Health Care System-Wide Analysis Identifies High Radiation Use Factors and Behaviors in Surgery

Objective: Usage of radiation among various surgical specialists has not been comprehensively evaluated. A systems-based analysis evaluating intraoperative radiation can help identify high use factors and dose reduction behaviors leading to quality improvement initiatives. Methods: A retrospective review of all operative fluoroscopic-guided procedures from 2010 to 2017 from 4 hospitals in a tertiary academic health care system was performed. Results: One thousand two hundred fifty-two cases were analyzed, and notable trends in metrics including type of equipment, procedures, surgical field, surgical specialty, and dose reduction techniques were demonstrated. Higher radiation exposures were correlated with fixed vs. mobile C-arm usage (1229 mGy vs. 331 mGy, P =.001), abdominal/pelvic procedures (429.2 mGy vs. 274.0 mGy, P =.002), and embolization (2450.6 mGy vs. 328.2 mGy, P =.019). Vascular surgery averaged 40 times higher radiation exposure per patient than other specialties (613.3 mGy vs. 15.6 mGy, P =.001). Notably, vascular surgeons utilized dose reduction techniques less frequently than urology (21.5% vs. 70%, P =.001) but more than neurosurgery and orthopedics (21.5% vs. 1.3% and 0%, P =.001, respectively). Conclusions: A system-wide health care analysis identified vascular surgery procedures, use of a fixed C-arm, abdominal/pelvic procedures, and embolization cases as having the highest radiation exposure. These data can serve as baseline information for future quality improvement initiatives regarding fluoroscopy usage by surgeons.