Radiation exposure in augmented fluoroscopic bronchoscopy procedures: a comprehensive analysis for patients and physicians

Abstract

Objective. Cancer is a major health challenge and causes millions of deaths worldwide each year, and the incidence of lung cancer has increased. Augmented fluoroscopic bronchoscopy (AFB) procedures, which combine bronchoscopy and fluoroscopy, are crucial for diagnosing and treating lung cancer. However, fluoroscopy exposes patients and physicians to radiation, and therefore, the procedure requires careful monitoring. The National Council on Radiation Protection and Measurement and the International Commission on Radiological Protection have emphasized the importance of monitoring patient doses and ensuring occupational radiation safety. The present study evaluated radiation doses during AFB procedures, focusing on patient skin doses, the effective dose, and the personal dose equivalent to the eye lens for physicians.

Approach. Skin doses were measured using thermoluminescent dosimeters. Peak skin doses were observed on the sides of the patients’ arms, particularly on the side closest to the X-ray tube. Differences in the procedures and experience of physicians between the two hospitals involved in this study were investigated. 

Main results. AFB procedures were conducted more efficiently at Hospital A than at Hospital B, resulting in lower effective doses. Cone-beam computed tomography contributes significantly to patient effective doses because it has higher radiographic parameters. Despite their higher radiographic parameters, AFB procedures resulted in smaller skin doses than did image-guided interventional and computed tomography fluoroscopy procedures. The effective doses differed between the two hospitals of this study due to workflow differences, with cone-beam computed tomography playing a dominant role. No significant differences in left and right eye Hp(3) values were observed between the hospitals. For both hospitals, the Hp(3) values were below the recommended limits, indicating that radiation monitoring may not be required for AFB procedures.

Significance. This study provides insights into radiation exposure during AFB procedures, concerning radiation dosimetry, and safety for patients and physicians.