The use of radiation protective surgical gloves reduces hand radiation exposure without increasing operator radiation dose during fluoroscopically guided interventions.

Abstract

Although it is contraindicated for physicians performing fluoroscopically guided interventions (FGIs) to position their hand directly in the beam, it can be unavoidable and results in greater operator exposure and risk. Clinical guidelines recommend against the use of radiation-protective gloves (PGs) during FGIs given the concern for higher radiation accumulation related to increased procedure scatter fraction (PSF). We describe hand radiation dose and procedural scatter during FGIs with regular surgical gloves (RGs) compared to lead-free PGs. Our primary end point was to evaluate hand radiation dose attenuation of tungsten PG and their effect on operator PSF. In the clinical setting, optically stimulated luminescence detectors were placed bilaterally at the volar and dorsal aspects of the operator's hands at the radioulnar joint and base of the ring finger. Control dots were positioned on the sternum. All operators were trained in applying as low as reasonably achievable principles. In the simulation, fluorography was performed on a 25 × 50 cm, 15-cm thick acrylic phantom for an exposure of 250 mGy reference air kerma. An anthropomorphic hand was placed at 7.5-cm intervals along the length of the table from the point of the fingertips at the center of the x-ray beam, 0 to 30 cm caudally. Radiation dose was calculated based on a calibration coefficient factor to estimate radiation at 80 kVp. The PSF was estimated by normalizing the sternum dose measurement with the dose area product. Wrist and finger radiation doses were normalized by dividing by the sternum dose to control for case length and procedure factors. A paired Wilcoxon test was performed to identify statistically significant differences of normalized PSF, finger, and wrist dose with RG vs PG. A total of 50 FGIs were performed: 25 with RGs and 25 with PGs. The median procedure reference air kerma was 98 mGy (interquartile range [IQR], 26-137 mGy) with RGs and 63 mGy (IQR, 38-134 mGy) with PGs. The hand radiation dose was lower for both dominant and nondominant hands with the PGs (270 μGy [IQR, 200-520 μGy] vs 590 μGy [IQR, 300-830 μGy], P = .015; and 260 μGy [IQR, 180-240 μGy] vs 660 μGy [IQR, 410-870 μGy]; P < .001) vs RGs. There was no significant increase in PSF with PGs vs RGs (4.46 [IQR, 3.15-5.67] vs 8.21 [IQR, 7.09-12.19]; P = .777). In the simulated setting, hand radiation dose was 58% lower with PG vs RG at all distances (8600 μGy vs 21,000 μGy; P < .001), with no significant differences in PSF for PGs vs RGs. Operator hands are directly in the x-ray beam more than recognized, leading to an increased lifetime risk. PGs can be expensive and cumbersome, but are effective at decreasing hand radiation exposure without increasing operator radiation dose. They should be considered for use in procedures where hand proximity to the beam is likely.