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Evaluating Strategies for Reducing Scattered Radiation in Fixed-Imaging Operating Suites
Claire Miller, MS, Daniel Kendrick, MD, Andrew Shevitz, BS, Ann Kim, MD, Henry Baele, MD, David Jordan, PhD, Vikram Kashyap, MD.
University Hospitals - Case Medical Center, Cleveland, OH, USA.
OBJECTIVES:
High resolution fixed C-arm fluoroscopic systems allow for high quality endovascular imaging, but come at a cost of greater scatter radiation generation, and increased occupational exposure for surgeons. The purpose of this study is to evaluate the efficacy of two methods - a personal, real-time dose monitoring system and a dose reduction software algorithm - in reducing scattered radiation exposure.
METHODS:
A series of 158 cases were performed at a single institution over 16-months. Phase 1: Baseline radiation exposure was calculated. Phase 2: Staff used real-time radiation dose monitoring (dosimetry badges, Unfors RaySafe™). Phase 3: A software imaging algorithm was installed that reduces radiation (Philips EcoDose Software ™). All cases were performed in a fixed-imaging hybrid operating suite. Mean room dose and surgeon exposure (mSv) were compared during cases of varying complexity using unpaired t-test.
RESULTS:
A total of 68 baseline cases, 34 cases in phase 2 and 56 cases in phase 3 were performed. Total mean surgeon dose varied across all case categories, with 46% and 32% dose reduction trends seen with real time exposure feedback during EVAR and upper extremity access cases respectively (Mean ±SD; 0.23 ±0.29mSv vs. 0.13 ±0.10mSv; 0.12 ±0.13mSv vs. 0.08 ±0.08mSv, p=NS). These cases involved the highest surgeon exposure at baseline. With the EcoDose software, reduction trends were seen in surgeon dose during CAS, EVAR and diagnostic lower extremity angiograms (Mean ±SD; 0.02 ±0.02mSv vs. 0.01 ±0.01mSv; 0.23 ±0.29mSv vs. 0.14 ±0.13mSv; 0.03 ±0.03mSv vs. 0.02 ±0.02mSv, p=NS). Total mean room dose was reduced in phase 3 when compared to baseline, (Figure 1) with diagnostic lower extremity angiograms showing significance (Mean ±SD; 0.70 ±0.47mSv vs. 0.44 ±0.30mSv, p=.053).
CONCLUSIONS:
Dose reduction software may be an effective technique to lower radiation exposure. However, real-time feedback of radiation exposure provides a negligible reduction because clinical needs supersede operative behavior changes. Implementation of strategies to reduce radiation is needed to reduce lifetime occupational radiation exposure for endovascular staff.
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