Operator Radiation Exposure Research Articles

Determinants of radiation dose during right transradial access: Insights from the RAD-MATRIX study

The RAD-MATRIX trial reported a large operator radiation exposure variability in right radial percutaneous coronary procedures. The reasons of these differences are not well understood. Our aim was to appraise the determinants of operator radiation exposure during coronary right transradial procedures. Patient arrangement during transradial intervention was investigated across operators involved in the RAD-MATRIX trial. Operator radiation exposure was analyzed according to the position of the patient right arm (close or far from the body) and in relation to the size of the upper leaded glass. Among the 14 operators who agreed to participate, there was a greater than 10-fold difference in radiation dose at thorax level (from 21.5 to 267 μSv) that persisted after normalization by dose-area product (from 0.35 to 3.5 μSv/Gy*cm2). Among the operators who positioned the instrumented right arm far from the body (110.4 μSv, interquartile range 71.5-146.5 μSv), thorax dose was greater than that in those who placed the instrumented arm close to the right leg (46.1 μSv, 31.3-56.8 μSv, P = .02). This difference persisted after normalization by dose-area product (P = .028). The use of a smaller full glass shield was also associated with a higher radiation exposure compared with a larger composite shield (147.5 and 60 μSv, respectively, P = .016). In the context of the biggest radiation study conducted in patients undergoing transradial catheterization, the instrumented right arm arrangement close to the leg and greater upper leaded shield dimensions were associated with a lower operator radiation exposure. Our findings emphasize the importance of implementing simple preventive measures to mitigate the extra risks of radiation exposure with right radial as compared with femoral access.

TCT-317 Propensity Score-Matched Analysis of Operator Radiation Exposure in Percutaneous Coronary Intervention with Radial versus Femoral Approach

Data regarding operator radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study sought to compare operator and patient radiation exposure during PCI with radial versus femoral access. This

Is lead shielding of patients necessary during fluoroscopic procedures? A study based on kyphoplasty.

To determine the benefits, risks, and limitations associated with wrapping a patient with lead shielding during fluoroscopy-guided kyphoplasty procedures as a way to reduce operator radiation exposure. An anthropomorphic phantom was used to mimic a patient undergoing a kyphoplasty procedure under fluoroscopic guidance. Radiation measurements of the air kerma rate (AKR) were made at several locations and under various experimental conditions. First, AKR was measured at various angles along the horizontal plane of the phantom and at varying distances from the phantom, both with and without a lead apron wrapped around the lower portion of the phantom (referred to here as phantom shielding). Second, the effect of an operator's apron was simulated by suspending a lead apron between the phantom and the measurement device. AKR was measured for the four shielding conditions-phantom shielding only, operator apron only, both phantom shielding and operator apron, and no shielding. Third, AKR measurements were made at various heights and with varying C-arm angle. At all locations, the phantom shielding provided no substantial protection beyond that provided by an operator's own lead apron. Phantom shielding did not reduce AKR at a height comparable to that of an operator's head. Previous reports of using patient shielding to reduce operator exposure fail to consider the role of an operator's own lead apron in radiation protection. For an operator wearing appropriate personal lead apparel, patient shielding provides no substantial reduction in operator dose.

P2349Right lateral vs. left lateral view in transradial procedures - an operator radiation exposure and image quality study

P2349Right lateral vs. left lateral view in transradial procedures - an operator radiation exposure and image quality study

Operator radiation exposure during transradial coronary angiography : Effect of single vs. double catheters.

The right radial artery has gained popularity as the preferred access site for coronary angiography. To save time and limit the radiation exposure of operators and patients, newly designed catheters can be used to access both the right and left coronary arteries. The aim of this study was to compare operator radiation exposure between single-catheter (SCA) and two-catheter approaches (TCA). In all, 256 patients undergoing diagnostic coronary angiography via the right radial artery in ahigh-volume medical center were randomized to either the SCA or TCA group. The dose of radiation exposure of the operators was measured by an electronic dosimeter attached to the breast pocket of the operator's apron. The dose-area product and air kerma were used as indices of patient exposure to radiation. The duration of fluoroscopy "beam-on" time, acquisition time, and total duration of the procedure were measured and analyzed for the two groups. Operator radiation exposure was 21.6± 11.4 µSv in the SCA group, which was significantly less than 28.0± 14.9 µSv in the TCA group. The duration of fluoroscopy was significantly shorter in the SCA group than in the TCA group (152± 83 vs. 203± 121 s; p< 0.001). Moreover, the total duration of the diagnostic procedure was also shorter in the SCA group compared with the TCA group (9.5± 3.2 vs. 11.4± 4.0 min; p< 0.001). The use of SCA is advantageous over TCA in reducing the exposure of operators to radiation. The shorter duration of fluoroscopy beam-on time and total procedure time may contribute to the lower exposure of operators to radiation.

