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Radiation doses to operators performing transjugular intrahepatic portosystemic shunt using a flat-panel detector-based system and ultrasound guidance for portal vein targeting



The aim of this study was to prospectively evaluate effective dose (E) of operators performing transjugular intrahepatic portosystemic shunts (TIPS) in a single centre. Patients’ radiation exposure was also collected.


Between 8/2015 and 6/2016, 45 consecutive TIPS were performed in adult patients using a flat-panel detector-based system (FPDS) and real-time ultrasound guidance (USG) for portal vein targeting. Electronic personal dosimeters were used to measure radiation doses to the primary and assistant operators, anaesthesia nurse and radiographer. Patients’ radiation exposure was measured with dose area product (DAP); fluoroscopy time (FT) was also collected.


Mean E for the primary operator was 1.40 μSv (SD 2.68, median 0.42, range 0.12 – 12.18), for the assistant operator was 1.29 μSv (SD 1.79, median 0.40, range 0.10 – 4.89), for the anaesthesia nurse was 0.21 μSv (SD 0.67, median 0.10, range 0.03 – 3.99), for the radiographer was 0.42 μSv (SD 0.71, median 0.25, range 0.03 – 2.67). Mean patient DAP was 59.31 GyCm2 (SD 56.91, median 31.58, range 7.66 – 281.40); mean FT was 10.20 min (SD 7.40, median 10.40, range 3.8 – 31.8).


The use of FPDS and USG for portal vein targeting allows a reasonably low E to operators performing TIPS.

Key points

The operators’ E vary according to the complexity of the procedure.

FPDS and USG allow a reasonably low E to TIPS operators.

FPDS and USG have an important role in reducing the occupational exposure.

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Fig. 1



Transjugular intrahepatic portosystemic shunt


Dose area product


Fluoroscopy time


Effective dose


Flat-panel detector based system


Real-time ultrasound guidance


  1. 1.

    Miller DL, Balter S, Cole PE et al (2003) Radiation doses in interventional radiology procedures: the RAD-IR study: part I: overall measures of dose. J Vasc Interv Radiol 14(6):711–727

    Article  PubMed  Google Scholar 

  2. 2.

    Kim KP, Miller DL, Berrington de Gonzalez A et al (2012) Occupational radiation doses to operators performing fluoroscopically-guided procedures. Health Phys 103(1):80–99

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Longo JM, Bilbao JI, Rousseau HP et al (1992) Color Doppler-US guidance in transjugular placement of intrahepatic portosystemic shunts. Radiology 184:281–284

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Miraglia R, Maruzzelli L, Cortis K et al (2015) Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation. Cardiovasc Intervent Radiol

  5. 5.

    Miller DL, Kwon D, Bonavia GH (2009) Reference levels for patient radiation doses in interventional radiology: proposed initial values for U.S. practice. Radiology 253(3):753–764

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Williams JR (1997) The interdependence of staff and patient doses in interventional radiology. Br J Radiol 70:498–503

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Boone JM, Levin DC (1991) Radiation exposure to angiographers under different fluoroscopic imaging conditions. Radiology 180:861–865

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Wambersie A (2005) International Commission on Radiological Units and Measurements. Patient dosimetry for X-rays used in medical imaging. ICRU Report 74. J ICRU 5(2):iv–vi

    Google Scholar 

  9. 9.

    Padovani R, Rodella CA (2001) Staff dosimetry in interventional cardiology. Radiat Prot Dosimetry 94:99–103

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Niklason LT, Marx MV, Chan HP (1994) The estimation of occupational effective dose in diagnostic radiology with two dosimeters. Health Phys 67:611–615

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Vano E, Gonzalez L, Fernández JM, Haskal ZJ (2008) Eye lens exposure to radiation in interventional suites: caution is warranted. Radiology 248:945–953

    Article  PubMed  Google Scholar 

  12. 12.

    Siegel JA, Pennington CW, Sacks B, Welsh JS. (2015) The Birth of the Illegitimate Linear No-Threshold Model: An Invalid Paradigm for Estimating Risk Following Low-dose Radiation Exposure. Am J Clin Oncol

  13. 13.

    Picano E, Vano E, Domenici L, Bottai M, Thierry-Chef I (2012) Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer 12:157

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Eagan JT Jr, Jones CT (2010) Cutaneous cancers in an interventional cardiologist: a cautionary tale. J Interv Cardiol 24:49–55

    Article  PubMed  Google Scholar 

  15. 15.

    Finkelstein MM (1998) Is brain cancer an occupational disease of cardiologists? Canadian J Cardiol 14:1385–1388

    CAS  Google Scholar 

  16. 16.

    Matanoski GM, Seltser R, Sartwell PE et al (1975) The current mortality rates of radiologists and other physician specialists: specific causes of death. Am J Epidemiol 101:199–210

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Hidajat N, Wust P, Kreuschner M et al (2006) Radiation risks for the radiologist performing transjugular intrahepatic portosystemic shunt (TIPS). Br J Radiol 79(942):483–486

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Martin CJ, Whitby M (2003) Application of ALARP to extremity doses for hospital workers. J Radiol Prot 23:405–421

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Zweers D, Geleijns J, Aarts NJM et al (1998) Patient and staff radiation dose in fluoroscopy-guided TIPS procedures and dose reduction, using dedicated fluoroscopy exposure settings. Br J Radiol 71:672–676

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    International Commission on Radiological Protection (2012) ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs—threshold doses for tissue reactions in a radiation protection context. ICRP Publication 118. Ann. ICRP 41(1–2). Elsevier

  21. 21.

    Ketelsen D, Groezinger G, Maurer M et al. (2016) Three-dimensional C-arm CT-guided transjugular intrahepatic portosystemic shunt placement: Feasibility, technical success and procedural time. Eur Radiol

  22. 22.

    Chen Y, Ye P, Li Y et al (2015) Percutaneous transhepatic balloon-assisted transjugular intrahepatic portosystemic shunt for chronic, totally occluded, portal vein thrombosis with symptomatic portal hypertension: procedure technique, safety, andclinical applications. Eur Radiol 25(12):3431–7

    Article  PubMed  Google Scholar 

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The scientific guarantor of this publication is Dr. Angelo Luca. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: prospective, observational, performed at one institution.

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Correspondence to Roberto Miraglia.

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Miraglia, R., Gerasia, R., Maruzzelli, L. et al. Radiation doses to operators performing transjugular intrahepatic portosystemic shunt using a flat-panel detector-based system and ultrasound guidance for portal vein targeting. Eur Radiol 27, 1783–1786 (2017).

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  • TIPS
  • Radiation protection
  • Occupational exposure
  • Ultrasound
  • Liver