title: Surgeon and staff radiation exposure during radioguided parathyroidectomy at a high-volume institution.
abstract: BACKGROUND
  Radioguided parathyroidectomy (RGP) uses technetium-99 m sestamibi causing gamma ray emission during RGP to aid dissection and confirm parathyroid excision. Source (the patient) proximity and exposure duration determine degree of exposure. The purpose of this study was to quantify surgeon and staff radiation exposure during RGP.
  
  
  METHODS
  Surgeons and assistants wore radiation dosimeters during RGP procedures at a high-volume endocrine surgery practice. Area dosimeters measured personnel potential exposure. Data were prospectively collected. Provider exposures were corrected for both duration of exposure and case volume. Institutional safety requirements uses 100 mrem/year as an indicator for radiation safety training, 500 mrem/year for personal monitoring, and a maximum allowed exposure of 4,500 mrem/year.
  
  
  RESULTS
  A total of 120 RGP were performed over 6 months. Badges were worn in 82 cases (68 %). Three faculty and four assistants were included. Primary hyperparathyroidism was the diagnosis for 95 %. Median case volume per provider was 13 cases (range 6-45), with median exposure of 18 h (range 9-70). Mean provider deep dose exposure (DDE) was 22 ± 10 mrem. Corrected for exposure duration, mean DDE was 0.6 ± 0.2 mrem/h. Corrected for case volume, mean DDE was 0.8 ± 0.2 mrem/case. Anesthesia exposure was minimal, while mayo stand exposure was half to two thirds that of the surgeon and assistant. Based on institutional guidelines and above data, 125 RGP/year warrants safety training, 625 RGP/year warrants monitoring, whereas >5,600 RGP/year may result in maximum allowed radiation exposure to the surgeon.
  
  
  CONCLUSIONS
  Surgeon and staff radiation exposure during RGP is minimal. However, high-volume centers warrant safety training.
authors.affiliation: Section on Endocrine Surgery, Department of Surgery, University of Wisconsin, 600 Highland Ave., K4/739 Clinical Science Center, Madison, WI, 53792-7375, USA, oltmann@surgery.wisc.edu.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Brekke
authors.forename: Jose D
authors.initials: JD
authors.lastname: Macatangay
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D016273:Occupational Exposure / Q000032:analysis*; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy; D011379:Prognosis; D011446:Prospective Studies; D011829:Radiation Dosage; D011874:Radiometry; D011877:Radionuclide Imaging; D018570:Risk Assessment; D066231:Surgeons; D025321:Surgery, Computer-Assisted; D017256:Technetium Tc 99m Sestamibi
chemical_list: D017256:Technetium Tc 99m Sestamibi