School of Chemistry and Physics, Faculty of Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.
Cardiovascular Suites, Greenslopes Private Hospital, Ramsay Health Care, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, Australia.
Phys Eng Sci Med. 2023 Mar;46(1):353-365. doi: 10.1007/s13246-023-01226-7. Epub 2023 Mar 6.
X-ray guided procedures are being performed by an increasing variety of medical specialties. Due to improvements in vascular transcatheter therapies, there is an increasing overlap of imaged anatomy between medical specialties. There is concern that non-radiology fluoroscopic operators may not have sufficient training to be well informed of the potential implications of radiation exposure and mitigation strategies to reduce dose. This was a prospective, observational, single center study to compare occupational and patient dose levels when imaging different anatomical regions during fluoroscopically guided cardiac and endovascular procedures. Occupational radiation dose was measured at the level of the temple of 24 cardiologists and 3 vascular surgeons (n = 1369), 32 scrub nurses (n = 1307) and 35 circulating nurses (n = 885). The patient dose was recorded for procedures (n = 1792) performed in three angiography suites. Abdominal imaging during endovascular aneurysm repair (EVAR) procedures was associated with a comparatively high average patient, operator and scrub nurse dose despite additional table-mounted lead shields. Air kerma was relatively high for procedures performed in the chest, and chest + pelvis. Higher dose area product and staff eye dose were recorded during procedures of the chest + pelvis due to the use of digital subtraction angiography to evaluate access route prior to/during transaortic valve implantation. Scrub nurses were exposed to higher average radiation levels than the operator during some procedures. Staff should be cognizant of the potentially higher radiation burden to patients and exposed personnel during EVAR procedures and cardiac procedures using digital subtraction angiography.
X 射线引导的程序正由越来越多的医学专业执行。由于血管经导管治疗的改进，不同医学专业之间的影像学解剖重叠越来越多。人们担心非放射科透视操作人员可能没有足够的培训，无法充分了解辐射暴露的潜在影响和减少剂量的缓解策略。这是一项前瞻性、观察性、单中心研究，旨在比较在心血管和血管内介入程序中透视引导的心脏和血管内成像不同解剖区域时的职业和患者剂量水平。在 24 名心脏病专家和 3 名血管外科医生（n=1369）、32 名刷手护士（n=1307）和 35 名巡回护士（n=885）的太阳穴处测量职业辐射剂量。记录了在三个血管造影室进行的 1792 次手术中的患者剂量。尽管额外使用了桌子安装的铅屏蔽，但在血管内动脉瘤修复（EVAR）手术中进行腹部成像时，患者、操作人员和刷手护士的平均剂量相对较高。在胸部和胸部+骨盆进行的手术中，空气比释动能相对较高。由于在经主动脉瓣植入术之前/期间使用数字减影血管造影术评估进入途径，因此在胸部+骨盆手术中记录了更高的剂量面积乘积和工作人员眼部剂量。在某些手术中，刷手护士比操作人员的平均辐射水平更高。在 EVAR 手术和使用数字减影血管造影术的心脏手术中，工作人员应意识到患者和暴露人员可能会受到更高的辐射负担。
