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Published in: CardioVascular and Interventional Radiology 4/2015

01-08-2015 | Clinical Investigation

Occupational Radiation Exposure During Endovascular Aortic Repair

Authors: Anna M. Sailer, Geert Willem H. Schurink, Martine E. Bol, Michiel W. de Haan, Willem H. van Zwam, Joachim E. Wildberger, Cécile R. L. P. N. Jeukens

Published in: CardioVascular and Interventional Radiology | Issue 4/2015

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Abstract

Purpose

The aim of the study was to evaluate the radiation exposure to operating room personnel and to assess determinants for high personal doses during endovascular aortic repair.

Materials and Methods

Occupational radiation exposure was prospectively evaluated during 22 infra-renal aortic repair procedures (EVAR), 11 thoracic aortic repair procedures (TEVAR), and 11 fenestrated or branched aortic repair procedures (FEVAR). Real-time over-lead dosimeters attached to the left breast pocket measured personal doses for the first operators (FO) and second operators (SO), radiology technicians (RT), scrub nurses (SN), anesthesiologists (AN), and non-sterile nurses (NSN). Besides protective apron and thyroid collar, no additional radiation shielding was used. Procedural dose area product (DAP), iodinated contrast volume, fluoroscopy time, patient’s body weight, and C-arm angulation were documented.

Results

Average procedural FO dose was significantly higher during FEVAR (0.34 ± 0.28 mSv) compared to EVAR (0.11 ± 0.21 mSv) and TEVAR (0.06 ± 0.05 mSv; p = 0.003). Average personnel doses were 0.17 ± 0.21 mSv (FO), 0.042 ± 0.045 mSv (SO), 0.019 ± 0.042 mSv (RT), 0.017 ± 0.031 mSv (SN), 0.006 ± 0.007 mSv (AN), and 0.004 ± 0.009 mSv (NSN). SO and AN doses were strongly correlated with FO dose (p = 0.003 and p < 0.001). There was a significant correlation between FO dose and procedural DAP (R = 0.69, p < 0.001), iodinated contrast volume (R = 0.67, p < 0.001) and left-anterior C-arm projections >60° (p = 0.02), and a weak correlation with fluoroscopy time (R = 0.40, p = 0.049).

