VESS15 - Real-time Dosimetry Measurements Reduce Surgeon Radiation Exposure during Endovascular Procedures

Objectives: The objective of this study was to evaluate the impact of real-time radiation dosimetry on operator radiation exposure during endovascular procedures. We hypothesized that surgeons’ awareness of radiation dose in real-time would result in reduced radiation exposure.

Methods: In this single arm, pre-post intervention study, 5 surgeons underwent continuous real-time intraoperative radiation dosimetry measurement using the Raysafe (Fluke Biomedical, Everett, WA) system. Only cases performed in an image-guided hybrid OR were included. Routine radiation mitigation strategies were employed throughout the study period. During the first (control) month, surgeons were blinded to their real-time dosimeter readings. During the second month, real-time surgeon dosimeter readings were visible during elective endovascular cases, including: 1) infrarenal EVAR; 2) TEVAR and complex EVAR/TAAA; 3) lower extremity intervention; and 4) renal/visceral intervention. If multiple surgeons were involved, radiation data from the primary surgeon and fellow were utilized. To account for variation in case complexity and radiation use, surgeon dose was normalized to patient dose in every case.

Results: A total of 70 data points for 51 elective endovascular cases performed during the study period were included in the analysis. Awareness of real-time radiation dose did not impact patient radiation dose. Across the four procedure categories, surgeon radiation dose decreased when real-time dosimetry data were visible. This finding persisted after normalizing for patient radiation dose (Table 1). The reduction in normalized surgeon dose was statistically significant in routine EVAR (p=0.02) and lower extremity interventions (p=0.02). Participating surgeons completed a brief survey instrument at the study’s completion; 4/5 “strongly agreed” and 1/5 “agreed” that awareness of radiation exposure in real-time resulted in behavior modification to mitigate their radiation dose.

Conclusions: Awareness of real-time intraoperative radiation dosimetry data resulted in reduced surgeon radiation exposure during endovascular procedures, irrespective of patient dose. Real-time dosimetry appears to result in behavior modification and improved adherence to best-practices for radiation safety during endovascular surgery. Real-time dosimetry appears to be a useful adjunct for mitigating radiation exposure of endovascular operators and staff and warrants further study.