Right lateral versus left lateral view for forearm coronary angiography. An operator radiation exposure and image quality study

Objectives. The aim of this study was to analyze the operator radiation exposure (ORE) and the image quality in a coronary angiography (CA) of the standard left lateral view (LLV) and compare it with an alternative right lateral view (RLV). Background. Interventional cardiologists are exposed to high doses of scatter radiation, especially in angulated projections. Methods. We prospectively included consecutive patients who underwent diagnostic CA. A standard +90° LLV and an alternative RLV (−90°) were done in each patient with the same protocol. The operator effective dose rate (mSv/h) was determined for each projection with digital dosimeters located in the collar, waist and knee. The image quality of both the LLV and RLV was analyzed and compared to a standard projection. Results. 116 patients were enrolled; left coronary artery (LCA) was assessed in 52 patients and right coronary artery (RCA) in 64 patients. The ORE was significantly lower with the RLV compared to the conventional LLV with a maximum ORE reduction of 91.5% in the operator waist (LLV: 6.84 mSv h−1 versus RLV: 0.58 mSv h−1, p < 0.001). No significant differences in image quality were observed for the RCA in both projections. For the LCA, a slight loss of quality was observed with the RLV. Conclusions. −90° RLV is associated with a significant decrease in ORE compared to the conventional +90° LLV without losing image resolution for the RCA and resulting in a slight quality loss for the LCA evaluation. The RLV should be the first choice for RCA evaluation. For the LCA, the RLV loss of resolution should be balanced with the benefit of minimizing ORE, mainly in cases with long fluoroscopy times, such as complex percutaneous coronary interventional procedures.

Minimizing Ionizing Radiation Exposure in Invasive Cardiology Safety Training for Medical Doctors

Advanced imaging systems, such as C-Arm machines, greatly improve physicians' diagnostic abilities and provide greater precision. Yet, these benefits come with a price of ionizing radiation exposure to medical teams and patients. Supplying proper training and skill improvement to operators on how to use this technology safely can help minimize risk of exposure. Previous studies on radiation knowledge among physicians and radiologists presented disturbing results of underestimated risk of exposure. The following research is based on an innovation in simulation-based training (SBT), a simulator using the Wizard of Oz (WOZ) concept that incorporates an online human trainer and was used for training emergency room (ER) physicians and ultrasound medical personnel. This research integrated WOZ technology with a radiation exposure formula for training to minimize unnecessary radiation exposure. The exposure formula presents real-time and overall exposure levels to operators based on their technique. The simulator also incorporates 3D animation graphics, enabling trainees to simulate the control of various factors. Image quality and the operator's radiation exposure levels are also animated, assisting trainees to focus on their exposure based on their device settings. Contrary to most previous studies, we measured radiation dose to the operator and quantified image quality accordingly. Validation was done on different C-Arm machines. Validation of learning outcomes was done using knowledge exams. Results from our knowledge exams presented significant improvement. The average result of knowledge exams given prior to training was 54%, whereas the average result after training was 94% (p &lt; 0.001). Additionally, after a gap of 2–3 months, high retention was also found.

Minimising operator dose during JET shutdown using virtual

Effective data visualisation is a key part of the scientific process with complex geometric datasets. It is the bridge between the quantitative content of the data and human intuition. Immersion in virtual reality (VR) provides benefits beyond the traditional “desktop” visualization tools and it leads to a demonstrably better perception of dataspace geometry, more intuitive data understanding, and a better retention of the perceived relationships in the data.VR has a great potential for fusion research and in the analysis of its complex physics-based datasets. The work presented in this paper is one of the applications that have been implemented at UKAEA which combines shutdown dose calculations with a virtual reality model of the Joint European Tokamak (JET) in a new code called VORTEX (Virtual Operator RadiaTion EXposure). The shutdown dose calculations were performed for various time steps during the JET DTE2 campaign using the UKAEA code MCR2S which links MCNP and FISPACT-II using the rigorous two step method. The 3 Dimensional dose and activation data created by MCR2S is integrated into the game engine Unity using C# routines to create VORTEX. A virtual reality model has been created from JET CAD data combined with the 3 dimensional radiation and activation data to create of virtual model of the radiological environment after the DTE2 campaign. This model enables more precise planning of operational procedures by having the operator/planner walk around the virtual environment using a virtual reality headset such as the Oculus rift or the HTC vive.

