Radioprotection Measures during the Learning Curve with Hybrid Operating Rooms

Background: Endovascular procedures come with a potential risk of radiation hazards both to patients and to the vascular staff. Classically, most endovascular interventions took place in regular operating rooms (ORs) using a fluoroscopy C-arm unit controlled by a third party. Hybrid operating rooms (HORs) provide an optimal surgical suit with all the qualities of a fixed C-arm device, while allowing the device to be controlled by the surgical team. The latest studies suggest that an operator-controlled system may reduce the radiation dose. The purpose of the present study is to determine the amount of absorbed radiation using an HOR in comparison with a portable C-arm unit and to assess whether the radioprotection awareness of the surgical team influences the radiation exposure. The primary end point was the effective dose in milliSievert (mSv) for the surgical team and the average dose-area product (ADAP) in Gray-meters squared (Gym 2) for patients. Methods: The values of absorbed radiation of the surgical team's dosimeters were collected from January 2015 to May 2016. The HOR was installed in June 2015, and a radioprotection seminar was given in October 2015. The HOR-issued radiation, measured by the maximum dose-area product, ADAP, average dose (AD) per procedure, maximum dose per procedure per month, maximum fluoroscopy time, average fluoroscopic time, peak skin dose, and average skin dose (ASD), was collected monthly from September 2015 to July 2016. The timeline was divided into 3 periods: 5 months pre-HOR (Pre-HOR), 5 months after the HOR installation (PreS-HOR), and 5 months after a radioprotection seminar (PostS-HOR). Results: The average number of procedures per month was 22.55 (+/- 4.9), including endovascular aneurysm repair/thoracic endovascular aneurysm repair, carotid, visceral, and upper and lower limb endovascular revascularization. The average amount of absorbed radiation by the surgeons during PreS-HOR was 1.07 +/- 0.4 mSv, which was higher than the other periods (Pre-HOR 0.06 +/- 0.03 mSv, P = 0.002; PostS-HOR 0.14 +/- 0.09 mSv, P = 0.000, respectively). The ADAP during PreS-HOR was 0.016 +/- 0.01 Gym(2), which was lower than the PostS-HOR (0.001 +/- 0.002 Gym(2)) (P = 0.034). The AD during PreS-HOR was 0.78 +/- 0.3 Gy and 0.39 +/- 0.3 Gy during PostS-HOR (P = 0.098). The ASD during PreS-HOR was 0.40 +/- 0.2 Gy and 0.20 +/- 0.1 Gy during PostS-HOR (P = 0.099). Conclusions: In our experience, the HOR increases the amount of absorbed radiation for both patients and surgeons. The radioprotection seminars are of utmost importance to provide a continued training and optimize the use of ionizing radiation while using an HOR. Despite the awareness of the surgical team in the radioprotection field, the amount of absorbed radiation using an HOR is higher than the one using a C-Arm unit.