Radiation Exposure in Dialysis Access‐Related Procedures Decreases with Increase in Number of Procedures Performed by the Interventional Nephrologist

Ramanath Dukkipati,Kamyar Kalantar-Zadeh,Gautam Tammewar,Rajiv Dhamija

doi:10.1111/j.1525-139x.2010.00798.x

Abstract

An appreciation of the inherent risks with radiation exposure to patients and to the physician performing the procedure and the staff is urgently needed. The objective of this study is to assess radiation exposure to both patients and interventional nephrologists performing procedures and see any trends in the procedure and fluoroscopy times over a 2-year period. A total of 400 procedures performed at our vascular access center by a new to practice interventional nephrologist were recorded and retrospectively analyzed. Fluoroscopic time and procedure time for various procedures over the course of 2 years were recorded. This data were subsequently separated into eight groups (four quarters per year) based on the date of the procedure. Our study demonstrates a decrease in mean and median fluoroscopy times and procedure times for newly trained interventional with gain in number of procedures. The mean fluoroscopy time for the first two quarters was 5 minutes and 4 seconds, and the median was 3 minutes and 37 seconds. The mean procedure time for the first two quarters was 38 minutes, and the median was 32 minutes. The mean fluoroscopy time for the last two quarters was 1 minute and 54 seconds, and the median was 1 minute and 26 seconds. The mean procedure time for the last two quarters was 27 minutes, and the median was 21 minutes. In conclusion, gain of experience by the practicing Interventional Nephrologist from performing an increasing number of procedures leads to decreased procedure times and fluoroscopy times, which lowers the risk of radiation.

Highlights

A rigorous understanding of the core curriculum of principles and practice of radiation safety is neither uniform nor universal among interventional nephrologists
The aims of this study are (i) to test the hypothesis that a greater number of procedures performed by an interventional nephrologist will result in a decrease in both procedure time and fluoroscopy time and (ii) to assess radiation exposure to both patients and interventional nephrologists performing procedures over a 2-year period
After the approval of the Institutional review board, procedure time and fluoroscopy time of all procedures performed at our outpatient access suite were entered in the database from July 1, 2008 to July 6, 2010 and were retrospectively analyzed and compared to national standards

Summary

Introduction

A rigorous understanding of the core curriculum of principles and practice of radiation safety is neither uniform nor universal among interventional nephrologists. Fluoroscopy times for thrombectomy were 8 minutes and 10 seconds and 7 minutes and 6 seconds, respectively. The mean and median procedure times for fluoroscopy were 1 hour and 18 minutes and 1 hour and 21 minutes, respectively. Over the course of these 2 years, the practicing interventional nephrologist received a deep-dose equivalent (DDE, or external body exposure at a tissue depth of 1 cm) of 47 mrem, an LDE (eye dose equivalent, or external exposure of the lens at a tissue depth of 0.3 cm) of 32 mrem, and an shallow dose equivalent (SDE, or external exposure of the skin or extremity at a tissue depth of 0.007 cm) of 47 mrem

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Conclusion