{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:04:52Z","timestamp":1793649892181,"version":"4.5.1"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T00:00:00Z","timestamp":1744502400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T00:00:00Z","timestamp":1744502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009379","name":"Interdisziplin\u00e4res Zentrum f\u00fcr Klinische Forschung, Universit\u00e4tsklinikum W\u00fcrzburg","doi-asserted-by":"publisher","award":["Z-3BC\/02"],"award-info":[{"award-number":["Z-3BC\/02"]}],"id":[{"id":"10.13039\/501100009379","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>Radiation safety concerns have spurred the development of real-time dosimetry systems. This study investigated the occupational dose exposure of interventional radiologists during lower extremity and abdominal procedures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and methods<\/jats:title>\n            <jats:p>Real-time dosimetry was performed during 102 consecutive interventions (51 lower extremity, 51 abdominal). Radiation protection measures included protective glasses (lead equivalent 0.5\u2009mm), thyroid shielding (0.5\u2009mm), vests (0.35\u2009mm), aprons (0.25\u2009mm), as well as movable acrylic and table shields (both 0.5\u2009mm) during all procedures. Dosimeters were attached to the interventionalist\u2019s glasses on the side of the x-ray tube, to the back of the supporting hand, and under the vest. Using standardized values over time to account for exposure time differences between interventions, dose-area products and the dose equivalent H<jats:sub>P<\/jats:sub>(10) were recorded in all three positions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Lower extremity angiographies were associated with a substantially lower median dose-area product (5.3 vs. 51.4\u2009Gy \u00d7 cm<jats:sup>2<\/jats:sup>) and exposure time (462 vs. 762\u2009s) than abdominal interventions (both <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). For lower extremity procedures, H<jats:sub>P<\/jats:sub>(10) per minute recorded by the hand, cranium\/eye lens, and body trunk dosimeters was 2.45, 0.01, and &lt; 0.01 \u00b5Sv\/min, respectively. Markedly higher dose equivalents were documented for the hand (7.54 \u00b5Sv\/min), cranium\/eye lens (0.26 \u00b5Sv\/min), and body trunk (0.04 \u00b5Sv\/min) during abdominal interventions (all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Real-time dosimetry confirmed sufficient radiation protection with the application of dedicated safety measures, even in dose-intensive abdominal procedures. Interventionalists\u2019 supporting hands are subjected to the highest radiation exposure, followed by the cranium\/eye lens and the body trunk.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Question<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>Active dosimetry facilitates real-time assessment of radiation exposure in different measurement sites, but a multi-dosimeter setup has not been explored for interventional radiology so far.<\/jats:italic>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Findings<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>Occupational radiation exposure is considerably higher in abdominal than in lower extremity procedures. Interventionalists\u2019 supporting hands receive the highest dose equivalents regardless of procedure type.<\/jats:italic>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Clinical relevance<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>Dose monitoring in real time is key to understanding the radiation burden of different anatomical features during image-guided interventions. Especially in dose-intensive abdominal procedures, protective measures are essential to minimize the occupational radiation exposure of the interventionalist.