Radiation Doses to Staff in a Hybrid Operating Room: An Anthropomorphic Phantom Study with Active Electronic Dosimeters

Abstract

To quantify the effects of different imaging settings on radiation exposure to the operator and surgical team in a hybrid operating room (OR). Measurements to determine scatter radiation in different imaging and geometry settings using an anthropomorphic phantom were performed in a hybrid OR equipped with a robotic C arm interventional angiography system (Artis Zeego; Siemens Healthcare, Erlangen, Germany). The radiation dose (RD) was measured with seven calibrated Philips DoseAware active electronic dosimeters and a Raysafe Xi survey detector, which were placed at different locations in the hybrid OR. The evaluated set ups included low dose, medium dose, and high dose fluoroscopy for abdomen; fluoroscopy fade; roadmap; and digital subtraction angiography (DSA), all using 20s exposures. The effect of magnification, tube angulation, field size, source to skin distance, and RADPAD protection shields were assessed. Finally RD during cone beam computed tomography (CBCT) was obtained. In the operator position the initial settings with low dose fluoroscopy caused a RD of 1.03μGy. The use of fluorofade did not increase the radiation dose (1.02μGy), whereas the roadmap increased it threefold (2.84μGy). The RD with "normal fluoro" was 4.13μGy and increased to 6.44μGy when high dose fluoroscopy mode was used. Magnification or field size varying from 42cm to 11cm led the RD to change from 0.86μGy to 2.10μGy. Decreasing the field of view to 25% of the initial size halved the RD (0.48μGy). The RDs for the left anterior oblique 30° and right anterior oblique 30° were 3.26μGy and 1.63μGy, respectively. DSA increased the cumulative dose 33 fold but the RADPAD shield decreased the DSA RD to 4.92μGy. The RD for CBCT was 47.2μGy. Radiation exposure to operator and personnel can be significantly reduced during hybrid procedures with proper radiation protection and dose optimisation. A set of six behavioural rules were established.