Radiation Awareness for EVAR in Hybrid Operating Room: An Instant Operator Risk Chart

In plain language

In 50 endovascular aneurysm repair (EVAR) procedures in one hybrid OR, operator dose rates rose disproportionately with C-arm rotation and roughly 2.5-3 fold with brachial versus femoral access. These are over-apron dosimeter readings, not health outcomes.

At a glance

Type of study: Original research, Dosimetry measurement study
Who was studied: Vascular surgeons, Patients
Size: n = 12,865 X-ray acquisitions (from 50 patients)
Topics: Dosimetry and monitoring Dose reduction techniques Patient dose Training and education
Summary based on: the full text

What it found

Switching from femoral to brachial access markedly increased operator dose rate, far more than patient dose rate.
Key figures: Odds ratio (OR) 2.5 [2.32-2.67] for operator vs 1.05 for patient (fluoroscopy)
C-arm rotation increased operator dose rate disproportionately compared with patient dose rate.
Key figures: 69% (fluoroscopy) and 85% (DSA) per 30° vs 24% and 37% for patient
Predicted time to reach 20 mSv annual limit during 2 fps DSA was much shorter from brachial than femoral access.
Key figures: 941 minutes femoral vs 358 minutes brachial
DSA acquisitions gave much higher operator dose rates than fluoroscopy.
Key figures: median 0.833 mSv/h DSA vs 0.119 mSv/h fluoroscopy
Replacing 2 fps DSA with a fluoroscopy roadmap reduced operator dose rate.
Key figures: effect size 0.45 (55% reduction)

Limits to keep in mind

Single hybrid OR, 50 patients, two operators with a single over-apron chest dosimeter (no eye lens dose, positions and shield placement not recorded); low-dose runs below detector range were excluded, and operator models explained limited variance (r2 0.38-0.48).

Surgeon Education Decreases Radiation Dose In Complex Endovascular Procedures And Improves Patient Safety (2013, Retrospective cohort study)
ICRP Publication 117. Radiological Protection In Fluoroscopically Guided Procedures Performed Outside The Imaging Department (2010, Guideline or consensus statement)
ICRP Draft - Radiological Protection in Fluoroscopically Guided Procedures (Guideline or consensus statement)
AAPM Medical Physics Practice Guideline 12.a - Fluoroscopy Dose Management (2022, Guideline or consensus statement)
IU Health Handbook of Fluoroscopy Safety (Guideline or consensus statement)

How this summary was made

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Prepared November 3, 2026.