Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Jul;103(1):80-99.
doi: 10.1097/HP.0b013e31824dae76.

Occupational radiation doses to operators performing fluoroscopically-guided procedures

Kwang Pyo Kim  1 , Donald L Miller, Amy Berrington de Gonzalez, Stephen Balter, Ruth A Kleinerman, Evgenia Ostroumova, Steven L Simon, Martha S Linet
Affiliations
Review

Occupational radiation doses to operators performing fluoroscopically-guided procedures

Kwang Pyo Kim et al. Health Phys. 2012 Jul.

Abstract

In 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 μSv for PCNL, 0.1-101 μSv for vertebroplasty, 2.5-88 μSv for orthopedic extremity nailing, 2.0-46 μSv for biliary tract procedures, 2.5-74 μSv for TIPS, 1.8-53 μSv for head/neck endovascular therapeutic procedures, and 0.2-49 μSv 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) μSv at eye level, 6-1,180 (median = 75) μSv at the neck, and 2-1,600 (median = 302) μSv 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Mean effective dose estimates per case for operators performing various types of FG procedures. Each line represents the mean value from one published study under similar exposure conditions. The length of each line represents the number of cases in each study. Effective dose estimates for cardiac procedures are also depicted for comparison. PCNL (percutaneous nephrolithotomy), VP (Vertebroplasty), TIPS (transjugular intrahepatic portosystemic shunt creation), HN (Head/neck endovascular therapeutic procedures), ERCP (endoscopic retrograde cholangiopancreatography), DC (diagnostic catheterization), PCI (percutaneous coronary intervention).
Figure 2
Figure 2
Mean effective dose rate. Effective dose rate estimates are normalized by fluoroscopy time. Each line represents the mean value from one published study under similar exposure conditions. The length of each line represents the number of cases in each study. Effective dose rate estimates for cardiac procedures are also depicted for comparison. PCNL (percutaneous nephrolithotomy), VP (Vertebroplasty), TIPS (transjugular intrahepatic portosystemic shunt creation), HN (Head/neck endovascular therapeutic procedures), ERCP (endoscopic retrograde cholangiopancreatography), DC (diagnostic catheterization), PCI (percutaneous coronary intervention).
Figure 3
Figure 3
Mean effective dose normalized by patient radiation dose (as kerma area product). Each line represents the mean value from one published study under similar exposure conditions. The length of each line represents the number of cases in each study. Data for cardiac procedures are also depicted for comparison. PCNL (percutaneous nephrolithotomy), VP (Vertebroplasty), TIPS (transjugular intrahepatic portosystemic shunt creation), HN (Head/neck endovascular therapeutic procedures), ERCP (endoscopic retrograde cholangiopancreatography), DC (diagnostic catheterization), PCI (percutaneous coronary intervention).
Figure 4
Figure 4
Mean hand dose rate. Radiation dose rates measured at the operator’s hand are normalized by fluoroscopy time. Each line represents the mean value from one published study under similar exposure conditions. The length of each line represents the number of cases in each study. Data for cardiac procedures are also depicted for comparison. PCNL (percutaneous nephrolithotomy), VP (Vertebroplasty), TIPS (transjugular intrahepatic portosystemic shunt creation), HN (Head/neck endovascular therapeutic procedures), ERCP (endoscopic retrograde cholangiopancreatography), DC (diagnostic catheterization), PCI (percutaneous coronary intervention).
Figure 5
Figure 5
Mean organ dose estimates per case for operators performing various types of FG procedures. Each line represents the mean value from one published study under similar exposure conditions. The length of each line represents the number of cases in each study. Organ dose estimates for cardiac procedures are also depicted for comparison. PCNL (percutaneous nephrolithotomy), VP (Vertebroplasty), TIPS (transjugular intrahepatic portosystemic shunt creation), HN (Head/neck endovascular therapeutic procedures), ERCP (endoscopic retrograde cholangiopancreatography), DC (diagnostic catheterization), PCI (percutaneous coronary intervention).
See this image and copyright information in PMC

References

    1. Arnstein PM, Richards AM, Putney R. The Risk from Radiation Exposure during Operative X-Ray Screening in Hand Surgery. Journal of Hand Surgery-British and European. 1994;19B:393–396. - PubMed
    1. Balter S, Schueler BA, Miller DL, Cole PE, Lu HT, Berenstein A, Albert R, Georgia JD, Noonan PT, Russell EJ, Malisch TW, Vogelzang RL, Geisinger M, Cardella JF, St George J, Miller GL, Anderson J. Radiation doses in interventional radiology procedures: The RAD-IR study Part III: Dosimetric performance of the interventional fluoroscopy units. Journal of Vascular and Interventional Radiology. 2004;15:919–926. - PubMed
    1. Berthelsen B, Cederblad A. Radiation-Doses to Patients and Personnel Involved in Embolization of Intracerebral Arteriovenous-Malformations. Acta Radiologica. 1991;32:492–497. - PubMed
    1. Bhargavan M. Trends in the utilization of medical procedures that use ionizing radiation. Health Physics. 2008;95:612–27. - PubMed
    1. Blattert TR, Fill UA, Kunz E, Panzer W, Weckbach A, Regulla DF. Skill dependence of radiation exposure for the orthopaedic surgeon during interlocking nailing of long-bone shaft fractures: a clinical study. Archives of Orthopaedic and Trauma Surgery. 2004;124:659–664. - PubMed

Publication types