Radiation Exposure and Vascular Access in Acute Coronary Syndromes: The RAD-Matrix Trial

BackgroundIt remains unclear whether radial access increases the risk of operator or patient radiation exposure compared to transfemoral access when performed by expert operators. ObjectivesThis study sought to determine whether radial access increases radiation exposure. MethodsA total of 8,404 patients, with or without ST-segment elevation acute coronary syndrome, were randomly assigned to radial or femoral access for coronary angiography and percutaneous intervention, and collected fluoroscopy time and dose-area product (DAP). RAD-MATRIX is a radiation sub-study of the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) trial. We anticipated that 13 or more operators, each wearing a thorax (primary endpoint), wrist, and head (secondary endpoints) lithium fluoride thermoluminescent dosimeter, and randomizing at least 13 patients per access site, were needed to establish noninferiority of radial versus femoral access. ResultsAmong 18 operators, performing 777 procedures in 767 patients, the noninferiority primary endpoint was not achieved (p value for noninferiority = 0.843). Operator equivalent dose at the thorax (77 μSv) was significantly higher with radial than femoral access (41 μSv; p = 0.02). After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ for right radial (84 μSv) compared to left radial access (52 μSv; p = 0.15). In the overall MATRIX population, fluoroscopy time and DAP were higher with radial compared to femoral access: 10 min versus 9 min (p < 0.0001) and 65 Gy·cm2 versus 59 Gy·cm2 (p = 0.0001), respectively. ConclusionsCompared to femoral access, radial access is associated with greater operator and patient radiation exposure when performed by expert operators in current practice. Radial operators and institutions should be sensitized towards radiation risks and adopt adjunctive radioprotective measures. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX; NCT101433627)

Determinants of operator radiation exposure during percutaneous coronary procedures

Radiation exposure is an important issue for interventional cardiologists that is often underevaluated. Our aim was to evaluate determinants of operator radiation exposure during percutaneous coronary procedures. The RADIANT (NCT01974453) is a prospective, single-center observational study involving 4 expert operators and 2 fellows performing percutaneous coronary procedures. The operator radiation dose was evaluated using dedicated electronic dosimeters in 2,028 procedures: 1,897 transradial access (TRA; 1,120 right and 777 left TRA) and 131 transfemoral access (TFA). In the whole population, operator radiation dose at the thorax did not differ between TFA (9μSv [interquartile range 5-18μSv]) and TRA (9μSv [4-21μSv]), but after propensity score matching analysis, TFA showed lower dose (9μSv [5-18μSv]) compared with TRA (17μSv [9-28μSv], P<.001). In the whole transradial group, left TRA (5μSv [2-12μSv]) was associated with significant lower operator dose compared with right TRA (13μSv [6-26μSv], P<.001).The use of adjunctive protective pelvic drapes was significantly associated with lower radiation doses compared with procedures performed without drapes (P<.001). Among the operators, an inverse relation between height and dose was observed. Finally, left projections and the use of angiographic systems not dedicated for coronary and high frame rates were all associated with a significant higher operator radiation exposure. In a high-volume center for transradial procedures, TFA is associated with lower operator radiation dose compared with TRA. The use of adjunctive anti-rx drapes seems a valuable tool to reduce the higher operator radiation exposure associated with TRA.

Reduction in operator radiation exposure during transradial coronary procedures using a simple lead rectangle.

ObjectivesTransradial access for percutaneous coronary intervention (PCI) reduces procedural complications however, there are concerns regarding the potential for increased exposure to ionizing radiation to the primary operator. We evaluated the efficacy of a lead-attenuator in reducing radiation exposure during transradial PCI.Methods and resultsThis was a non-randomized, prospective, observational study in which 52 consecutive patients were assigned to either standard operator protection (n = 26) or the addition of the lead attenuator across their abdomen/pelvis (n = 26). In the attenuator group patients were relatively older with a higher prevalence of peripheral vascular disease (67.9 vs 58.7 p = 0.0292 and 12% vs 7.6% p < 0.001 respectively). Despite similar average fluoroscopy times (12.3 ± 9.8 min vs. 9.3 ± 5.4 min, p = 0.175) and average examination doses (111866 ± 80790 vs. 91,268 ± 47916 Gycm2, p = 0.2688), the total radiation exposure to the operator, at the thyroid level, was significantly lower when the lead-attenuator was utilized (20.2% p < 0.0001) as compared to the control group. Amongst the 26 patients assigned to the lead-attenuator, there was a significant reduction in measured radiation of 94.5% (p < 0.0001), above as compared to underneath the lead attenuator.ConclusionsAdditional protection with the use of a lead rectangle-attenuator significantly lowered radiation exposure to the primary operator, which may confer long-term benefits in reducing radiation-induced injury.Advances in knowledgeThis is the first paper to show that a simple lead attenuator almost completely reduced the scattered radiation at very close proximity to the patient and should be considered as part of the standard equipment within catheterization laboratories.

