Best Practices & Benign Disease
Introduction & Objective : Ionizing radiation exposure is associated with an increased risk of developing leukemias and solid tumors. Consequently, lead-lined aprons are typically used to cover highly radiosensitive structures in the neck, chest, abdomen, and pelvis during fluoroscopy. More recently, data suggests that radiation exposure to typically unleaded areas such as eyes and hands may be harmful as well. There is, however, a paucity of data on the amount of radiation exposure experienced by urology residents. Given the high volume of cases that they assist in as part of intensive urologic training, we hypothesized that urology residents may be subjected to high levels of radiation, particularly at unleaded areas of the body.
Junior urology residents wore dosimeters during all urologic surgeries where fluoroscopy was utilized during a four-month rotation at a single institution from March 2017 to June 2017. A ring dosimeter was worn on the hand and a badge dosimeter was worn on the external surface of the lead thyroid collar to determine radiation exposure to the hand and eyes, respectively. A control dosimetry badge was worn at the waist under the lead apron. Radiation data from all three dosimetry badges were then recorded at 30-day intervals.
Results : Junior residents assisted in 109 cases requiring the use of intraoperative fluoroscopy. For the collar dosimeter, the deep-dose equivalent (DDE) was 335 mrems (mean 83.75 mrems/month, anticipated 1,005 mrems/year), the lens-dose equivalent (LDE) was 337 mrems (84.25 mrems/month, anticipated 1,011 mrems/year), and the shallow-dose equivalent (SDE) was 324 mrems (81 mrems/month, anticipated 972 mrems/year). For the ring dosimeter, the total DDE was 2,250 mrems (562.5 mrems/month, anticipated 6,750 mrem/year). Waist dosimetry badges had undetectable radiation exposure.
Conclusions : At our institution, DDE levels measured at the hands are on pace to surpass typical “As Low As Reasonably Achievable” (ALARA) recommended DDE limits of 5,000 mrems/year (416.67 mrems/month). While radiation safety recommendations suggest exposures up to 50,000 mrems annually may be tolerable at the extremities, our data indicate that residents performing routine “low-dose” procedures may still be incurring significant DDE exposure to unleaded parts of the body. As a result, further investigation into hand radiation exposure and opportunities to improve hand radiation safety for residents should be pursued. Lens exposure for residents appears well within the ALARA recommendations.