Surgeon and Staff Radiation Exposure During Radioguided Parathyroidectomy at a High-Volume Institution
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Radioguided parathyroidectomy (RGP) uses technetium-99 m sestamibi causing gamma ray emission during RGP to aid dissection and confirm parathyroid excision. Source (the patient) proximity and exposure duration determine degree of exposure. The purpose of this study was to quantify surgeon and staff radiation exposure during RGP.
Surgeons and assistants wore radiation dosimeters during RGP procedures at a high-volume endocrine surgery practice. Area dosimeters measured personnel potential exposure. Data were prospectively collected. Provider exposures were corrected for both duration of exposure and case volume. Institutional safety requirements uses 100 mrem/year as an indicator for radiation safety training, 500 mrem/year for personal monitoring, and a maximum allowed exposure of 4,500 mrem/year.
A total of 120 RGP were performed over 6 months. Badges were worn in 82 cases (68 %). Three faculty and four assistants were included. Primary hyperparathyroidism was the diagnosis for 95 %. Median case volume per provider was 13 cases (range 6–45), with median exposure of 18 h (range 9–70). Mean provider deep dose exposure (DDE) was 22 ± 10 mrem. Corrected for exposure duration, mean DDE was 0.6 ± 0.2 mrem/h. Corrected for case volume, mean DDE was 0.8 ± 0.2 mrem/case. Anesthesia exposure was minimal, while mayo stand exposure was half to two thirds that of the surgeon and assistant. Based on institutional guidelines and above data, 125 RGP/year warrants safety training, 625 RGP/year warrants monitoring, whereas >5,600 RGP/year may result in maximum allowed radiation exposure to the surgeon.
Surgeon and staff radiation exposure during RGP is minimal. However, high-volume centers warrant safety training.
- Murray SE, Pathak PR, Pontes DS, et al. Timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism. Surgery. 2013;154(6):1463–9. CrossRef
- Wang TS, Pasieka JL, Carty SE (2014). Techniques of parathyroid exploration at North American endocrine surgery fellowship programs: what the next generation is being taught. Am J Surg, 207(4), 527–32. CrossRef
- Nagar S, Reid D, Czako P, Long G, Shanley C (2012). Outcomes analysis of intraoperative adjuncts during minimally invasive parathyroidectomy for primary hyperparathyroidism. Am J Surg. 2012;203(2):177–81. CrossRef
- Chen H, Mack E, Starling JR. A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg. 2005;242(3):375–80; discussion 380–3.
- Oltmann SC, Chen H. Minimally invasive radioguided parathyroidectomy. Curr Surg Rep. 2013;1(1):1–6. CrossRef
- Murphy C, Norman J. The 20% rule: a simple, instantaneous radioactivity measurement defines cure and allows elimination of frozen sections and hormone assays during parathyroidectomy. Surgery. 1999;126(6):1023–9. CrossRef
- Noureldine SI, Abbas A, Tufano RP, et al. The impact of surgical volume on racial disparity in thyroid and parathyroid surgery. Ann Surg Oncol. Mar 17 2014.
- Saunders BD, Wainess RM, Dimick JB, Doherty GM, Upchurch GR, Gauger PG. Who performs endocrine operations in the United States? Surgery. 2003;134(6):924–31; discussion 931. CrossRef
- Nottmeier EW, Pirris SM, Edwards S, Kimes S, Bowman C, Nelson KL (2013). Operating room radiation exposure in cone beam computed tomography-based, image-guided spinal surgery: clinical article. J Neurosurg Spine. 2013;19(2):226–31. CrossRef
- Wenner DE, Whitwam P, Turner D, Kennedy K, Hashmi S (2005). Actual time required for dynamic fluoroscopic intraoperative cholangiography. JSLS. 2005;9(2):174–7.
- Bartal G, Vano E, Paulo G, Miller DL (2014). Management of patient and staff radiation dose in interventional radiology: current concepts. Cardiovasc Interv Radiol. 2014;37:289–98.
