Minimizing radiation exposure to the vascular surgeon

Objectives: To determine radiation exposure for members of an endovascular surgery team during imaging procedures by varying technique. Methods: Digital subtraction angiography imaging of the abdomen and pelvis (Innova 4100; GE, Fairfield, Conn) was performed on cadavers, varying positioning and technique within the usual bounds of clinical practice. Radiation exposure was monitored in real-time with dosimeters (DoseAware; Philips, Andover, Mass) to simulate the position of the operator, assistant, and anesthesiologist. The DoseAware system reports radiation exposure in 1-second intervals. Three to five consecutive data points were collected for each imaging configuration. Results: Operator radiation exposure is minimized with detector-to-patient distance <5 cm (2.1 mSv/h) in contrast to 10 to 15 cm (2.8 mSv/h); source-to-image distance of <15 cm (2.3 mSv/h) in contrast to 25 cm (3.3 mSv/h). Increasing image magnification from 0 (2.3 mSv/h) to 3 (0.83 mSv/h) decreases operator exposure by 74%. Increasing linear image collimation from 0 (2.3 mSv/h) to 10 cm (0.30 mSv/h) decreases operator exposure by 87%. The anesthesiologist's radiation exposure is 11% to 49% of the operator's, greatest in the left anterior oblique (LAO) 90 degree projection. The assistant's radiation exposure is 23% to 46% of the operator's. The highest exposure to the operator was noted to be in the LAO 90 degree projection (30.3 mSv/h) and lowest exposure with 10-cm vertical collimation (0.28 mSv/h). Conclusions: Varying imaging techniques results in different radiation exposure to members of an endovascular surgery team. Knowledge of the variable intensity of radiation exposure may allow modification of the technique to minimize radiation exposure to the team while providing suitable imaging. (J Vasc Surg 2012; 55: 799-805.) Clinical Relevance: The increased utility of endovascular procedures has exposed interventionalists to potentially high levels of occupational radiation. This study demonstrates that the magnitude and distribution of scatter radiation can be measured to the operator, assistant, and anesthesiologist under various fluoroscopic imaging conditions and techniques. Knowledge of the various angiographic parameters and their impact in scatter radiation levels can help operators utilize the dose reduction techniques and incorporate them in their routine practices.