title: Effects of chronic low-dose exposure to ionizing radiation on physician microvascular structure revealed by nail fold capillaroscopy.
abstract: The aim of this study was to assess the long-term asymptomatic effects of low-dose radiation on microvascular structure among interventional physicians, whose hands are exposed to ionizing radiation during daily practice. The study, approved by the national ethics committee, included 186 radiation-exposed (surgeons, cardiologists, radiologists) and 35 unexposed physicians, all of whom had provided written consent. The subjects completed a questionnaire describing their current and past daily practice, from which tentative estimates of current and cumulative radiation exposure estimates were computed. Subject dermal microcirculation state was assessed by capillaroscopy of the nail fold of eight fingers (thumbs excluded) based on photographs. Two quantitative scores characterizing extravasation and morphological abnormalities based on seven semiquantitative indices were obtained from post hoc coding of the photographs by five capillaroscopists. These evaluations were randomized and blind to the exposure. The effect of the radiation exposure on both abnormality scores was modelled using multilevel proportional odds regression adjusted for potential confounders. The proportion of physicians for which the most frequent act is close to the radiation source was highest among surgeons, but with fewer weekly acts. The median duration of exposure was highest among radiologists and cardiologists. No exposure effect could be detected on the extravasation score. The morphological anomaly score increased significantly with duration of exposure and estimated cumulative exposure among surgeons and interventional radiologists, unlike cardiologists among whom no effect could be detected. It is concluded that the shown effects of chronic low-dose exposure to ionizing radiation on physician microvascular structure reveal the importance of increased exposure monitoring and prevention.
authors.affiliation: INRS Scientific Management, rue du Morvan, CS 60027, 54519, Vandoeuvre Les Nancy Cedex, France. pascal.wild@inrs.fr.
authors.forename: Pascal
authors.identifier: http://orcid.org/0000-0003-3165-3808
authors.initials: P
authors.lastname: Wild
authors.affiliation: INRS Medical Assistance and Studies, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Gauron
authors.affiliation: Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Champion
authors.affiliation: Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Cohen
authors.affiliation: University Hospital, Grenoble, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Menez
authors.affiliation: University Hospital, Lille, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Tellart
authors.affiliation: University Hospital, Clermont-Ferrand, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Thiel
authors.affiliation: Department of Epidemiology, INRS, Vandoeuvre, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Grzebyk
authors.affiliation: Naples University Federico II, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pennarola
authors.affiliation: Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Choudat
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D055806:Microvessels / Q000528:radiation effects*; D008875:Middle Aged; D016273:Occupational Exposure / Q000032:analysis*; D010820:Physicians; D012189:Retrospective Studies; D013997:Time Factors
keywords: Epidemiology; Interventional radiologists; Vascular structure