0.28, 0.28, 0.03, 0.11, and 0.12 mSv, respectively. Radiation exposure to the hands was significantly higher compared with that to the legs (P<.0001). In recanalization procedures, fluoroscopy time, total procedure time, and mean number of angiographic runs were higher (all P<.001) than those for percutaneous transluminal angioplasty (PTA), as were radiation exposures to the hands and left leg (all P<.05). Left-sided access interventions resulted in higher doses to the right hand and leg (both P<.05). For right-sided access interventions, doses to the left hand and leg were higher (P<.0001). Eye lens radiation dose was significantly higher for procedures with the flat-panel detector system (P=.002). Operator radiation exposure to the hands, legs, and eyes during percutaneous interventional procedures performed on hemodialysis AVFs and AVGs is relatively low. Radiation exposure to the hands was higher than that to the legs, and the hand and leg closest to the AVF or AVG received a higher dose. Recanalization procedures resulted in higher doses to the hands and left leg than did PTA. Eye lens radiation dose may be higher with a flat-panel detector system.