3:36 PMAbstract No. 297 - Primary operator radiation exposure in yttrium-90 radioembolization: transradial vs transfemoral approaches

3:36 PMAbstract No. 297 - Primary operator radiation exposure in yttrium-90 radioembolization: transradial vs transfemoral approaches

Reduction of Radiation Exposure Using Dynamic Trace Digital Angiography and Spot Fluoroscopy During Adrenal Venous Sampling.

To compare radiation exposure of adrenal venous sampling (AVS) using dynamic trace digital angiography (DTDA) and spot fluoroscopy with that using conventional methods. AVS was performed in 11 patients using DTDA and spot fluoroscopy (Group A) and 11 patients using conventional digital subtraction angiography (DSA) with collimation (Group B). Radiation exposure and image quality of adrenal venography using a five-point scale were compared between the groups. The acquisition dose-area product (DAP) using DTDA and fluoro-DAP using spot fluoroscopy in Group A were lower than those using conventional DSA (5.3±3.7 vs. 29.1±20.1Gycm2, p<0.001) and collimation (33.3±22.9 vs. 59.1±35.7Gycm2, p=0.088) in Group B. The total DAP in Group A was significantly lower than that in Group B (38.6±25.9 vs. 88.2±53.6Gycm2, p=0.006). The peak skin dose for patients and operator radiation exposure in Group A were significantly lower than those in Group B (403±340 vs. 771±416mGy, p=0.030, and 17.1±14.8 vs. 36.6±21.7μSv, p=0.013). The image quality of DTDA (4.4±0.6) was significantly higher than that of digital angiography (3.8±0.9, p=0.011) and equivalent to that of DSA (4.3±0.8, p=0.651). Radiation exposure during AVS can be reduced by approximately half for both patients and operators by using DTDA and spot fluoroscopy without sacrificing image quality.

Beam projections and radiation exposure in transradial and transfemoral approaches during coronary angiography.

Objective:We aimed to compare the operator and patient radiation exposure in standard projections during elective diagnostic coronary angiography procedures via transradial (TRA) versus transfemoral (TFA) approaches.Methods:In this analytical cross-sectional study, a total of 202 consecutive patients who were candidates for diagnostic coronary angiography were randomized to undergo the procedure via TFA or TRA approaches (101 in each group). Patients with abnormal Allen test and history of coronary artery bypass surgery, valvular heart disease, and unsuccessful coronary angiography were excluded from the study. A single operator performed all of the procedures using a single angiography system. Patient and operator radiation exposure were measured using diamentor and an electronic personal dosimeter, respectively. Each procedure comprised a standardized sequence of projections including four standard views for the left coronary system and two standard views for the right coronary system.Results:Left anterior oblique (LAO) caudal (50°/30°) and right anterior oblique RAO (30°) projections were associated with the highest and lowest patient radiation exposure, respectively. The operator received a significantly higher radiation exposure in the TRA approach for LAO cranial (for both left and right coronary systems) and LAO caudal (for left coronary system) projections during coronary angiography compared with the TFA approach.Conclusion:Though a similar amount of patient radiation exposure in each projection was observed among TFA and TRA groups; LAO cranial and LAO caudal projections were associated with a significantly higher operator radiation exposure in the TRA group. These findings need to be considered when choosing the optimal arterial approach for patients scheduled for coronary angiography.

Reduction Method of Operator and Medical Staff Radiation Exposure in Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension.

