Occupational Radiation Doses to Operators Performing Fluoroscopically-Guided Procedures

AbstractIn the past 30 y, the numbers and types of fluoroscopically-guided (FG) procedures have increased dramatically. The objective of the present study is to provide estimated radiation doses to physician specialists, other than cardiologists, who perform FG procedures. The authors searched Medline to identify English-language journal articles reporting radiation exposures to these physicians. They then identified several primarily therapeutic FG procedures that met specific criteria: well-defined procedures for which there were at least five published reports of estimated radiation doses to the operator, procedures performed frequently in current medical practice, and inclusion of physicians from multiple medical specialties. These procedures were percutaneous nephrolithotomy (PCNL), vertebroplasty, orthopedic extremity nailing for treatment of fractures, biliary tract procedures, transjugular intrahepatic portosystemic shunt creation (TIPS), head/neck endovascular therapeutic procedures, and endoscopic retrograde cholangiopancreatography (ERCP). Radiation doses and other associated data were abstracted, and effective dose to operators was estimated. Operators received estimated doses per patient procedure equivalent to doses received by interventional cardiologists. The estimated effective dose per case ranged from 1.7–56 &mgr;Sv for PCNL, 0.1–101 &mgr;Sv for vertebroplasty, 2.5–88 &mgr;Sv for orthopedic extremity nailing, 2.0–46 &mgr;Sv for biliary tract procedures, 2.5–74 &mgr;Sv for TIPS, 1.8–53 &mgr;Sv for head/neck endovascular therapeutic procedures, and 0.2–49 &mgr;Sv for ERCP. Overall, mean operator radiation dose per case measured over personal protective devices at different anatomic sites on the head and body ranged from 19–800 (median = 113) &mgr;Sv at eye level, 6–1,180 (median = 75) &mgr;Sv at the neck, and 2–1,600 (median = 302) &mgr;Sv at the trunk. Operators’ hands often received greater doses than the eyes, neck, or trunk. Large variations in operator doses suggest that optimizing procedure protocols and proper use of protective devices and shields might reduce occupational radiation dose substantially.