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Contemporary Trends in Radiation Exposure during Vascular Surgery Fellowship Training: a Ten Year Review
Stephen A. Tonks, MD, Junior Univers, MD, Robert E. Heidel, PhD, Joshua D. Arnold, MD, Michael B. Freeman, MD, Oscar H. Grandas, MD, Scott L. Stevens, MD, Mitchell H. Goldman, MD, Michael M. McNally, MD.
UTMCK, Knoxville, TN, USA.
OBJECTIVES:
Vascular Surgery fellowship training is a two year surgical training period with an increasing amount of endovascular procedures and assumed radiation exposure. Currently, there is a paucity in the literature reporting radiation exposure in vascular surgery trainees. The objective of this study is to examine radiation exposure in vascular surgery fellows over the last ten years.
METHODS:
A retrospective analysis was performed reviewing demographics and ACGME endovascular case logs for all vascular surgery fellowship graduates from a single institution between 2005 and 2015. Clinical endpoints included radiation exposure, specifically deep dose equivalent (DDE), shallow dose equivalent (SDE) and lens dose equivalent (LDE). Based on demographics, a subanalysis was performed grouping fellowship graduates into TALL (n=5) or SHORT (n=5) groups (180 cm division) and analyzed with Mann-Whitney U tests to evaluate differences. P <0.05 was significant.
RESULTS:
A total of ten vascular surgery fellowship graduates ACGME endovascular case logs (defined categories Endovascular Diagnostic, Endovascular Therapeutic and Endovascular Aneurysm Repair) were compared with cumulative radiation exposure during their two year fellowship. Despite a trend in increased endovascular therapeutic interventions and total number of endovascular procedures, there was no correlation with radiation exposure. Analysis of the specific demographic of vascular fellow height demonstrated the SHORT group of vascular surgery trainees had significantly higher radiation exposure across all radiation exposure endpoints: DDE (3698 vs 2042 mrem, p=0.03), SDE (12,279 vs 6224 mrem, p=0.02) and LDE (12,228 vs 6294 mrem, p=0.02).
CONCLUSIONS:
Despite increased numbers of endovascular therapies and endovascular case numbers, there was not an increase in radiation exposure recorded among vascular surgery fellow trainees. Shorter vascular surgery trainees were exposed to disproportionately higher amounts of radiation compared with their taller counterparts. Further investigation and directed radiation exposure prevention techniques are warranted in this higher risk group of trainees.
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