Conclusion

Average FO dose was a factor four higher than SO dose. Predictors for high personal doses are procedural DAP, iodinated contrast volume, and left-anterior C-arm projections greater than 60°.
Literature
1.
2.
go back to reference Matsumura JS, Melissano G, Cambria RP, Dake MD, Mehta S, Svensson LG, Moore RD, Zenith TX2 Clinical Trial Investigators (2014) Five-year results of thoracic endovascular aortic repair with the Zenith TX2. J Vasc Surg 60(1):1–10PubMedCrossRef Matsumura JS, Melissano G, Cambria RP, Dake MD, Mehta S, Svensson LG, Moore RD, Zenith TX2 Clinical Trial Investigators (2014) Five-year results of thoracic endovascular aortic repair with the Zenith TX2. J Vasc Surg 60(1):1–10PubMedCrossRef
3.
go back to reference Greenberg RK, Sternbergh WC III, Makaroun M, Ohki T, Chuter T, Bharadwaj P, Saunders A, Fenestrated Investigators (2009) Intermediate results of a United States multicenter trial of fenestrated endograft repair for juxtarenal abdominal aortic aneurysms. J Vasc Surg 50(4):730–737 Greenberg RK, Sternbergh WC III, Makaroun M, Ohki T, Chuter T, Bharadwaj P, Saunders A, Fenestrated Investigators (2009) Intermediate results of a United States multicenter trial of fenestrated endograft repair for juxtarenal abdominal aortic aneurysms. J Vasc Surg 50(4):730–737
4.
go back to reference Valentin J (2000) Avoidance of radiation injuries from medical interventional procedures. Ann ICRP 30(2):7–67PubMedCrossRef Valentin J (2000) Avoidance of radiation injuries from medical interventional procedures. Ann ICRP 30(2):7–67PubMedCrossRef
5.
go back to reference Kirkwood ML, Arbique GM, Guild JB, Timaran C, Chung J, Anderson JA, Valentine RJ (2013) Surgeon education decreases radiation dose in complex endovascular procedures and improves patient safety. J Vasc Surg 58(3):715–721PubMedCrossRef Kirkwood ML, Arbique GM, Guild JB, Timaran C, Chung J, Anderson JA, Valentine RJ (2013) Surgeon education decreases radiation dose in complex endovascular procedures and improves patient safety. J Vasc Surg 58(3):715–721PubMedCrossRef
6.
go back to reference Eleveld H, Tanzi CP (2004) Ministry of Social Affairs and Employment Netherlands. Standaardisatie van persoonsdosimetrie bij beroepsmatige blootstelling aan ioniserende straling, report no. 329 Eleveld H, Tanzi CP (2004) Ministry of Social Affairs and Employment Netherlands. Standaardisatie van persoonsdosimetrie bij beroepsmatige blootstelling aan ioniserende straling, report no. 329
7.
go back to reference Van Dijk JWE, Ebben L, Franken Y (2008) Netherlands Commission on Radiation Dosimetry Subcommittee Lead Aprons. Code of practice for personal dosimetry of professionals wearing protective clothing during radiological procedures. Report 19 of the Netherlands Commission on Radiation Dosimetry Van Dijk JWE, Ebben L, Franken Y (2008) Netherlands Commission on Radiation Dosimetry Subcommittee Lead Aprons. Code of practice for personal dosimetry of professionals wearing protective clothing during radiological procedures. Report 19 of the Netherlands Commission on Radiation Dosimetry
8.
go back to reference Bartal G, Vano E, Paulo G, Miller DL (2014) Management of patient and staff radiation dose in interventional radiology: current concepts. Cardiovasc Intervent Radiol 37(2):289–298PubMedCrossRef Bartal G, Vano E, Paulo G, Miller DL (2014) Management of patient and staff radiation dose in interventional radiology: current concepts. Cardiovasc Intervent Radiol 37(2):289–298PubMedCrossRef
9.
go back to reference Sutton DG, Williams JR (2012) Radiation shielding for diagnostic radiology. British Institute of Radiology, London, pp 74–77 Sutton DG, Williams JR (2012) Radiation shielding for diagnostic radiology. British Institute of Radiology, London, pp 74–77
10.
go back to reference Haqqani OP, Agarwal PK, Halin NM, Iafrati MD (2013) Defining the radiation “scatter cloud” in the interventional suite. J Vasc Surg 58(5):1339–1345PubMedCrossRef Haqqani OP, Agarwal PK, Halin NM, Iafrati MD (2013) Defining the radiation “scatter cloud” in the interventional suite. J Vasc Surg 58(5):1339–1345PubMedCrossRef
11.
go back to reference Mohapatra A, Greenberg RK, Mastracci TM, Eagleton MJ, Thornsberry B (2013) Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg 58(3):702–709PubMedCrossRef Mohapatra A, Greenberg RK, Mastracci TM, Eagleton MJ, Thornsberry B (2013) Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg 58(3):702–709PubMedCrossRef
12.
go back to reference Kloeze C, Klompenhouwer EG, Brands PJ, van Sambeek MR, Cuypers PW, Teijink JA (2014) Use of disposable radiation-absorbing surgical drapes results in significant dose reduction during EVAR procedures. Eur J Vasc Endovasc Surg 47(3):268–272PubMedCrossRef Kloeze C, Klompenhouwer EG, Brands PJ, van Sambeek MR, Cuypers PW, Teijink JA (2014) Use of disposable radiation-absorbing surgical drapes results in significant dose reduction during EVAR procedures. Eur J Vasc Endovasc Surg 47(3):268–272PubMedCrossRef
13.
go back to reference Patel AP, Gallacher D, Dourado R, Lyons O, Smith A, Zayed H, Waltham M, Sabharwal T, Bell R, Carrell T, Taylor P, Modarai B (2013) Occupational radiation exposure during endovascular aortic procedures. Eur J Vasc Endovasc Surg 46(4):424–430PubMedCrossRef Patel AP, Gallacher D, Dourado R, Lyons O, Smith A, Zayed H, Waltham M, Sabharwal T, Bell R, Carrell T, Taylor P, Modarai B (2013) Occupational radiation exposure during endovascular aortic procedures. Eur J Vasc Endovasc Surg 46(4):424–430PubMedCrossRef
14.
go back to reference Vano E, Kleiman NJ, Duran A, Romano-Miller M, Rehani MM (2013) Radiation-associated lens opacities in catheterization personnel: results of a survey and direct assessments. J Vasc Interv Radiol 24(2):197–204PubMedCrossRef Vano E, Kleiman NJ, Duran A, Romano-Miller M, Rehani MM (2013) Radiation-associated lens opacities in catheterization personnel: results of a survey and direct assessments. J Vasc Interv Radiol 24(2):197–204PubMedCrossRef
