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Considering that obese patients emit greater amounts of scatter radiation during fluoroscopic procedures, it is possible that the growing obesity epidemic could adversely affect the occupational health of physicians performing percutaneous coronary intervention (PCI). This study was performed to determine the impact of patient BMI on physician radiation exposure during PCI.
Real-time radiation exposure data were prospectively collected from PCI cases. Patient radiation dose was estimated using dose-area product (DAP). Using data from an outer dosimeter (Hos) and body dosimeter (Hu), the physician effective dose per case (E) was calculated as E = 0.02 (Hos - Hu) + Hos. Patient BMI was categorized using the NIH classification.
Among 338 consecutive PCI cases, there were significant increases in both patient and physician radiation doses across increasing patient BMI categories. A BMI ≥40 was associated with a 2.6-fold increase in DAP compared to a BMI <25 (184.7 [114.8, 249.1] Gy x cm2 vs. 70.0 [45.0, 103.2] Gy x cm2, p<0.001). A patient BMI ≥40 was associated with a 24-fold increase in physician effective dose compared a patient BMI <25 (4.8 [0.3, 11.0] μSv vs. 0.2 [0.0, 4.8] μSv, p = 0.01). When compared to PCI in patients with a BMI <25, PCI in patients with a BMI ≥40 was associated with a 164% increase in the patient radiation dose and a 2300% increase in the physician radiation dose.
Significant increases in patient and physician radiation doses were observed across increasing patient BMI categories, yet patient BMI had a disproportionately greater impact on the relative increase in the radiation dose to physicians. Whereas prior studies have documented the adverse health consequences of obesity on the patient, the findings of this study suggest that patient obesity may have adverse health effects on physicians as well, in the form of increased radiation doses during PCI.