Study Evaluates Occupational Radiation Exposure During EVAR

July 21, 2015—Findings from a study conducted to evaluate radiation exposure to operating room personnel and to assess determinants for high personal doses during endovascular aneurysm repair (EVAR) were published by Anna M. Sailer, MD, et al in CardioVascular and Interventional Radiology (2015;38:827–832).

The study showed that the average first-operator dose was higher than the average second-operator dose by a factor of four. Predictors for high personal doses are procedural dose area product, iodinated contrast volume, and left-anterior C-arm projections greater than 60°, concluded the investigators.

As summarized in CardioVascular and Interventional Radiology, the investigators prospectively evaluated occupational radiation exposure during 22 infrarenal EVAR procedures, 11 thoracic EVAR procedures (TEVAR), and 11 fenestrated or branched EVAR procedures (FEVAR). Real-time overlead dosimeters attached to the left breast pocket measured personal doses for the first and second operators, radiology technicians, scrub nurses, anesthesiologists, and nonsterile nurses. Except for a protective apron and thyroid collar, no additional radiation shielding was used. Procedural dose area product, iodinated contrast volume, fluoroscopy time, the patient’s body weight, and C-arm angulation were documented.

The investigators found that the average procedural first-operator 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 = .003). Average personnel doses were 0.17 ± 0.21 mSv for first operators, 0.042 ± 0.045 mSv for secondary operators, 0.019 ± 0.042 mSv for radiation technicians, 0.017 ± 0.031 mSv for scrub nurses, 0.006 ± 0.007 mSv for anesthesiologists, and 0.004 ± 0.009 mSv for nonsterile nurses.

Second-operator and anesthesiologist doses were strongly correlated with first-operator doses (P = .003 and P < .001). There was a significant correlation between the first-operator dose and procedural dose area product (R = 0.69; P < .001), iodinated contrast volume (R = 0.67; P < .001), and left-anterior C-arm projections > 60° (P = .02) and a weak correlation with fluoroscopy time (R = 0.4; P = .049), reported the investigators in CardioVascular and Interventional Radiology.