Occupational Doses to Medical Staff Performing or Assisting with Fluoroscopically Guided Interventional Procedures

Abstract

Background Staff who perform fluoroscopically guided interventional (FGI) procedures are among the most highly radiation-exposed groups in medicine. However, there are limited data on monthly or annual doses (or dose trends over time) for these workers. Purpose To summarize occupational badge doses (lens dose equivalent and effective dose equivalent values) for medical staff performing or assisting with FGI procedures in 3 recent years after accounting for uninformative values and one- versus two-badge monitoring protocol. Materials and Methods Badge dose entries of medical workers believed to have performed or assisted with FGI procedures were retrospectively collected from the largest dosimetry provider in the United States for 49 991, 81 561, and 125 669 medical staff corresponding to years 2009, 2012, and 2015, respectively. Entries judged to be uninformative of occupational doses to FGI procedures staff were excluded. Monthly and annual occupational doses were described using summary statistics. Results After exclusions, 22.2% (153 033 of 687 912) of the two- and 32.9% (450 173 of 1 366 736) of the one-badge entries were judged to be informative. There were 335 225 and 916 563 of the two- and one-badge entries excluded, respectively, with minimal readings in the above-apron badge. Among the two-badge entries, 123 595 were incomplete and 76 059 had readings indicating incorrect wear of the badges. From 2009 to 2015 there was no change in lens dose equivalent values among workers who wore one badge (P = .96) or those who wore two badges (P = .23). Annual lens dose equivalents for workers wearing one badge (median, 6.9 mSv; interquartile range, 3.8213.8 mSv; n = 6218) were similar to those of staff wearing two badges (median, 7.1 mSv; interquartile range, 4.6-11.2 mSv; n = 1449) (P = .18), suggesting a similar radiation environment. Conclusion These workers are among the highest exposed to elevated levels of ionizing radiation, although their occupational doses are within U.S. regulatory limits. This is a population that requires consistent and accurate dose monitoring; however, failure to return one or both badges, reversal of badges, and improper badge placement are a major hindrance to this goal. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Karellas in this issue.

Graphical abstract

Figure 1:

Flowchart of selection of badge entries used to report monthly and annual dose values. The numbers reported are the sum of all years, 2009, 2012, and 2015. The lower limit of detection (LOD) is 0.02 mSv. Entries below the dotted line are judged to provide informative data on occupational doses within the fluoroscopic suite; however, not all of these entries were included in our analysis of monthly or annual doses either because the workers were not on a monthly exchange protocol or they lacked a full year of reliable doses, respectively. H_E = effective dose equivalent.

Figure 2a:

Box-and-whisker plots show (a) annual lens dose equivalent and (b) effective dose equivalent among workers monitored with a one-badge (n = 6218) and two-badge (n = 1449) protocol. The ends of the box are the upper and lower quartiles.

Figure 2b:

Box-and-whisker plots show (a) annual lens dose equivalent and (b) effective dose equivalent among workers monitored with a one-badge (n = 6218) and two-badge (n = 1449) protocol. The ends of the box are the upper and lower quartiles.