The purpose of this study is to investigate a reduction method of radiation exposure for operator and medical staff in balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). We devised a new radiation protection, which is U-shaped acrylic supporting table with 0.35 mmPb unleaded radiation protection sheet. A human phantom was put on the bed of cardiac angiography system [C-arm angulation: posteroanterior (PA), L-arm angulation: left anterior oblique (LAO) 60°]. The ambient equivalent dose rate was measured under fluoroscopy with and without three radiation protections: U-shaped acrylic supporting table with 0.35 mmPb unleaded radiation protection sheet, radiation protection for the lower body, and radiation protection for the upper body. With the three radiation protections, the ambient equivalent dose rate was decreased more than 99% at the height of 100 cm above the floor at the operator position (PA: from 186.2 μSv/h to 0.5 μSv/h, LAO 60°: from 350.4 μSv/h to 1.6 μSv/h). Ambient equivalent dose rate at the other points are also decreased effectively. The devised dose reduction method can reduce operator and medical staff radiation exposure effectively and be set up without interference for BPA procedure.

THE EXPERIENCE OF IMPROVING TECHNOLOGICAL PROPERTIES OF SEMI-FINISHED PRODUCTS AND QUALITY OF THORIATED TUNGSTEN PRODUCTS THROUGH DEPOSITION OF TUNGSTEN COATINGS BY WF&lt;sub&gt;6&lt;/sub&gt; HYDROGEN REDUCTION

Tungsten deposition from a gaseous mixture of tungsten hexafluoride and hydrogen on the surface of a porous preform made of thoriated tungsten makes it possible to bond particles of peripheral layers and its core against each other, and create more plastic surface coating capable of relaxing stresses occurring during rotary forging, thus preventing destruction of semi-finished products. The described method made it possible to carry out rotary forging of the pilot batch consisting of insufficiently sintered preforms of thoriated tungsten which were previously destroyed if processed uncoated. The achieved improvement of technological properties may be used in the production of similar tungsten-based compositions (grade VL and VI), as well as for other types of deformation. The results can be applicable for the following: 1) Lowering the sintering-welding temperature of bars (and rods) made of dispersion-strengthened tungsten-based compositions, thus reducing power consumption and increasing the time between equipment overhauls; 2) Increasing the size of semi-finished products produced with the existing equipment, thus increasing the process productivity and expanding the range of output products; 3) Releasing less environmentally hazardous thoriated tungsten products, thus greatly reducing radiation exposure of operators; 4) Using composite cathodes in arc xenon lamps, thus increasing their operational life by 2–3 times.

Effect of Left Versus Right Radial Artery Approach for Coronary Angiography on Radiation Parameters in Patients With Predictors of Transradial Access Failure

Left transradial approach (TRA) for coronary angiography is associated with lower radiation parameters than right TRA in an all-comers population. The aim of this study was to determine the effects of left versus right TRA on radiation parameters in patients with predictors of TRA failure. Patients with predictors of TRA failure (≥3 of 4 following criteria: age ≥70years, female gender, height ≤64 inches, and hypertension) referred to TRA operators were randomized to either right (n= 50) or left (n= 50) TRA, whereas those referred to transfemoral approach (TFA) operators were enrolled in a prospective registry (n= 50). The primary end point was the radiation measure of dose-area product (DAP). In an intention-to-treat analysis, DAP (34.1Gy·cm(2) [24.9 to 45.6] vs 41.9Gy·cm(2) [27.3 to 58.0], p= 0.08), fluoroscopy time (3.7minutes [2.4 to 6.3] vs 5.6minutes [3.1 to 8.7], p= 0.07), and operator radiation exposure (516 μR [275 to 967] vs 730 μR [503 to 1,165], p= 0.06) were not significantly different between left and right TRA, but total dose (411mGy [310 to 592] vs 537mGy [368 to 780], p= 0.03) was significantly lower with left versus right TRA. Radiation parameters were lowest in the TFA cohort (DAP 24.5Gy·cm(2) [15.7 to 33.2], p <0.001; fluoroscopy time 2.3minutes [1.5 to 3.7], p <0.001; operator radiation exposure 387 μR [264 to 557]; total dose 345mGy [250 to 468], p= 0.001). Results were similar after adjustment for differences in baseline characteristics. In conclusion, median measurements of radiation were overall not significantly different between left versus right TRA in this select population of patients with predictors of TRA failure. All measurements of radiation were lowest in the TFA group.

