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

Rebecca A. Hersh-Boyle 1Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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William T. N. Culp 1Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Dorothy C. Brown 3Martingale Consulting LLC, 2420 Martingale Rd, Media, PA 19063.

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Austin C. Luskin 4Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Amy S. Kapatkin 1Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Po-Yen Chou 1Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Kimberly A. Agnello 4Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Jennifer A. Reetz 4Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Mark A. Oyama 4Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Lance C. Visser 2Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Carrie A. Palm 2Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Dana L. Clarke 4Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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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.

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.

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