title: Occupational radiation exposure during endovascular aortic procedures.
abstract: OBJECTIVE
  To measure the radiation exposure of the operating team during endovascular aortic procedures, and to determine factors that predict high exposures.
  
  
  METHODS
  Electronic dosimeters placed over and under protective lead garments, were used to prospectively record radiation exposure during endovascular aortic repairs performed in a designated interventional radiology suite. Univariate and multivariate linear regression analyses of predictors of radiation exposure were performed.
  
  
  RESULTS
  A total of 26 infra-renal and 10 thoracic endovascular cases were studied. Median (IQR) patient age and body mass index were 76.0 (70.0-81.8) years and 26.2 (23.9-28.9) kg/m(2) respectively. Over-lead exposure to the operator was higher for thoracic than for infra-renal procedures (421.0 [233.8-597.8] μSv vs. 52.5 [27.8-179.8] μSv, p = .0003), reflecting a significant exposure to unprotected parts of the body. Under-lead exposures for operator and assistant were 5.5 (2.0-14.2) μSv and 1.0 (0.0-2.3) μSv respectively, which for an average caseload would comply with total body effective dose limits. Type of case and percentage of digital subtraction angiography (DSA) time in left anterior oblique angulations predicted dose to the operator (p < .0001).
  
  
  CONCLUSIONS
  Thoracic procedures, DSA runs and obliquity of the C-arm are strong predictors of radiation exposure during endovascular aortic repairs. Understanding scatter radiation dynamics and instigating measures to minimise radiation exposure should be mandatory.
authors.affiliation: Vascular Unit, Guy's & St Thomas' NHS Foundation Trust and King's College London, Cardiovascular Clinical Academic Group, King's Health Partners, United Kingdom.
authors.forename: A P
authors.initials: AP
authors.lastname: Patel
authors.forename: D
authors.initials: D
authors.lastname: Gallacher
authors.forename: R
authors.initials: R
authors.lastname: Dourado
authors.forename: O
authors.initials: O
authors.lastname: Lyons
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: H
authors.initials: H
authors.lastname: Zayed
authors.forename: M
authors.initials: M
authors.lastname: Waltham
authors.forename: T
authors.initials: T
authors.lastname: Sabharwal
authors.forename: R
authors.initials: R
authors.lastname: Bell
authors.forename: T
authors.initials: T
authors.lastname: Carrell
authors.forename: P
authors.initials: P
authors.lastname: Taylor
authors.forename: B
authors.initials: B
authors.lastname: Modarai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000009:adverse effects; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects*; D004867:Equipment Design; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000009:adverse effects* / Q000517:prevention & control; D016272:Occupational Health; D011446:Prospective Studies; D011481:Protective Clothing; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011834:Radiation Monitoring; D011835:Radiation Protection / Q000295:instrumentation; D015641:Radiography, Interventional / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D012542:Scattering, Radiation
keywords: Aortic repair; Dosimetry; Endovascular; Occupational radiation exposure