Radiation Exposure of the Operator During Coronary Interventions (from the RADIO Study)

We sought to compare operator radiation exposure during procedures using right femoral access (RFA), right radial access (RRA), and left radial access (LRA) during coronary angiography (CA) and percutaneous coronary intervention (PCI). Because of an increased incidence of long-term malignancy in interventional cardiologists, operator radiation exposure is of rising concern. This prospective study included all consecutive patients who underwent elective or emergency CA±PCI from September 2014 to March 2015. The primary end point was operator radiation exposure, quantified as the ratio of operator cumulative dose (CD) and patient radiation reported as dose-area product (DAP) (CD/DAP). Secondary end points included CD, DAP, and fluoroscopy time (FT). Overall 830 procedures (457 CA [55%] and 373 PCI [45%]) were performed, 455 (55%) through RFA, 272 (33%) through RRA, and 103 (12%) through LRA. The CD/DAP was lower in RFA (0.09 μSv/Gycm(2) [0.02 to 0.20]) compared with RRA (0.47 μSv/Gycm(2) [0.25 to 0.75], p <0.001). The LRA showed lower CD/DAP compared with RRA (p <0.001). CD was significantly lower in RFA (3μSv [1 to 7]) compared with RRA (12 μSv [6 to 29], p <0.001). The LRA showed lower CD compared with RRA (p <0.001). There were no significant differences in DAP among the 3 access sites. FT was similar for the 3 groups (RFA 7 ± 7, RRA 5 ± 5, LRA 6 ± 5minutes, RFA vs RRA: p= 1, RFA vs LRA: p= 0.16, RRA vs LRA: p= 0.52). In conclusion, the use of RFA during CA±PCI is associated with significantly lower operator radiation exposure compared with RRA. LRA is associated with significantly lower operator radiation exposure compared with RRA.

Experience in Improving the Manufacturing Properties of Semifinished Products and Quality of Thoriated Tungsten Products by the Deposition of Tungsten Coatings with WF6 Hydrogen Reduction

Tungsten deposition from a gaseous mixture of its hexafluoride with hydrogen on the surface of a porous billet of thoriated tungsten makes it possible to fasten the particles of peripheral layers and its core between each other, as well as to form a more plastic shell on the surface capable of relaxing stresses appearing during rotary forging, thus preventing the destruction of semifinished products. This procedure makes it possible to perform the rotary forging of a pilot batch of insufficiently sintered billets of thoriated tungsten, which would be destroyed if treated uncoated. The improvement of manufacturing properties can be used when fabricating similar tungsten-based compositions (of W(La2O3) and W(Y2O3)), as well as for other types of deformation. These results can be applicable for (i) lowering the sintering–welding temperature of bars (and rods) of dispersion-strengthened tungsten-based compositions, thereby reducing power consumption and increasing the overhaul period of equipment; (ii) increasing the sizes of semifinished products using the existing equipment thereby increasing the production process productivity and expanding the range of output products; (iii) producing less environmentally hazardous thoriated tungsten products, multiply reducing the radiation exposure of operators; and (iv) using composite cathodes in arc xenon lamps, thereby increasing their service life by a factor of 2–3.

Randomized comparison of long and short vascular sheaths in reduction of the operator radiation exposure during uterine artery embolization.

To introduce a method in which a long sheath is used instead of the traditional short sheath, to reduce the radiation exposure of operators in uterine artery embolization (UAE). 52 patients undergoing UAE were randomly divided into two groups before the procedure: an 11-cm short sheath was used in Group A (n = 25), and a 45-cm-long sheath was used in Group B (n = 27); the 45-cm-long sheath was only partly inserted such that the hub of the sheath was approximately 34 cm caudal to the groin puncture site. All the procedures were standard bilateral UAE operations through unilateral approach. The other parameters of the two groups were kept the same, including the fluoroscopy conditions and the pelvic radiation field size. The thermoluminescent personal dosemeters were attached to the left wrist and left outer side of the thyroid collar of the operator during each operation. The radiation exposure of the operator, procedure duration and fluoroscopy time of each procedure were recorded. Statistical analysis was performed using independent samples t-test. The radiation exposure of both the left hand and thyroid of the operator was significantly reduced with the long sheath compared with the short sheath (89.5 ± 7.2 μGy vs 186.7 ± 12.6 μGy, p < 0.001, and 54.1 ± 5.5 μGy vs 63.9 ± 7.4 μGy, p < 0.001, respectively). No significant differences were found in the procedure duration and fluoroscopy time between the two groups (p > 0.1). Using a long sheath in UAE could significantly reduce the radiation exposure to the interventionists without extending the procedure duration or fluoroscopy time. For the first time, we introduce a simple and convenient method to reduce the radiation exposure of the operator in the UAE procedure.