15.
go back to reference Broughton J, Cantone MC, Ginjaume M, Shah B (2013) Report of Task Group on the implications of the implementation of the ICRP recommendations for a revised dose limit to the lens of the eye. J Radiol Prot 33(4):855–868PubMedCrossRef Broughton J, Cantone MC, Ginjaume M, Shah B (2013) Report of Task Group on the implications of the implementation of the ICRP recommendations for a revised dose limit to the lens of the eye. J Radiol Prot 33(4):855–868PubMedCrossRef
16.
go back to reference van Rooijen BD, de Haan MW, Das M, Arnoldussen CW, de Graaf R, van Zwam WH, Backes WH, Jeukens CR (2013) Efficacy of radiation safety glasses in interventional radiology. Cardiovasc Intervent Radiol 37(5):1149–1155 van Rooijen BD, de Haan MW, Das M, Arnoldussen CW, de Graaf R, van Zwam WH, Backes WH, Jeukens CR (2013) Efficacy of radiation safety glasses in interventional radiology. Cardiovasc Intervent Radiol 37(5):1149–1155
17.
go back to reference ICRP (2007) The 2007 recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP 37:1–332 ICRP (2007) The 2007 recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP 37:1–332
18.
go back to reference ICRP (1997) Publication 74: conversion coefficients for use in radiological protection against external radiation. Annals of the ICRP, vol 26/3. Elsevier, Oxford ICRP (1997) Publication 74: conversion coefficients for use in radiological protection against external radiation. Annals of the ICRP, vol 26/3. Elsevier, Oxford
19.
go back to reference Lie ØØ, Paulsen GU, Wøhni T (2008) Assessment of effective dose and dose to the lens of the eye for the interventional cardiologist. Radiat Prot Dosim 132(3):313–318CrossRef Lie ØØ, Paulsen GU, Wøhni T (2008) Assessment of effective dose and dose to the lens of the eye for the interventional cardiologist. Radiat Prot Dosim 132(3):313–318CrossRef
20.
go back to reference Sanchez RM, Vano E, Fernandez JM, Ginjaume M, Duch MA (2014) Measurements of eye lens doses in interventional cardiology using osl and electronic dosemeters. Radiat Prot Dosim. doi:10.1093/rpd/nct368 Sanchez RM, Vano E, Fernandez JM, Ginjaume M, Duch MA (2014) Measurements of eye lens doses in interventional cardiology using osl and electronic dosemeters. Radiat Prot Dosim. doi:10.​1093/​rpd/​nct368
21.
go back to reference Maurel B, Hertault A, Sobocinski J, Le Roux M, Gonzalez TM, Azzaoui R, Saeed Kilani M, Midulla M, Haulon S (2014) Techniques to reduce radiation and contrast volume during EVAR. J Cardiovasc Surg (Torino) 55(2 Suppl 1):123–131 Maurel B, Hertault A, Sobocinski J, Le Roux M, Gonzalez TM, Azzaoui R, Saeed Kilani M, Midulla M, Haulon S (2014) Techniques to reduce radiation and contrast volume during EVAR. J Cardiovasc Surg (Torino) 55(2 Suppl 1):123–131
22.
go back to reference Scheurig-Muenkler C, Powerski MJ, Mueller JC, Kroencke TJ (2014) Radiation exposure during uterine artery embolization: effective measures to minimize dose to the patient. Cardiovasc Intervent Radiol. doi:10.1007/s00270-014-0962-6 Scheurig-Muenkler C, Powerski MJ, Mueller JC, Kroencke TJ (2014) Radiation exposure during uterine artery embolization: effective measures to minimize dose to the patient. Cardiovasc Intervent Radiol. doi:10.​1007/​s00270-014-0962-6
23.
go back to reference Sailer AM, de Haan MW, Peppelenbosch AG, Jacobs MJ, Wildberger JE, Schurink GW (2014) CTA with fluoroscopy image fusion guidance in endovascular complex aortic aneurysm repair. Eur J Vasc Endovasc Surg 47(4):349–356PubMedCrossRef Sailer AM, de Haan MW, Peppelenbosch AG, Jacobs MJ, Wildberger JE, Schurink GW (2014) CTA with fluoroscopy image fusion guidance in endovascular complex aortic aneurysm repair. Eur J Vasc Endovasc Surg 47(4):349–356PubMedCrossRef
24.
go back to reference Hertault A, Maurel B, Sobocinski J, Martin Gonzalez T, Le Roux M, Azzaoui R, Midulla M, Haulon S (2014) Impact of hybrid rooms with image fusion on radiation exposure during endovascular aortic repair. Eur J Vasc Endovasc Surg 48(4):382–390 Hertault A, Maurel B, Sobocinski J, Martin Gonzalez T, Le Roux M, Azzaoui R, Midulla M, Haulon S (2014) Impact of hybrid rooms with image fusion on radiation exposure during endovascular aortic repair. Eur J Vasc Endovasc Surg 48(4):382–390
25.
go back to reference Fetterly KA, Magnuson DJ, Tannahill GM, Hindal MD, Mathew V (2011) Effective use of radiation shields to minimize operator dose during invasive cardiology procedures. JACC Cardiovasc Interv 4(10):1133–1139PubMedCrossRef Fetterly KA, Magnuson DJ, Tannahill GM, Hindal MD, Mathew V (2011) Effective use of radiation shields to minimize operator dose during invasive cardiology procedures. JACC Cardiovasc Interv 4(10):1133–1139PubMedCrossRef
26.
go back to reference Murphy JC, Darragh K, Walsh SJ, Hanratty CG (2011) Efficacy of the RADPAD protective drape during real world complex percutaneous coronary intervention procedures. Am J Cardiol 108(10):1408–1410PubMedCrossRef Murphy JC, Darragh K, Walsh SJ, Hanratty CG (2011) Efficacy of the RADPAD protective drape during real world complex percutaneous coronary intervention procedures. Am J Cardiol 108(10):1408–1410PubMedCrossRef
Metadata
Title
Occupational Radiation Exposure During Endovascular Aortic Repair
Authors
Anna M. Sailer
Geert Willem H. Schurink
Martine E. Bol
Michiel W. de Haan
Willem H. van Zwam
Joachim E. Wildberger
Cécile R. L. P. N. Jeukens
Publication date
01-08-2015
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 4/2015
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-014-1025-8

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