Skip to main content

Advertisement

SpringerLink
Log in

Surgeon and Staff Radiation Exposure During Radioguided Parathyroidectomy at a High-Volume Institution

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

Surgeon and staff radiation exposure during RGP is minimal. However, high-volume centers warrant safety training.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Murray SE, Pathak PR, Pontes DS, et al. Timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism. Surgery. 2013;154(6):1463–9.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    PubMed  PubMed Central  Google Scholar 

  5. Oltmann SC, Chen H. Minimally invasive radioguided parathyroidectomy. Curr Surg Rep. 2013;1(1):1–6.

    Article  Google Scholar 

  6. 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.

    Article  PubMed  CAS  Google Scholar 

  7. 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.

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    PubMed  PubMed Central  Google Scholar 

  11. 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.

  12. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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.

    Article  PubMed  CAS  Google Scholar 

  14. 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.

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

  17. 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.

    Article  CAS  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  CAS  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Norman J, Chheda H. Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery. 1997;122(6):998–1003; discussion 1003–4.

    Article  PubMed  CAS  Google Scholar 

  25. 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.

    PubMed  PubMed Central  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  Google Scholar 

Download references

Author information

Authors and 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

    Sarah C. Oltmann MD, Andrew V. Brekke, David F. Schneider MD, MS, Herbert Chen MD & Rebecca S. Sippel MD

  2. Department of Safety, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    Jose D. Macatangay MS

Authors
  1. Sarah C. Oltmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew V. Brekke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jose D. Macatangay MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David F. Schneider MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Herbert Chen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rebecca S. Sippel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah C. Oltmann MD.

Additional information

Poster Presentation at Society of Surgical Oncology, Phoenix, AZ, March 12-15, 2014.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oltmann, S.C., Brekke, A.V., Macatangay, J.D. et al. Surgeon and Staff Radiation Exposure During Radioguided Parathyroidectomy at a High-Volume Institution. Ann Surg Oncol 21, 3853–3858 (2014). https://doi.org/10.1245/s10434-014-3822-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3822-3

Keywords

Search

Navigation