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Analysis of Radiation Exposure Learning Curve for Vascular Surgery Trainees During Fluoroscopically Guided Interventions
Antonio Solano, Andrea Klein, Michael C Siah, Gerardo Gonzalez-Guardiola, Khalil Chamseddin, Michael Shih, Mirza S Baig, Carlos H Timaran, Jeffrey Guild, Melissa L Kirkwood
University of Texas Southwestern Medical Center, Dallas, TX

BACKGROUND: The volume of fluoroscopically guided interventions (FGIs) performed by vascular surgeons has increased significantly nationwide, however appropriate and timely radiation safety training varies by institution. Vascular surgery trainees often learn radiation safety techniques concurrently with learning the art of vascular surgery. This can create an environment of higher radiation dose exposure to all team members during early training months. We sought to determine the radiation dose exposure to trainees, faculty surgeons and patients during FGIs according to level of training. METHODS: A prospective cohort study was performed to determine radiation dose to trainees, attending surgeon and patients during FGIs during a 5-month period. Optically stimulated luminescence dosimeters were placed outside the lead apron at the thyroid and sternal positions for one attending surgeon and all assisting fellows performing FGIs. Cases were stratified according to fellow training stage: first 6 months in the first year (PGY6) and final six months of the second year (PGY7). Operator radiation dose was calculated based on a calibration coefficient factor to estimate radiation at 80 kVp. Procedural reference air kerma (RAK), fluoroscopy time, dose area product (DAP) and patient BMI were recorded. Scatter fractions were measured with thyroid and sternum counts to DAP ratio, and DAP/RAK ratio (surrogate for collimation and use of magnification). Paired Wilcoxon and chi-square tests were performed to identify statistical significance of training stage on radiation dose exposure and radiation reduction performance. RESULTS: A total of 40 FGIs were performed (Table I), 21 with PGY6 fellows and 19 with PGY7 fellows. Median thyroid and sternal radiation dose was significantly higher for PGY6 fellows compared to PGY7 (Figure 1) (82 μGy [IQR 47-94] vs 44 μGy [IQR 30-57], P=0.009; 89 μGy [IQR 75-128] vs 54 μGy [IQR 48-77], P =0.007). The attending surgeon dose was similar when operating with either fellow. No differences were reported for patient BMI, RAK, fluoroscopy time, source-to-image distance (SID) or the average field size as measured by the DAP/RAK ratio between groups. Scatter fractions measured by the thyroid/DAP and sternum/DAP ratios were significantly higher for PGY6 fellows (1.97 vs 1, P = 0.018; 2.64 vs 1.23, P = 0.041). CONCLUSIONS: Vascular fellow radiation dose exposure for routine FGIs was higher during the first year. However, patient dose and attending surgeon dose was unchanged. No difference was noted in SID or DAP/RAK ratio, which was likely controlled by the attending surgeon. The increased dose for PGY6s could be attributed to lack of distancing from the source during acquisitions as seen in the increased scatter fractions. The difference noted between PGY 6 and PGY 7s is likely enhanced for vascular residents (PGY 1-5) and further underscores the importance of early and thorough education in radiation safety for all trainees.


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