Physician and Patient Radiation Exposure During Endovascular Procedures

Endovascular procedures expose both patients and physicians to fluoroscopic ionizing radiation that carries a dose-dependent risk of acute toxicity and a small, but demonstrable, long-term risk of malignancy due to resultant genetic mutations. Exposure doses vary widely based upon patient-related factors including body size and anatomic complexity, operator technique, procedure type (diagnostic vs. therapeutic), vascular bed imaged, and imaging equipment employed. Effective dosage may vary as much as 200-fold for physicians and 20-fold for patients depending upon the procedure: for example, complex aortic interventions with branched graft devices may convey mean effective doses of more than 0.4 mSv for physicians and 100 mSv for patients, whereas distal, small-vessel angiography may entail mean effective doses of less than 0.002 mSv for physicians and 5 mSv for patients. Particular attention is given to physicians' ocular exposure, which may cause cataract development, and to hand exposure, which is significantly higher than total body exposure when operators work near the x-ray beam. Given the risks of radiation exposure, numerous strategies have been developed to reduce both physician and patient doses. These measures include physician education about dose-reducing imaging techniques, development of low-dose imaging equipment, introduction of new radiation shielding drapes and caps, and real-time dose monitoring. Here, we review physician and patient effective doses of radiation by procedure type as reported in the literature and present recent data regarding dose-reduction strategies.