- Jorgensen JE, Rubenstein JH, Goodsitt MM, Elta GH (2010). Radiation doses to ERCP patients are significantly lower with experienced endoscopists. Gastrointest Endosc. 2010;72(1):58–65. CrossRef
- Bronsard N, Boli T, Challali M, et al. (2013). Comparison between percutaneous and traditional fixation of lumbar spine fracture: intraoperative radiation exposure levels and outcomes. Orthop Traumatol Surg Res. 2013;99(2):162–8. CrossRef
- Ullery BW, Landau B, Wang GJ, Faifrman RM, Woo EY (2014). Radiation dose to the interventionalist is directly affected by the operating position. Vascular. 2014;22:149–53.
- Mohapatra A, Greenberg RK, Mastracci TM, Eagleton MJ, Thornsberry B. Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg. 2013;58(3):702–9. CrossRef
- U.S. Nuclear Regulatory Commission Regulations: Title 10, Code of Federal Regulations, Part 20, Standards for protection against radiation. http://www.nrc.gov/reading-rm/doc-collections/cfr/part020/. Accessed 14 Jan 2014.
- Kristoffersen US, Straalman K, Schmidt G, et al. Radiation exposure to surgical staff during hyperthermic isolated limb perfusion with 99 m Technetium labeled red blood cells. Int J Hypertherm 2009;25(1):86–9. CrossRef
- Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33. CrossRef
- McGhan LJ, McKeever SC, Pockaj BA, et al. Radioactive seed localization for nonpalpable breast lesions: review of 1,000 consecutive procedures at a single institution. Ann Surg Oncol. 2011;18(11):3096–101. CrossRef
- Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Ann Surg Oncol. 2012;19(11):3313–24. CrossRef
- Nejc D, Wrzesien M, Piekarski J, et al. Sentinel node biopsy in patients with breast cancer–evaluation of exposure to radiation of medical staff. Eur J Surg Oncol. 2006;32(2):133–8. CrossRef
- Nejc D, Wrzesien M, Piekarski J, et al. Sentinel node biopsy in skin melanoma patients–measurements of absorbed doses of radiation to the hands of medical staff. J Surg Oncol. 2006;93(5):355–61. CrossRef
- Bekis R, Celik P, Uysal B, et al. Exposure of surgical staff in surgical probe applications in radioguided parathyroidectomy. Eur Arch Otorhinolaryngol. 2008;265(12):1545–8. CrossRef
- Norman J, Chheda H. Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery. 1997;122(6):998–1003; discussion 1003–4. CrossRef
- Chen H, Mack E, Starling JR. Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg. 2003;238(3):332–7; discussion 337–8.
- Chen H, Sippel RS, Schaefer S. The effectiveness of radioguided parathyroidectomy in patients with negative technetium tc 99 m-sestamibi scans. Arch Surg. 2009;144(7):643–8. CrossRef
- Wisconsin Department of Health Services, Chapter 157 - Radiation Protection, Subchapter III- Standards for Protection from Radiation. https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/157/III/22. Accessed 14 Jan 2014.
- Norman J, Politz D. 5,000 parathyroid operations without frozen section or PTH assays: measuring individual parathyroid gland hormone production in real time. Ann Surg Oncol. 2009;16(3):656–66. CrossRef
- Stavrakis AI, Ituarte PH, Ko CY, Yeh MW. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery. 2007;142(6):887–99; discussion 887–99. CrossRef
- Rubello D, Al-Nahhas A, Mariani G, Gross MD, Rampin L, Pelizzo MR. Feasibility and long-term results of focused radioguided parathyroidectomy using a “low” 37 MBq (1 mCi) 99mTc-sestamibi protocol. Int Sem Surg Oncol. 2006;3:30. CrossRef
- Surgeon and Staff Radiation Exposure During Radioguided Parathyroidectomy at a High-Volume Institution
Annals of Surgical Oncology
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Section on Endocrine Surgery, Department of Surgery, University of Wisconsin, 600 Highland Ave., K4/739 Clinical Science Center, Madison, WI, 53792-7375, USA
- 2. Department of Safety, University of Wisconsin Hospital and Clinics, Madison, WI, USA