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requires considerable radiation exposure. Doses were determined for a team of three vascular surgeons performing 47 consecutive EAIA repairs over a 1-year period to determine whether this exposure constitutes a radiation hazard. Methods: Twenty-nine surgeon-made aortounifemoral devices and 18 bifurcated devices were used. Three surgeons wore dosimeters (1) on the waist, under a lead apron; (2) on the waist, outside a lead apron; (3) on the collar; and (4) on the left ring finger. Dosimeters were also placed around the operating table and room to evaluate the patient, other personnel, and ambient doses. Exposures were compared with standards of the International Commission on Radiological Protection (ICRP). Results: Total fluoroscopy time was 30.9 hours (1852 minutes; mean, 39.4 minutes per case). Yearly total effective body doses for all surgeons (under lead) were below the 20 mSv/y occupational exposure limit of the ICRP. Outside lead doses for two surgeons approximated recommended limits. Lead aprons attenuated 85% to 91% of the dose. Ring doses and calculated eye doses were within the ICRP exposure limits. Patient skin doses averaged 360 mSv per case (range, 120-860 mSv). The ambient (> 3 m from the source) operating room dose was 1.06 mSv/y. Conclusions: Although the total effective body doses under lead fell within established ICRP occupational exposure limits, they are not negligible. Because radiation exposure is cumulative and endovascular procedures are becoming more common, individuals performing these procedures must carefully monitor their exposure. Our results indicate that a team of surgeons can perform 386 hours of fluoroscopy per year or 587 EAIA repairs per year and remain within occupational exposure limits. Individuals who perform these procedures should actively monitor their effective doses and educate personnel in methods for reducing exposure. (J Vasc Surg 2000;32:704-10.) Endovascular aortoiliac aneurysm (EAIA) repair has recently become a procedure approved by the Food and Drug Administration. Endovascular treatments for other vascular processes are also being more widely used. It has been estimated that up to 80% of all abdominal aortic aneurysms can be treated with an endovascular graft, and that in the near future, 40% to 70% of all vascular interventions will be performed with an endovascular method.1 These procedures require the use of digital cinefluoroscopy, which exposes both the patient and staff to ionizing radiation. Comprehensive training in radiation safety and radiation physics is not a part of general or vascular surgical residency training programs. Additionally, radiation safety issues are significantly underrepresented in the vascular surgery literature compared with that of other specialties. To determine whether the endovascular repair of aortoiliac aneurysms constitutes a radiation hazard to the vascular surgeons performing them, we evaluated the exposure to three vascular surgeons over a 1-year period. Radiation exposure to the patients and operating room staff was also evaluated. Methods Forty-seven endovascular repairs of aortic or iliac aneurysms that were performed over a 1-year period beginning in July 1998 were included in the study. Other fluoroscopic procedures such as diagnostic or completion angiography, iliac or renal artery angioplasty and stenting, fluoroscopically assisted thromboembolectomy, and inferior vena cava filter placement were not included. A surgeon-made aortounifemoral device, Montefiore Endovascular Graft System, was used in 29 cases. Bifurcated devices, including Talent (World Medical Manufacturing Corp, Sunrise, Fla), Excluder (W. L. Gore, Flagstaff, Ariz), and Vanguard (Boston Scientific Corp, Natick, Mass), were used in 18 cases. Fluoroscopy was performed with a Philips BV212 (Philips, Medical Systems, Shelton, Conn) in 18 cases, an OEC 9800 (OEC Medical Systems, Salt Lake City, Utah) in two cases, and a Philips BV312 in 28 cases. Image intensifier sizes were 31, 23, and 17 cm for the Philips and 31, 23, and 15 cm for the OEC. Digital subtraction and high-level fluoroscopic aquisitions were
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