<\/jats:italic>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00330-025-11566-5","type":"journal-article","created":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T07:19:24Z","timestamp":1744528764000},"page":"6575-6582","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Real-time dosimetry in interventional radiology\u00a0\u2013\u00a0comparing the occupational radiation exposure in fluoroscopy-guided lower extremity and abdominal procedures"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6340-6735","authenticated-orcid":false,"given":"Kristina","family":"Krompa\u00df","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mareike","family":"Mutschler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Peter","family":"Grunz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Thurner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten Alexander","family":"Bley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Voelker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Kickuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,13]]},"reference":[{"key":"11566_CR1","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1186\/s12883-018-1138-9","volume":"18","author":"Y Tang","year":"2018","unstructured":"Tang Y, Yin F, Fu D et al (2018) Efficacy and safety of minimal invasive surgery treatment in hypertensive intracerebral hemorrhage: a systematic review and meta-analysis. BMC Neurol 18:136. https:\/\/doi.org\/10.1186\/s12883-018-1138-9","journal-title":"BMC Neurol"},{"key":"11566_CR2","first-page":"547","volume":"99","author":"MJ Arnold","year":"2019","unstructured":"Arnold MJ, Keung JJ, McCarragher B (2019) Interventional radiology: indications and best practices. Am Fam Physician 99:547\u2013556","journal-title":"Am Fam Physician"},{"key":"11566_CR3","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1055\/a-0891-1116","volume":"191","author":"AM Augustin","year":"2019","unstructured":"Augustin AM, Fluck F, Bley T, Kickuth R (2019) Endovascular therapy of gastrointestinal bleeding. Rofo 191:1073\u20131082. https:\/\/doi.org\/10.1055\/a-0891-1116","journal-title":"Rofo"},{"key":"11566_CR4","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.jacr.2015.01.012","volume":"12","author":"JR LaRoy","year":"2015","unstructured":"LaRoy JR, White SB, Jayakrishnan T et al (2015) Cost and morbidity analysis of chest port insertion: interventional radiology suite versus operating room. J Am Coll Radiol 12:563\u2013571. https:\/\/doi.org\/10.1016\/j.jacr.2015.01.012","journal-title":"J Am Coll Radiol"},{"key":"11566_CR5","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1055\/a-0998-4204","volume":"192","author":"F Fluck","year":"2020","unstructured":"Fluck F, Augustin AM, Bley T, Kickuth R (2020) Current treatment options in acute limb ischemia. Rofo 192:319\u2013326. https:\/\/doi.org\/10.1055\/a-0998-4204","journal-title":"Rofo"},{"key":"11566_CR6","doi-asserted-by":"publisher","first-page":"e67","DOI":"10.2459\/JCM.0000000000000451","volume":"18","author":"S Grotti","year":"2017","unstructured":"Grotti S, Bolognese L (2017) Interventional cardiology is changing: demographic, clinical and economic considerations. J Cardiovasc Med 18:e67\u2013e70. https:\/\/doi.org\/10.2459\/JCM.0000000000000451","journal-title":"J Cardiovasc Med"},{"key":"11566_CR7","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1269\/jrr.09112","volume":"51","author":"K Chida","year":"2010","unstructured":"Chida K, Kato M, Kagaya Y et al (2010) Radiation dose and radiation protection for patients and physicians during interventional procedure. J Radiat Res 51:97\u2013105. https:\/\/doi.org\/10.1269\/jrr.09112","journal-title":"J Radiat Res"},{"key":"11566_CR8","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s00117-016-0083-0","volume":"56","author":"R Adamus","year":"2016","unstructured":"Adamus R, Loose R, Wucherer M et al (2016) Radiation protection in interventional radiology. Radiologe 56:275\u2013281. https:\/\/doi.org\/10.1007\/s00117-016-0083-0","journal-title":"Radiologe"},{"key":"11566_CR9","doi-asserted-by":"publisher","first-page":"129","DOI":"10.3344\/kjp.2022.35.2.129","volume":"35","author":"S Park","year":"2022","unstructured":"Park S, Kim M, Kim JH (2022) Radiation safety for pain physicians: principles and recommendations. Korean J Pain 35:129\u2013139. https:\/\/doi.org\/10.3344\/kjp.2022.35.2.129","journal-title":"Korean J Pain"},{"key":"11566_CR10","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1161\/01.CIR.0000157946.29224.5D","volume":"111","author":"JW Hirshfeld Jr","year":"2005","unstructured":"Hirshfeld JW Jr, Balter S, Brinker JA et al (2005) ACCF\/AHA\/HRS\/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation\/American Heart Association\/American College of Physicians Task Force on Clinical Competence and Training. Circulation 