title: Defining the radiation "scatter cloud" in the interventional suite.
abstract: OBJECTIVE
  We hypothesized that fluoroscopic imaging creates radiation fields that are unevenly scattered throughout the endovascular suite. We sought to quantify the radiation dose spectrum at various locations during imaging procedures and to represent this in a clinically useful manner.
  
  
  METHODS
  Digital subtraction imaging (Innova 4100; GE Healthcare, Waukesha, Wisc) of the abdomen and pelvis was performed on a cadaver in anteroposterior, left lateral, and right anterior oblique 45° projections. Radiation exposure was monitored in real time with DoseAware dosimeters (Phillips, Houston, Tex) in eight radial projections at distances of 2, 4, and 6 ft from the center of the imaged field, each at 5-ft heights from the floor. Three to five consecutive data points were collected for each location.
  
  
  RESULTS
  At most positions around the angiographic table, radiation exposure decreased as the distance from the source emitter increased; however, the intensity of the exposure varied dramatically around the axis of imaging. With anteroposterior imaging, the radiation fields have symmetric dumbbell shapes, with maximal exposure perpendicular to the table at the level of the gantry. Peak levels at 4 and 6 ft from the source emitter were 2.4 times and 3.4 times higher, respectively, than predicted based on the inverse square law. Maximal radiation exposure was measured in the typical operator position 2 ft away and perpendicular to the table (4.99 mSv/h). When the gantry was rotated 45° and 90°, the radiation fields shifted, becoming more asymmetric, with increasing radiation doses to 10.9 and 69 mSv/h, respectively, on the side of the emitter. Minimal exposure is experienced along the axis of the table, decreasing with distance from the source (<0.77 mSv/h).
  
  
  CONCLUSIONS
  Quantifiable and reproducible radiation scatter is created during interventional procedures. Radiation doses vary widely around the perimeter of the angiography table and change according to imaging angles. These data are easily visualized using contour plots and scatter three-dimensional mesh plots. Rather than the concentric circles predicted by the inverse square law, these data more closely resemble a "scatter cloud." Knowledge of the actual exposure levels within the endovascular environment may help in mitigating these risks to health care providers.
authors.affiliation: Department of Vascular Surgery, The Cardiovascular Center, Tufts Medical Center, Boston, Mass. Electronic address: omar.haqqani@midmichigan.org.
authors.forename: Omar P
authors.initials: OP
authors.lastname: Haqqani
authors.forename: Prakhar K
authors.initials: PK
authors.lastname: Agarwal
authors.forename: Neil M
authors.initials: NM
authors.lastname: Halin
authors.forename: Mark D
authors.initials: MD
authors.lastname: Iafrati
mesh_terms: D015901:Angiography, Digital Subtraction / Q000009:adverse effects; D002102:Cadaver; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control; D016272:Occupational Health; D056888:Patient Positioning; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011834:Radiation Monitoring / Q000379:methods; D011835:Radiation Protection; D015641:Radiography, Interventional / Q000009:adverse effects; D012542:Scattering, Radiation