European Review Aims to Minimize Radiation Exposure in Endovascular Procedures

July 21, 2015—With x-ray exposure associated with biological risks for both patients and physicians, a review that aims to provide basic knowledge about x-ray physics, biological risks, dose metrics, and radiation protection in endovascular procedures has been published by Adrien Hertault, MD, et al in the European Journal of Vascular & Endovascular Surgery (EJVES; 2015;50:21–36). 

The review proposes standard nomenclature to measure, estimate, and report radiation doses in order to perform accurate comparisons between publications and practices. A literature review per common procedure type with reference levels is also proposed to allow physicians to evaluate their daily practice.

The authors advise that today’s trainees will be highly exposed to radiation throughout their practice. It is thus compulsory that they undergo dedicated radiation education during their initial training and regular refresher sessions later. In daily practice, focusing on dose reduction and monitoring patient and staff exposure are mandatory, concluded the author in EJVES.

The authors noted that the content of education and professional practices vary widely from one country to another. Medical x-ray practitioners must follow ALARA (“as low as reasonably achievable”) principles, which aim at using the lowest radiation exposure to obtain data safely; European and international recommendations also suggest that adequate theoretical and practical training is mandatory during the initial education of physicians. 

In this review, a panel of endovascular therapists (vascular surgeons and radiologists) and physicists summarize international recommendations and review literature via MEDLINE to identify studies reporting dosages of common endovascular procedures. The document briefly provides the basic knowledge required on x-ray physics and image production.

Additionally, it describes the different mechanisms, biological risks, and the associated potential effects on health. Details on dose metrics are provided. Key points of the European and international legislation regarding medical x-ray use are summarized, and radiation protection basics for patients and staff are detailed. Finally, a literature review is proposed for physicians to evaluate their practice.