Radiation exposure of dogs and cats undergoing fluoroscopic procedures and for operators performing those procedures

Abstract

OBJECTIVE To evaluate radiation exposure of dogs and cats undergoing procedures requiring intraoperative fluoroscopy and for operators performing those procedures. SAMPLE 360 fluoroscopic procedures performed at 2 academic institutions between 2012 and 2015. PROCEDURES Fluoroscopic procedures were classified as vascular, urinary, respiratory, cardiac, gastrointestinal, and orthopedic. Fluoroscopy operators were classified as interventional radiology-trained clinicians, orthopedic surgeons, soft tissue surgeons, internists, and cardiologists. Total radiation exposure in milligrays and total fluoroscopy time in minutes were obtained from dose reports for 4 C-arm units. Kruskal-Wallis equality of populations rank tests and Dunn pairwise comparisons were used to compare differences in time and exposure among procedures and operators. RESULTS Fluoroscopy time (median, 35.80 minutes; range, 0.60 to 84.70 minutes) was significantly greater and radiation exposure (median, 137.00 mGy; range, 3.00 to 617.51 mGy) was significantly higher for vascular procedures than for other procedures. Median total radiation exposure was significantly higher for procedures performed by interventional radiology-trained clinicians (16.10 mGy; range, 0.44 to 617.50 mGy), cardiologists (25.82 mGy; range, 0.33 to 287.45 mGy), and internists (25.24 mGy; range, 3.58 to 185.79 mGy). CONCLUSIONS AND CLINICAL RELEVANCE Vascular fluoroscopic procedures were associated with significantly longer fluoroscopy time and higher radiation exposure than were other evaluated fluoroscopic procedures. Future studies should focus on quantitative radiation monitoring for patients and operators, importance of operator training, intraoperative safety measures, and protocols for postoperative monitoring of patients.

Radiation exposure associated with percutaneous fluoroscopically guided lag screw fixation for sacroiliac luxation in dogs

“…Fluoroscopy unit dose for the 37 orthopedic cases, of which three were SIL, was reported to yielded a mean of 2.27 mGy (range, 0.14–74.33), which is similar but has a much wider range compared with the present study of 17 SIL cases with a mean of 2.36 ± 1.39 mGy (range, 0.38–4.7). The previous report 21 described median fluoroscopic screening time (1.71 minutes), while, in the present study, we used only still shot mode and reported a mean of 37.63 shots, which makes comparing these results difficult. Over the course of 17 cases and 639 acquired images, only the assistant had detectable exposure on the wrist of their dominant arm, with a cumulative dose of 0.4 mrem.…”

“…The six cases that did not require reduction required acquisition of fewer fluoroscopic images and took less time to complete, thus skewing the results of this study. Fluoroscopic use was limited to still shots rather than cine mode, as has been described in other reports 21,26 . Use of cine mode may have decreased cadaver positioning and surgical durations, but at the cost of increased radiation exposure.…”

“…Researchers evaluating the use of MIO for SIL in cats using a cannulated screw system reported a mean fluoroscopic screening time of 44 ± 6 seconds per procedure 26 . Hersh‐Boyle and colleagues 21 documented patient radiation exposure for a variety of orthopedic and interventional procedures in dogs and cats using C‐arm dose reports, but no report has documented direct exposure levels for veterinary surgical personnel. In small animals, radiation dose was reported to be lower for orthopedic procedures than for any other procedure type evaluated.…”

“…Because the use of intraoperative imaging is becoming more commonplace in small animal orthopedics, it is important to understand the relative risks associated with fluoroscopically assisted procedures for operating room personnel. Hersh‐Boyle and colleagues 21 documented radiation exposure to dogs and cats undergoing orthopedic and interventional procedures, but, to the best of the authors' knowledge, no published report has documented direct exposure levels for veterinary surgical personnel during MIO.…”

ICRP Publication 153: Radiological Protection in Veterinary Practice

“…While several of the above studies state that estimated annual doses will be well below regulatory limits for a given caseload, other studies of occupational doses in veterinary medicine have found that personnel doses may approach annual dose limits recommended by ICRP (Table 4.1) (Hernández-Ruiz et al., 2012; Canato et al., 2014). (128) Recently, dosimetric data have been published for veterinary interventional radiology and intra-operative fluoroscopically guided surgery, where there is close proximity between personnel and animal patients during exposure, often for extended periods (Sung et al., 2018; An et al., 2019; Hersh-Boyle et al., 2019). Reported operator dose levels may approach or even exceed regulatory limits, which emphasises the need for both quantitative radiation monitoring and the use of appropriate protective measures during these procedures. (129) With regards to dose to the animal patient, few dosimetric studies have been published.…”