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The use of radiation has become essential for the treatment and management of multiple vascular problems. An understanding and systematic implementation of guidelines and techniques to lower radiation exposure is critical for vascular surgeons during their training and throughout their careers. It is well known that radiation exposure is cumulative over time and has long-term effects on the practitioner, the patient, and staff. As such, careful consideration of radiation utilization, in addition to an appreciation of the risks associated with radiation exposure, is crucial to treat patients safely and ensure personal and staff protection.

To begin, we will review the basic terminology used for radiation and fluoroscopy. This will include common terms which were seen and need to be appreciated by practitioners using fluoroscopy on a regular basis. Regarding radiation utilization, the basic principles include optimization as well as radiation dose.

X-rays are composed of high-energy photons within the electromagnetic spectrum.1 X-rays are notable in that they are powerful enough to break molecular bonds, ionize atoms, and can alter DNA structure.2 This ionization produces free radicals, which are chemically active compounds that can indirectly damage DNA.3 DNA damage can occur from radiation exposure resulting in chromosomal aberrations which can lead to genetic mutation and cancer. Ionizing radiation on a human cell has two main effects: direct cellular damage and indirect cellular damage through production of reactive oxidative species.4

Basic Definitions of Radiation

The following are important concepts and terminology to understand prior to reviewing techniques, indications, as well as consequences of radiation exposure.

X-Ray Production

X-rays are formed via interactions of accelerated electrons with electrons of tungsten nuclei within a tube. The flow from the filament to the target is referred to as the tube current and is expressed in milliamperes.5 The number of x-rays produced at the source of radiation is determined by the tube current and the voltage. The proportion of x-ray production is directly proportional to the tube current.


Radiation exposure is defined as the measure of the ionization of air by photons (gamma and X-rays) at a standard temperature and pressure. Measurements of exposure rates for fluoroscopy are typically measured in fluoroscopy output per minute.1

Absorbed Dose

The energy imparted per unit mass by ionizing radiation to matter at a specified point. The International System of Units (SI) unit of absorbed dose is the joule per kilogram, which is referred to as gray (Gy).6 For purposes of radiation protection and assessing dose or risk to humans, the quantity calculated is the mean absorbed dose in an organ or tissue.6 Absorbed dose is defined as the energy delivered to and deposited in an organ divided ...

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