111:511\u2013532. https:\/\/doi.org\/10.1161\/01.CIR.0000157946.29224.5D","journal-title":"Circulation"},{"key":"11566_CR11","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.2214\/AJR.15.15265","volume":"206","author":"P Rajaraman","year":"2016","unstructured":"Rajaraman P, Doody MM, Yu CL et al (2016) Cancer risks in U.S. radiologic technologists working with fluoroscopically guided interventional procedures, 1994\u20132008. AJR Am J Roentgenol 206:1101\u20131108. https:\/\/doi.org\/10.2214\/AJR.15.15265","journal-title":"AJR Am J Roentgenol"},{"key":"11566_CR12","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1093\/aje\/kwn171","volume":"168","author":"G Chodick","year":"2008","unstructured":"Chodick G, Bekiroglu N, Hauptmann M et al (2008) Risk of cataract after exposure to low doses of ionizing radiation: a 20-year prospective cohort study among US radiologic technologists. Am J Epidemiol 168:620\u2013631. https:\/\/doi.org\/10.1093\/aje\/kwn171","journal-title":"Am J Epidemiol"},{"key":"11566_CR13","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s13244-015-0410-4","volume":"6","author":"European Society of Radiology (ESR)","year":"2015","unstructured":"European Society of Radiology (ESR) (2015) Summary of the European Directive 2013\/59\/Euratom: essentials for health professionals in radiology. Insights Imaging 6:411\u2013417. https:\/\/doi.org\/10.1007\/s13244-015-0410-4","journal-title":"Insights Imaging"},{"key":"11566_CR14","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1016\/j.ejmp.2016.11.006","volume":"32","author":"L Servoli","year":"2016","unstructured":"Servoli L, Bissi L, Fabiani S et al (2016) Personnel real time dosimetry in interventional radiology. Phys Med 32:1724\u20131730. https:\/\/doi.org\/10.1016\/j.ejmp.2016.11.006","journal-title":"Phys Med"},{"key":"11566_CR15","doi-asserted-by":"publisher","first-page":"68.e1","DOI":"10.1016\/j.jhsa.2018.05.010","volume":"44","author":"JRM van Rappard","year":"2019","unstructured":"van Rappard JRM, de Jong T, Hummel WA et al (2019) Radiation exposure to surgeon and assistant during flat panel mini C-arm fluoroscopy in hand and wrist surgical procedures. J Hand Surg Am 44:68.e1\u201368.e5. https:\/\/doi.org\/10.1016\/j.jhsa.2018.05.010","journal-title":"J Hand Surg Am"},{"key":"11566_CR16","doi-asserted-by":"publisher","first-page":"e289","DOI":"10.1016\/j.wneu.2019.01.063","volume":"125","author":"T Kim","year":"2019","unstructured":"Kim T, Kwon O-K, Ban SP et al (2019) A phantom menace to medical personnel during endovascular treatment of cerebral aneurysms: real-time measurement of radiation exposure during procedures. World Neurosurg 125:e289\u2013e296. https:\/\/doi.org\/10.1016\/j.wneu.2019.01.063","journal-title":"World Neurosurg"},{"key":"11566_CR17","doi-asserted-by":"publisher","first-page":"e13860","DOI":"10.1002\/acm2.13860","volume":"24","author":"V Koch","year":"2023","unstructured":"Koch V, Conrades LM, Gruenewald LD et al (2023) Reduction of radiation dose using real-time visual feedback dosimetry during angiographic interventions. J Appl Clin Med Phys 24:e13860. https:\/\/doi.org\/10.1002\/acm2.13860","journal-title":"J Appl Clin Med Phys"},{"key":"11566_CR18","unstructured":"RaySafe (2014) RaySafe i2 system user manual. Available via https:\/\/www.raysafe.com\/sites\/default\/files\/2018-12\/5001047-raysafe-i2-system_manual-en-4.1_0.pdf. Accessed 1 Nov 2024"},{"key":"11566_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.icrp.2012.02.001","volume":"41","author":"FA Stewart","year":"2012","unstructured":"Stewart FA, Akleyev AV, Hauer-Jensen M et al (2012) ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs\u2014threshold doses for tissue reactions in a radiation protection context. Ann ICRP 41:1\u2013322. https:\/\/doi.org\/10.1016\/j.icrp.2012.02.001","journal-title":"Ann ICRP"},{"key":"11566_CR20","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1055\/s-0032-1330728","volume":"185","author":"M Galster","year":"2013","unstructured":"Galster M, Guhl C, Uder M, Adamus R (2013) Exposition of the operator\u2019s eye lens and efficacy of radiation shielding in fluoroscopically guided interventions. Rofo 185:474\u2013481. https:\/\/doi.org\/10.1055\/s-0032-1330728","journal-title":"Rofo"},{"key":"11566_CR21","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1093\/rpd\/ncp099","volume":"135","author":"U Ankerhold","year":"2009","unstructured":"Ankerhold U, Hupe O, Ambrosi P (2009) Deficiencies of active electronic radiation protection dosimeters in pulsed fields. Radiat Prot Dosim 135:149\u2013153. https:\/\/doi.org\/10.1093\/rpd\/ncp099","journal-title":"Radiat Prot Dosim"},{"key":"11566_CR22","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1093\/rpd\/ncv052","volume":"165","author":"M Baptista","year":"2015","unstructured":"Baptista M, Figueira C, Teles P et al (2015) Assessment of the occupational exposure in real time during interventional cardiology procedures. Radiat Prot Dosim 165:304\u2013309. https:\/\/doi.org\/10.1093\/rpd\/ncv052","journal-title":"Radiat Prot Dosim"},{"key":"11566_CR23","doi-asserted-by":"publisher","first-page":"1805","DOI":"10.1016\/j.jhsa.2014.06.133","volume":"39","author":"MM Vosbikian","year":"2014","unstructured":"Vosbikian MM, Ilyas AM, Watson DD, Leinberry CF (2014) Radiation exposure to hand surgeons\u2019 hands: a practical comparison of large and mini C-arm fluoroscopy. J Hand Surg Am 39:1805\u20131809. https:\/\/doi.org\/10.1016\/j.jhsa.2014.06.133","journal-title":"J Hand Surg Am"},{"key":"11566_CR24","unstructured":"RaySafe (2012) RaySafe i2 product and specification brochure. Available via https:\/\/www.raysafe.com\/sites\/default\/files\/2018-12\/5200037-c_i2_spec_leaflet_raysafe_en_web.pdf. Accessed 1 Nov 2024"},{"key":"11566_CR25","doi-asserted-by":"publisher","first-page":"N65","DOI":"10.1088\/0952-4746\/34\/3\/N65","volume":"34","author":"Y Inaba","year":"2014","unstructured":"Inaba Y, Chida K, Kobayashi R et al (2014) Fundamental study of a real-time occupational dosimetry system for interventional radiology staff. J Radiol Prot 34:N65\u2013N71. https:\/\/doi.org\/10.1088\/0952-4746\/34\/3\/N65","journal-title":"J Radiol Prot"},{"key":"11566_CR26","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1088\/1361-6498\/ab7fba","volume":"40","author":"C Walsh","year":"2020","unstructured":"Walsh C (2020) Interpretation of risk for low dose radiation exposures: inconsistencies, philosophical problems and fallacies. J Radiol Prot 40:646\u2013653. https:\/\/doi.org\/10.1088\/1361-6498\/ab7fba","journal-title":"J Radiol Prot"},{"key":"11566_CR27","doi-asserted-by":"publisher","first-page":"155932581882420","DOI":"10.1177\/1559325818824200","volume":"17","author":"CW Pennington","year":"2019","unstructured":"Pennington CW, Siegel JA (2019) The linear no-threshold model of low-dose radiogenic cancer: a failed fiction. Dose Response 17:1559325818824200. https:\/\/doi.org\/10.1177\/1559325818824200","journal-title":"Dose Response"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-11566-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-025-11566-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-11566-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T10:03:41Z","timestamp":1757498621000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-025-11566-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,13]]},"references-count":27,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["11566"],"URL":"https:\/\/doi.org\/10.1007\/s00330-025-11566-5","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,13]]},"assertion":[{"value":"4 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 February 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2025","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The the affiliation details for Author Wolfram Voelker were incorrectly given as \u2018Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital Wurzburg, Wurzburg, Germany\u2019 but should have been \u2018Department of Medicine I\/Cardiology, University Clinic of W\u00fcrzburg, W\u00fcrzburg, Germany\u2019.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Ralph Kickuth (Kickuth_R@ukw.de).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors (Jan-Peter Grunz) has significant statistical expertise. Of note, no complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was waived by the institutional review board of the University of W\u00fcrzburg, Germany (IRB number 20240513 01).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Ethical approval was obtained from the institutional review board of the University of W\u00fcrzburg, Germany (IRB number 20240513 01).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No study subjects or cohorts have been previously reported.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}