RS31 - The use of leaded surgical gloves reduces hand radiation exposure without increasing operator radiation dose during fluoroscopically guided interventions

Saturday, June 7, 2025

11:59 AM – 12:06 PM CT

Location: Morial CC, Second Floor, Room 208-210

Submitting & Presenting Author(s)

Antonio Solano, MD (he/him/his)

Research Fellow, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas

Slides

Senior Author Discussant(s)

Melissa L. Kirkwood, MD

Professor and Chief, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas

Co-Author(s)

AK

Andrea Klein

Assistant Professor, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
Michael C. Siah, MD

Assistant Professor, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
GG

Gerardo Gonzalez-Guardiola

Assistant Professor, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
KC

Khalil Chamseddin

Assistant Professor, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
AW

Aaron Wagner

Assistant Professor, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
VP

Vivek Prakash

Assistant Professor, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
MS

Michael Shih

Assistant Professor and Program Director, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
MB

Mirza S. Baig

Associate Professor, Division of Vascular and Endovascular Surgery
University of Texas Southwestern Medical Center Dallas
Dallas, Texas
Carlos H. Timaran, MD, MS

Professor of Surgery
University of Texas Southwestern Medical Center Dallas
Dallas, Texas
JG

Jeffrey Guild

Professor, Medical Physics
UT Southwestern Medical Center
Dallas, Texas

Objectives: While it is contraindicated for physicians performing fluoroscopically guided interventions(FGIs) to position their hand directly in the beam, it can be unavoidable and produces higher operator exposure and risk. Clinical guidelines recommend against usage of radiation protective gloves(PG) during FGIs given concern for higher radiation accumulation related to increased procedural scatter(PS). We describe hand radiation dose(HRD) and PS during FGIs with regular surgical gloves(RG) compared to lead-free PG.

Methods: The HRD attenuation of ESPTM PG (Boston Scientific, Spencer, IN) and their effect on PS was evaluated in clinical and simulated scenarios. In the clinical setting, optically stimulated luminescence detectors were placed bilaterally at the volar and dorsal aspects of the operator’s hands at the radioulnar joint and base of the ring finger. Dosimeters were positioned on the sternum and chest wall closest to the x-ray beam. All operators were trained in applying ALARA principles. In the simulation, fluorography was performed on a 15-cm-thick acrylic phantom for an exposure of 250 mGy reference air kerma(RAK) with an anthropomorphic hand placed at 6, 3, 0, -3, and -6 inches from the beam edge with both RG and PG; negative distances indicate direct position in the beam. HRD was calculated based on a calibration coefficient factor to estimate radiation at 80 kVp. Procedure scatter fractions(PSF) were estimated by normalizing the sternum dose measurement with the DAP. Wrist and finger radiation doses were normalized by dividing by the sternum dose to control for case length and procedure factors. Paired Wilcoxon and chi-square tests were performed to identify statistically significant differences of normalized sternum, finger, and wrist dose with RG versus PG.

Results: A total of 50 FGIs were performed(Table I): 25 RG and 25 PG. No differences were observed for median procedure RAK between groups. HRD was lower for both dominant and non-dominant hands with the PG [271 μGy vs 587 μGy(P=0.015);262 μGy vs 662 μGy(P < 0.001)] versus RG. There was no significant increase in PSF with PG. In the simulated setting, HRD was 58% lower with PG at all distances (P < 0.001) with no significant differences in PSF for PG versus RG.

Conclusions: Operator hands are directly in the x-ray beam more than recognized leading to increased lifetime risk. PG can be expensive and cumbersome but are effective at decreasing hand radiation exposure without increasing operator radiation dose. They should be considered for use in procedures where hand proximity to the beam is likely.