Radiation Dose to Patients and Clinicians During Fluoroscopically-Guided Biopsy of Peripheral Pulmonary Lesions

BACKGROUND: Fluoroscopic guidance may be utilized in some bronchoscopic procedures, including ultrasound-guided bronchoscopy for investigation of peripheral pulmonary lesions. Some authors have suggested this procedure may be performed without fluoroscopy, to minimize risks due to radiation exposure. However, the radiation dose has never been quantified, so the risk remains unknown.

OBJECTIVE: To determine the patient and clinician radiation exposure from fluoroscopy during bronchoscopy.

METHODS: We recorded exposure parameters during 45 consecutive ultrasound bronchoscopies with fluoroscopic guidance with a mobile C-arm fluoroscopy system. We calculated the patient effective radiation dose with Monte Carlo computer simulations. Passive personal film dosimeters were placed on 4 sites on both the proceduralist and the primary nursing assistant.

RESULTS: The mean fluoroscopy screening time was 96 ± 55 s. Patients received a median effective radiation dose of 0.49 ± 0.37 milli-Sieverts (mSv) (range 0.16–1.3 mSv). Only the film dosimeters worn outside the clinicians' protective aprons recorded measurable radiation doses. Based on typical attenuation properties of the protective garments across the diagnostic x-ray energy range, we estimate that the effective radiation dose per procedure to the proceduralist was 0.4 micro-Sieverts (μSv) and to the assistant was 0.2 μSv.

CONCLUSIONS: Patients are exposed to relatively small amounts of radiation from fluoroscopy during bronchoscopy. Clinically indicated fluoroscopic guidance during bronchoscopy should not be precluded on the basis of radiation safety concerns. Adequate shielding of clinicians results in negligible radiation doses during ultrasound bronchoscopy. (Australian and New Zealand Clinical Trials Registry ACTRN12607000514404)