Occupational exposure during endovascular aneurysm repair (EVAR) and aortoiliac percutaneous transluminal angioplasty (PTA) procedures

  • Eleftherios Tzanis
  • Dimitrios Tsetis
  • Elias Kehagias
  • Christos V. Ioannou
  • John DamilakisEmail author



The purpose of this study was to determine the radiation exposure of primary interventionalist’s different body parts during endovascular aneurysm repair (EVAR) procedures and aortoiliac percutaneous transluminal angioplasty (PTA) procedures and to evaluate the efficacy of a radioprotective drape.


Occupational doses for 36 consecutive aortoiliac PTA procedures and 17 consecutive EVAR procedures were estimated using thermoluminescence dosimetry (TLD) chips (TLD-200, Hashaw, Solon, OH). Effective dose (ED) was calculated using the Niklason algorithm. For the evaluation of a 0.25 mm Pb equivalent drape (Ecolab, Saint Paul, Minnesota, USA), experiments were performed using two physical anthropomorphic phantoms (Rando-Alderson Research Labs, CA, USA).


Median ED for a typical EVAR and PTA procedure was 4.7 ± 1.4 μSv and 4.4 ± 3.6 μSv, respectively. The highest radiation doses were measured for the operator’s hands in both procedures. Moreover, considerable doses were measured to the operator’s head, eye lenses and thyroid. Due to the use of the drape, radiation exposure of primary operator’s abdominal area, genitals, thyroid and eye lenses was reduced by an average of 59%, 60%, 65% and 59%, respectively. However, dose area product (DAP) and peak skin dose (PSD) were increased by 20% when part of the drape was placed into the X-ray field.


During EVAR and PTA procedures, primary operator’s organs are exposed to considerable radiation doses. Occupational radiation exposure can be reduced significantly with the proper use of a radioprotective drape.


Occupational radiation exposure Radioprotective drapes Fluoroscopy Dosimetry EVAR PTA 


Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Eleftherios Tzanis
    • 1
  • Dimitrios Tsetis
    • 2
  • Elias Kehagias
    • 2
  • Christos V. Ioannou
    • 3
  • John Damilakis
    • 4
    Email author
  1. 1.Department of Medical Physics, Medical SchoolUniversity of CreteHeraklion, CreteGreece
  2. 2.Interventional Radiology Unit, Department of Radiology, University Hospital of Heraklion, Medical SchoolUniversity of CreteCreteGreece
  3. 3.Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Medical SchoolUniversity of CreteCreteGreece
  4. 4.Department of Medical Physics, University Hospital of Heraklion, Medical School, Faculty of MedicineUniversity of CreteIraklion, CreteGreece

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